Uterine perforation with IUC (IUCD)

The rate of uterine perforation associated with IUC is up to 2 per 1000 insertions and is approximately six-fold higher in breastfeeding women (1)

Suspected Uterine Perforation

• some uterine perforations are identified at the time of insertion - however there can be a delay before perforation is identified
  • for those women in whom perforation is identified at the time of insertion
    • the procedure should be stopped, the IUC removed, and vital signs (blood pressure and pulse rate) and level of discomfort monitored until stable
• possible clinical features associated with perforation include:
  • mild lower abdominal pain, 'lost threads', changes in bleeding (LNG-IUS) and a history of pain at the time of insertion may indicate uterine perforation
  • threads may remain in the vagina and may break off at attempted removal if an IUC has become embedded in the uterine wall or has perforated the cervix
• if perforation is suspected then:
  • an ultrasound scan is indicated
    • also if perforation suspected then a plain abdominal and pelvic X-ray should be arranged as soon as possible in order to locate the device
    • women should be advised to use additional contraceptive precautions in the interim
    • if perforation confirmed then:
      • arrange elective laparoscopic removal (not a medical emergency unless bowel or vessel perforation suspected). Offer reinsertion of IUD/IUS after minimum of 4 weeks after perforation

Reference:

• FSRH Guidance (April 2015) Intrauterine Contraception