0:01

So here we'll review again, normal positioning,

0:04

not on a PowerPoint, but in an actual case.

0:06

So our sonography here nicely

0:09

labeled the IUD for us right here.

0:11

In this case, this was transabdominal.

0:13

This is actually the bladder bit

0:14

back here, and this is because

0:15

that uterus was flopped anteriorly.

0:17

This is the vagina back here, decompressed

0:20

bladder, and then this is actually the

0:21

body of the uterus and the fundus that

0:22

had flopped anteriorly right here.

0:24

You can see the arms of the IUD.

0:26

So we already have a good idea that it's

0:28

probably going to be in a good, normal location.

0:32

When we go transvaginally, you

0:33

can see some material, some echogenic

0:35

material here in the cervix.

0:36

This is probably going to be the string.

0:39

See, it's sort of melds to the positioning of

0:42

the cervix right here, where as an IUD is not

0:44

going to kind of bend like a string would.

0:47

But important to keep in mind, you want to see

0:48

the rest of the IUD in the right positioning.

0:51

So let's skip through some of these right here.

0:53

And now we have our sagittal view.

0:54

Here's your IUD.

0:55

In this case, we have all that artifact

0:57

and it's causing all the shadow right

0:59

here, but beautifully positioned exactly

1:01

where we expect it to be right here.

1:03

And again, you just go slightly off and you

1:05

lose a lot of that shadowing right there.

1:07

So your cine clips can be really helpful

1:09

to tell you exactly where that is.

1:11

So speaking of that, let's go to our cineclips.

1:13

Here's our sagittal cineclip

1:15

through the uterus right here.

1:18

Come into the uterus right here.

1:22

It's going to be decompressed

1:23

bladder here anteriorly.

1:24

You can already start to see some of the

1:26

artifacts caused by one of the arms of the IUD.

1:30

And there's the rest of it right here.

1:32

And you can see it goes all the way up to

1:34

the tippy top of the endometrium right here.

1:36

So that's good positioning.

1:38

We've confirmed it on the sagittal.

1:40

But let's figure out where those arms are.

1:42

Go back to a transverse,

1:43

a little bit of bladder right here.

1:44

So transverse cine clip right here.

1:49

There's one arm right there.

1:50

There's your other arm right there.

1:52

Little bit of shadowing right there.

1:54

But beautifully positioned.

1:55

Here's the rest of the IUD.

1:56

You can follow that all the way down as well.

1:58

And then we don't even see the

2:00

string necessarily in this image,

2:01

little bits of string down here.

2:04

The string itself, though, doesn't

2:05

matter, it's where the IUD itself is.

2:07

A lot of times, patients may come in for an

2:09

IUD check because they can't feel that string

2:11

anymore, and it's just because it kind of

2:12

got pulled up or bunched up into the cervix.

2:14

That's okay. That's not a problem.

2:16

All that matters really is

2:17

where the IUD itself is.