A 26-year-old woman in China told doctors although she was using an intrauterine device for contraception, she fell pregnant.

According to Live Science, the woman explained that she gave birth to the baby in 2012 via cesarean section, but when doctors were performing her surgery they found no sign of the device. Thinking it may have become embedded in the walls of her uterus another IUD was inserted.

Five years later, the woman was complaining to doctors about her frequency of urination and abdominal pain, including blood in her urine. The woman claimed she had been in pain for five years and no treatments seemed to work.

Doctors at the First Hospital of Jilin University in Changchun, China, reportedly performed an X-ray of the woman’s pelvis and discovered that the missing IUD had actually perforated the woman’s uterine wall and traveled to her bladder. There, the IUD had perforated the bladder as well but it healed without requiring treatment.

At the time the woman had two IUDs — one in her bladder responsible for the pain — and one in her uterus. The woman’s case was published in the October 2017 issue of Medicine, although the circumstances surrounding doctor’s failure to find the “missing” IUD are unknown.

Dearly spoke with Dr. Stacey Leigh Rubin, an instructor at the Department of Gynecology and Obstetrics Johns Hopkins School of Medicine and board certified OB-GYN, about the unusual nature of having two IUDs inserted at the same time.

Rubin explained that in the U.S., there are a series of steps to determine the placement of an IUD if it is no longer detected, including an ultrasound and X-ray. Uterine perforations are a serious complication of IUDs and reportedly occur in every 1 in 1,000 users.

According to Rubin, though it’s “unusual” some women may not know their IUD has fallen out which often requires the need to localize it. Other times, and less common when an IUD is displaced, are perforations of the uterine wall. According to Rubin, although uterine perforations requiring surgery are “rare” it has happened. There is “no circumstance” in which a second IUD should be inserted, Rubin explained.

Researchers in China believe the woman’s IUD may have perforated the uterus because of labor contractions.

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