The prognosis of pregnancy conceived despite the presence of an intrauterine device (IUD).
Intrauterine devices (IUDs) are used for contraception worldwide; however, the management of pregnancies with an IUD poses a clinical challenge. The purpose of this study was to determine the outcome of pregnancy in patients with an IUD.



A retrospective cohort study (December 1997-June 2007) was conducted. The cohort consisted of 12,297 pregnancies, of which 196 had an IUD. Only singleton pregnancies were included. Logistic regression analysis was used to adjust for potential confounders between the groups.



1) Pregnancies with an IUD were associated with a higher rate of late miscarriage, preterm delivery, vaginal bleeding, clinical chorioamnionitis, and placental abruption than those without an IUD; 2) among patients with available histologic examination of the placenta, the rate of histologic chorioamnionitis and/or funisitis was higher in patients with an IUD than in those without an IUD (54.2% vs. 14.7%; P<0.001). Similarly, among patients who underwent an amniocentesis, the prevalence of microbial invasion of the amniotic cavity (MIAC) was also higher in pregnant women with an IUD than in those without an IUD (45.9% vs. 8.8%; P<0.001); and 3) intra-amniotic infection caused by Candida species was more frequently present in pregnancies with an IUD than in those without an IUD (31.1% vs. 6.3%; P<0.001).



Pregnant women with an IUD are at a very high risk for adverse pregnancy outcomes. This finding can be attributed, at least in part, to the high prevalence of intra-amniotic infection and placental inflammatory lesions observed in pregnancies with an IUD.
Kim
Sun Kwon
SK
Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA.
Romero
Roberto
R
Kusanovic
Juan Pedro
JP
Erez
Offer
O
Vaisbuch
Edi
E
Mazaki-Tovi
Shali
S
Gotsch
Francesca
F
Mittal
Pooja
P
Chaiworapongsa
Tinnakorn
T
Pacora
Percy
P
Oggé
Giovanna
G
Gomez
Ricardo
R
Yoon
Bo Hyun
BH
Yeo
Lami
L
Lamont
Ronald F
RF
Hassan
Sonia S
SS
D000328:Adult; D000653:Amniotic Fluid / Q000382:microbiology; D002677:Chile / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007434:Intrauterine Devices; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult