Pregnancy with intrauterine contraceptive device (IUCD) is uncommon and an IUCD is a highly effective contraception method. Chances of pregnancy to occur is highest during the first year of IUCD usage and there are chances of adverse outcomes during pregnancy.
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Terminology
The preferred abbreviation for an intrauterine contraceptive device is IUCD. IUD is also commonly employed instead, however, this shortening is disliked by some specialists as it is also used as an abbreviation for intrauterine death.
Epidemiology
Pregnancy with an intrauterine contraceptive device may occur in as high as 2 in 100 females, although recently published figures state 0.2% occurrence in levonorgestrel-releasing IUCD and 0.8% in copper-releasing IUCD 4.
Treatment and prognosis
The management of these patients is based on the gestational age and intrauterine contraceptive device location. The difficulty and risk of removal of the IUCD increase with advancing gestational age, so early identification of an intrauterine pregnancy and IUCD result in a better prognosis.
During the first trimester, removal of the intrauterine contraceptive device is recommended. However, this decision is to be made weighing the risks and the benefits. If the location makes removal difficult or will disrupt the pregnancy, the risks of IUCD removal outweigh the benefits.
Removal during the second trimester is riskier as it may potentially lead to the rupture of membranes, excessive bleeding, or even fetal loss. Ultrasound localization is critical for the decision-making and removal is again based on location and lack of incorporation into the placenta or gestational sac.
Beyond the late second trimester, the risks of removal are more than the benefits.
Complications
Neonatal
- low birth weight
- low APGAR score
- higher neonatal admission rate 5
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