OB review- IUD Flashcards
Paragard IUD vs. Mirena IUD?
Paragaurd:
- 2 parellel hyperechoic linear echoes with intense posterior acoustic shadowing
Mirena:
- hypoechoic or midly echogenic stem with thin echogenic “T-arms”
the strings of an IUD are never visualized on U/S T or F?
false- they are occasionaly visualized
what is lippes loop?
multiple echogenic dots within the endometiral canal
abnormal or ectopic locations of IUD’s? (3)
- migration from superior fundal portion to inferior portion of endometrium or vaginal canal
- myometrial penetration
- perforation into peritoneal cavity
complications of abnormal or ectopic locations of IUD’s? (3)
- PID
- ectopic pregnancy
- coexisting IUP
expulsion of IUD generally occurs when?
- within 1st year
- most commonly during first few months after insertion
expulsion of IUD is more likely to occur when? (4)
- inserted soon after childbirth
- history of expulsion
- nulliparity
- severe menorrhagia
s/s of IUD expulsion?
- asymptomatic
- cramping
- vaginal discharge
- intermenstrual or postcoital bleeding
- dyspareunia
when IUD is not viualized in the endometrial canal sonographically what should be obtained?
- plain film radiograph of abdomen and pelvis
migration of IUD
what is myometiral penetration?
- extension of penetration of the IUD through the basal layer of the endometrium into the uterine myometrium
where is myometial penetration typically located?
“T” portion extends partially or completely through lateral and fundal portions of the endometiral layers embedding into the myometrium of the uterus
myometrial penetration s/s?
- asymptomatic
- pelvic pain
- irregular bleeding
perforation occurs in how may insertions?
- rare
- 1 in 1000 insertions
when does perforation typically occur?
- almost always during insertion
what causes perforation? (3)
- inexperienced clinician
- retroverted uterus
- congenital uterine anomalies
perforation s/s and complications?
- pelvic pain
complicaitons:
- damage/scarring of surrounding organs
- pelvic infection
perforation into myometrium
infection risk?
- previous history of STD
- insertion technique
what can infection develop into?
a serious condition affecting the uterus, fallopian tubes, adnexa, peritoneum
what can infection result in? (3)
- endomyometritis
- pyosalpinx
- tuboovarian abcess
Endomyometritis on U/S?
- endometrium appears thick and irregular
- uterus may appear large and inhomogeneous
- hypervascular endometrium and myometrium may be evident with colour doppler imaging
The risk of pregnancy with an IUD in place is highest when?
- in the first year after insertion
Pregnancy in the presence of an IUD is associated with several complications including? (7)
- ectopic pregnancy
- spontaneous abortion
- chorioamnionitis
- premature rupture of membranes
- preterm labor
- septic abortion
- maternal death
