Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study

Uterine Perforation by Levonorgestrel-Releasing Intrauterine Device: A Case Report

“…The patient we present did not have the IUD inserted in the following six months after delivery nor she was breastfeeding at the time of the insertion, which are factors found to increase the risk of uterine perforation by IUD [ 9 - 12 ]. The only possible risk factor in her case was uterine retroversion and retroflexion as it has been reported that 42% of perforations occur in retroverted uteri [ 13 ].…”

Efficacy and safety of intrauterine device placement during a planned cesarean section

“…Intra-cesarean placement also avoids a potentially more difficult insertion through a narrowed endocervical canal weeks after birth and, at times, a challenging position of the uterus, particularly after repeated cesareans [ 15 ]. The authors of a recent, large multisite cohort study examined the risk of uterine perforation with IUD insertion and observed complete perforations at their highest rates 4 days to 6 weeks postpartum, whereas none was diagnosed following insertion between within 3 days postpartum [ 16 ].…”

Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion

“…The study design and validation of variable selection have been described in detail previously. 13 , 16 , 17 Approval or exemption for the conduct of this study was provided by the IRBs of Kaiser Permanente Northern California, Kaiser Permanente Southern California, Kaiser Permanente Washington, and Regenstrief Institute; Kaiser Permanente Southern California also received approval from California state agencies for the use of vital statistics data.…”

“… 1 , 3 , 4 , 6 – 11 The APEX-IUD (Association of Perforation and EXpulsion of IntraUterine Devices) study was an observational cohort study of 326,658 individuals designed to assess the association of breastfeeding and timing of postpartum IUD insertion with IUD expulsion and IUD-related uterine perforation among individuals in the United States. 12 , 13 The study also evaluated risks of IUD expulsion and uterine perforation in individuals with heavy menstrual bleeding and by IUD type (copper IUDs vs levonorgestrel-releasing intrauterine systems [LNG-IUDs]). 14 , 15 …”