Pirwany I R, Boddy K
Queen Mother's Hospital, Glasgow, Scotland.
Contraception. 1997 Nov;56(5):337-9. doi: 10.1016/s0010-7824(97)00161-3.
Uterine perforation remains the most serious complication of the intrauterine contraceptive device (IUD). It is more common in the puerperium, usually occurring at the time of insertion of a new device. Perforation may, however, also occur in the puerperium if a pre-existing device is not removed in early pregnancy or extruded at the time of delivery. The case is presented of a 30-year-old woman who became pregnant for the third time following insertion of an IUD in the puerperium of her second pregnancy. An uneventful pregnancy and delivery followed. Failure to detect the IUD at the time of delivery led to laparoscopy and laparotomy to locate the device. A colotomy was necessary to retrieve the device, which had formed a colocolic fistula. It is concluded that the puerperium remains the time of greatest risk of uterine perforation by an IUD. Although most occur at the time of insertion, this complication can also occur with a previously inserted device. Severe intra-abdominal complications may ensue if the device is not localized and removed. Laparotomy is justified if the laparoscopic removal is unsuccessful. A high degree of suspicion is necessary if serious consequences are to be avoided.
子宫穿孔仍然是宫内节育器（IUD）最严重的并发症。它在产褥期更为常见，通常发生在放置新节育器时。然而，如果在妊娠早期未取出已放置的节育器，或在分娩时节育器被挤出，产褥期也可能发生穿孔。本文报道了一名30岁女性，在第二次妊娠产褥期放置IUD后第三次怀孕。随后妊娠和分娩过程顺利。分娩时未检测到IUD，导致通过腹腔镜检查和剖腹探查来定位节育器。需要进行结肠切开术取出节育器，该节育器已形成结肠结肠瘘。结论是产褥期仍然是IUD导致子宫穿孔风险最高的时期。虽然大多数穿孔发生在放置时，但这种并发症也可能发生在先前已放置的节育器上。如果节育器未被定位并取出，可能会发生严重的腹腔内并发症。如果腹腔镜取出不成功，剖腹探查是合理的。要避免严重后果，必须保持高度怀疑。
