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OB review > OB review- IUD > Flashcards

OB review- IUD Flashcards

1
Q

Paragard IUD vs. Mirena IUD?

A

Paragaurd:
- 2 parellel hyperechoic linear echoes with intense posterior acoustic shadowing

Mirena:
- hypoechoic or midly echogenic stem with thin echogenic “T-arms”

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2
Q

the strings of an IUD are never visualized on U/S T or F?

A

false- they are occasionaly visualized

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3
Q

what is lippes loop?

A

multiple echogenic dots within the endometiral canal

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4
Q

abnormal or ectopic locations of IUD’s? (3)

A
  1. migration from superior fundal portion to inferior portion of endometrium or vaginal canal
  2. myometrial penetration
  3. perforation into peritoneal cavity
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5
Q

complications of abnormal or ectopic locations of IUD’s? (3)

A
  • PID
  • ectopic pregnancy
  • coexisting IUP
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6
Q

expulsion of IUD generally occurs when?

A
  • within 1st year

- most commonly during first few months after insertion

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7
Q

expulsion of IUD is more likely to occur when? (4)

A
  • inserted soon after childbirth
  • history of expulsion
  • nulliparity
  • severe menorrhagia
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8
Q

s/s of IUD expulsion?

A
  • asymptomatic
  • cramping
  • vaginal discharge
  • intermenstrual or postcoital bleeding
  • dyspareunia
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9
Q

when IUD is not viualized in the endometrial canal sonographically what should be obtained?

A
  • plain film radiograph of abdomen and pelvis
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10
Q
A

migration of IUD

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11
Q

what is myometiral penetration?

A
  • extension of penetration of the IUD through the basal layer of the endometrium into the uterine myometrium
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12
Q

where is myometial penetration typically located?

A

“T” portion extends partially or completely through lateral and fundal portions of the endometiral layers embedding into the myometrium of the uterus

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13
Q

myometrial penetration s/s?

A
  • asymptomatic
  • pelvic pain
  • irregular bleeding
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14
Q

perforation occurs in how may insertions?

A
  • rare

- 1 in 1000 insertions

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15
Q

when does perforation typically occur?

A
  • almost always during insertion
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16
Q

what causes perforation? (3)

A
  • inexperienced clinician
  • retroverted uterus
  • congenital uterine anomalies
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17
Q

perforation s/s and complications?

A
  • pelvic pain

complicaitons:

  • damage/scarring of surrounding organs
  • pelvic infection
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18
Q
A

perforation into myometrium

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19
Q

infection risk?

A
  • previous history of STD

- insertion technique

20
Q

what can infection develop into?

A

a serious condition affecting the uterus, fallopian tubes, adnexa, peritoneum

21
Q

what can infection result in? (3)

A
  1. endomyometritis
  2. pyosalpinx
  3. tuboovarian abcess
22
Q

Endomyometritis on U/S?

A
  • endometrium appears thick and irregular
  • uterus may appear large and inhomogeneous
  • hypervascular endometrium and myometrium may be evident with colour doppler imaging
23
Q

The risk of pregnancy with an IUD in place is highest when?

A
  • in the first year after insertion
24
Q

Pregnancy in the presence of an IUD is associated with several complications including? (7)

A
  1. ectopic pregnancy
  2. spontaneous abortion
  3. chorioamnionitis
  4. premature rupture of membranes
  5. preterm labor
  6. septic abortion
  7. maternal death
25
Q

using an IUD increases the risk for ectopic pregnancy T or F?

A

false

  • although a pregnancy that occurs with an IUD is more likely to be an ectopic compared to general population
26
Q

most ectopic pregnancies are located where?

A

ampulla

27
Q

treatment of ectopic pregnancy? (2)

A
  • medical therepy (methotrexate)

- surgical intervention

28
Q

what is PID?

A
  • type of sexually transmitted disease or bilateral infection associated with IUD use
29
Q

unilateral PID may result from?

A
  • direct extension of primary lower abdominal or pelvis abcess
  • complications from abortion or child birth
30
Q

how is PID diagnosed?

A
  • assessment of patient history and symptoms
  • pelvic exam
  • urine test
  • culture of vaginal secretions
31
Q

treatment of PID?

A
  • antibiotic treatment
32
Q

what is salpingitis and what are the 3 categories??

A

infection of fallopian tubes

- can be acute, sub-acute, chronic

33
Q

sono apperance of acute salingitis?

A
  • nodular thickening of walls of fallopian tubes with diverticula
  • hyperemia
  • PCDS fluid
  • uterine enlargement
34
Q

chronic salpingitis and hydrosalphix are related to what?

A
  • reccurent bouts of PID
35
Q

chronic salpingitis and hydrosalphix s/s?

A
  • pain during sex or bowel movements and menses
36
Q

chronic salpingitis and hydrosalphix sono apperance?

A
  • tubal scarring
  • cystic structures extending from uterus to adnexa
  • chain of lakes sign or string of pearl sign
37
Q

what can chronic salpingitis and hydrosalphix cause?

A
  • infertility
  • ectopic pregnancy
    (from tubal scarring)
38
Q

what is Pyosalpinx?

A
  • progression of PID

- fallopian tubes become swollen with purulent exudates

39
Q

sono apperance of Pyosalpinx?

A
  • thick-walled tubular or serpiginous structures surrounding the ovaries
  • echogenic material or debris related to pus in fallopian tubes
40
Q
A

pyosalphix

41
Q

what is hydrosalphinx?

A
  • 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)
42
Q
A

hydrosalphinx

43
Q

what is Tubo-ovarian abscess-TOA?

A
  • results from pus leaking from an infected fallopian tube (pyosalphinx)
  • may occur from communication with ovary
44
Q

what is Tubo-ovarian abscess-TOA a result of?

A
  • serious pelvic infection

- seen in later stages of PID

45
Q

Tubo-ovarian abscess-TOA treatment?

A
  • small abscess may respond to antibiotics

- large abscess may need surgical removal

OB review (10 decks)

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