1. Pregnancy with IUCD in situ Dr. Anand Gangji O & G Department

2. IUCD efficacy 0.6 – 0.8 % at 1 year for Cu IUCD 0.2 – 0.3 % at 1 year for LNG IUS Highest risk of failure in first year Malposition of IUCD

3. Misplaced IUCD with intrauterine pregnancy

4. Pregnancy with IUCD Woman’s Intention for the pregnancy IUCD strings visible Location of pregnancy Gestation

5. Pregnancy with IUCD Early risks – Miscarriage, sepsis Late risks – Preterm delivery, Chorioamnionitis No increased risk of birth defects Removal – increased risk of miscarriage, infection, preterm delivery

6. First trimester Wanted pregnancy, strings seen – Remove IUCD Wants termination, strings seen – Remove IUCD Ectopic pregnancy, strings seen – Remove IUCD and manage ectopic by surgery Medical management of ectopic, IUCD may be left in situ.

7. First trimester Strings not seen, wanted Intrauterine pregnancy – counsel risks, +/- USS guidance removal Strings not seen, Ectopic pregnancy - manage ectopic pregnancy, search for IUCD at the time of procedure

8. Second trimester String seen, wanted pregnancy – remove IUCD String not seen, wanted pregnancy – counsel, USS guidance Unwanted pregnancy, if strings seen – remove, plan medical termination Antibiotic cover

9. Jadelle (LNG implant) Pregnancy symptoms Risk of ectopic 1 in 2000 HWY of use Removal No increased risk of birth defects

10. Thank you