Diagnosis and management of uterine perforations after intrauterine device insertion: a report of 11 cases

Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforat...

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Bibliographic Details
Published in:Gynécologie, obstétrique & fertilité obstétrique & fertilité, 2013-05, Vol.41 (5), p.314-321
Main Authors: Boyon, C, Giraudet, G, Guérin Du Masgenêt, B, Lucot, J-P, Goeusse, P, Vinatier, D
Format: Article
Language:fre
Subjects:
Adult
Breast Feeding
Female
France
Humans
Intrauterine Devices - adverse effects
Laparoscopy
Laparotomy
Pelvic Pain
Postpartum Period
Pregnancy
Radiography, Abdominal
Risk Factors
Time Factors
Ultrasonography
Uterine Perforation - diagnosis
Uterine Perforation - etiology
Uterine Perforation - surgery
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Summary:Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.
ISSN:1769-6682
DOI:10.1016/j.gyobfe.2012.05.006