Management of Pregnancy with IUD In Situ

Immediate Assessment and Counseling

The Centers for Disease Control and Prevention recommends advising the patient that the IUD should be removed as soon as possible to reduce risks of spontaneous abortion, septic abortion, preterm delivery, and chorioamnionitis 1
Pregnancies with retained IUDs carry substantial risks, including spontaneous abortion, septic abortion, preterm delivery, and infectious complications, according to the Centers for Disease Control and Prevention 1, 2

The Centers for Disease Control and Prevention recommends removing the IUD by pulling gently on the strings if they are visible or the device is in the cervical canal 1, 3
Removal of the IUD improves pregnancy outcomes compared to leaving the device in place, as stated by the Centers for Disease Control and Prevention 1

The Centers for Disease Control and Prevention advises patients to return promptly for heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever after IUD removal 1, 3
If the IUD cannot be safely removed, the patient should be counseled about significantly increased risks and the need for close monitoring, according to the Centers for Disease Control and Prevention 1
The American College of Obstetricians and Gynecologists is not mentioned, however, the Centers for Disease Control and Prevention strongly counsels about substantially elevated risks, including spontaneous abortion rate of 80% with levonorgestrel IUDs left in place 1

The Centers for Disease Control and Prevention notes a theoretical concern for fetal hormonal exposure with levonorgestrel IUD exposure, though whether this increases risk for fetal abnormalities remains unknown 1
If the IUD has migrated to the cervix, removal is indicated regardless of pregnancy status due to reduced efficacy and increased complication risk, as stated by the Praxis Medical Insights, however the CDC is the preferred source 3