Intrauterine device insertion-related complications: can they be predicted?
OBJECTIVE
To determine risk factors affecting the incidence of intrauterine device (IUD) insertion-related complications and failures and, in particular, whether postcoital IUD insertions have a higher incidence of complications than routine IUD insertions.


METHODS
Retrospective case notes analysis.


METHODS
The study examined 545 case notes of patients having IUD insertions at East Cheshire NHS Trust family planning clinics between 1 October 1997 and 31 December 2000.


METHODS
The incidence of complications at insertion, or up to 12 weeks after insertion, was determined and included failed insertion, cervical problems, syncope, bradycardia, convulsions, early perforation and early expulsion. Fourteen potential risk factors were examined to determine the effect on incidence of complications.


RESULTS
Failed insertions were statistically more likely in women who had never previously had a vaginal delivery and also when a less experienced doctor performed the insertion. Nulliparous women were at statistically increased risk of cervical problems and bradycardia. Cervical problems at insertion also increased significantly with age. Patients who were amenorrhoeic at insertion were more likely to suffer an early IUD expulsion.


CONCLUSIONS
Of the potential risk factors, nulliparity was the most important. IUD insertion failures and complications were no more common in postcoital than routine IUD insertions. In general, complications were unpredictable, indicating the need for constant vigilance and the inserting doctor being trained and prepared to deal with any complication arising.
Farmer
Miranda
M
East Cheshire NHS Trust, Macclesfield District General Hospital, Victoria Road, Macclesfield SK10 3BL, UK. mataylor@onetel.net.uk
Webb
Anne
A
D000293:Adolescent; D000328:Adult; D001919:Bradycardia / Q000209:etiology; D003267:Contraception / Q000379:methods*; D004739:England; D005193:Family Planning Services / Q000592:standards; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion / Q000209:etiology; D007434:Intrauterine Devices / Q000009:adverse effects* / Q000592:standards*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014595:Uterine Perforation / Q000209:etiology; D016387:Women's Health