Dilation and evacuation with intrauterine device placement in a patient with acute promyelocytic leukemia: A case report

Abstract

Introduction: Pregnant leukemia patients should be offered continuation or termination of pregnancy. Treatment of leukemia in reproductive-age patients includes consideration of contraception. Hormonal intrauterine devices (IUDs) prevent pregnancy and decrease menstrual bleeding. Despite safety data for IUDs in immunocompromised patients, infection and vaginal bleeding concerns may inhibit their placement. Case Report: We report a case of a 28-year-old female at 13 weeks 4 days gestation with acute promyelocytic leukemia (APL) who presented with coagulopathy. When stabilized, dilation and evacuation (D and E) with levonorgestrel IUD placement was performed. The postoperative course was uncomplicated. Despite chemotherapy and neutropenia, this APL patient tolerated D and E with levonorgestrel IUD placement well with only routine preoperative antibiotics. Conclusion: Comprehensive options counseling for pregnant patients with new APL diagnoses are imperative, and interdisciplinary consideration of risks for individual patient concerns of pregnancy prevention during treatment with teratogenic potential, avoidance of combined hormonal contraception (CHC) coagulopathy risk, and menstrual bleeding reduction in the setting of pancytopenia with levonorgestrel IUD contraception management in immunocompromised patients may be considered.