Intrauterine devices and risk of uterine perforation: current perspectives

Rowlands, Sam; Oloto, Emeka; Horwell, David

doi:10.2147/oajc.s85546

Cited by 84 publications

(158 citation statements)

References 92 publications

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“…Perforation into the pouch of Douglas, bowel and urinary tract are all recognised complications of insertion of IUC 3. Insertion in the postpartum period carries an increased risk of perforation from 4 to 36 weeks after delivery 4.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device

Reynolds-Wright

Heller

2019

BMJ Sex Reprod Health

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IntroductionInsertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with ‘missing threads’ or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common.Case historyIn January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous ‘lost’ intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been ‘lost’ and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms.ConclusionThis case reports an unusual presentation of a delayed and importantly ‘silent’ perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.

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Section: Discussionmentioning

confidence: 99%

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device

Reynolds-Wright

Heller

2019

BMJ Sex Reprod Health

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“…In The European Active Surveillance (EURAS) study, lactation or breastfeeding was associated with six fold risk of perforation. 9 One of the unstudied, yet possible risk factor in IUD perforation was the patient had forgotten their contraceptives. In a single case report in Turkey, a woman was found to have an IUD migration to her bladder due to pelvic pain and hematuria refractory to treatments for urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2019

Obgynia

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Introduction: Intrauterine device (IUD) is accepted and used as an effective contraception globally. Malposition of intrauterine device into the bladder with stone formation was very rare complication. In this study, we report a case in which IUD malposition had caused bladder stone formation in a female patient Case presentation: Patient was a female, 50 years old, complained of painful urination approximately 1 year before admission and was diagnosed with recurrent urinary tract infection (UTI). Patient also had history of IUD insertion for ten years. Instead of IUD insertion in her uterine, patient had history of 2 times birth delivery. Imaging examination was performed on April 2018, in Hasan Sadikin Hospital, Bandung and found IUD in pelvic area. In ultrasound imaging we found a hyperechoic with acoustic shadow that resembles an IUD. Endoscopic management was performed by cystoscopy instrument. We found a half of IUD in the bladder with encrustation and calcification in the device. We performed lithotripsy with pneumatic lithotripter to disintegrate the encrustation. An IUD extracted from the bladder cavity by cystoscopy grasper. Postoperative evaluation we found no complications and send home the patient 3 days after the procedure. Conclusion: IUD malposition can be found to bladder cavity. Recurrent UTI needs radiological investigation to provide for any abnormality in urinary tract. IUD extraction could be performed by transvesical approach if the device malposeed to the bladder.

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“…GyneFix ® carries risks of similar complications as other IUDs, including expulsion, failure of implantation, uterine perforation, bowel perforation and bowel resection (6)(7)(8). The incidence of uterine perforation is estimated at between 0.4 and 1.6 per 1000 insertions for copper IUDs (9). Despite this, an incidence of uterine perforation with GyneFix ® has not yet been reported instead of case series.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, an incidence of uterine perforation with GyneFix ® has not yet been reported instead of case series. Laparoscopy should be the method for managing intraperitoneal IUDs (8,9). To overcome complications such as uterine perforation and bowel resection with GyneFix ® the practitioner should be well-trained and skilled in using the device, as well as aware of complications for timely intervention.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of a Frameless Intrauterine Device-GyneFix Embedded in the Mesentery of the Ileum

Canda

Demir

2017

Gynecol Obstet Reprod Med

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GyneFix ® is a small, frameless, armless, flexible intrauterine device. The proximal end contains a knot that is anchored in the uterine fundus using a special apparatus. A 31-year-old woman presented with abdominal cramps ten days after GyneFix ® insertion. Transvaginal ultrasonography was unsuccessful in locating the intrauterine device therefore a direct X-ray sonogram of the abdomen while standing was performed. The X-ray sonogram of the abdomen showed the intrauterine device in the right quadrant. An exploratory laparoscopy was performed and showed that the intrauterine device perforated the uterine fundus and was embedded in the mesentery of the ileum. The intrauterine device was removed without complication. Although the reported complication rates are very low for GyneFix ® , practitioners should be well trained and should be aware of such complications that could lead to bowel resection. We report the first case of a GyneFix ® -Intrauterine device presenting with uterine perforation and nearly intestinal perforation since its recent introduction into the Turkish market.

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Intrauterine devices and risk of uterine perforation: current perspectives

Cited by 84 publications

References 92 publications

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device

Untitled

Laparoscopic Management of a Frameless Intrauterine Device-GyneFix Embedded in the Mesentery of the Ileum

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