An IUD (levonorgestrel-releasing intrauterine system, LNG-IUS 52 mg) is inserted in a 32-year-old nulliparous woman with dysmenorrhoea and menorrhagia. Six months later, she presents with lower abdominal pain and irregular spotting. Ultrasound shows the IUD is in the lower uterine segment with the stem partially protruding through the internal os. This is best described as:

• A IUD expulsion
• B IUD perforation into the cervical canal
• C Normal IUD position for nulliparous women
• D IUD malposition — low-lying IUD, fundal displacement ✓

Explanation

An IUD located in the lower uterine segment with the stem at or through the internal os represents malposition (low-lying IUD), not a normal position. The IUD should ideally sit with the horizontal arms in contact with the fundus. Malposition is associated with reduced contraceptive efficacy, pain, irregular bleeding, and increased expulsion risk. It is not classified as full expulsion (where the IUD exits the uterus) nor as perforation. Removal and re-insertion with verification of fundal position is recommended. This is more common in nulliparous women and women with a small uterine cavity.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.