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IUD and Pregnancy
December 2000

Q. I have found out that I am pregnant and need advice. I have an IUD still in place. What is the best choice regarding what to do with it? What are the statistics on its removal causing a miscarriage? Also, I had surgery in Nov., 1998 and have a blood clot for which I was taking coumadin. I am probably less than 2 months into the pregnancy; this will be determined soon. The question is, now that I have switched to low molecular heprin, what are the statistics about birth defects that may be caused by the use of approximately 5 mg of the coumadin per day over the first 1-2 months?

A. Your question is highly complex. Pregnancy occurring with an IUD (intrauterine device) is not common. The IUD is about 97% effective in preventing pregnancy. Obviously, it didn't work too well in your case. However, given that there is a foreign object in your uterus (the IUD), there are increased risks of miscarriage whether you leave it in or take it out. Also, given the fact that you were on coumadin during part of the first trimester of pregnancy, there are increased risks of congenital anomalies (fetal deformities).

I do not know the exact percentile risks (I had trouble finding this data on a Medline search). Also, there is increased risk to you of having recurrent blood clots during pregnancy. Certainly, I would recommend you see a Maternal Fetal Specialist who would have more experience than I in this highly specialized case. Of course, you realize that because of the above increased risks to the fetus and to you, the specialist may recommend considering terminating the pregnancy. Of course only you and your significant other can make the final decision.

I wish you the best.

Ref: http://www.acog.org/

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