The prognosis of pregnancy conceived despite the presence of an intrauterine device (IUD)

Abstract

OBJECTIVE Intrauterine devices (IUDs) are used for contraception worldwide; however, the management of pregnancies with an IUD poses a clinical challenge. The purpose of this study was to determine the outcome of pregnancy in patients with an IUD. STUDY DESIGN A retrospective cohort study (December 1997-June 2007) was conducted. The cohort consisted of 12,297 pregnancies, of which 196 had an IUD. Only singleton pregnancies were included. Logistic regression analysis was used to adjust for potential confounders between the groups. RESULTS 1) Pregnancies with an IUD were associated with a higher rate of late miscarriage, preterm delivery, vaginal bleeding, clinical chorioamnionitis, and placental abruption than those without an IUD; 2) among patients with available histologic examination of the placenta, the rate of histologic chorioamnionitis and/or funisitis was higher in patients with an IUD than in those without an IUD (54.2% vs. 14.7%; p<.001). Similarly, among patients who underwent an amniocentesis, the prevalence of microbial invasion of the amniotic cavity (MIAC) was also higher in pregnant women with an IUD than in those without an IUD (45.9% vs. 8.8%; p<.001); and 3) intra-amniotic infection caused by Candida species was more frequently present in pregnancies with an IUD than in those without an IUD (31.1% vs. 6.3%; p<.001). CONCLUSION Pregnant women with an IUD are at a very high risk for adverse pregnancy outcomes. This finding can be attributed, at least in part, to the high prevalence of intra-amniotic infection and placental inflammatory lesions observed in pregnancies with an IUD.

Soluble ST2 in the fetal inflammatory response syndrome:in vivoevidence of activation of the anti-inflammatory limb of the immune response

“…Moreover, this condition has been identified in a subset of patients with a short cervix [39–42], cervical insufficiency [43,44], and other conditions which confer increased risk for preterm delivery, such as an intrauterine device in pregnancy [45], vaginal bleeding [46], and placenta previa [47]. …”

Comparing the adverse outcomes of contraception failure between IUD and withdrawal methods

“…Spontaneous abortion was significantly less in the withdrawal method users compared to cases with retained IUD, findings in agreement with those of other studies, which suggest that the endometritis and disturbed implantation site may be responsible for the increased abortion rate. 5,7,12 Moreover, Deveer et al found that the risk of miscarriage increased significantly when the IUD is retained, compared to when it is removed. 8 Brahmi et al demonstrated that if the IUD is left in the uterus, the rate of miscarriage, preterm labour, and chorioamnionitis are increased.…”

Comparison of C-reactive protein levels in pregnancies with retained and removed intrauterine device

“…Because amniocentesis was not performed in any of the patients, we could not determine the prevalence of microbial invasion of the amniotic cavity. Sun Kwan Kim et al [16] have demonstrated that pregnancies with an IUD had a higher rate of intra-amniotic infection and a higher rate of histological chorioamnionitis. According to our results, we can suggest that IUD removal in early gestation reduces the risk for obstetric complications, but we can not conclude that it eliminates because we did not have a third group of patients who conceived without an IUD.…”