An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30 year old, gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. The most appropriate course of action is to:
A woman with an IUCD in place, with amenorrhea should have a pregnancy test and pelvic examination.
An intrauterine pregnancy can occur and continue successfully to term with an IUCD in place.
A. If an intrauterine pregnancy is diagnosed and IUCD strings are visible:
IUCD should be removed as soon as possible in order to prevent septic abortion, premature rupture of membranes, and premature birth. Also do an USG to know whether it is intrauterine or ectopic pregnancy.
B. If an intrauterine pregnancy is diagnosed and IUCD strings are not visible:

An ultrasound examination should be performed to localize the IUCD and determine whether expulsion has occured.
If the IUCD is present there are 3 options for management.
	i. Therapeutic abortion
	ii. If IUCD is not fundal in location: ultrasound guided intrauterine removal of IUCD.
	iii. If IUCD is present in fundus of uterus: it should be left in place and pregnancy continued with the device left in place.
If pregnancy continues with the device in place, the patient should be warned of the symptoms of intrauterine infection like fever or flue like symptoms, abdominal cramping or bleeding.
At the earliest sign of infection, high dose intravenous antibiotic therapy should be given and the pregnancy evacuated promptly.
Note: Fetal malformations have not been reported to be increased with a device in place.
Leave the IUD in place without any other treatment
Remove the IUD to decrease the risk of malformations
Remove the IUD to decrease the risk of infection
Terminate the pregnancy because of the high risk of malformations.