Interactive Transcript
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
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see there is an intrauterine pregnancy.
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We have a gestational sac right here.
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We have an amnion here.
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We have a fetal pole
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right there, a little crown-rump length,
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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
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the yolk sac right here, you see this
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echogenic linear thing with shadowing.
0:34
That certainly looks like it could be an IUD.
0:36
Going a little bit further down,
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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,
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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,
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and she ended up getting pregnant.
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So it failed in that sense.
1:22
So in cases like this, they can
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potentially be successfully removed.
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And in this case, it was removed.
1:28
We have short interval follow-up on her
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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
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lower birth weight, premature labor,
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a chorioamnionitis, or a spontaneous abortion
1:45
up to about 50% risk of that.
1:48
Those risks are reduced with removal, especially
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the further you get from that removal.
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But it's important to know again, you can still
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get, even if it's a reasonable one to remove,
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such as this case, given where it's positioned,
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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.
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Or another example, if it's, you know,
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in the sac itself or if it's embedded in
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the placenta, those cannot be removed.
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So all good things that the OB
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needs to know ahead of time.
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