Pregnancy exclusion before IUD — DFSRH MCQ

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HardIntrauterine methodsPregnancy exclusion before IUDDFSRH

A 31-year-old woman attends for Cu-IUD insertion. She had unprotected sex 10 days ago, has irregular cycles, and pregnancy cannot be excluded. Pregnancy test today is negative and she wants insertion today. What is the most appropriate management?

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Correct answer: C — Defer Cu-IUD insertion and arrange pregnancy testing at least 21 days after UPSI

The best answer is “Defer Cu-IUD insertion and arrange pregnancy testing at least 21 days after UPSI”. A negative pregnancy test 10 days after UPSI cannot exclude pregnancy, and irregular cycles prevent confident EC timing, insertion should be deferred until pregnancy can be excluded. Inserting an IUD into an unrecognised pregnancy is inappropriate. LNG-IUD is not recommended as EC, DMPA still needs follow-up if quick-started, and delaying for a year is unnecessary. The pearl is to use the 21-day rule when recent UPSI prevents pregnancy exclusion. Intrauterine-method decisions require separation of expected bleeding from pregnancy, partial expulsion, perforation and pelvic infection. Device position, pregnancy risk, recent intercourse and clinical stability determine whether treatment, removal, imaging or emergency contraception is needed. Pelvic infection is treated promptly, but an IUD is not removed routinely when the patient is improving on appropriate antibiotics.

Reference: CoSRH/FSRH, Intrauterine Contraception (March 2023, amended January 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf