Intrauterine contraception: incidence and factors associated with uterine perforation--a population-based study
Open Access
- 3 July 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Human Reproduction
- Vol. 27 (9), 2658-2663
- https://doi.org/10.1093/humrep/des246
Abstract
What are the incidence and factors associated with uterine perforation by modern copper intrauterine device (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS)? Perforation incidence was similar to that reported in prior studies and did not vary between Cu-IUD and LNG-IUS groups. Lactation, amenorrhoea and a post-partum period of n = 17) and the LNG-IUS (n = 51) were analysed as one group and also compared using Mann–Whitney and chi-square tests. IUD/IUS sales numbers were used to calculate incidences. The overall incidence of perforation was 0.4/1000 sold devices, varying annually from 0 to 1.2/1000. The proportion of both sold and perforating LNG-IUSs increased during the study period, but perforation incidence was not affected. Demographic characteristics in the Cu-IUD and LNG-IUS groups were similar. More than half of the devices (55%) were inserted at <6 months post-partum. Breastfeeding at the time of insertion was common, comprising 32% of all patients. Moreover, of the breastfeeding women, 90% had delivered within 6 month prior to insertion. The population-based study setting represents a good overview of patients experiencing uterine perforation with an IUD/IUS. As previously reported, the post-partum period, lactation and amenorrhoea may increase the risk of perforation. As the study setting revealed only symptomatic patients or those attending regular follow-up, the true incidence might be somewhat higher. As there is no specific diagnostic code for uterine perforation or treatment, it is unlikely that all cases of uterine perforation can be identified in a retrospective study. Helsinki University Central Hospital research funds are acknowledged.This publication has 9 references indexed in Scilit:
- Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient CareRadioGraphics, 2012
- Recent developments in the clinical use of the levonorgestrel‐releasing intrauterine systemActa Obstetricia et Gynecologica Scandinavica, 2011
- Uterine Perforation with the Levonorgestrel-Releasing Intrauterine DeviceDrug Safety, 2011
- Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine systemContraception, 2010
- Use of the New Zealand Intensive Medicines Monitoring Programme to study the levonorgestrel‐releasing intrauterine device (Mirena)Pharmacoepidemiology and Drug Safety, 2003
- Analysis of risk factors associated with uterine perforation by intrauterine devicesThe European Journal of Contraception & Reproductive Health Care, 2003
- Health during prolonged use of levonorgestrel 20μg/d and the Copper TCu 380Ag intrauterine contraceptive devices: a multicenter studyFertility and Sterility, 1994
- Complete and Partial Uterine Perforation and Embedding following Insertion of Intrauterine Devices. II. Diagnostic Methods, Prevention, and ManagementObstetrical & Gynecological Survey, 1981
- Complete and Partial Uterine Perforation and Embedding following Insertion of Intrauterine Deives. I. Classification, Complications, Mechanism, Incidence, and Missing StringObstetrical & Gynecological Survey, 1981