Early pregnancy with an intrauterine device in place

A 22-year-old female presented to the emergency department (ED) with the complaint of vaginal bleeding. One week prior, the patient had seen her primary provider after she missed her period. She had a positive urine pregnancy test (UPT) at that time. This was a surprise to the patient as she had a mechanical copper intrauterine device (IUD) in place for the past several years. A pelvic exam was done at that office visit, and the physician could not visualize the strings of her IUD in the cervical os. She was advised to follow up closely with her OB/Gyn provider for an ultrasound to determine the location of the IUD, but presented to the ED before that appointment due to a small amount of vaginal bleeding. As part of her ED evaluation for a possible ectopic pregnancy, a bedside transvaginal ultrasound was performed by the emergency physician, which revealed the rare finding of an intrauterine pregnancy with an IUD in place. The gestational sac was located high in the uterine fundus with a crown-rump length (CRL) consistent with a gestational age of 6 weeks and fetal cardiac activity in the 130 s (Figs. 1, 2).