title: [Diagnosis and management of uterine perforations after intrauterine device insertion: a report of 11 cases].
abstract: OBJECTIVE
  Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious.
  
  
  METHODS
  Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management.
  
  
  RESULTS
  The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up.
  
  
  CONCLUSIONS
  Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.
authors: Maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, Lille cedex, France.
authors: C
authors: C
authors: Boyon
authors: G
authors: G
authors: Giraudet
authors: B
authors: B
authors: Guérin Du Masgenêt
authors: J-P
authors: JP
authors: Lucot
authors: P
authors: P
authors: Goeusse
authors: D
authors: D
authors: Vinatier
mesh_terms: D000328:Adult; D001942:Breast Feeding; D005260:Female; D005602:France; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D010535:Laparoscopy; D007813:Laparotomy; D017699:Pelvic Pain; D049590:Postpartum Period; D011247:Pregnancy; D011860:Radiography, Abdominal; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D014595:Uterine Perforation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*