Effect of Intrauterine Device Malposition on Pregnancy Occurrence [A38]

INTRODUCTION: We aimed to compare pregnancy occurrence within 12 months of ultrasound evaluation of intrauterine device (IUD) position. METHODS: We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected through medical record review. The Fisher exact test was used to compare groups. Institutional review board (IRB) approval was obtained. RESULTS: Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9, P=.02). Pregnancy status was available for 323 participants with malpositioned IUDs and 1007 participants with non-malpositioned IUDs. Compared to participants with non-malpositioned IUDS, those with malpositioned IUDs were more likely to be pregnant within 12 months of their initial ultrasound (10% and 5%, P=.002). Of the participants whose initial ultrasound showed a malpositioned IUD, 33 experienced a pregnancy: three with IUD in situ, 26 after IUD removal, and three after IUD expulsion. Of participants whose initial ultrasound showed a non-malpositioned IUD, 51 experienced a pregnancy: five with IUD in situ, 35 after IUD removal, and four after IUD expulsion. No significant difference was seen in pregnancy occurrence between groups for those with IUD in situ, after IUD expulsion, or after IUD removal. CONCLUSION: Participants with malpositioned IUDs were more likely to experience pregnancy within 12 months of initial ultrasound. However, this was not due to increased risk of pregnancy with an IUD in situ.