CASE REPORT
A 22-year female, from London, United Kingdom, had been using the intrauterine contraceptive device (IUCD) i.e. Copper T-380 A for 42 months. She was on her vacation to Kathmandu when she developed increasing intermittent episodes of lower abdominal pain for 3 weeks and hence presented to Gynecology and obstetrics out-patient-department (OPD) with additional complaints of cessation of menstruation for 2 months. She recalled that her menstrual periods otherwise were regular and elaborates that the lower abdominal pain was gradually progressing, cramping intermittently in nature, non-radiating with no known aggravating or relieving factors but was associated with episodes of nausea.
She had her urine pregnancy test (UPT) done at home using the pregnancy test kit 1 day before the OPD presentation which was positive. She recalls no history of fever, vomiting, Per Vaginal (PV) spotting or bleeding, or foul-smelling discharges in the past 2 months. The patient had no significant co-morbidities and no relevant medical, surgical, allergy, or psychosocial history. Her vitals were within normal limits and systemic examination of CardioPulmonary, Central nervous system, GastroIntestinal and GenitoUrinary systems were also within normal limits.
An urgent transabdominal ultrasound of the abdomen and pelvis was planned which revealed a gravid uterus containing a single gestational sac corresponding to 7 weeks and 0 days of gestation. The yolk sac was visualized but the fetal pole was not yet visualized. IUCD was seen in the endometrial cavity and the long arm of the IUD was positioned superiorly in the uterine cavity (Figure 1).