An intrauterine device (IUD) is a safe means of contraception with many advantages. Perforation of the uterus is an important complication that is fortunately rare.


Risk factors for uterine perforation:

(1) inexperienced inserter

(2) insertion while exclusive breastfeeding during post-partum period

(3) difficult insertion

(4) failure to sound and palpate the uterus (can alert the provider that the inserter tube has been pushed too far)


Early findings of uterine perforation:

(1) none (asymptomatic)

(2) lower abdominal pain

(3) heavy bleeding

(4) usual menses (an intrauterine IUD will change the menstrual bleeding pattern)


Complications of uterine perforation by the IUD:

(1) pregnancy

(2) intestinal perforation

(3) bowel obstruction

(4) bladder perforation

(5) infection


A missing IUD should always be located by one or more of the following:

(1) transvaginal ultrasound

(2) plain radiograph

(3) hysteroscopy


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