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Case Report
Dilation and evacuation with intrauterine device placement in a patient with acute promyelocytic leukemia: A case report
1 Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, NJ, USA
2 Hackensack Meridian School of Medicine, Hackensack Meridian Health Network, Nutley, NJ, USA
Address correspondence to:
Kelsey McClure
DO, Department of Ob/Gyn, Hackensack University Medical Center, 20 Prospect Avenue, Suite #805, Hackensack, NJ 07601,
USA
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Article ID: 100143Z08KM2023
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How to cite this article
McClure K, Benerofe S, Budge KL, Francis AP, Figueroa M. Dilation and evacuation with intrauterine device placement in a patient with acute promyelocytic leukemia: A case report. J Case Rep Images Obstet Gynecol 2023;9(1):40–43.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&E) with levonorgestrel IUD placement was performed. The postoperative course was uncomplicated. Despite chemotherapy and neutropenia, this APL patient tolerated D&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.
Keywords: Acute promyelocytic leukemia, Case report, Contraception, Immunocompromised, Levonorgestrel IUD
SUPPORTING INFORMATION
Author Contributions
Kelsey McClure - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sara Benerofe - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kelly L Budge - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Antonia P Francis - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Melissa Figueroa - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Kelsey McClure et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
