Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 11 , ISSUE 3 ( May-June, 2019 ) > List of Articles

REVIEW ARTICLE

Outcome of Pregnancy with Intrauterine Device In Situ: A Meta-analysis

Eka R Gunardi

Keywords : Intrauterine device, Intrauterine pregnancy, Outcome

Citation Information : Gunardi ER. Outcome of Pregnancy with Intrauterine Device In Situ: A Meta-analysis. J South Asian Feder Obs Gynae 2019; 11 (3):212-216.

DOI: 10.5005/jp-journals-10006-1689

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: Intrauterine devices (IUDs) constitute the second-most used contraceptive method worldwide. Pregnancy in the presence of IUD results in obstetric complications. This study aims to review the outcome of intrauterine pregnancies among IUD removed, IUD retained, and no IUD. Materials and methods: There were 89, 8, and 52 studies found in Pubmed®, Cochrane Library®, and Ovid® database. We included cohort or case-control studies consisting of minimally two groups: (i) no IUD and IUD retained or (ii) IUD removed and retained. Several outcomes were assessed, including preterm birth, miscarriage, premature rupture of membrane (PROM), placental abruption, placental previa, intrauterine growth restriction, chorioamnionitis, and cesarean delivery. The analysis of this meta-analysis used review manager 5.3. Results: There were 7 studies included owing to language barrier and accessibility of article. Pregnancy with IUD in situ increased the risk of miscarriage (RR 6.50; 95% CI 4.56–9.28), PROM (RR 1.88; 95% CI 0.98–3.62), placenta previa (RR 2.33; 95% CI 1.14–4.73), placental abruption (RR 4.51; 95% CI 2.82–7.20), chorioamnionitis (RR 6.07; 95% CI 3.91–9.42), and cesarean delivery (RR 1.33; 95% CI 1.03–1.71). Meanwhile, IUD removed decreased the risk of miscarriage (RR 0.51; 95% CI 0.39–0.66) and preterm birth (RR 0.57, 95% CI 0.38–0.86) compared with IUD retained. Conclusion: Conceiving with IUD in pregnancy increases the rate of miscarriage, placenta previa, abruption, chorioamnionitis, and cesarean delivery. Meanwhile, IUD removed early in pregnancy decreases the rate of miscarriage and preterm birth.


HTML PDF Share
  1. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 23 2010 Aug;(29):1–44.
  2. Indonesia KKR. Data dan Informasi Profil Kesehatan Indonesia 2016. Pus Data Dan Inf Kementrian Keshatan RI; 2017. pp. 119–121.
  3. de Araujo FF, Barbieri M, Guazzelli CAF, et al. The T 380A intrauterine device: a retrospective 5-year evaluation. Contraception 2008 Dec;78(6):474–478. DOI: 10.1016/j.contraception.2008.07.006.
  4. WHO|Selected practice recommendations for contraceptive use [Internet]. WHO. [cited 2018 Aug 15]. Available from: http://www.who.int/reproductivehealth/publications/family_planning/SPR-3/en/.
  5. Stanford JB, Mikolajczyk RT. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol 2002 Dec;187(6):1699–1708. DOI: 10.1067/mob.2002.128091.
  6. Horn LC, Nenoff P, Ziegert M, et al. Missed abortion complicated by Candida infection in a woman with rested IUD. Arch Gynecol Obstet 2001 Jan;264(4):215–217. DOI: 10.1007/s004040000117.
  7. Skjeldestad FE, Hammervold R, Peterson DR. Outcomes of pregnancy with an IUD in situ–a population based case-control study. Adv Contracept Off J Soc Adv Contracept 1988 Dec;4(4):265–270. DOI: 10.1007/BF01849267.
  8. Ganer H, Levy A, Ohel I, et al. Pregnancy outcome in women with an intrauterine contraceptive device. Am J Obstet Gynecol 2009 Oct;201(4):381.e1–381.e5. DOI: 10.1016/j.ajog.2009.06.031.
  9. Hoopes AJ, Simmons KB, Godfrey EM, et al. 2016 Updates to US Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use: Highlights for Adolescent Patients. J Pediatr Adolesc Gynecol 2017;30(2):149–155. DOI: 10.1016/j.jpag.2017.01.013.
  10. Tatum HJ, Schmidt FH, Jain AK. Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol 1976 Dec 1;126(7):869–879. DOI: 10.1016/0002-9378(76)90675-X.
  11. Chaim W, Mazor M. Pregnancy with an intrauterine device in situ and preterm delivery. Arch Gynecol Obstet 1992;252(1):21–24. DOI: 10.1007/BF02389602.
  12. Kim SK, Romero R, Kusanovic JP, et al. The prognosis of pregnancy conceived despite the presence of an intrauterine device (IUD). J Perinat Med 2010;38(1):45–53. DOI: 10.1515/jpm. 2009.133.
  13. Deveer R, Engin-Ustun Y, Sarikaya E, et al. Comparison of C-reactive protein levels in pregnancies with retained and removed intrauterine device. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 2011 Sep;24(9): 1152–1154. DOI: 10.3109/14767058.2010.545925.
  14. Ozgu-Erdinc AS, Tasdemir UG, Uygur D, et al. Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis. Contraception 2014 May;89(5):426–430. DOI: 10.1016/j.contraception.2014.01.002.
  15. Ananth CV, Oyelese Y, Prasad V, et al. Evidence of placental abruption as a chronic process: associations with vaginal bleeding early in pregnancy and placental lesions. Eur J Obstet Gynecol Reprod Biol 2006 Oct;128(1–2):15–21. DOI: 10.1016/j.ejogrb.2006. 01.016.
  16. Nath CA, Ananth CV, Smulian JC, et al. New Jersey-Placental Abruption Study Investigators. Histologic evidence of inflammation and risk of placental abruption. Am J Obstet Gynecol 2007 Sep;197(3):319.e1–319.e6. DOI: 10.1016/j.ajog.2007.06.012.
  17. Brahmi D, Steenland MW, Renner R-M, et al. Pregnancy outcomes with an IUD in situ: a systematic review. Contraception 2012 Feb;85(2): 131–139. DOI: 10.1016/j.contraception.2011.06.010.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.