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Viable pregnancy in the presence of an intrauterine contraceptive device
The Journal of Emergency Medicine, Vol. 20, No. 3, pp. 297–298, 2001 Copyright © 2001 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/01 $–see front matter
PII S0736-4679(00)00277-3
Visual Diagnosis in Emergency Medicine
VIABLE PREGNANCY IN THE PRESENCE OF AN INTRAUTERINE CONTRACEPTIVE DEVICE Christopher Ho,
MD
Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California Reprint Address: Christopher Ho, MD, Department of Emergency Medicine, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8676
A 20-year-old female presented to our Emergency Department (ED) complaining of intermittent vaginal bleeding for approximately 4 weeks. She was referred to the ED after being seen at an outside clinic earlier the same day and found to have a positive pregnancy test. The patient was surprised to find out that she was pregnant, as she had an intrauterine contraceptive device (IUCD) placed after the birth of her last child 2 years earlier. The patient was Gravida 5, Para 3, and reported that her last menstrual period was 8 weeks prior to her ED visit. She had had three normal-term spontaneous vaginal deliveries, the last one of which was 2 years ago. She was in good health, was on no
medications, and had no complaints other than vaginal bleeding. The physical examination was significant for a uterine fundus palpable just below the umbilicus in the midline, with an otherwise normal abdomen. Pelvic examination demonstrated no blood in the vaginal vault, a closed cervical os with a small amount of thick cervical mucus, and an estimated uterine size of 12 weeks’ gestation. Of note, there were no strings, wires, or other portion of an IUCD visible on speculum examination. Ultrasound revealed the presence of both an IUCD and a viable 11-week intrauterine fetus (Figures 1 and 2). The IUCD was felt to be extrinsic to the pregnancy.
Figure 1. Sagittal view of the IUCD. The T-shaped object is seen clearly within the uterine cavity.
Figure 2. Sagittal view of viable fetus within the uterine cavity.
RECEIVED: 3 March 2000; FINAL ACCEPTED: 17 October 2000
SUBMISSION RECEIVED:
22 September 2000; 297
298
Additionally, there was a small amount of fluid noted in the endocervical canal and possibly a small subchorionic hemorrhage. There was no evidence of uterine perforation. The obstetrical service was consulted, and their recommendation was to schedule outpatient removal of the IUCD, as the patient was felt to be hemodynamically
C. Ho
stable and in no immediate danger of spontaneous abortion or massive hemorrhage. As no portion of the IUCD protruded from the cervix, removal of the IUCD in the ED was not felt to be prudent. The patient was discharged home in good condition with strict return precautions and scheduled obstetric follow up.
PII S0736-4679(00)00277-3
Visual Diagnosis in Emergency Medicine
VIABLE PREGNANCY IN THE PRESENCE OF AN INTRAUTERINE CONTRACEPTIVE DEVICE Christopher Ho,
MD
Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California Reprint Address: Christopher Ho, MD, Department of Emergency Medicine, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8676
A 20-year-old female presented to our Emergency Department (ED) complaining of intermittent vaginal bleeding for approximately 4 weeks. She was referred to the ED after being seen at an outside clinic earlier the same day and found to have a positive pregnancy test. The patient was surprised to find out that she was pregnant, as she had an intrauterine contraceptive device (IUCD) placed after the birth of her last child 2 years earlier. The patient was Gravida 5, Para 3, and reported that her last menstrual period was 8 weeks prior to her ED visit. She had had three normal-term spontaneous vaginal deliveries, the last one of which was 2 years ago. She was in good health, was on no
medications, and had no complaints other than vaginal bleeding. The physical examination was significant for a uterine fundus palpable just below the umbilicus in the midline, with an otherwise normal abdomen. Pelvic examination demonstrated no blood in the vaginal vault, a closed cervical os with a small amount of thick cervical mucus, and an estimated uterine size of 12 weeks’ gestation. Of note, there were no strings, wires, or other portion of an IUCD visible on speculum examination. Ultrasound revealed the presence of both an IUCD and a viable 11-week intrauterine fetus (Figures 1 and 2). The IUCD was felt to be extrinsic to the pregnancy.
Figure 1. Sagittal view of the IUCD. The T-shaped object is seen clearly within the uterine cavity.
Figure 2. Sagittal view of viable fetus within the uterine cavity.
RECEIVED: 3 March 2000; FINAL ACCEPTED: 17 October 2000
SUBMISSION RECEIVED:
22 September 2000; 297
298
Additionally, there was a small amount of fluid noted in the endocervical canal and possibly a small subchorionic hemorrhage. There was no evidence of uterine perforation. The obstetrical service was consulted, and their recommendation was to schedule outpatient removal of the IUCD, as the patient was felt to be hemodynamically
C. Ho
stable and in no immediate danger of spontaneous abortion or massive hemorrhage. As no portion of the IUCD protruded from the cervix, removal of the IUCD in the ED was not felt to be prudent. The patient was discharged home in good condition with strict return precautions and scheduled obstetric follow up.