Three-dimensional ultrasonography versus two-dimensional ultrasonography for the diagnosis of intrauterine device malposition

Objective: To compare the diagnostic accuracy of two-dimensional (2D) versus three-dimensional (3D) ultrasonography for the diagnosis of intrauterine device (IUD) malposition. Methods: In a prospective study, women with a history of failed IUD removal and/or ultrasonography results indicating malposition were recruited at a center in Hangzhou, China, between March 1, 2009, and September 30, 2011. All patients underwent 2D and 3D ultrasonography. Hysteroscopy, laparoscopy, or laparotomy was carried out to remove the IUDs and was considered the gold standard for diagnosing malposition. Results: Among 130 participants, 128 (98.5%) were diagnosed with IUD malposition by hysteroscopy, laparoscopy, or laparotomy. Malposition had been correctly identified with 20 ultrasonography in 83 (64.8%) cases, and with 3D ultrasonography in 107 (83.6%) cases. The diagnostic accuracy of 3D ultrasonography was significantly better than was that of 2D ultrasonography (P < 0.001). Conclusion: The use of 2D ultrasonography is recommended for the follow-up of women who use IUDs as a contraceptive method. However, 3D ultrasonography should be used when malposition is suspected. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All right reserved.