PIP: The National Committee on Maternal Health reported on 28 cases of pe rforation of the uterus in a total of 16,338 first insertions of IUDs after confinement, an incidence of 1.7 perforations per 1000 insertions. 20 of the perforations followed the insertion of a bow. 16 of these occurred in patients less than 12 weeks postpartum. With the bow there is a highly significant correlation between the perforation rate and the number of weeks postpartum, especially if no menses have occurred. The perforation rate after 12 weeks postpartum for the bow is 2 per 1000 insertions. This is less than the perforation rate of 3.23 per 1000 found in a collected series of 77,903 curettages. The high perforation rate for the early postpartum insertions indicates that softness and friability of the uterus is a greater factor in the etiolog y of the perforations than the type of introducer employed. Perforation s with other devices are difficult to determine because of the lack of accompanying symptoms and the presence of a tail protruding through the cervix. Care in examining the patient, judicious timing of insertion, the use of a tenaculum, traction to straighten flexion deformities of the uterus, sounding the uterus, and gentleness during the introduction and ejection of the device into the uterus should greatly reduce the incidence of uterine perforation.