Diagnostic Approach for Suspected Displaced IUD

Initial Assessment and Diagnostic Algorithm

• The American College of Radiology recommends a combined transabdominal and transvaginal ultrasound with Doppler as the most appropriate first-line imaging study for patients with abnormal uterine bleeding and suspected IUD displacement, allowing visualization of both the uterine cavity and potential locations of a displaced IUD 1, 2
• The use of ultrasound as a first-line test is supported due to its non-invasive nature and ready availability in most emergency departments, as noted by Praxis Medical Insights 3

Management Based on Ultrasound Findings

• A malpositioned IUD that is low-lying or extending into the cervix should be removed in the emergency department if strings are visible and can be safely retrieved, particularly when associated with persistent pelvic pain and vaginal bleeding, according to Praxis Medical Insights 3

Special Considerations and Pitfalls

• If the initial ultrasound is inconclusive, the American College of Radiology suggests that MRI of the pelvis without and with contrast is the next appropriate imaging study 1, 2