Pregnancy with IUCD in situ

Dr. Anand Gangji

O & G Department

IUCD efficacy

•0.6 – 0.8 % at 1 year for Cu IUCD •0.2 – 0.3 % at 1 year for LNG IUS•Highest risk of failure in first year•Malposition of IUCD

Misplaced IUCD with intrauterine pregnancy

Pregnancy with IUCD

•Woman’s Intention for the pregnancy•IUCD strings visible•Location of pregnancy•Gestation

Pregnancy with IUCD

•Early risks – Miscarriage, sepsis •Late risks – Preterm delivery, Chorioamnionitis•No increased risk of birth defects• Removal – increased risk of miscarriage, infection, preterm delivery

First trimester•Wanted pregnancy, strings seen – Remove IUCD•Wants termination, strings seen – Remove IUCD•Ectopic pregnancy, strings seen – Remove IUCD and manage ectopic by surgery•Medical management of ectopic, IUCD may be left in situ.

First trimester•Strings not seen, wanted Intrauterine pregnancy – counsel risks, +/- USS guidance removal

•Strings not seen, Ectopic pregnancy - manage ectopic pregnancy, search for IUCD at the time of procedure

Second trimester•String seen, wanted pregnancy – remove IUCD•String not seen, wanted pregnancy – counsel, USS guidance•Unwanted pregnancy, if strings seen – remove, plan medical termination

•Antibiotic cover

Jadelle (LNG implant)

•Pregnancy symptoms •Risk of ectopic 1 in 2000 HWY of use•Removal•No increased risk of birth defects

Thank you