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Review
. 2016 Mar 16:7:19-32.
doi: 10.2147/OAJC.S85546. eCollection 2016.

Intrauterine devices and risk of uterine perforation: current perspectives

Sam Rowlands  1 , Emeka Oloto  2 , David H Horwell  3
Affiliations
Review

Intrauterine devices and risk of uterine perforation: current perspectives

Sam Rowlands et al. Open Access J Contracept. .

Abstract

Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy.

Keywords: intrauterine device; intrauterine system; uterine perforation.

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Conflict of interest statement

Disclosure The authors have received fees for consultancy and provision of training from the manufacturers of intrauterine devices. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Types of device. Notes: (A) Ota Ring, (B) Birnberg Bow, (C) Majzlin Spring, (D) Lippes Loop, (E) GyneFix®, (F) copper-bearing device: CuTT380 slimline, and (G) Levonorgestrel intrauterine system: Mirena®. Types (A–D) all obsolete. Images (A–D) courtesy of the Museum of Contraception and Abortion, Vienna (www.muvs.org). Images (E–G) courtesy of Durbin PLC, South Harrow, Middlesex, UK (www.durbin.co.uk).
Figure 2
Figure 2
Classification of partially perforated devices. Notes: Type A: IUD present in uterine cavity and myometrium; Type B: IUD present entirely in myometrium; Type C: IUD present in myometrium and peritoneal cavity; Type D: IUD present in all three compartments. A copper-T device is depicted: any device can perforate the uterus. The size of the IUDs relative to the uterus has been slightly reduced for illustrative purposes. Abbreviation: IUD, intrauterine device.
Figure 3
Figure 3
Diagrams showing direction of perforation in different uterine positions. Notes: (A) Posterior perforation in an anteverted uterus; (B) Anterior perforation in a retroverted uterus.
Figure 4
Figure 4
Ultrasound scan images of intrauterine IUDs and an IUS. Notes: (A) Sagittal view of framed IUD, (B) frameless IUD, and (C) sagittal view of IUS showing triangular acoustic shadow of device. Pictures courtesy of Emeka Oloto. Abbreviations: IUD, intrauterine device; IUS, intrauterine system.
Figure 5
Figure 5
X-ray images of extrauterine IUD and IUS. Notes: (A) Nova-T 380 IUD and (B) Mirena® IUS. Pictures courtesy of Emeka Oloto. Abbreviations: IUD, intrauterine device; IUS, intrauterine system.
See this image and copyright information in PMC

References

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