Normally the string of an intrauterine device (IUD) protrude through the cervical os. If a string is not seen then a problem may or may not be present.


Steps in patient evaluation:

(1) Insert an endocervical brush into the endocervical canal and twist. A string in the endocervical canal hopefully can be caught and retrieved.

(2) If Step 1 fails, then perform ultrasonography on the uterine cavity. If the IUD is located within the uterine cavity then it be left alone or it can be retrieved (under ultrasonographic or endoscopic guidance).

(3) If the IUD is not seen on ultrasonography within the uterine cavity then additional imaging studies need to be performed. This may include ultrasonography of the abdomen and pelvis or an abdominal X-ray. If the IUD is located outside of the uterus then it needs to be retrieved, usually by laparoscopy.

(4) If the IUD is not seen within the uterus or the abdominal cavity, then it may either have been passed or it has migrated further away.


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