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

Abstract

Background: Intrauterine 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.

Results: 29 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.

Conclusions: Unique 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.

Keywords: Hysteroscopy; IUD; Laparoscopy; Uterine perforation.

Fig. 1

IUDs and complications were associated with uterine perforation. A Different types of IUDs were identified in the patients with uterine perforation, including T-shaped copper (a), V-shaped copper (b), O-shaped (c), GyneFix (d), and other type (e) of IUDs. B Pelvic adhesion and abdominal pain were associated with uterine perforation. Five major types of IUDs were correlated with the intraoperative finding of pelvic adhesion (a) and clinical symptom of abdominal pain (b). Please note that significantly higher ratio of pelvic adhesions were observed in V-shaped copper IUD patients of 12/13 (92.3%) compared with O-shaped IUD patients of 3/4 (75%) with uterine perforation (Fisher’s exact test, *p < 0.05), while the abdominal pains were no different among all the types of IUDs used with uterine perforation. Note, w/o means without

Fig. 2

Migrated IUD was removed by laparoscopy in a typical case of uterine perforation. a A 36-year-old patient was visiting the 3rd Xiangya Hospital for checking of hysteromyoma in January 2015, and this patient was experienced with two types of IUD insertions, and because of that, she assumed that the first IUD was expelled. However, after she took out the second IUD, another IUD was monitored unexpectedly by computed tomography (CT), indicating that the first IUD had undergone uterine perforation. Note that the red arrow showed the IUD. b–f The laparoscopy was applied for the removal of the migrated IUD. It was shown that the IUD completely perforated through the uterine serosa and invaded into the sigmoid colon and, finally, the IUD was removed and the wounds were sewn under laparoscopy. Note that the migrated IUD was shown in yellow arrows, and the perforation site at the uterus and the invaded site of the sigmoid colon were shown in blue arrows. e The IUD was identified as a V-shaped copper IUD, and the string was already separated from the IUD body