An intrauterine contraceptive device (IUCD) is inserted in a woman and she returns 3 months later with strings not visible on speculum examination. Pelvic ultrasound shows no IUCD in the uterine cavity. The most likely explanation is:

• A Perforation of the uterus with intra-abdominal IUCD ✓
• B Expulsion of IUCD
• C Pregnancy with IUCD in situ
• D Strings have retracted into the cervical canal

Explanation

When the IUCD is not visible on pelvic ultrasound and there is no evidence in the vagina (expulsion), the possibility of uterine perforation with intraperitoneal migration must be excluded with an X-ray of the abdomen or pelvic CT scan. Perforation occurs in 1–2 per 1000 insertions, usually during or immediately after insertion. String retraction is possible but would show IUCD within the uterus on ultrasound.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.