Intraperitoneal levonorgestrel-releasing intrauterine device following uterine perforation: the role of progestins in adhesion formation.
BACKGROUND
Intrauterine contraception is a widely used, highly effective means of birth control. Uterine perforation is a serious, albeit rare, complication of intrauterine device (IUD) use. Although uterine perforation by levonorgestrel-releasing (20 micro g/day) intrauterine system (LNG-IUS) has already been reported, the peritoneal adhesion potential of this IUD is unknown.


METHODS
The medical files of all patients diagnosed with an intra-peritoneal IUD between the years 1990-2002 at Hadassah Medical Center were reviewed. Histopathological study of peritoneal adhesion tissue adjacent to levonorgestrel medicated IUD was conducted in one case.


RESULTS
Eight cases of dislocated IUDs were found. Four cases used LNG-IUS and four other cases used copper-IUD. Laparoscopy for IUD removal disclosed mild local peritoneal adhesions between omentum and pelvic organs in all cases. No difference was noted in the appearance of the peritoneum in the presence of either a copper-IUD or LNG-IUS. Histological examination of peritoneal tissue encasing the levonorgestrel-intrauterine system revealed loose connective tissue with aggregates of submesothelial cells with a pseudo-decidual change. Immunohistochemical staining for progesterone receptor was negative.


CONCLUSIONS
The peritoneal adhesions potential of LNG-IUS is low, similar to that of the copper-bearing IUD.
Department of Obstetrics and Gynecology and Department of Pathology, Hadassah University Hospital, Jerusalem, Israel. rkochman@hotmail.com
Ronit
R
Haimov-Kochman
Victoria
V
Doviner
Hagay
H
Amsalem
Diane
D
Prus
Amiram
A
Adoni
Yuval
Y
Lavy
D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003300:Copper; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage*; D010532:Peritoneal Diseases / Q000209:etiology; D010537:Peritoneum / Q000473:pathology; D011372:Progestins / Q000378:metabolism; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology; D014595:Uterine Perforation / Q000209:etiology* / Q000473:pathology
D003271:Contraceptive Agents, Female; D011372:Progestins; D016912:Levonorgestrel; D003300:Copper