INTRAUTERINE CONTRACEPTIVE DEVICE RELATED UTERINE PERFORATION AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE: A 5 YEAR REVIEW

Abstract

SUMMARY Background: Reports of perforation risk related to intrauterine devices (IUCDs) inserted immediately post-partum and among non-post-partum individuals are rare. However, there have been reports of IUCD related uterine perforation, which can lead to significant morbidity and potential complications. Risk factors associated with increased risk of perforation at the time of IUCD insertion include clinician inexperience, stenotic cervix and immobile or retroverted uterus. Being postpartum and/or lactating may independently increase the risk for perforation. The incidence is reported in 1/1000. This research aims to retrospectively analyze the IUD related uterine perforation and associated factors over a 5-year period. Objectives: To determine IUCD related uterine perforation managed at Saint Paul Hospital Millennium Medical College (SPHMMC). Methods: The study was conducted at Saint Paul Hospital Millennium Medical College (SPHMMC) starting from December 1, 2023- April 30, 2024. Data was collected through chart review using a data extraction questionnaire and analyzed using SPSS version 25 statistical software. Simple descriptive statistical analysis was performed as appropriate. Result: A history of prior uterine surgery was reported by 61.1% of participants, all of whom underwent cesarean delivery. IUCD insertion occurred exclusively in the postpartum period, with 44.4% inserted immediately postpartum (within 48 hours), 5.6% within six weeks, 47.2% between six weeks and six months, and 2.8% after six months. All individuals were breastfeeding at the time of IUCD insertion.The timing of uterine perforation diagnosis varied, with 33.3% diagnosed within six months of insertion, 22.2% within six months to a year, and 44.4% more than a year after insertion Conclusion:This study demonstrates a generally positive experience with postpartum Copper IUCD insertion. However, cases of uterine perforation highlight the importance of long-term follow-up and monitoring. Enhanced patient education on risks and symptoms is essential for optimal outcomes. Removal was mostly achieved through minimally invasive techniques, though adhesions were common all IUDs except one were removed either laparascopically or hysteroscopically