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Reminder of important clinical lesson
CASE REPORT
Pregnant with a perforated levonorgestrel intrauterine system and visible threads at the cervical os.
  1. David L Howard1,
  2. Lauren M Beasley2
  1. 1Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, USA
  2. 2633d Medical Group, Langley AFB, Hampton, Virginia, USA
  1. Correspondence to Dr David L Howard, dhoward{at}wellhealthqc.com

Summary

We present a case in which a patient presented with a pregnancy of unknown location and normally rising human chorionic gonadotropin (hCG) levels but with a levonorgestrel intrauterine device (LNG-IUD) present. The LNG-IUD had been placed 4.5 years ago. Although unintended, this pregnancy was desired. Strings were clearly visible and initial 2D ultrasound suggested intrauterine location of the LNG-IUD. The LNG-IUD could not be removed however. The patient was managed expectantly with close follow-up, serial beta-hCGs and serial ultrasounds until definitive diagnosis of the location of the pregnancy. The patient was diagnosed with an ectopic pregnancy and during laparoscopy the body of the IUD was noted in the posterior cul-de-sac. When patients present with multiple competing clinical problems it is important to look at the patient as a whole, taking into account their desires, in order to construct a cohesive management plan.

  • Pregnancy
  • Contraception

https://doi.org/10.1136/bcr-2017-220071

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    Footnotes

    • Contributors At the time of this work, DLH and LMB were military service members. They contributed equally to the conceptualisation of this report and both participated substantially in the writing and editing of the manuscript. This work was prepared as part of their official duties. Title 17, USC, 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17, USC, 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Air Force, Department of the Navy, Department of Defense, nor the US Government.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.