PERFORATIONS WITH INTRAUTERINE-DEVICES - REPORT FROM A SWEDISH SURVEY

This survey comprised 50 consecutive perforations occurring with intra uterine devices (IUD) reported to the National Patient Insurance Schem e Register during 1990 to 1993. All 50 women were parous and >20 years of age at the time of IUD insertion. Forty-two (84%) of the IUD were inserted by a midwife and eight by a gynecologist. A total of 45 women (90%) had their IUD inserted <1 year after a full-term pregnancy and 31 women (62%) had their IUD inserted less than or equal to 12 weeks a fter delivery. Of the 50 women, 27 (54%) reported that they were breas tfeeding at the time of IUD insertion. No particular IUD was overrepre sented in relation to its share on the market. In 31 cases (62%), seve re pain at insertion and during the first 24 h was recorded. In 24 wom en (28%), the perforation was diagnosed early (ie, within 1 month of i nsertion) and in 36 women (72%), the perforation was diagnosed >1 mont h after insertion. Lower abdominal pain was the most frequent symptom at early diagnosis but in two cases, the main symptom was heavy bleedi ng. Among the 36 women in whom the perforation was discovered more tha n 1 month after insertion, the diagnosis was made when an unexpected p regnancy occurred in 20 women (56%). In 15 cases, the IUD strings were not visible during pelvic examination at a routine check-up, which le d to efforts to locate the IUD. Thirty-two women (64%) underwent lapar otomy for removal. We conclude that lactating women seem to be a risk group for perforation and that a national register of IUD perforations could provide a better means of quality control. CONTRACEPTION 1998;5 7:251-255 (C) 1998 Elsevier Science Inc. All rights reserved.