A 28-year-old woman using a copper IUD (Cu-T 380A) for 3 years presents with secondary amenorrhea for 6 weeks and a positive urine pregnancy test. Transvaginal ultrasound shows intrauterine gestational sac with IUD strings visible. The MOST appropriate management is:
- A Immediately remove IUD to prevent infection and spontaneous abortion
- B Remove IUD gently in first trimester if strings visible; explain risks if left in place ✓
- C Leave IUD in place as removal risks spontaneous abortion
- D Terminate pregnancy as IUD in situ is teratogenic
Explanation
When intrauterine pregnancy is confirmed with IUD in situ and IUD strings are visible, guidelines recommend removal of the IUD in the first trimester — this reduces the risk of second trimester septic abortion, preterm delivery, and chorioamnionitis compared to leaving it in place. If left in place, risks include: 25% spontaneous abortion rate (vs 40% if left in place and 20% in general population), preterm birth, infection, and PPROM. The IUD itself is not teratogenic. If strings are not visible and removal would require instrumentation, the risk-benefit ratio is reassessed individually.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.