THE INTRAUTERINE DEVICE (IUD 3)

WHAT TO DO IN CASE OF PREGNANCY WITH AN IUD?

WHAT MONITORING IS REQUIRED? WHAT ARE THE CONTRAINDICATIONS?

Iud 3 english pregnancy

Dr. Claude Allouche, Gynecologist
Ahuza Clinic, Ra’anana, Israel | 058 726 02 64

Pregnancy with an IUD

Although rare, pregnancy with an IUD can occur, often due to device displacement or expulsion. Here's how to manage it:

Initial Verification

Objective: Rule out ectopic pregnancy (EP) or miscarriage.
Methods: Biological follow-up (pregnancy tests) and ultrasound.

In Case of Miscarriage

  • Action: Remove the IUD as soon as possible.
  • Management: Treatment options include watchful waiting, curettage, or medication depending on symptoms.

In Case of Ectopic Pregnancy (EP)

  • Action: Manage according to symptoms.
  • Methods: Observation, laparoscopy, or medication.

In Case of Ongoing Intrauterine Pregnancy

  • Monitoring: The pregnancy can continue with close monitoring.
  • IUD Removal: Preferable if the threads are visible and removal is feasible. Inform the patient of the miscarriage risk associated with removal.
  • If the IUD Cannot Be Removed: The pregnancy may proceed with the IUD in place, though risks of preterm delivery and premature rupture of membranes are higher.

IUD Expulsion

  • Management: The IUD is often expelled with the placenta during delivery.

Monitoring the IUD

Immediately After Insertion

  • Action: Confirm proper placement with ultrasound.

4 to 8 Weeks After Insertion

  • Check: Clinical and ultrasound consultation to verify placement and adjust threads if necessary.

Regular Follow-Up

  • Frequency: Annual or biannual consultation.
  • Methods: Speculum examination and pelvic ultrasound to ensure proper placement and detect complications.

Patient Self-Check

  • Method: Check IUD threads through self-palpation.
  • Thread Disappearance: May indicate displacement, expulsion, or pregnancy. Report changes to your physician.

Symptoms Requiring Consultation

  • Signs: Missing threads, IUD felt at the vaginal entrance, abnormal bleeding, delayed menstruation, positive pregnancy test, pelvic pain, unusual discharge, or fever.

Precautions

Anti-Inflammatory Medications

  • Copper IUD: Reduced efficacy with anti-inflammatories or corticosteroids. Use alternative contraception if needed.
  • Hormonal IUD: Not affected by anti-inflammatories.

Tampon Use

  • Recommendation: Change tampons twice a day to prevent infections.

Delay Before Trying for Another Pregnancy

  • Recommendation: No specific delay is required between IUD removal and conception.

Contraindications to the IUD

General Contraindications for All IUDs

  • Pregnancy, recent genital infections, acute cervicitis or vaginitis, cervical neoplasia, uterine malformations, unexplained bleeding, uterine cancers, fibroids or polyps, copper allergy, or valvular heart disease.

Specific Contraindications for Hormonal IUDs

  • Deep vein thrombosis, pulmonary embolism, migraines with neurological symptoms, breast cancer, acute liver disease, hepatic tumors, or ischemic heart disease.

Nulliparous Women

  • Observation: The IUD is effective even for nulliparous women. However, it does not protect against STIs or HIV. Condoms are recommended for risky sexual encounters.
  • Considerations: Increased pain during insertion and higher discontinuation rates. Preference for smaller IUDs like Novaplus T short or Jaydess for nulliparous women.

Additional Information

For more details, refer to the following guides:

  • IUD (1): What is it? How does it work?
  • IUD (2): How is it inserted?
  • IUD (3): How effective is it?
  • IUD (4): When and how should it be removed?
  • IUD (5): Which type to choose? Pros and cons.
  • IUD (6): Risks and complications.
  • IUD (7): What to do in case of pregnancy with an IUD?
  • IUD (8): Monitoring the IUD.
  • IUD (9): What are the contraindications?

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