[Causes, diagnosis and treatment of uterine perforations by intrauterine devices].

Perforations of the uterus by intra-uterine devices (I.U.D.) are still at present serious complications. Their incidence is very varied and diverse because they are often asymptomatic. Pregnancy of a frequent circumstance under which they are discovered, as well as the more general way, which is the disappearance of the strings, which should always give rise to the suspicion that perforation has happened. There are two types to be distinguished from one another: Immediate perforation due to a faulty technique in insertion, secondary perforation due to gradual wearing down of the uterine wall. The factors predisposing to the occurrence of these accidents are numerous but notable among them are the date in the cycle when the insertion was done and above all the time in relationship to the last pregnancy, parity, the position of the uterus and the experience of the operator. Diagnosis of perforation is not always easy and may require not only radiological investigation without preliminary preparation but also hysterography, ultrasound examination and hysteroscopy. Withdrawal of a device that has perforated the uterus is advisable even if its migration has not given rise to any clinical symptoms. The technique for removing it varies often from case to cause between laparoscopy, laparotomy and culdotomy. Prevention of perforations should not only take into account the contra-indications to insertion but also knowledge of favourable factors, of a rigorous technique for insertion as well as clinical supervision in order to screen for secondary perforations.