Most common IUD-related reason for ED presentation
Small removal strings are left protruding from cervix on insertion
Women are instructed to feel for string with finger, if strings seem shorter or cannot be felt, may indicate malposition or<unk> Management:
Attempt to visualize strings
If cannot, IUD position can be confirmed on ultrasound or (for copper IUDs) abdominal x-ray
If extrauterine, needs surgical removal
Attempt to visualize strings
If cannot, IUD position can be confirmed on ultrasound or (for copper IUDs) abdominal x-ray
If extrauterine, needs surgical removal
Extremely rare
Suspect in patient with IUD and symptoms of endometritis, salpingitis, and/or peritonitis
Diagnosed by imaging: IUD may be imbedded in uterine wall or free in peritoneum
Requires emergent Ob/gyn consult for surgical removal/repair
Extremely rare, as IUDs are >99% effective in preventing pregnancy
Increased risk of ectopic pregnancy if hCG positive and IUD still in place
Consult OB/Gyn for urgent evaluation/management
IUD use associated with increased rate of PID, particularly in first 21 days after insertion
Related to preexisting STDs rather than the IUD itself
Screening at time of insertion greatly reduces PID risk
Management of PID with IUD in place
CDC does NOT recommend empirically removing IUD, as it is not the source of infection
No change in usual antibiotic treatment (ceftriaxone + azithromycin or doxycycline +/- metronidazole
If patient has had IUD for <3 weeks, consider referring to OB/Gyn for possible removal
Screening at time of insertion greatly reduces PID risk
CDC does NOT recommend empirically removing IUD, as it is not the source of infection
No change in usual antibiotic treatment (ceftriaxone + azithromycin or doxycycline +/- metronidazole
If patient has had IUD for <3 weeks, consider referring to OB/Gyn for possible removal
More common with copper IUD
Irregular menses
Heavy vaginal bleeding
Pelvic pain
No real indication for removal in the emergency department
However, if patient desires removal and outpatient referral is unfeasible, can be safely removed in the ED:
Visualize string(s) protruding from cervix
Grasp string with Kelly clamp or long forceps
Pull with steady, gentle force until<unk>  emerges
Do NOT jerk string, as this may detatch string from<unk> , making removal much more difficult
Visualize string(s) protruding from cervix
Grasp string with Kelly clamp or long forceps
Pull with steady, gentle force until<unk>  emerges
Do NOT jerk string, as this may detatch string from<unk> , making removal much more difficult
Intrauterine device complications
Comorbid diseases in pregnancy
Pregnancy 
Trauma in pregnancy
Vaginal trauma
Dysfunctional uterine bleeding
Preterm labor
Postpartum hemorrhage