An intrauterine device (IUD) is a form of birth control a healthcare provider inserts into the uterus. These devices are highly effective, preventing pregnancy for several years once in place. While IUDs are over 99% effective, pregnancy can still occur in rare instances.
Confirming Pregnancy with an IUD
If you suspect pregnancy with an IUD, common signs include a missed period, nausea, breast tenderness, fatigue, or mild cramping. Changes in IUD strings, such as feeling out of place or missing, might also indicate pregnancy or IUD displacement.
The initial step is a home pregnancy test. Regardless of the result, immediate medical confirmation through a healthcare provider is necessary. A provider will typically perform blood tests to measure human chorionic gonadotropin (hCG) levels and conduct an ultrasound. An ultrasound helps locate the pregnancy, determining if it is inside or outside the uterus, and to confirm the IUD’s position.
Understanding the Risks
Pregnancy with an IUD carries specific medical risks that affect both the pregnancy and the pregnant individual’s health. Medical evaluation is important to assess these potential complications.
Ectopic pregnancy is a serious risk when pregnancy occurs with an IUD. An ectopic pregnancy happens when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. If a pregnancy does occur, there is a higher chance it will be ectopic. Symptoms can include lower back pain, abnormal vaginal bleeding, and mild cramping on one side of the pelvis. An ectopic pregnancy requires immediate medical intervention.
The presence of an IUD also increases the risk of miscarriage, also known as spontaneous abortion. If an IUD remains in the uterus during pregnancy, the chance of miscarriage is significantly higher compared to pregnancies without an IUD. The risk of miscarriage can be as high as 48% to 77% if the IUD is retained.
Infection is another concern, specifically pelvic inflammatory disease (PID) or other uterine infections. The presence of an IUD during pregnancy can lead to an elevated risk of infection in the uterus. These infections affect the health of the pregnant individual and the developing pregnancy.
If the pregnancy continues to term with an IUD in place, there is an increased risk of preterm labor and delivery. Individuals who conceive with an IUD in place have a higher likelihood of delivering prematurely. This heightened risk exists whether the IUD is removed or retained, although removing the IUD can reduce this risk.
Management and Decisions
Once a pregnancy with an IUD is confirmed, and the specific risks are understood, healthcare providers will discuss management options. The decision-making process is individualized, considering the specific circumstances and preferences of the patient. Close medical monitoring is necessary throughout the pregnancy, regardless of the chosen path, to manage any potential complications.
IUD removal is often recommended if the strings are visible and the device can be safely retrieved, ideally during the first trimester. This procedure is typically performed by gently pulling on the visible strings in an office setting. While IUD removal carries a small risk of miscarriage immediately following the procedure, estimated around 20%, it significantly improves the chances of a successful pregnancy outcome compared to leaving the IUD in place. Removing the IUD can reduce the risks of spontaneous abortion, preterm delivery, and infection.
In some situations, the IUD cannot be easily removed, such as when the strings are not visible, or the device is embedded in the uterine wall. If the IUD cannot be removed, or if the patient chooses to retain it, the pregnancy will continue with the IUD in place. This scenario carries continued elevated risks of adverse outcomes, including miscarriage, infection, and preterm birth. Close monitoring becomes even more important in these cases to detect and manage complications.
The decision regarding IUD removal or retention is made collaboratively between the patient and their healthcare provider. This discussion involves weighing the specific risks and benefits based on the IUD’s location, the gestational age, and the patient’s desire to continue the pregnancy. Regular follow-up appointments and ultrasounds are crucial to monitor the pregnancy’s progression and the IUD’s position, ensuring timely intervention if complications arise.