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Contraception - Management
How should I manage a woman using a levonorgestrel-releasing intrauterine device (IUS) who may be pregnant?

  • If a woman is found to be pregnant whilst using the levonorgestrel-releasing intrauterine device (IUS):
    • Exclude the possibility of an ectopic pregnancy.
    • Inform her that:
      • The risks of second-trimester miscarriage, preterm delivery, and infection are increased if the device is left in situ.
      • The device should be removed within the first 12 weeks of gestation.
  • If the woman wishes to continue with the pregnancy:
    • Inform her that where possible to remove the device, removal reduces adverse outcomes. However, removal itself carries a small risk of miscarriage.
    • Remove the device, provided that the woman understands the risks and agrees to removal.
    • Whether or not the device 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 there is no evidence that the levonorgestrel-releasing IUS was expelled before pregnancy, it should be sought at delivery or abortion. If the device is not identified, plain abdominal radiography should be arranged to determine whether it is extrauterine.
Basis for recommendation
  • Guidelines published by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), recommend that suspected perforation, lost threads, pregnancy, presence of actinomyces-like organisms, and pelvic infection should be managed as for copper intrauterine device use [FFPRHC, 2004d].

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