0:01

All right, so wrapping up IUD, a few

0:03

teaching points when you are reading

0:04

an ultrasound for IUD positioning or if

0:07

you're just incidentally seeing one when

0:09

they're being imaged for other reasons.

0:11

Ultrasound, that is going

0:12

to be the mainstay of IUD.

0:13

It's cheap, there's no radiation,

0:15

there's not usually a long wait

0:16

time, it's very easily accessible.

0:19

That's where you're going to start.

0:21

The cineclips are vital.

0:23

If you don't have 3D imaging, which not all

0:25

machines necessarily do, having cineclips,

0:28

if that is not a normally positioned IUD,

0:30

is really going to be helpful for you deciding

0:32

where it's positioned, how it's positioned,

0:34

and if there is embedment or perforation.

0:37

If you have 3D though, you should

0:39

always acquire it for IUDs.

0:41

It's super helpful, even just

0:43

seeing where normals are.

0:44

We have our sonographers practice a

0:46

lot, just getting them on normal ones

0:47

so that they're used to acquiring them.

0:49

So when they become abnormal, they're

0:51

already experts at getting them.

0:53

Again, always think about embedment into the myometrium

0:57

versus perforation, which is out the serosa.

1:00

That's going to change how they remove

1:02

this, whether it's an outpatient

1:03

procedure, whether they need sedation or

1:06

whether they need an actual operation.

1:09

And then, always remember, if there is no

1:11

IUD present on your ultrasound, you can

1:13

look in the abdomen, though you're probably

1:15

not going to find it because of bowel.

1:17

Bowel gas is going to be bright,

1:18

IUDs are bright, hard to tell.

1:20

But, your differential is, it is either

1:22

expelled via the vagina, which honestly

1:25

is the most common abdominal positioning

1:28

and X-ray to prove that, exp of exclusion.

1:36

If it is in, they're going to need to