IUD Displaced in the Cervical Canal: Ultrasound Findings and Clinical Management
Uterus in anteversion, presenting regular contours and homogeneous myometrial echotexture. Thickened and homogeneous endometrial echo. Note the presence of a metallic intrauterine device (IUD) (compatible with a copper IUD) in an anomalous situation. The upper end of the device is displaced caudally, located at the level of the internal orifice of the uterine cervix (it is interesting that the ultrasound doctor shows here the distance from the upper portion of the IUD to the uterine fundic serosa). There are no textural signs of myometrial perforation or associated intracavitary fluid collections.
Case discussion
Clinical and Pathophysiological Discussion
Poor positioning of a copper Intrauterine Device (IUD) is one of the most common causes of contraceptive failure, abnormal uterine bleeding (AUB), and pelvic pain. Pathophysiologically, the effectiveness of the copper IUD depends on its proximity to the uterine fundus, where the local release of copper ions promotes a sterile inflammatory reaction in the endometrium that alters cervical mucus and inhibits sperm motility and viability. When caudal displacement occurs towards the endocervical canal, the concentration of copper ions in the uterine fundus is drastically reduced, increasing the method failure rate (Pearl Index). Displacement may result from cavitary disproportion (small uteri or those with submucosal fibroids), uterine hypermotility in the first months post-insertion or inadequate implantation technique. In transvaginal ultrasound evaluation, the diagnosis is based on measuring the distance between the upper stem of the IUD and the fundal endometrial echo (fundus-IUD distance normally less than or equal to 10 mm), with the presence of the stem or horizontal arms invading the cervical canal being evident.
Differential Diagnoses (DDx)
1. Caudal displacement / IUD in endocervical canal (IUD inserted into the cavity that migrated to the cervix).
2. Low insertion of the IUD (primary malpositioning, where the device never reached the uterine fundus during the procedure).
3. Partial expulsion of the IUD (rod exiting through the external orifice of the uterine cervix).
4. Ingrown IUD / Partial myometrial perforation (when, in addition to being dislocated, its rods penetrate the cervical or corporal myometrium).
How to report it
Conclusion
Intrauterine device (IUD) with a metallic pattern presenting poor positioning, characterized by caudal displacement and current location in the endocervical canal.
Report to the Attending Physician & Recommended Conduct
The finding must be reported to the attending physician for planning clinical management, as the device loses its ideal contraceptive efficacy in this location. It is recommended to advise the patient to use alternative barrier contraceptive methods (such as condoms) until the condition resolves. The gold standard approach involves removing the device by traction of the wires (if visible) or with the aid of forceps under direct visualization/hysteroscopy, evaluating the opportunity to insert a new device in the same session, if this is the patient's desire and there are no local contraindications (such as active infection).
How to explain it to the patient
What does a copper IUD displaced in the cervical canal mean?
The ultrasound exam showed that her copper IUD had come out of its correct position. Instead of being safely stored at the bottom of the uterus (which is where it needs to be to prevent pregnancy), it has slipped down and is now located in the endocervical canal, which is the region of the cervix.
Does a misplaced IUD protect against pregnancy?
Not in the right way. When the IUD leaves its ideal position and descends into the cervix, its effectiveness decreases greatly. This means that the risk of an unwanted pregnancy increases significantly. Therefore, it is very important to use a condom in all sexual relations until you consult your doctor.
What are the symptoms of an IUD coming out of place?
Many women don't feel anything (the finding is by chance on a routine ultrasound), but the most common symptoms of a misplaced IUD include:
• Cramps in the region of the foot of the belly or pelvic pain.
• Breakthrough bleeding or menstruation that lasts more days than normal.
• Feel the plastic/metal tip of the IUD with your fingers when cleaning the area.
• Pain or discomfort during intimate intercourse.
What to do if the IUD is in the cervical canal?
Ultrasound is an imaging test that serves to guide the diagnosis, but your doctor is the one who defines the treatment. You must schedule a return appointment with the gynecologist who inserted the device or the doctor who has been following you. Most of the time, the recommended procedure is to remove this IUD and, if you want, insert a new one in the right position. Do not try to move or pull the threads at home, as this may hurt your uterus.