Case report A 22-year-old female presented with the complaint of vaginal bleeding 1 week after a positive pregnancy test. An emergency department bedside transvaginal ultrasound revealed an early intrauterine pregnancy (IUP) in the presence of an intrauterine device (IUD). Discussion While a rare event, pregnancy can occur in the presence of an IUD. The emergency physician should be aware of the complications of this obstetrical condition.