A 32-year-old woman using a copper-T 380A (Cu-T) IUD for 2 years presents with 6 weeks of amenorrhoea. Urine pregnancy test is positive. The MOST appropriate initial management is:

• A Remove the IUD immediately and prescribe mifepristone
• B Leave the IUD in situ and continue pregnancy monitoring
• C Administer emergency levonorgestrel to prevent pregnancy continuation
• D Rule out ectopic pregnancy first with transvaginal ultrasound before further management ✓

Explanation

Any pregnancy occurring with an IUD in situ carries a significantly elevated risk of ectopic pregnancy (up to 50% of IUD failures in some series). The first step must be transvaginal ultrasound to locate the pregnancy and confirm intrauterine (versus ectopic) implantation. Ectopic pregnancy is a life-threatening emergency; removing the IUD before ruling out ectopic is premature. Emergency contraception post-confirmed pregnancy is ineffective.

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.