Prevalence of perforation of the cervix by the strings of intrauterine devices and systems.
ESC Congress Library. Gbolade B. May 4, 2016; 126994; A-168
Mr. Babatunde A. Gbolade
Mr. Babatunde A. Gbolade
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Abstract
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Objectives:

To establish the prevalence of perforation of the cervix by the strings of intrauterine devices, determine its aetiology, ascertain optimal management and explore strategies for prevention.

Method:

A detailed search of the English literature using electronic databases, reference lists of identified key articles and hand searching of relevant journals.

Results:

Between 1978, when the first case was reported and 2015, we were able to identify only seven cases in the English literature although there are a few anecdotal reports and there may be reports in other languages that were not accessible. Half of all the cases found were reported within the last 10 years, indicating either increasing occurrence or wider and better recognition of the condition. Majority of the women were asymptomatic. The mean age of the women was 32 (23 - 47) years, with a mean duration of IUD/IUS use of 33.6 (1 - 72) months. A variety of IUD types were involved but all three cases reported from 2010 were in women using the Levonorgestrel Intrauterine System. The exit points of the threads were variable with the lateral regions of the cervix being the most common. Management was in most cases simple and straightforward. Following removal of the devices, none of the women experienced any adverse effects. Various hypotheses have been propounded in attempts to explain the occurrence of this condition but no single hypothesis has been deemed applicable to all cases. The condition remains an enigma.

Conclusions:

Perforation of the cervix by threads of intrauterine devices and systems is a very rare occurrence with less than ten reported cases in the English literature. The significance and potential side effects of this complication are not known, and would appear to be not serious. None of the explanations or hypotheses offered for its occurrence seems applicable in all instances and its aetiology remains unclear. However, the process by which the threads penetrate the cervical tissue (and especially where two threads together appear through a single opening) is difficult to understand and has yet to be discovered. In the absence of a plausible aetiological model, it remains virtually impossible to develop a preventive strategy. We therefore recommend that research be undertaken on this topic.

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