We had a patient who came to us with a pregnancy of 6 weeks and a Cu-T 380 in situ. The threads of the IUD were seen at the external os. She wanted a medical termination of the pregnancy on grounds of a failure of contraception.
"I think the reason for failure of the IUD could be a low-placement, so that the transverse bars are not close to the fundus," I said. "if not, it is bad luck."
"How can we confirm the diagnosis?" the Registrar asked.
"We could a pelvic ultrasonography" I said. "But that costs money. Since she wants a medical termination of pregnancy, we can make the diagnosis clinically."
"Clinically?"
"Yes. At the time of the MTP. Work it out" I said.
They could not work it out. Finally I watched the MTP and told them it was indeed a low-placed IUD.
"How, Sir?"
"The length of the cervical canal was 2.5 cm. Correct?"
"Yes, Sir."
The length of the threads attached to the IUD was also 2.5 cm. Correct?"
"Yes, Sir."
"That means the lower end of the IUD was at the internal os. That means the transverse bar of the IUD was below the uterine fundus, since the uterine cavity length was more than the length of the IUD."
"Yes, Sir."
"There would be some enlargement of the uterine cavity with pregnancy" I said. "But that draws the IUD up, rather than keep it down while the fundus rises."
That convinced them.
"I think the reason for failure of the IUD could be a low-placement, so that the transverse bars are not close to the fundus," I said. "if not, it is bad luck."
"How can we confirm the diagnosis?" the Registrar asked.
"We could a pelvic ultrasonography" I said. "But that costs money. Since she wants a medical termination of pregnancy, we can make the diagnosis clinically."
"Clinically?"
"Yes. At the time of the MTP. Work it out" I said.
They could not work it out. Finally I watched the MTP and told them it was indeed a low-placed IUD.
"How, Sir?"
"The length of the cervical canal was 2.5 cm. Correct?"
"Yes, Sir."
The length of the threads attached to the IUD was also 2.5 cm. Correct?"
"Yes, Sir."
"That means the lower end of the IUD was at the internal os. That means the transverse bar of the IUD was below the uterine fundus, since the uterine cavity length was more than the length of the IUD."
"Yes, Sir."
"There would be some enlargement of the uterine cavity with pregnancy" I said. "But that draws the IUD up, rather than keep it down while the fundus rises."
That convinced them.
