Examkin

Soru

Zorluk: ZorMenstrual Cycle Abnormalities and Contraception

A healthy 25-year-old female visits the gynecology clinic for a routine wellness check. She underwent insertion of a levonorgestrel-releasing intrauterine device (IUD) twelve months ago. She reports feeling well with no pelvic pain, and she has experienced expected light spotting. However, she notes that she cannot palpate the device's strings, which she previously checked monthly. The patient's vital signs are stable. During speculum examination, the threads are not visualized protruding from the cervical os. Arrange the following diagnostic and management steps in the correct chronological sequence to evaluate this finding.

  1. 1Administer a urine beta-hCG test to rule out an unintended pregnancy.
  2. 2Use a cytobrush to gently sweep the endocervical canal in an attempt to draw out retracted threads.
  3. 3Obtain a transvaginal ultrasound to visualize the uterine cavity and confirm the device's location.
  4. 4Order an anteroposterior and lateral abdominal radiograph to evaluate for extrauterine device migration.

Cevap

The correct sequential order for evaluating missing intrauterine device (IUD) strings is to first exclude pregnancy with a urine beta-hCG test, then attempt to retrieve retracted strings with a cytobrush, followed by a transvaginal ultrasound if strings are still not found, and finally an abdominal X-ray if the uterus is completely empty.
The correct algorithm for missing IUD strings minimizes risk and invasive procedures by starting with a pregnancy test to ensure safety, followed by a simple clinic maneuver (cytobrush) to solve the most common etiology. Imaging escalates from the safest modality (ultrasound) to radiographic evaluation only if the uterus is proven empty.

Adım Adım Çözüm

1
Rule out pregnancy with a urine beta-hCG test.
Confirms whether the missing strings are due to an expelled IUD resulting in an unintended pregnancy.
Establishing pregnancy status is critical to ensure the safety of further instrumentation and guides subsequent patient counseling.
2
Sweep the endocervix gently with a cytobrush.
Often retrieves strings that have simply retracted into the cervical canal.
Retraction into the endocervix is the most common cause of missing strings; a quick in-office sweep can resolve the issue and avoid unnecessary, expensive imaging.
3
Perform a transvaginal ultrasound.
Identifies if the IUD is present and properly positioned within the uterine cavity.
When strings are completely absent from the cervix, imaging is required to confirm the device has not been unknowingly expelled or perforated through the myometrium.
4
Obtain an abdominal radiograph.
Locates the IUD within the abdominal cavity or confirms expulsion if absent from the image.
This differentiates between silent expulsion (no IUD seen) and uterine perforation (IUD seen in the abdomen), dictating whether laparoscopic retrieval is necessary.

Anahtar Kavram

Algorithmic evaluation of missing intrauterine device (IUD) strings
Bu soruyu puanla

Konular

Menstrual Cycle Abnormalities and Contraception

Bu konudan daha fazla soru