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Contraception - Management
How should I manage a woman using a copper intrauterine device (IUD) who may be pregnant?

  • If a woman is found to be pregnant whilst using the copper intrauterine device (IUD):
    • Exclude ectopic pregnancy.
    • Inform her that:
      • Risks of second-trimester miscarriage, preterm delivery, and infection are increased if the copper IUD is left in situ.
      • The copper IUD should be removed as soon as possible within the first 12 weeks of gestation.
  • If the woman wishes to continue with the pregnancy:
    • Inform her that, where it is possible to remove the copper IUD, this reduces adverse outcomes. However, removal itself carries a small risk of miscarriage.
    • Remove the copper IUD, provided that the woman understands the risks and agrees to removal.
    • Whether or not the copper IUD is removed, a pregnant woman should be advised to seek medical care if she develops heavy bleeding, cramping pain, abnormal vaginal discharge, or fever.
  • If the woman does not wish to continue with the pregnancy, the IUD can be removed at the time of abortion.
  • If there is no evidence that the copper IUD was expelled before pregnancy, it should be sought at delivery or abortion. If the IUD is not identified, plain abdominal X-ray should be arranged to determine whether it is present and if it is extra-uterine — ultrasonography may be required to determine the position of the IUD.
Clarification / Additional information
  • The reason for recommending that a copper intrauterine device (IUD) not be removed if the gestational age is more than 12 weeks is that:
    • It is believed that after this time, the gestational sac occupies the whole of the uterine cavity, and removal would endanger the pregnancy.
    • Threads are more likely to be visible in the first trimester than later; in the second trimester, threads are unlikely to be visible unless the device is at the lower pole of the uterus or in the endocervical canal.
Basis for recommendation

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