Original Article

Management of Intrauterine Contraception in Early Pregnancy

Authors: Shanthi S. Ramesh, MD, Samantha Charm, MPH, Alison Kalinowski, MD, Abigail L. Liberty, MD, Gretchen S. Stuart, MD, MPHTM

Abstract

Objectives: Women with rare intrauterine contraception (IUC) failures are advised to have their IUC removed because of the risk of poor obstetric outcomes with a retained IUC. Specifics regarding IUC removal in early pregnancy including techniques for removal, rates of success, and immediate pregnancy outcomes following removal are not well described, however. The objective of this study was to identify women with an IUC in early pregnancy examined at a tertiary care center with the primary objective of describing IUC removal attempts, IUC removal successes, and pregnancy outcomes at 20 weeks following IUC removal.

Methods: Case series of women with concurrent IUC and early pregnancy who presented to a tertiary care ultrasound center by 12 weeks’ gestation.

Results: A total of 3116 women had an early pregnancy ultrasound during the study period. Nineteen (19/3116, 0.61%) women underwent ultrasounds that identified a pregnancy before 12 weeks and an IUC in the uterus. A copper IUC was identified in 11 women (11/19, 58%) on their first ultrasound, and a levonogestrel IUC was identified in 5 women (5/19, 26%). Seventeen (17/19, 88%) women attempted to remove their IUC; 11 of 69 (69%) were successfully removed on the first attempt. Fourteen (14/19; 74%) women with an IUC examined by 12 weeks’ gestation had an ongoing pregnancy at 20 weeks compared with 1782 (1782/2678, 67%; P = 0.209) women without an IUC.

Conclusions: Pregnancy with IUC is rare. Among the 19 women who were found to have an in situ IUC and early pregnancy, most had a successful IUC removal and had an ongoing pregnancy at 20 weeks’ gestation. In our case series, IUC removal in the first trimester was a straightforward procedure and likely successful.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. American College of Obstetricians and Gynecologists. Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol 2011;118:184-196.
 
2. Trussell J. Contraceptive failure in the United States. Contraception 2011;83:397-404.
 
3. Brahmi D, Steenland MW, Renner RM, et al. Pregnancy outcomes with an IUD in situ: a systematic review. Contraception 2012;85:131-139.
 
4. Ozgu-Erdinc AS, Tasdemir UG, Uygur D, et al. Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis. Contraception 2014;89:426-430.
 
5. Ganer H, Levy A, Ohel I, et al. Pregnancy outcome in women with an intrauterine contraceptive device. Am J Obstet Gynecol 2009;201:381.e1-e5.
 
6. World Health Organization. Selected practice recommendations for contraceptive use. http://www.who.int/reproductivehealth/publications/family_planning/SPR-3/en. Published 2008. Accessed June 7, 2017.
 
7. Kim SK, Romero R, Kusanovic JP, et al. The prognosis of pregnancy conceived despite the presence of an intrauterine device (IUD). J Perinat Med 2010;38:45-53.
 
8. Inal MM, Ertopcu K, Ozelmas I. The evaluation of 318 intrauterine pregnancy cases with an intrauterine device. Eur J Contracept Reprod Health Care 2005;10:266-271.
 
9. Tatum HJ, Schmidt FH, Jain AK. Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol 1976;126:869-879.
 
10. von Theobald P, Duchemin JM, Levy G. The outcome of continuing pregnancies in patients with intrauterine devices. A retrospective study from the Maternity Unit of the University Hospital Center at Caen during the period 1985-1988. J Gynecol Obstet Biol Reprod (Paris) 1990;19:863-868.
11. Mermet J, Bolcato C, Rudigoz RC, et al. Outcome of pregnancies with an intrauterine devices and their management. Rev Fr Gynecol Obstet 1986;81:23323-23325.