Outcome of pregnancy with intrauterine device in situ: A meta-analysis

Abstract

Introduction: Intrauterine devices (IUDs) constitute the second-most used contraceptive method worldwide. Pregnancy in the presence of IUD results in obstetric complications. This study aims to review the outcome of intrauterine pregnancies among IUD removed, IUD retained, and no IUD. Materials and methods: There were 89, 8, and 52 studies found in Pubmed®, Cochrane Library®, and Ovid® database. We included cohort or case-control studies consisting of minimally two groups: (i) no IUD and IUD retained or (ii) IUD removed and retained. Several outcomes were assessed, including preterm birth, miscarriage, premature rupture of membrane (PROM), placental abruption, placental previa, intrauterine growth restriction, chorioamnionitis, and cesarean delivery. The analysis of this meta-analysis used review manager 5.3. Results: There were 7 studies included owing to language barrier and accessibility of article. Pregnancy with IUD in situ increased the risk of miscarriage (RR 6.50; 95% CI 4.56-9.28), PROM (RR 1.88; 95% CI 0.98-3.62), placenta previa (RR 2.33; 95% CI 1.14-4.73), placental abruption (RR 4.51; 95% CI 2.82-7.20), chorioamnionitis (RR 6.07; 95% CI 3.91-9.42), and cesarean delivery (RR 1.33; 95% CI 1.03-1.71). Meanwhile, IUD removed decreased the risk of miscarriage (RR 0.51; 95% CI 0.39-0.66) and preterm birth (RR 0.57, 95% CI 0.38-0.86) compared with IUD retained. Conclusion: Conceiving with IUD in pregnancy increases the rate of miscarriage, placenta previa, abruption, chorioamnionitis, and cesarean delivery. Meanwhile, IUD removed early in pregnancy decreases the rate of miscarriage and preterm birth.