Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs)

Abstract

BackgroundIntrauterine devices (IUDs) are the most popular form of contraception used worldwide; however, IUD is not risk-free. IUD migrations, especially uterine perforations, were frequently occurred in patients. The aim of this study was to investigate the clinical characteristics and intraoperative findings in patients with migrated IUDs.Results29 cases of uterine perforation associated with migrated IUDs and 69 control patients were followed between January 2008 to March 2015. Patients who used IUDs within first 6 months from the last delivery experienced a characteristically high rate of the perforation of the uterine wall. A significantly larger number of IUD insertion associated with uterine perforation were performed in rural hospitals or operated at a lower level health care system. There was no clear difference in the age and presented symptoms in patients between two groups. Majority of contraceptive intrauterine devices was the copper-releasing IUDs. Furthermore, patients who used V-shaped IUD showed significantly higher incidence of pelvic adhesions when compared with the users of O-shaped IUDs.ConclusionsUnique clinical characteristics of IUD migration were identified in patients with uterine perforation. Hysteroscopy and/or laparoscopy were the effective approaches to remove the migrated IUDs. Improving operating skills is required at the lower level of health care system.

Laparoscopy Approach to Sigmoid Colon Perforation Secondary to Intrauterine Device Migration

“…Perforations are reported to be mostly located in the myometrium and the greater omentum, with a frequency of 21%. In the second place, the colon sigmoid with a frequency of 17% and the left uterosacral ligament and bladder with a 10% frequency (5). Risk factors for perforation include IUD insertion during lactation, first time using the IUD, insertion during the first 6 months of postpartum, and anatomic abnormalities, such as cervical stenosis and a retroverted uterus (4,5).…”

Laparoscopy Approach to Sigmoid Colon Perforation Secondary to Intrauterine Device Migration

“…Perforations are reported to be mostly located in the myometrium and the greater omentum, with a frequency of 21%. In the second place, the colon sigmoid with a frequency of 17% and the left uterosacral ligament and bladder with a 10% frequency [5].…”

“…Risk factors for perforation include IUD insertion during lactation, rst time using the IUD, insertion during the rst 6 months of postpartum, and anatomic abnormalities, such as cervical stenosis and a retroverted uterus [4,5].…”

Intrauterine device found in an ovarian tumor

“…[ 13 ] Risk factors that impact the occurrence of uterine perforation include breastfeeding and postpartum state, experience of the inserting doctor and uterine anatomy. [ 5 , 14 – 16 ] Women who were breastfeeding at the time of insertion have a 6-fold higher perforation risk than women who were not breastfeeding. [ 5 ] Malpositioned IUDs may lead to a high rate of pregnancy due to the possible reduced efficacy.…”

“…Studies showed that the type of IUD did not affect the risk of uterine perforation, although stainless steel IUDs were less effective for contraception and easier to expulse. [ 5 , 14 ] As the incidence of IUD malposition is increased in patients with uterine structure abnormality, [ 16 ] it was not clear whether the partial septate uterus in this patient contributed to the IUD translocation.…”