Translocation of intrauterine contraceptive device
Borkotoky, R.K.; Chumar Mampilli, K.J.
Journal of the Indian Medical Association 67(6): 147-149
1976
ISSN/ISBN: 0019-5847 PMID: 147910 Document Number: 100719
Perforations of the uterus are of 2 types: 1) the IUD is completely in the peritoneal cavity; or 2) the IUD is partly in the peritoneal cavity, partly embedded in the uterine wall. The incidence of uterine perforation is 0.6, 0.6, 1.6 and 5.0/1000 for the loop, spiral, steel ring, and bows respectively; the type of applicator used may influence the rate. Devices similar to the Grafenberg ring and the Birnberg bow are associated with intestinal obstruction and predispose to bowel herniation. There is a virtual absence of endometrial reactions in the polythelene spirals and loops, which are pliable and unlikely to penetrate the intact uterine wall due to muscle contraction alone. Most perforations occur at the time of insertion; insertion during the early postpartum period or during the period of lactational amenorrhoea, or in the case of an undiagnosed pregnant uterus or an acutely anteflexed or retroflexed uterus can be the cause. Other factors are 1) the manner of insertion; 2) the consistency of the uterine wall and its position; and 3) the type of device and introducer used. Thorough knowledge of gynecological anatomy is required to avoid defective placements. The hypothesis of erosion of the uterine wall was based on misdiagnosis due to the use of plain films in cases of incomplete perforation; perforation is best diagnosed by hysterography. Although polyethylene devices are said to be free of irritation or adhesions inside the peritoneal cavity, laparotomy is probably the best treatment for all cases and particularly where the IUD is in an anterior position.