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
using an IUD increases the risk for ectopic pregnancy T or F?
false
- although a pregnancy that occurs with an IUD is more likely to be an ectopic compared to general population
most ectopic pregnancies are located where?
ampulla
treatment of ectopic pregnancy? (2)
- medical therepy (methotrexate)
- surgical intervention
what is PID?
- type of sexually transmitted disease or bilateral infection associated with IUD use
unilateral PID may result from?
- direct extension of primary lower abdominal or pelvis abcess
- complications from abortion or child birth
how is PID diagnosed?
- assessment of patient history and symptoms
- pelvic exam
- urine test
- culture of vaginal secretions
treatment of PID?
- antibiotic treatment
what is salpingitis and what are the 3 categories??
infection of fallopian tubes
- can be acute, sub-acute, chronic
sono apperance of acute salingitis?
- nodular thickening of walls of fallopian tubes with diverticula
- hyperemia
- PCDS fluid
- uterine enlargement
chronic salpingitis and hydrosalphix are related to what?
- reccurent bouts of PID
chronic salpingitis and hydrosalphix s/s?
- pain during sex or bowel movements and menses
chronic salpingitis and hydrosalphix sono apperance?
- tubal scarring
- cystic structures extending from uterus to adnexa
- chain of lakes sign or string of pearl sign
what can chronic salpingitis and hydrosalphix cause?
- infertility
- ectopic pregnancy
(from tubal scarring)
what is Pyosalpinx?
- progression of PID
- fallopian tubes become swollen with purulent exudates
sono apperance of Pyosalpinx?
- thick-walled tubular or serpiginous structures surrounding the ovaries
- echogenic material or debris related to pus in fallopian tubes
pyosalphix
what is hydrosalphinx?
- consequence of PID
- fallopian tube becomes closed at fimbriae
- pus within a pyosalpinx liquefies, leaving serous fluid
- walls of tubes become thinner (dilate to twice as normal)
hydrosalphinx
what is Tubo-ovarian abscess-TOA?
- results from pus leaking from an infected fallopian tube (pyosalphinx)
- may occur from communication with ovary
what is Tubo-ovarian abscess-TOA a result of?
- serious pelvic infection
- seen in later stages of PID
Tubo-ovarian abscess-TOA treatment?
- small abscess may respond to antibiotics
- large abscess may need surgical removal
