Pelvic pain

for contraception, and ordering pelvic ultrasonography.6 ACOG recommendations for the management of IUD malpositioning depend on the device’s location and the pa- tient’s symptomatology. ❚ Management of low-lying IUDs is complex. An IUD that is malpositioned in the cervix is considered partially expelled and should be completely removed. 6 For asymp- tomatic patients with an IUD located in the lower uterine segment and above the inter - nal cervical os, there should be strong con- sideration given to leaving the IUD in place because removal is associated with higher rates of pregnancy given the low rates of ini- tiation of effective contraception following removal.6 IUD malpositioning in the peritoneal cav- ity requires surgical intervention. Although ACOG’s first-line recommendation is laparo- scopic intervention, laparotomy can be con- sidered if laparoscopy does not result in the removal of the IUD or the patient has more severe complications (sepsis or bowel perfora- tion).6 At the time of IUD removal, the clinician should also discuss and/or prescribe interim contraception. ❚ Treatment for our patient included uncomplicated laparoscopic surgical remov- al of the intra-abdominal IUD. The patient’s symptoms went away following the procedure, and she was subsequently switched to an oral contraceptive. JFP CONTINUED PHOTO ROUNDS

1. Aoun J, Dines VA, Stovall DW, et al. Effects of age, parity, and de- vice type on complications and discontinuation of intrauterine devices. Obstet Gynecol. 2014;123:585-592. 2. Berenson AB, Tan A, Hirth JM, et al. Complications and continu- ation of intrauterine device use among commercially insured teenagers. Obstet Gynecol. 2013;121:951-958. 3. Braaten KP , Benson CB, Maurer R, et al. Malpositioned intra- uterine contraceptive devices: risk factors, outcomes, and future pregnancies. Obstet Gynecol. 2011;118:1014-1020. 4. de Kroon CD, van Houwelingen JC, Trimbos JB, et al. The value of transvaginal ultrasound to monitor the position of an intrauter- ine device after insertion. A technology assessment study. Hum Reprod. 2003;18:2323-2327. 5. Thonneau P , Almont T , de La Rochebrochard E, et al. Risk factors for IUD failure: results of a large multicentre case-control study. Hum Reprod. 2006;21:2612-2616. 6. ACOG Committee on Gynecologic Practice. Committee Opinion No 672: clinical challenges of long-acting reversible contracep- tive methods. American College of Obstetricians and Gynecolo- gists. Obstet Gynecol. 2016;128:e69-e77. 7. Heinemann K, Reed S, Moehner S, et al. Risk of uterine perfora- tion with levonorgestrel-releasing and copper intrauterine de- vices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015;91:274-279. 8. Benacerraf BR, Shipp TD, Bromley B. Three-dimensional ultra- sound detection of abnormally located intrauterine contracep- tive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 2009;34:110-115. 9. Bhavasr AK, Felner EJ, Shorma T . Common questions about the evaluation of acute pelvic pain. Am Fam Physician. 2016;93:41-48. 10. Peri N, Graham D, Levine D. Imaging of intrauterine contracep- tive devices. J Ultrasound Med. 2007;26:1389-1401. 50 THE JOURNAL OF FAMILY PRACTICE | JANUARY/FEBRUARY 2021 | VOL 70, NO 1 PRACTICE OPPORTUNITIES Please contact Tim LaPella to inquire about classified advertising in The Journal of Family Practice (circulation: 95,000). Display rates are available, with a discount for frequency. Per word rate for line ads is $5.25. Phone 484-921-5001. Fax 484-921-5005. E-mail: [email protected]. Visit our Web site at mdedge.com/familymedicine; visit MedJobNetwork.com. POSITIONS AVAILABLE 309554 JFP_0121_Classifieds_new.indd 50 1/19/21 9:48 AM 50 THE JOURNAL OF FAMILY PRACTICE | JANUARY/FEBRUARY 2021 | VOL 70, NO 1