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Uterine perforation with intrauterine contraceptive devices: Review of the literature and cases reported to the National Committee on Maternal Health

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Abstract

The National Committee on Maternal Health reported on 28 cases of perforation of the uterus in a total of 16,338 first insertions of IUCD's after confinement, an incidence of 1.7 perforations per 1,000 insertions. Twenty of the perforations followed the insertion of a “Bow”. Sixteen of these occurred in patients less than 12 weeks post partum. With the “Bow” there is a highly significant correlation between the perforation rate and the number of weeks post partum, especially if no menses have occurred. The perforation rate after 12 weeks post partum for the “Bow” is 2.0 per 1,000 insertions. This is less than the perforation rate of 3.23 per 1,000 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 etiology of the perforations than the type of introducer employed. Perforations with other devices are difficult to determine due to 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.

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