Ex-vivo Forces Associated with Intrauterine Device Placement and Perforation: a Biomechanical Evaluation of Hysterectomy Specimens

Overview

Journal BMC Womens Health

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2021 Apr 8

PMID 33827522

Citations 1

Authors

Jane Duncan

Kathryn Fay

Jessica Sanders

Benjamin Cappiello

Jane Saviers-Steiger

David K Turok

Affiliations

Soon will be listed here.

Abstract

Background: This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound.

Methods: We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers' placement instruments for two commercially available products and a metal sound.

Results: Sixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p < .001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3 N (SD ± 3.8 N), followed by the copper T380A intrauterine device placement instrument 14.1 N (SD ± 4.0 N), and highest for the metal sound 17.9 N (SD ± 7.6 N) (p < 0.01).

Conclusions: In this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not. This study received Institutional Review Board (IRB0059096) approval.

Citing Articles

Case report: Uterine perforation caused by migration of intrauterine devices.

Li Q, Qi D, Bi T, Guo X, Chen H Front Med (Lausanne). 2024; 11:1455207.

PMID: 39301484 PMC: 11410695. DOI: 10.3389/fmed.2024.1455207.

References

Caliskan E, Ozturk N, Dilbaz B, Dilbaz S . Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 2003; 8(3):150-5. View

Goldstuck N . 'Bowing' forces with IUD inserters in vitro: relevance to difficult IUD insertions. Clin Reprod Fertil. 1987; 5(4):173-6. View

Hubacher D, Kavanaugh M . Historical record-setting trends in IUD use in the United States. Contraception. 2018; 98(6):467-470. DOI: 10.1016/j.contraception.2018.05.016. View

Goldstuck N, Wildemeersch D . Role of uterine forces in intrauterine device embedment, perforation, and expulsion. Int J Womens Health. 2014; 6:735-44. PMC: 4132253. DOI: 10.2147/IJWH.S63167. View

Turok D, Nelson A, Dart C, Schreiber C, Peters K, Schreifels M . Efficacy, Safety, and Tolerability of a New Low-Dose Copper and Nitinol Intrauterine Device: Phase 2 Data to 36 Months. Obstet Gynecol. 2020; 135(4):840-847. PMC: 7098438. DOI: 10.1097/AOG.0000000000003756. View

Santos A, Valeria Bahamondes M, Hidalgo M, Atti A, Bahamondes L, Monteiro I . Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section. Contraception. 2013; 88(1):164-8. DOI: 10.1016/j.contraception.2012.10.015. View

Canteiro R, Valeria Bahamondes M, Fernandes A, Espejo-Arce X, Marchi N, Bahamondes L . Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities. Contraception. 2010; 81(6):515-9. DOI: 10.1016/j.contraception.2010.01.006. View

Heinemann K, Reed S, Moehner S, Minh T . Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015; 91(4):274-9. DOI: 10.1016/j.contraception.2015.01.007. View

Dermish A, Turok D, Jacobson J, Murphy P, Saltzman H, Sanders J . Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians. Contraception. 2016; 93(6):533-8. DOI: 10.1016/j.contraception.2016.01.011. View

10.

Goldstuck N . Insertion forces with intrauterine devices: implications for uterine perforation. Eur J Obstet Gynecol Reprod Biol. 1987; 25(4):315-23. DOI: 10.1016/0028-2243(87)90142-0. View

11.

Curtis K, Tepper N, Jatlaoui T, Berry-Bibee E, Horton L, Zapata L . U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016; 65(3):1-103. DOI: 10.15585/mmwr.rr6503a1. View

12.

Jatlaoui T, Riley H, Curtis K . The safety of intrauterine devices among young women: a systematic review. Contraception. 2016; 95(1):17-39. PMC: 6511984. DOI: 10.1016/j.contraception.2016.10.006. View

13.

Christenson K, Lerma K, Shaw K, Blumenthal P . Assessment of a simplified insertion technique for intrauterine devices. Int J Gynaecol Obstet. 2016; 134(1):29-32. DOI: 10.1016/j.ijgo.2015.12.004. View

14.

OBrien P, Pillai S . Uterine perforation by intrauterine devices: a 16-year review. J Fam Plann Reprod Health Care. 2017; 43(4):289-295. DOI: 10.1136/jfprhc-2016-101684. View