Interactive Transcript
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The next lesson is IUD, the positioning
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and what you need to look for.
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So intrauterine devices are a contraceptive
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device that are very, very highly
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effective, approximately 98% to 90%.
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Depending on what kind you have,
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it can last for 5 to 10 years.
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Correct positioning, though, is important
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because the correct positioning has
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the highest contraceptive efficacy.
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If it's incompletely placed,
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your contraceptive effectiveness rapidly
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drops, depending on where it is.
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So what you wanna look for is, is their
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abnormal positioning and the risk that
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this would have include risk of pregnancy,
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of course not being effective, but also a
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risk of intrauterine or intra pregnancy,
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but also ectopic pregnancy as well.
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There's also risk of the IUD embedding
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into the myometrium, and if it embeds into
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the myometrium and stays there, it can
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actually perforate through the serosa.
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And if that keeps going, it can actually migrate
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into the abdominal cavity for which you would
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need a surgery to remove it at that point.
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So here are just three different examples
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that you can actually see an MRI,
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an IUD device if you're looking carefully.
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So here's your pre contrast T1.
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You can see it nicely positioned right there.
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Post-contrast, beautifully see it.
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And your subtraction, nice,
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beautiful positioning of your IUD.
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Can even see the strings
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a little bit lower down.
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So when you look for IUD positioning,
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I rely on the transverse uterus imaging
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supplemented by the sagittal imaging.
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The transverse is really helpful for
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the short arms of that T of the IUD.
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In this particular place right here, we can see
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a little bit of shadowing from the long part
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of the IUD here in the endometrium.
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Our next imaging, a little bit
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higher towards the fundus, you can
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see portions of the arms right here.
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They are symmetric and they're
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within the endometrium.
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That's where they should be.
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The sagittal is really useful for
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looking for how far it is from
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the fundus of the endometrium.
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So not the fundal contour, but the
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top of the endometrium right here.
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If it's more than four millimeters from
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that border, which would be right here,
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you have a higher risk of having symptoms
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such as increased or abnormal bleeding,
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pain, and you have an increased risk of
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expulsion or displacement of the IUD.
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So this is an ultrasound artifact.
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The IUD is not this thick, but it's so
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echogenic right here that it creates this
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artifact, and you can see it right here.
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It's important to remember,
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you may not see all parts of the IUD.
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It depends on what kind it is.
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They have different images that
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can be viewed sonographically.
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Some of it may be lucent, some of it
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is very echogenic, like in this case.
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And oftentimes, you can actually see
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the strings coiled in the cervix.
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So just keep that in mind as well.
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Cine clips for these
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are extraordinarily useful.
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I like the transverse to document those
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arms again being in symmetric position,
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and I like the sagittal to document the body
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of the IUD that's in the right spot.
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And if you have 3Ds, they are
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just really, really helpful.
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I definitely recommend them.
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Here's an example of a normal position.
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So in this same patient right here,
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you can see our contour fundus up here,
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the rest of the uterus somewhere around here.
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This is going to be your endometrial
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cavity right here, approximately.
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You can see that the IUD is beautifully
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and perfectly positioned
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within that canal right here.
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Easy imaging to prove that
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it's in the right spot.
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