A 21-year-old gravida 2, para 1011 presents to the outpatient office for missing intrauterine device (IUD) strings following IUD insertion. The patient had an IUD placed at her six-week postpartum visit. She noted increased discomfort with this IUD placement compared with the one she had prior to the pregnancy. She also noted increased bleeding immediately following the procedure. Since placement she has had unprovoked intermittent abdominal discomfort that is sharp in nature and self resolves. She denies changes in her bowel or bladder habits and reports her menstrual cycles are short, one to three days, occurring monthly. Her past medical history is significant for depression and postpartum endometritis. Her past surgical history is significant for right anterior cruciate ligament repair. She is not taking any medications and she has no allegies.

A 30-year-old female, gravida1, para 0, presents to the office for a suction dilation and curettage (D&C) for management of a six-week missed abortion. Transvaginal ultrasound diagnosed the missed abortion one week ago and it was reconfirmed three days ago. She is taking ibuprofen 400 mg PO q 4 hours PRN and took diazepam 5 mg PO × 1 before arriving. She has no past medical or surgical history and no known drug allergies. On bimanual examination, a small, retroflexed uterus is noted. The cervix is stenotic, but dilation was able to be performed. Near the end of the procedure, the suction cannula passes without resistance deeper than expected. The patient describes a sudden increase in her pain. The procedure is stopped.