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IUD Pregnancy, then......

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Hello. I am looking for as many professional opinions as I can get right now. Work in an office with other doctors? Ask them too.... Please!

Patient comes in for IUD (Mirena) implant. Medication in given to soften cervix, IUD inserted, the end.....

Patient is 32 and unknowingly conceived 10 days prior. Medication and IUD SHOULD (statistically) terminated unknown pregnancy. Patient goes to ER thinking she has a cyst causing pain on left ovary, only to discover she is pregnant, with a boy (17w3d).

Seen at OB for ultrasound. RNP thinks she sees IUD, but unsure. It is never looked for again. Doctor seen through rest of pregnancy says there is "no evidence" of it being there, assumes it came out soon after going in. 

What steps would you take during a suspected IUD pregnancy or following delivery to ensure the IUD was out of patient's body? (Not in uterus or somewhere else in abdomen)

1 year since birth of child, no return of menses, and IUD was recently found in uterus on ultrasound. How would you proceed?

Bayer was ZERO help when called for guidance.

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Second year student here,

Was the IUD placement correct on ultrasound? Does the current placement of the IUD bother the patient? Can you visualize the strings on pelvic? Does the patient wish to continue with current birth control?

If the answer to all these questions are "yes" than I would just continue with the current track you are on, explain any thoughts/concern with the patient and have them agree with your plan. Just for CYA I would request x-ray and reason for exam would be "confirm correct placement of IUD" because I think they are radiopaque (you should now have two imaging studies to confirm correct placement).

Please keep in mind I am still a student and have minimal experience but this path seems the most logical to me and if the patient agrees then it's not like she was denied information if an unexpected event occurs. Please feel free to correct if you know something I don't.

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Ultrasound was not used to confirm placement. Current position is not causing pain or discomfort. Strings are not visible during pelvic, but recent ultrasound shows that it is otherwise in "perfect position." Patient has requested removal given overall experience with IUD.

This is a really strange case, right? Placed after conception, was still in there throughout pregnancy and didn't come out during labor, and now perfectly placed (minus no visual of strings) a year after giving birth. Hysteroscope will be used for removal.

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Yea it's kinda weird. I have to admit it's not that weird overall as I use to be a surg tech and I have done a few exploratory laparotomies to remove IUD that punctured through the uterus and slipped into the abdomen. Imagine explaining to a woman who had an IUD inserted through her vagina that you were about to remove it surgically through her abdomen...

Thanks for the interesting case, it is nice to see what other people are thinking regarding the same problems. Hopefully I will run into another OBGYN and see if they have had similar experience. For now I am in pediatrics and my first day has been quite the opposite of what I was expecting. 

Good luck with everything.

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