INTRODUCTION:
The intrauterine device (IUD) is one of the most popular methods of contraception used globally. There are 2 classes of IUDs available worldwide: metal containing and levonorgestrel releasing. Limited data exists on complications associated with IUD. However, to date there is no data available on the risk of adhesion formation and associated morbidities, if a perforation occurs with metal containing versus levonorgestrel releasing IUD. The primary purpose of this systematic review was to compare the potential for adhesion formation between metal containing and levonorgestrel releasing IUD.
METHODS:
A PubMed electronic search with key words and subject heading “intrauterine device” and “perforation” was performed. Patient demographics, class of IUD, site of adhesion formation and the description of these adhesions were tabulated. The adhesions were classified into 3 groups: Group I, II and III based on the degree of the adhesions (dense/severe to filmy). The degree of intra-peritoneal adhesion formation and the class of IUD was analyzed.
RESULTS:
Seventy five articles describing 85 cases were included in the study. Metal containing devices were found to have a statistically higher number of dense adhesions compared to levonorgestrel releasing IUD (P=.000056). The sigmoid colon (22%) was found to be the most common site of adhesions formation following perforation of IUD. Laparotomy was performed in 59% of cases in which a metal containing IUD had perforated.
CONCLUSION:
The degree of intra peritoneal adhesions following IUD perforation depends on whether the IUD is metal containing. Further studies are warranted to establish the significance of this in patient selection criteria.
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