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Suspected uterine perforation — DFSRH MCQ

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HardIntrauterine methodsSuspected uterine perforationDFSRH

A 29-year-old woman has a 52 mg LNG-IUD fitted 10 days ago. She reports persistent pelvic pain, shoulder-tip discomfort and light bleeding; pregnancy test is negative. Threads are not visible and ultrasound cannot identify the device in the uterus. What is the most appropriate investigation?

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Correct answer: E — Abdominal and pelvic X-ray to locate a perforated device

If ultrasound does not show an IUD in the uterine cavity, X-ray is needed to identify an extrauterine device or confirm expulsion. The symptoms and missing threads make simple reassurance unsafe. Blind retrieval risks harm, and antibiotics alone do not locate the device. The pearl is that a negative pregnancy test does not exclude uterine perforation.

Reference: FSRH Guideline: Intrauterine Contraception