0:02

So we've reviewed the

0:03

normal positioning of IUDs.

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Let's look at some abnormal

0:05

positioning examples.

0:07

So starting with this case right here,

0:08

I'll go through a few of the still images.

0:11

Once they're abnormally positioned,

0:13

I find the still images can be really

0:15

hard to figure out exactly where it is.

0:17

Even sometimes on the cine clips, I

0:19

can still have a hard time figuring

0:20

out exactly how it's positioned, even

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though you can tell it's abnormal.

0:24

So here they labeled this an oblique fundal IUD.

0:27

We're not seeing anything that we expect.

0:29

Like that last case, we definitely

0:30

see shadowing from the IUD, but I have

0:32

no idea where it is at this point.

0:34

Sagittal image right here, then you can

0:36

see a bit of it, but I expect it to be a

0:38

long, that long arm of the T to come all

0:40

the way down here, that body of the T, we

0:42

don't see that, so where the heck is this?

0:44

Tech also nicely measured

0:46

here that it's too low, right?

0:47

We talked about four millimeters

0:48

from the top of the endometrium.

0:50

This one is nearly 12 millimeters.

0:52

That's already too low.

0:53

So we know this is a malpositioned IUD.

0:56

Now we just have to figure

0:57

out how is it malpositioned.

0:59

So here is your 3D right here.

1:02

And I think this is just so helpful.

1:04

We'll look at the cine clips in a moment,

1:05

but here is your uterine contour right here.

1:08

There's a bit of the endometrium right here,

1:10

following along right here.

1:11

This is sort of the left right

1:13

here and we lose the right.

1:14

But here's your IUD.

1:15

Here are your arms right here.

1:17

Here's the long body.

1:19

The long body is actually pointing

1:20

out towards the left fallopian tube.

1:22

So this thing flipped and sort of rotated as well.

1:26

It's almost completely

1:27

upside down and then rotated.

1:28

So here's your arms here.

1:29

Here's the body here.

1:30

So this is completely abnormal.

1:32

So we know that's abnormal, but

1:34

what we have to decide next is not

1:36

just that it's abnormal, needs to be

1:37

removed, which is definitely step one.

1:40

But we also need to know, is

1:41

this embedded in the myometrium?

1:43

Is it perforating through?

1:44

If it's just abnormally positioned, a lot

1:46

of times they can just, in the office,

1:47

go ahead and remove this, potentially.

1:50

But if it's deeply embedded or out

1:52

through the serosa, they're going to

1:54

need sedation to remove that basically.

1:56

And then obviously if it's completely

1:57

perforated through and into the

1:59

cavity, you need a full surgery.

2:01

So I'll just show you on here as well.

2:04

Here's your sagittal cine view.

2:05

She had a C-section scar right here.

2:08

I found it very difficult to figure

2:11

out exactly where this IUD is.

2:12

And I do try to look first before I look at

2:14

the 3D just to see if I can figure it out.

2:17

And you can follow this for sure, but

2:20

it's really hard to visualize, at least

2:21

for me, exactly how that's positioned,

2:23

where the 3D just shows you right there.

2:26

And if you still weren't sure, for some

2:28

reason that was unbeknownst to me, she

2:30

actually ended up getting an MRI of

2:32

her pelvis, I assume for other reasons.

2:34

And you're teaching we did imaging right here.

2:37

There you go.

2:38

You can prove it right there as well.

2:40

There's your IUD it's flipped

2:41

and it's rotated, right?

2:43

Here's the long portion of it, not

2:45

embedded into the myometrium here.

2:48

See the arm right here,

2:49

not embedded, not embedded.

2:50

I would not suggest getting

2:51

an MRI to look for an IUD.

2:53

The ultrasound itself should be more

2:55

than sufficient and was in this case.

2:57

But the IUD, you can see it nicely via MRI.

3:00

So you should definitely look for it.

3:02

If you have an MRI with a person

3:03

with an IUD, always comment on it.