Transvaginal Three-Dimensional Ultrasound for Evaluation of Intrauterine Device Position Six Weeks After Insertion

Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptives. Complications such as expulsion, perforation, and embedment can reduce contraceptive effectiveness and cause abnormal uterine bleeding or pelvic pain. Traditional 2D transvaginal ultrasound may fail to detect malpositioned IUDs, especially levonorgestrel-IUDs or when uterine anomalies are present. 3D transvaginal ultrasound offers improved visualization of the uterine cavity and IUD position.

Objectives

To evaluate the accuracy of 3D transvaginal ultrasound in detecting IUD displacement six weeks after insertion and compare it to conventional 2D ultrasound.

Methods

Study Design: Cross-sectional study Setting: Assiut General Hospital and Women's Health Hospital, Assiut, Egypt Duration: July 2025 - June 2026 Participants: Women aged 18-45 receiving postpartum IUD insertion (vaginal or cesarean) Sample Size: 138 women, accounting for 10% loss to follow-up

Procedures:

Participants provide written informed consent.

Baseline data collection: age, parity, residency, educational level, reproductive history, prior IUD use, dysmenorrhea, cervical surgery, lactation status.

Copper T380A IUD insertion:

Vaginal insertion: sterile technique, uterine sounding, insertion per manufacturer instructions.

Cesarean insertion: IUD placed in uterine fundus post-placenta delivery before uterine closure.

Follow-up at 6 weeks with 2D and 3D transvaginal ultrasound to assess IUD position.

Outcomes:

Primary: Prevalence of IUD displacement at 6 weeks

Secondary: Accuracy of 3D vs 2D ultrasound in detecting displacement, partial expulsion, embedment, and perforation.

Data Management:

Data entered and analyzed using SPSS v21.

Categorical variables: Chi-square or Fisher's exact test

Quantitative variables: Shapiro-Wilkes test for normality; Mann-Whitney or Student's t-test as appropriate

Significance: p < 0.05

Ethical Considerations

Study approved by Assiut Faculty of Medicine Ethical Review Committee

Conducted according to Declaration of Helsinki and Good Clinical Practice

Participant privacy and confidentiality ensured

Inclusion criteria

• Females aged 18-45 years

Postpartum women receiving copper T380A IUD insertion, either vaginal or cesarean

Agree to participate and provide written informed consent

Exclusion criteria

• Uterine anomalies (e.g., bicornuate uterus)

Significant uterine pathology (e.g., large fibroids)

Puerperal sepsis

Refusal to insert IUD

Past history of IUD complications