IUCD Ultrasound Position Guide

A Practical Guide for Sonographers, clinicians and women

Intrauterine contraceptive devices (IUCDs), also known as intrauterine devices (IUDs), are among the most effective long-acting reversible contraceptives. Ultrasound plays a critical role in confirming correct placement, identifying malposition, and detecting complications such as embedment or perforation.

For sonographers and clinicians, understanding standardized IUCD position types ensures accurate reporting, patient safety, and appropriate gynecological referral.

This guide explains IUCD position types on ultrasound; Type 1A, 1B, 2A, 2B, Type 3, and other clinically significant displaced positions with practical insights for daily scanning.

Why Ultrasound Assessment of IUCD Position Matters

Ultrasound evaluation is indicated in cases of:

• Pelvic pain

• Abnormal uterine bleeding

• Missing or shortened IUCD strings

• Post-insertion confirmation

• Suspected expulsion or perforation

• Infertility work-up

Transvaginal ultrasound (TVS) is the gold standard for IUCD localization due to superior endometrial cavity visualization.

IUCD Position Types on Ultrasound

1). Type 1A – Well Localized (Normal Position)

Definition:

IUCD centrally located within the endometrial cavity

Fundally positioned

Horizontal arms fully deployed

No embedment into myometrium

Ultrasound Features:

• T-shaped echogenic structure

• Stem aligned with endometrial canal

• Arms extended at fundus

• No surrounding myometrial penetration

Clinical Significance:

Ideal placement

No intervention required

Effective contraception expected

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2). Type 1B – Slightly Low-Lying

Definition:

IUCD remains within endometrial cavity

Slightly inferior to fundus

Arms may not be fully opened

Still entirely within endometrium

Ultrasound Features:

• Device positioned lower than expected

• No myometrial embedment

• Internal os remains above device

Clinical Significance:

Often asymptomatic

Monitor depending on symptoms

May slightly reduce contraceptive efficacy if significantly low

3). Type 2A – Partially Embedded

Definition:

IUCD partially embedded in myometrium

Majority of device remains within endometrial cavity

Ultrasound Features:

• One arm or stem penetrating superficial myometrium

• Asymmetrical arm appearance

• Possible focal myometrial distortion

Clinical Significance:

Abnormal position

May cause pelvic pain or bleeding

Gynecology referral recommended

4). Type 2B – Significantly Embedded

Definition:

IUCD deeply embedded within myometrium

Significant portion of device within uterine wall

Ultrasound Features:

• Marked myometrial penetration

• Difficult visualization of full device contour

• Possible shadowing within myometrium

Clinical Significance:

High risk for complications

Removal may be difficult

Specialist referral required

5). Type 3 – Perforated IUCD

Definition:

IUCD perforates through myometrium

Partially or completely outside uterine cavity

Ultrasound Features:

• Device seen breaching serosa

• Absent from endometrial cavity

• May be visualized in pelvis

Clinical Significance:

Surgical evaluation required

Risk of bowel or bladder injury

Urgent gynecological referral

6). Type 4 – Displaced/Malpositioned IUCD (Cervical or Lower Uterine Segment)

Although not always classified numerically in all systems, displaced positions are clinically significant.

Definition:

IUCD located in cervix or lower uterine segment

Ultrasound Features:

• Device below internal os

• Stem partly in cervical canal

• Possible partial expulsion

Clinical Significance:

Considered ineffective

Higher expulsion risk

Removal and reinsertion often required

Additional Clinically Significant IUCD Findings

1. Expelled IUCD

Device absent from uterine cavity

Confirm via clinical exam

2. Fragmented IUCD

Broken arms or retained fragment

3. Embedded Strings Only

Device migrated but strings visible

4. Pregnancy with IUCD in situ

Evaluate for ectopic pregnancy

Practical Scanning Tips for Sonographers

✔ Always perform transvaginal ultrasound when possible

✔ Scan in sagittal and transverse planes

✔ Identify fundus clearly

✔ Measure distance from fundus to IUCD

✔ Assess relationship to internal cervical os

✔ Evaluate myometrial integrity

✔ Look for free fluid

How To Report: Ultrasound Report Template (IUCD Position Assessment)

Pelvic Ultrasound Report

Patient Name: - Age: -years

Clinical Indication: Pelvic pain/Post IUCD insertion check/Abnormal bleeding/Missing strings

Technique: Transvaginal ultrasound performed with high-frequency endocavitary probe. Multiplanar grayscale imaging obtained.

Uterus:

Size: (_ × _ × _) cm

Orientation: Anteverted/Retroverted

Myometrium: Homogeneous/Heterogeneous

Focal lesions: Present/Absent

Endometrium:

Thickness: _ mm

Cavity: Normal/Distorted

IUCD:

Type: Copper T/Hormonal (if known)

Position: Fundal/Low-lying/Cervical

Classification: Type 1A / 1B / 2A / 2B / Type 3 / Displaced

Arms: Fully deployed/Partially deployed

Embedment: None / Partial / Significant

Perforation: Absent / Suspected / Confirmed

Distance from fundus: ___ mm

Relationship to internal os: Above / At / Below

Adnexa:

Ovaries: Normal/Abnormal

Masses: Present/Absent

Cul-de-sac:

Free fluid: Present / Absent

Impression/Conclusion:

1. IUCD in situ, classified as Type [1A/1B/2A/2B/3] as described above.

2. (If Type 2-3): Findings suggestive of myometrial embedment/perforation. Gynecology referral is recommended for further management.

3. (If Type 1A): Normal IUCD placement.

   
   

Sonographer/Reporting Physician:

[Name/Title]

Key Reporting Principles

✔ Clearly state IUCD classification

✔ Avoid vague terms like “slightly misplaced”

✔ Comment on fundal position and embedment

✔ Recommend referral when Types 2–3 identified

Evidence-Based References

1). World Health Organization (WHO) – Family Planning Guidelines

2). American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on Long-Acting Reversible Contraception

3). Radiology and Obstetrics Ultrasound literature on IUCD complications

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Final Clinical Insight for Sonographers

In routine reporting:

• Type 1A = Ideal placement

• Types 2–3 = Abnormal, refer to gynecology

• Cervical displacement = Often ineffective

Accurate IUCD classification improves patient outcomes, prevents complications, and strengthens your credibility as a sonographer.

If you're building expertise in gynecological ultrasound, mastering IUCD assessment is essential. At UltrasoundStudy.co, we continue to provide practical, standardized reporting tools to elevate your clinical confidence and professional growth.