CONTENTS
HIGHLIGHTS
December 1995 |
Perforation of the uterus occurs when the IUD, the inserter tube, the sound, or another gynecological instrument used during insertion pierces the uterine muscle wall, most often at the fundus, or top of the uterus. Careful insertion technique can prevent most perforations (see Insertion Technique Chapter 3.1). In large clinical trials perforation has been rare—no more than 1.3 per 1,000 insertions (73, 90, 200, 314, 332, 364, 437, 444, 564). Perforations may go unnoticed at the time of insertion, however (42). Perforations may be partial, with just part of the IUD piercing the uterine wall or cervix, or complete, with the IUD passing through the uterine wall into the abdominal cavity. Also, over time IUDs may become embedded in the uterine wall without perforating it (42, 130, 340, 450). In general, a partial perforation of the uterine fundus heals quickly, and no treatment is required. If perforation is obvious during insertion, the procedure should be stopped, and the IUD, removed (587). Copper and hormone-releasing IUDs that have completely perforated the uterus after insertion should be removed only if the perforation is discovered within a few days or weeks after insertion and then only by a surgeon experienced at removing such IUDs by laparoscopy. While copper IUDs may become partially or completely encased in adhesions, they rarely cause any problems, whereas removal may lead to pelvic abscesses and other complications (614). Some researchers think that unmedicated devices should be removed (42, 183, 237, 449). The IPPF International Medical Advisory Panel considers this necessary only if the woman has abdominal symptoms (164). |