O&G Cases · Sexual and reproductive health — long-acting reversible contraception
Lost IUD strings after 52 mg LNG-IUS insertion — assessment and management station
LARC procedural station: lost IUD strings algorithm; communication with anxious patient; the investigative imaging sequence and referral pathway; the consent for ongoing or alternative contraception. Assessor key and fail criteria included.
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Station brief
Format. Procedural and counselling station, approximately 12 minutes. A 28-year-old nulliparous woman attends the gynaecology outpatient clinic after a 52 mg LNG-IUS insertion 6 weeks ago because her self-check today cannot locate the strings. On speculum examination the threads are not visible at the external os. The examiner will run the clock and feed you information; the assessor will observe your sequence of actions, your imaging plan and your communication.
[16]Candidate instruction. Take a focused history, lead the examination, order the appropriate imaging, counsel the patient on outcomes, and document the plan. Verbalise your thinking out loud.
References2ShowHide
- [6]Curtis KM, Nguyen AT, Tepper NK, Zapata LB, Snyder EM, Hatfield-Timajchy K, Kortsmit K, Cohen MA, Whiteman MK U.S. Selected Practice Recommendations for Contraceptive Use, 2024 MMWR Recomm Rep, 2024.PMID 39106301
- [16]Dermish AI, Turok DK, Jacobson JC, Flores ME, McFadden M, Burke K Failed IUD insertions in community practice: an under-recognized problem? Contraception, 2013.PMID 22979954