If a woman becomes pregnant with an intrauterine device (IUD) in place, should the IUD be removed?
When a viable intrauterine pregnancy occurs with an intrauterine device (IUD) still in place, the device lies between the membranes and the uterine wall. Current evidence confirms that the presence of an IUD does not increase the risk of congenital anomalies.
However, multiple recent cohort studies (AJOG, Obstet Gynecol 2012–2023) show significantly higher risks when the IUD remains in situ:
- Spontaneous abortion: 40–50%
- Septic abortion / chorioamnionitis: increased 3–5×
- Preterm delivery: nearly doubled
- Increased risk of PPROM and placental complications
Removal of the IUD early in pregnancy—when strings are visible and removal can be performed safely—significantly reduces (but does not eliminate) these risks:
- Miscarriage risk decreases to ~20–25%
- Lower rates of septic abortion and chorioamnionitis
- Lower preterm birth risk
The American College of Obstetricians and Gynecologists (Practice Bulletin No. 186 and reaffirmations) advises:
- Remove the IUD if the strings are visible.
- Do NOT attempt blind removal if strings are not visible, due to risk of pregnancy loss or membrane disruption.
- Patients should be counseled that elevated risks remain even after removal.
Therefore, **the recommended approach is to remove the IUD early in pregnancy if this can be done safely**. If removal is not feasible, careful surveillance is required due to the increased risks.
References
1. Brahmi D, Steenland MW, Renner RM, Gaffield ME, Curtis KM. Pregnancy outcomes with an IUD in situ: a systematic review. Contraception. 2012;85:131–139.
2. Kohn JE et al. Pregnancy outcomes after intrauterine device failure: a contemporary analysis. Obstet Gynecol. 2012;119:981–987.
3. ACOG Practice Bulletin No. 186: Long-Acting Reversible Contraception. Reaffirmed 2020–2023.
4. Mosby. Comprehensive Gynecology. 4th ed. St. Louis: 2001.