A copper intrauterine device (Cu-IUD) is inserted in a 25-year-old nulliparous woman for long-term contraception. She returns 2 months later with a positive pregnancy test. Ultrasound confirms an intrauterine pregnancy at 7 weeks with the IUD strings visible. She wishes to continue the pregnancy. The MOST appropriate immediate management is:

• A Advise termination of pregnancy as continuation is not possible
• B Leave the IUD in situ throughout pregnancy and monitor
• C Remove the IUD if strings are visible in the first trimester ✓
• D Prescribe prophylactic antibiotics and observe

Explanation

When an intrauterine pregnancy occurs with an IUD in situ and the patient wishes to continue, the IUD should be removed in the first trimester if the strings are visible, as leaving it in place significantly increases the risk of second-trimester septic abortion, preterm labour, and chorioamnionitis. Removal itself carries a small risk of miscarriage, but the risks of leaving it are greater. After the first trimester, removal is more risky and the IUD may need to be left in situ with close surveillance.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.