What if uterine perforation occurs?
Most concerning complication but rarely occurs (1 in 1,000 insertions)
Usually happens at the time of uterine sounding or insertion
If the IUD perforates into the peritoneal cavity, confirm the location of the IUD by ultrasound
Consult OB/Gyn colleagues to remove the IUD by laparoscopy or laparotomy
What if your patient thinks that she is pregnant?
Perform a pregnancy test
Obtain an ultrasound to determine the location of the pregnancy and the IUD
Consult OB/Gyn colleagues for early removal of the IUD
What if your patient thinks that her IUD has fallen out?
Most frequently occurs in the first three months of use
Perform a speculum exam to determine if IUD strings are present
Remove partially expelled IUD
The IUD can be replaced or use another form of birth control
What if you cannot see the IUD strings when trying to remove the IUD?
Place a cytobrush in the endocervix and gently sweep downward to locate strings curled up in the canal
If this is not successful, then confirm intrauterine location of the IUD by ultrasound
Consult OB/Gyn colleagues to remove the IUD, possibly with hysteroscopic guidance