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Pregnancy with IUD in situ — DFSRH MCQ

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HardIntrauterine methodsPregnancy with IUD in situDFSRH

A 33-year-old woman with a copper IUD reports a positive pregnancy test and mild unilateral pelvic pain. Threads are visible on speculum examination and she is stable. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange urgent assessment to exclude ectopic pregnancy and discuss IUD removal if intrauterine pregnancy is confirmed

Pregnancy with an IUD requires urgent assessment because ectopic pregnancy must be excluded, and removal is discussed if an intrauterine pregnancy is confirmed and threads are accessible. Immediate removal before location is known may be inappropriate in some pathways and does not address ectopic risk. Methotrexate is specialist management, and an IUD reduces overall pregnancy but pregnancies that occur need ectopic assessment. The pearl is that contraceptive failure with pain is an ectopic until proven otherwise.

Reference: FSRH Guideline: Intrauterine Contraception; NICE Ectopic Pregnancy and Miscarriage