Intrauterine device complications - Revision history

Rossdonaldson1: /* See Also */

2022-08-03T20:33:03Z

Rossdonaldson1 at 20:12, 3 August 2022

2022-08-03T20:12:23Z

← Revisión anterior		Revisión del 20:12 3 ago 2022
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			==Background==
			[[File:Blausen 0400 FemaleReproSystem 02b.png\|thumb\|Pelvic anatomy including organs of the female reproductive system.]]
	[[File:IUDs.png\|thumb\|Paragard, Mirena, and Skyla]]		[[File:IUDs.png\|thumb\|Paragard, Mirena, and Skyla]]
	~~==Background==~~
	*Intrauterine devices (IUDs) are one of the most effective contraceptive methods		*Intrauterine devices (IUDs) are one of the most effective contraceptive methods
	*T-shaped device inserted through cervix, can be used for up to 3-12 years		*T-shaped device inserted through cervix, can be used for up to 3-12 years
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	==Complications and Management==		==Complications and Management==
			[[File:IUDUS.png\|thumb\|IUD on ultrasound]]
	==="Lost" IUD===		==="Lost" IUD===
	*Most common IUD-related reason for ED presentation		*Most common IUD-related reason for ED presentation
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	**If cannot, IUD position can be confirmed on [[ultrasound]] or (for copper IUDs) abdominal x-ray		**If cannot, IUD position can be confirmed on [[ultrasound]] or (for copper IUDs) abdominal x-ray
	**If extrauterine, needs surgical removal		**If extrauterine, needs surgical removal
	~~[[File:IUDUS.png\|thumb\|IUD on ultrasound]]~~
	===Uterine perforation===		===Uterine perforation===
	*Extremely rare		*Extremely rare
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	*Diagnosed by imaging: IUD may be imbedded in uterine wall or free in peritoneum		*Diagnosed by imaging: IUD may be imbedded in uterine wall or free in peritoneum
	*Requires emergent Ob/gyn consult for surgical removal/repair		*Requires emergent Ob/gyn consult for surgical removal/repair

	===Pregnancy with IUD in place===		===Pregnancy with IUD in place===
	*Extremely rare, as IUDs are >99% effective in preventing pregnancy<ref>http://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/family-planning-methods-2014.pdf</ref>		*Extremely rare, as IUDs are >99% effective in preventing pregnancy<ref>http://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/family-planning-methods-2014.pdf</ref>
	*Increased risk of [[ectopic pregnancy]] if hCG positive and IUD still in place		*Increased risk of [[ectopic pregnancy]] if hCG positive and IUD still in place
	*Consult OB/Gyn for urgent evaluation/management		*Consult OB/Gyn for urgent evaluation/management

	===[[PID]]===		===[[PID]]===
	*IUD use associated with increased rate of PID, particularly in first 21 days after insertion		*IUD use associated with increased rate of PID, particularly in first 21 days after insertion
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	**No change in usual antibiotic treatment ([[ceftriaxone]] + [[azithromycin]] or [[doxycycline]] +/- [[metronidazole]]		**No change in usual antibiotic treatment ([[ceftriaxone]] + [[azithromycin]] or [[doxycycline]] +/- [[metronidazole]]
	**If patient has had IUD for <3 weeks, consider referring to OB/Gyn for possible removal		**If patient has had IUD for <3 weeks, consider referring to OB/Gyn for possible removal

	===Other Adverse Effects===		===Other Adverse Effects===
	*More common with copper IUD		*More common with copper IUD
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	*Heavy [[Vaginal Bleeding (Non-Pregnant)\|vaginal bleeding]]		*Heavy [[Vaginal Bleeding (Non-Pregnant)\|vaginal bleeding]]
	*[[Pelvic pain]]		*[[Pelvic pain]]

	===IUD Removal===		===IUD Removal===
	*No real indication for removal in the emergency department		*No real indication for removal in the emergency department

Rossdonaldson1: Rossdonaldson1 moved page Intrauterine device problems to Intrauterine device complications

2021-03-11T17:28:56Z

Rossdonaldson1 moved page Intrauterine device problems to Intrauterine device complications

← Revisión anterior	Revisión del 17:28 11 mar 2021
(Sin diferencias)

ClaireLewis: /* Background */

2016-11-14T04:19:41Z

Background

← Revisión anterior		Revisión del 04:19 14 nov 2016
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	**tend to cause more side effects (heavy/irregular menses, [[pelvic pain]])		**tend to cause more side effects (heavy/irregular menses, [[pelvic pain]])
	**also extremely effective as [[emergency contraception]] if inserted within 120 hours of unprotected sex		**also extremely effective as [[emergency contraception]] if inserted within 120 hours of unprotected sex
	*Hormonal IUDs (Mirena, Liletta, Mirena, Skyla, Kyleena): secrete small amount of progestin (levonorgestrel) ~~locally~~		*Hormonal IUDs (Mirena, Liletta, Mirena, Skyla, Kyleena): secrete small amount of progestin ([[levonorgestrel]])
	**MIrena effective up to 6 years, the others for 3-5 years		**MIrena effective up to 6 years, the others for 3-5 years
	**Menses tend to get significantly lighter or disappear altogether after the first few months		**Menses tend to get significantly lighter or disappear altogether after the first few months

ClaireLewis: /* Background */

2016-11-14T04:15:32Z

Background

← Revisión anterior		Revisión del 04:15 14 nov 2016
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	**MIrena effective up to 6 years, the others for 3-5 years		**MIrena effective up to 6 years, the others for 3-5 years
	**Menses tend to get significantly lighter or disappear altogether after the first few months		**Menses tend to get significantly lighter or disappear altogether after the first few months
	**~~Since~~ little ~~(if any) hormone~~ absorbed systemically, women tend ''NOT'' to have the hormonal side effects or increased [[DVT]]/[[PE]] risk associated with oral contraceptives<ref>Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5(3):561-74.</ref>		**Very little progestin absorbed systemically, so women tend ''NOT'' to have the hormonal side effects or increased [[DVT]]/[[PE]] risk associated with oral contraceptives<ref>Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5(3):561-74.</ref>

	==Complications and Management==		==Complications and Management==

ClaireLewis: Created page with "Paragard, Mirena, and Skyla ==Background== Intrauterine devices (IUDs) are one of the most effective contraceptive methods T-shaped device inserted..."

2016-11-14T03:08:07Z

Created page with "thumb|Paragard, Mirena, and Skyla ==Background== *Intrauterine devices (IUDs) are one of the most effective contraceptive methods *T-shaped device inserted..."

Página nueva

[[File:IUDs.png|thumb|Paragard, Mirena, and Skyla]]
==Background==
*Intrauterine devices (IUDs) are one of the most effective contraceptive methods
*T-shaped device inserted through cervix, can be used for up to 3-12 years
*Serious complications are rare, <1% of women with IUDs
*Copper IUD (Paraguard):
**lasts up to 12 years, no hormones, usually cheaper
**tend to cause more side effects (heavy/irregular menses, [[pelvic pain]])
**also extremely effective as [[emergency contraception]] if inserted within 120 hours of unprotected sex
*Hormonal IUDs (Mirena, Liletta, Mirena, Skyla, Kyleena): secrete small amount of progestin (levonorgestrel) locally
**MIrena effective up to 6 years, the others for 3-5 years
**Menses tend to get significantly lighter or disappear altogether after the first few months
**Since little (if any) hormone absorbed systemically, women tend ''NOT'' to have the hormonal side effects or increased [[DVT]]/[[PE]] risk associated with oral contraceptives<ref>Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5(3):561-74.</ref>

==Complications and Management==
==="Lost" IUD===
*Most common IUD-related reason for ED presentation
*Small removal strings are left protruding from cervix on insertion
*Women are instructed to feel for string with finger, if strings seem shorter or cannot be felt, may indicate malposition or complication
*Management:
**Attempt to visualize strings
**If cannot, IUD position can be confirmed on [[ultrasound]] or (for copper IUDs) abdominal x-ray
**If extrauterine, needs surgical removal
[[File:IUDUS.png|thumb|IUD on ultrasound]]
===Uterine perforation===
*Extremely rare
*Suspect in patient with IUD and symptoms of [[endometritis]], salpingitis, and/or peritonitis
*Diagnosed by imaging: IUD may be imbedded in uterine wall or free in peritoneum
*Requires emergent Ob/gyn consult for surgical removal/repair
===Pregnancy with IUD in place===
*Extremely rare, as IUDs are >99% effective in preventing pregnancy<ref>http://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/family-planning-methods-2014.pdf</ref>
*Increased risk of [[ectopic pregnancy]] if hCG positive and IUD still in place
*Consult OB/Gyn for urgent evaluation/management
===[[PID]]===
*IUD use associated with increased rate of PID, particularly in first 21 days after insertion
*Related to preexisting [[STDs]] rather than the IUD itself
**Screening at time of insertion greatly reduces PID risk
*Management of PID with IUD in place
**CDC does '''NOT''' recommend empirically removing IUD, as it is not the source of infection<ref>http://www.cdc.gov/reproductivehealth/contraception/pdf/management-during-contraception_508tagged.pdf</ref>
**No change in usual antibiotic treatment ([[ceftriaxone]] + [[azithromycin]] or [[doxycycline]] +/- [[metronidazole]]
**If patient has had IUD for <3 weeks, consider referring to OB/Gyn for possible removal
===Other Adverse Effects===
*More common with copper IUD
*Irregular menses
*Heavy [[Vaginal Bleeding (Non-Pregnant)|vaginal bleeding]]
*[[Pelvic pain]]
===IUD Removal===
*No real indication for removal in the emergency department
*However, if patient desires removal and outpatient referral is unfeasible, can be safely removed in the ED:
**Visualize string(s) protruding from cervix
**Grasp string with Kelly clamp or long forceps
**Pull with steady, gentle force until device emerges
**Do NOT jerk string, as this may detatch string from device, making removal much more difficult

==See Also==
*[[Pelvic pain]], [[Vaginal bleeding]]
*[[Ectopic pregnancy]]
*[[PID]]

==External Links==

==References==
<references/>

[[Category:OBGYN]]

← Revisión anterior		Revisión del 20:33 3 ago 2022
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	==See Also==		==See Also==
	*[[Pelvic pain]], [[Vaginal bleeding]]		*[[Pelvic pain]]
			*[[Vaginal bleeding]]
	*[[Ectopic pregnancy]]		*[[Ectopic pregnancy]]
	*[[PID]]		*[[PID]]
			*[[Medical device complications]]

	==External Links==		==External Links==

Intrauterine device complications - Revision history

Rossdonaldson1: /* See Also */

Rossdonaldson1 at 20:12, 3 August 2022

Rossdonaldson1: Rossdonaldson1 moved page Intrauterine device problems to Intrauterine device complications

ClaireLewis: /* Background */

ClaireLewis: /* Background */

ClaireLewis: Created page with "Paragard, Mirena, and Skyla ==Background== *Intrauterine devices (IUDs) are one of the most effective contraceptive methods *T-shaped device inserted..."

ClaireLewis: Created page with "Paragard, Mirena, and Skyla ==Background== Intrauterine devices (IUDs) are one of the most effective contraceptive methods T-shaped device inserted..."