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Dana is a 38-year-old, who had a previous uncomplicated caesarean section one year ago. She had a discussion about contraception with her midwife during pregnancy and planned to have a copper intrauterine device (IUD) inserted after her baby was born. She was provided with the progestogen-only pill before leaving the maternity unit and used this until attending her local sexual health clinic for IUD insertion 8 weeks later. The patient reports this being in her words a “difficult” insertion due to discomfort. Following insertion, she continued to have regular periods. Around 12 months after the IUD was inserted, she presents acutely with lower abdominal pain.
On further questioning, Dana reports having missed her most recent period. She had no vaginal bleeding and was otherwise clinically well. Repeat urinary pregnancy testing was positive. On examination, there was central lower abdominal tenderness but no guarding or rebound. On speculum examination, the IUD threads were not visible.
Intrauterine contraception (including the hormonal and non-hormonal IUD) is one of the most effective methods of preventing pregnancy. Failure rates for the copper IUD with a copper content >300 mm2 are between 0.1% and 1% in the first year of use and around 2.2% after 12 years.1 The 52 mg levonorgestrel-releasing IUD has a pregnancy rate of 0.5 per 100 users over 5 years.1 However, as no method has 100% efficacy, pregnancy should always be considered a possibility in any patient of reproductive years.1
There are a number of clinical considerations when someone is found to have a positive pregnancy test in the context of a previous or recent IUD insertion. Differential diagnosis includes: …
Editor's note The details of this case are fictitious. Any resemblance to actual persons, living or dead, or actual events is coincidental.
Contributors BS collected case information and current information on the topic and contributed to writing the manuscript. MC supervised and was a major contributor to writing the manuscript. Both authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.