J Fam Plann Reprod Health Care. 2017 Jul 24. pii: jfprhc-2016-101684.

Uterine perforation by intrauterine devices: a 16-year review

O'Brien PA and Pillai S

Abstract

Introduction: One of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period.

Methods: We prospectively collected data on uterine perforations for the years 2000-2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding.

Results: We identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel.

Conclusion: Our perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3?months postpartum as that may be a time when a high proportion of insertions are done.

Comment: This complete and comprehensive retrospective review shows that IUD and IUC insertions in good hands have a very low risk of uterine perforations: 1.3 per 1000, so many of us will luckily never see one. It is worth noting, however, that in the first 5 months postpartum the risk is highest, so even more reason to be careful and to check with ultrasound when in doubt. (HMV)