Evaluation of patients with uterine perforation after intrauterine device placement and determination of risk factors: A Retrospective Case-Control Study

INTRODUCTION: To determine the risk factors by evaluating patients with uterine perforation after intrauterine devices (IUD) placement. Also, it was to make suggestions and contribute to the literature in order to prevent uterine perforation after the IUDs placement and how we should behave when we encounter these patients.
METHODS: Twenty-two patients with uterine perforation after IUDs placement (patient group) diagnosed and treated at our clinic and 30 patients with IUDs in place in the uterine cavity (control group) were retrospectively evaluated and compared.
RESULTS: IUDs insertion by a midwife and during the breastfeeding and puerperal period significantly increased the frequency of uterine perforation after IUDs placement, while insertion during the menstrual period significantly reduced risk. Uterine perforation after IUDs placement were most frequently localized in the myometrium (54.5%) and the douglas (13.6%). Uterine perforation-related complications were absent in 59.1% of patients. Of patients, 40.9% underwent hysteroscopy, 18.2% laparoscopy. The diagnostic method was ultrasonography alone at a rate of 68.2%.
DISCUSSION AND CONCLUSION: IUDs could be inserted during menstruation where possible, and patients could be informed about the high risk of uterine perforation after IUDs placement associated with the breastfeeding and puerperal periods. We recommend that IUDs be inserted with ultrasonography in this period. Midwives should receive regular training in order to increase their knowledge and experience on this subject. We recommend ultrasonography as the primary diagnostic method. Those with IUDs embedded in the myometrium can primarily undergo hysteroscopy, and those with IUDs in the abdomen can undergo laparoscopy or laparotomy.