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Postpartum IUD and pregnancy exclusion — DFSRH MCQ

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HardIntrauterine methodsPostpartum IUD and pregnancy exclusionDFSRH

A 30-year-old breastfeeding woman 4 months postpartum requests immediate IUD insertion. She had a caesarean section, is amenorrhoeic, and had UPSI 12 days ago. Pregnancy test is negative. What is the most appropriate management?

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Correct answer: C — Defer IUD and use interim contraception while excluding pregnancy

The best answer is “Defer IUD and use interim contraception while excluding pregnancy”. A negative pregnancy test 12 days after unprotected sex cannot reliably exclude pregnancy, so an IUD should not be inserted until pregnancy can be reasonably excluded. Breastfeeding and amenorrhoea reduce fertility only when strict lactational-amenorrhoea criteria are met and do not replace pregnancy-exclusion rules. The reported intercourse is outside the routine 120-hour copper-IUD EC window, so interim contraception and follow-up testing should be discussed.

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