Pediatric emergency medicine trisk 2167 2167

Use of long-acting reversible contraceptive (LARC) devices among adolescent
patients has increased significantly over the past decade. In 2002, only 2.4% of
young women used these devices, but by 2013 more than 11.6% were using one
of these methods. There are two main types of LARC devices—IUDs and
subdermal hormonal implants. Although side effects are rare, ED clinicians
should be aware of complications that represent potential clinical emergencies.
CLINICAL PEARLS AND PITFALLS
Recognize when patients who have a contraceptive device in place
may be presenting with symptoms suggestive of a complication.
Provide guidance on the optimal process for evaluating complications
related to use of a contraceptive device.

INTRAUTERINE DEVICES
Clinical Manifestations
Serious complications related to having a contraceptive device place are rare.
Among IUD users, rare, but serious side effects include pregnancy, uterine
perforation, expulsion, and infection. Pregnancies with an in situ IUD have a
higher risk of being an ectopic pregnancy and, if the IUD is left in place, women
are more likely to experience a spontaneous abortion or prolonged bleeding.
The risk of perforation is low, and is estimated to be 1 in 1,000; most occur
within 2 months of insertion. Clinical symptoms of perforation include persistent
or worsening pain, bleeding, hematuria, abdominal distention, and fever.
Perforations are usually fundal and, given that the device has no sharp edges and
that no incisions or sharp instruments are placed in the uterus during the
procedure, are generally not associated with hemorrhage or damage to internal
visceral organs. However, cervical perforation or lateral perforation at the level of
the internal cervical os or within the uterus can result in vascular disruption with
associated hemodynamic changes, including hemodynamic instability. Anterior
perforation may result in damage to the bladder, which may present with
suprapubic pain, dysuria, or persistent vaginal leakage of fluid. The diagnosis
may be made based on clinical symptoms or with an ultrasound. Abdominal as

well as transvaginal images are generally necessary to confirm the diagnosis, with
3D ultrasound providing greater sensitivity, particularly in obese women and