Study Shows Few Adverse Effects of Intra-Abdominal IUD Perforation

   Researchers at Beth Israel Deaconess Medical Center in Watertown, Massachusetts, have found that serious adverse effects of intra-abdominal IUD perforation are uncommon. They presented their findings at the American College of Obstetricians and Gynecologists’ 59th Annual Clinical Meeting in Washington, D.C.

   Perforation of an IUD into the abdominal cavity is a rare event that could be better understood. Hayley F. Quant, MD, and colleagues sought to do that by conducting one of the largest series of case studies performed at a single institution.

   There were 19 operative removals (all laparoscopic) of intra-abdominal IUDs performed from 2005 to 2009.  The mean age of patients was 33  (range 22-42).  Eighteen were multiparous, 11 having had at least one vaginal delivery (one patient’s parity was unknown). Two of the IUDs were placed within six weeks postpartum; nine were placed between six weeks and six months postpartum. The time interval between IUD placement and operative removal ranged from one day to greater than three years.

   The clinical presentation included pain (52.6%), not feeling/seeing strings (47.4%), irregular bleeding (21.1%), and pregnancy (5.3%).  The IUD was discovered free-floating in the abdominal cavity (42.1%) or adherent to omentum (31.6%), fallopian tube (15.8%), or peritoneum (10.5%).  The site of uterine perforation was visible in four cases. There were no major complications of perforation or of laparoscopic removal.

   “Based on our center’s experience,” the investigators concluded, “serious adverse effects of intra-abdominal IUD perforation are uncommon and removal via laparoscopy is safe and effective.”