those with subtle problems of positioning, like embedment of the long arms of the device within the myometrium Expulsion occurs in approximately 2% of IUD placements The risk is highest among nulliparous women The symptoms of expulsion include persistent abdominal discomfort following insertion that is not improving over time, or worsening pain that suddenly resolved Rarely, women may identify the device following expulsion; more commonly, the device is only partially expulsed resulting in ongoing pain Infection occurs following 1% of IUD placements and is most likely during 21 days following IUD placement Patients with symptoms of vaginitis should be evaluated for an STD, bacterial vaginosis, or a vulvovaginal yeast infection and treated accordingly Management Management of pregnancies with an in situ IUD depends on the woman’s desire to continue or terminate the pregnancy, gestational age, IUD location, and whether IUD strings are visible The U.S Food and Drug Administration, the Centers for Disease Control, and the American College of Obstetricians and Gynecologists (ACOG) recommend that the IUD be removed from a pregnant woman as soon as possible, if the strings are visualized or if the IUD is in the cervix If perforation is confirmed by ultrasound, and the patient recently had the device placed (