Women's Reproductive Health Research Center, Al‑Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Endometriosis Research Center, Iranian Society of Minimally Invasive Gynecology, Iran University of Medical Sciences, Tehran, Iran.
BMC Womens Health. 2024 Sep 27;24(1):538. doi: 10.1186/s12905-024-03298-3.
Intrauterine devices (IUDs) are one of the most popular methods of contraception, and uterine perforation has been presented among the most significant potential complications of IUD use. The aim of this study is to evaluate the risk factors of uterine perforation when using an IUD.
In this retrospective study, all 164 women who have referred to Al-Zahra hospital in Tabriz- Iran to remove the retained IUD from March 2018 to March 2021, were investigated in two groups. Patients in case group underwent surgery to remove the dislocated device and management of its complications. In control group, the devices were removed using a Novak or ring forceps with or without hysteroscopy with no uterine perforation. Data were analyzed using SPSS software, and P < 0.05 was considered statistically significant. P-Value was obtained for qualitative data via Fisher's exact test and Chi-Squared test and for quantitative data via Mann-Whitney U test and independent T-test.
The mean age of patients in the groups with or without uterine perforation was 30.57 and 36.78 years respectively (P = 0.01). The frequency of two or more parities among patients with uterine perforation was higher than other patients (P = 0.13). Ultrasound study before (p = 0.037) and after (p = 0.007) IUD insertion was higher among patients without uterine perforation. The less inexperience of healthcare providers (P = 0.013) and lack of scheduled follow-up visits after the IUD insertion (P < 0.001), are the other important factors affecting the uterine perforation. Abdominal pain was the most common compliant of uterine perforation (P < 0.001) and laparoscopy was the most used surgery to remove the misplaced device.
Uterine perforation can be effectively prevented by hiring experienced health care providers and appropriate patient selection.
宫内节育器（IUD）是最受欢迎的避孕方法之一，而子宫穿孔已被认为是 IUD 使用中最严重的潜在并发症之一。本研究旨在评估使用 IUD 时子宫穿孔的危险因素。
在这项回顾性研究中，我们对 2018 年 3 月至 2021 年 3 月期间前往伊朗大不里士 Al-Zahra 医院取出滞留 IUD 的 164 名女性进行了研究，将其分为两组。病例组患者接受手术取出移位装置并处理其并发症。在对照组中，使用 Novak 或环形钳子在没有子宫穿孔的情况下取出节育器，或在宫腔镜下取出节育器。使用 SPSS 软件分析数据，P 值<0.05 为统计学显著。定性数据采用 Fisher 确切检验和卡方检验，定量数据采用 Mann-Whitney U 检验和独立 T 检验。
有子宫穿孔和无子宫穿孔患者的平均年龄分别为 30.57 岁和 36.78 岁（P=0.01）。子宫穿孔患者中有两次或更多次分娩的比例高于其他患者（P=0.13）。无子宫穿孔患者的超声检查在 IUD 插入前（p=0.037）和插入后（p=0.007）均较高。医护人员经验不足（P=0.013）和缺乏 IUD 插入后的定期随访（P<0.001）是影响子宫穿孔的其他重要因素。腹痛是子宫穿孔最常见的投诉（P<0.001），腹腔镜是取出移位装置最常用的手术。
通过雇佣有经验的医疗保健提供者和适当的患者选择，可以有效预防子宫穿孔。
