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. 2024 Sep 27;24(1):538.
doi: 10.1186/s12905-024-03298-3.

Risk factors of uterine perforation when using contraceptive intrauterine devices

Fatemeh Tabatabaei  1   2 , Seyedeh Tala Nabipour Hosseini  3 , Parvin Hakimi  3 , Razieh Vejdani  4 , Bahareh Khademi  3
Affiliations

Risk factors of uterine perforation when using contraceptive intrauterine devices

Fatemeh Tabatabaei et al. BMC Womens Health. .

Abstract

Background: Intrauterine devices (IUDs) are one of the most popular methods of contraception, and uterine perforation has been presented among the most significant potential complications of IUD use. The aim of this study is to evaluate the risk factors of uterine perforation when using an IUD.

Methods: In this retrospective study, all 164 women who have referred to Al-Zahra hospital in Tabriz- Iran to remove the retained IUD from March 2018 to March 2021, were investigated in two groups. Patients in case group underwent surgery to remove the dislocated device and management of its complications. In control group, the devices were removed using a Novak or ring forceps with or without hysteroscopy with no uterine perforation. Data were analyzed using SPSS software, and P < 0.05 was considered statistically significant. P-Value was obtained for qualitative data via Fisher's exact test and Chi-Squared test and for quantitative data via Mann-Whitney U test and independent T-test.

Results: The mean age of patients in the groups with or without uterine perforation was 30.57 and 36.78 years respectively (P = 0.01). The frequency of two or more parities among patients with uterine perforation was higher than other patients (P = 0.13). Ultrasound study before (p = 0.037) and after (p = 0.007) IUD insertion was higher among patients without uterine perforation. The less inexperience of healthcare providers (P = 0.013) and lack of scheduled follow-up visits after the IUD insertion (P < 0.001), are the other important factors affecting the uterine perforation. Abdominal pain was the most common compliant of uterine perforation (P < 0.001) and laparoscopy was the most used surgery to remove the misplaced device.

Conclusion: Uterine perforation can be effectively prevented by hiring experienced health care providers and appropriate patient selection.

Keywords: Intrauterine devices; Laparoscopy; Uterine perforation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Misplaced IUDs embedded to various adjacent organs A Dislocated device which was embedded to the bowel. The device was removed and the bowel was repaired. B The string of the perforated device was located inside the abdomen and the device was enwrapped with omentum. C Dislocated device was penetrated to appendix. Appendectomy was performed and the device was removed. D The device was penetrated to anterior rectal wall. Laparoscopy was converted to laparotomy due to notable bowel damage
See this image and copyright information in PMC

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