0:01

This patient comes to the ED

0:02

with abnormal vaginal bleeding.

0:04

She reports that she has an IUD, and they

0:06

check a pregnancy test, and she was positive.

0:09

So she gets her ultrasound, and you can

0:10

see there is an intrauterine pregnancy.

0:12

We have a gestational sac right here.

0:14

We have an amnion here.

0:15

We have a fetal pole

0:17

right there, a little crown-rump length,

0:19

very cute. Yolk sac, everything normal so far.

0:23

However, she did have a reported history

0:25

of an IUD, so you have to look for it.

0:28

In this case, as we're looking at

0:29

the yolk sac right here, you see this

0:31

echogenic linear thing with shadowing.

0:34

That certainly looks like it could be an IUD.

0:36

Going a little bit further down,

0:38

you see more shadowing out here, measuring

0:41

a little subchorionic hemorrhage

0:42

at that point, live pregnancy.

0:45

We have a fetal heart rate, which is good news.

0:48

But if we come back up and we look at our

0:51

cine clips right here, you have an IUP.

0:55

As we scroll through right here,

0:57

you see this structure right here.

0:59

That looks like that long bar of the T-shaped

1:02

uterus or IUD, with the arms right here.

1:06

So it looks like it probably flipped,

1:07

and it's sort of anterior right here.

1:10

So this is a diagnosis of

1:12

an IUD that is complicated.

1:15

It must have been abnormally positioned.

1:16

We can see that it's flipped,

1:18

and she ended up getting pregnant.

1:19

So it failed in that sense.

1:22

So in cases like this, they can

1:24

potentially be successfully removed.

1:26

And in this case, it was removed.

1:28

We have short interval follow-up on her

1:29

that showed a live IUP with interval growth.

1:32

But if you leave the IUD in place, let's

1:34

say it's in a bad spot that you can't

1:36

remove it without potentially losing the

1:37

pregnancy as well, you are at risk of a

1:40

lower birth weight, premature labor,

1:42

a chorioamnionitis, or a spontaneous abortion

1:45

up to about 50% risk of that.

1:48

Those risks are reduced with removal, especially

1:51

the further you get from that removal.

1:53

But it's important to know again, you can still

1:55

get, even if it's a reasonable one to remove,

1:57

such as this case, given where it's positioned,

1:59

removal can result in a pregnancy loss.

2:01

So our jobs as the radiologist here to describe

2:04

where that IUD is in relation to the pregnancy.

2:07

Because that's important when the OB is

2:10

going to counsel the patient as to their

2:12

risks of leaving it in versus removing it.

2:15

Or another example, if it's, you know,

2:16

in the sac itself or if it's embedded in

2:18

the placenta, those cannot be removed.

2:21

So all good things that the OB

2:23

needs to know ahead of time.