Clinical outcomes after removal of malpositioned intrauterine devices in the emergency department.

Pelvic pain is a common chief complaint in the acute care setting. As intrauterine devices continue to grow in prevalence, incidence of complications will naturally increase. While the care of malpositioned IUDs is well described in obstetrics/gynecologic and radiologic literature, there is limited information regarding it in the emergency department. In this case series we identified four cases of symptomatic, malpositioned IUDs with removal in the emergency department and documented symptomatic improvement. Removal in all cases was uncomplicated. These cases suggest that malpositioned IUDs are a potential source of acute pelvic pain and vaginal bleeding and that removal has been safe and effective. While these findings align with prior literature that removal of malpositioned IUDs is safe, their broader clinical implications are limited by the small sample size and safeguards inherent in a tertiary care center. Further research specific to the acute care setting and the emergency provider is needed.