Journal of Medical Sciences and Health

Introduction

Because of the ease of availability, and lowcost intrauterine contraceptive device (IUCD) is the second most common used contraceptive worldwide.[1] One of the reasons for discontinuation rates of 20-40% is the fear of complications such as excessive bleeding, pain, infection, uterine perforation, and spontaneous expulsion.[2-4] Uterine perforation is one such complication which is rare and occurs in 0.5/1000 insertions.[5] However, it has a potential health risk and is often silent.[5] Health workers need to be aware of this complication and should take necessary precautions while inserting Copper T and be able to provide prompt diagnosis and treatment in the case of missing IUCD so as to prevent chances of migration of IUCD and prevent bowel and bladder perforation.[6] Here, we present a 25-year-old female, G2P1L1 with previous lower segment Caesarean section (LSCS) with 5.6 weeks with missing Copper T. In our case, the Copper T was successfully removed by the laparoscopic approach.

Case Report

On examination, her general condition was good, vital signs were normal. Abdomen was soft. On speculum examination, IUCD thread was not seen and uterus was enlarged to 6 weeks size on a vaginal examination. An ultrasound was done which suggested single live intrauterine gestation of 5 weeks 6 days. Since the patient was stable and all her investigations carried were within normal limits and patient did not want to continue pregnancy, termination of pregnancy was done by the medical method. After 15 days post-abortion, she was posted for laparoscopic removal of Copper T (if ne eded for conversion to laparotomy).

Procedure

Discussion

Uterine perforation following IUCD is rare and occurs in 0.5-3/1000 insertions but it is a potential health risk. Primary insertion occurs at the time of insertion.[7] Causes include faulty technique, inappropriate timing of insertion, soft uterine wall, wrong measurement of uterocervical length.[8] Secondary uterine perforation is silent and occurs due to slow migration of Copper T through the uterus with the concurrent bowel peristalsis, spontaneous uterine contractions, bladder contractions.[9] Migrated IUCD may not be discovered until it is found missing or patient become pregnant. Sometimes they may present with pain abdomen or urinary disturbances. Post-insertion women should have follow-up visits as recommended. First, visit should be at the first menstrual period or after 1-month, whichever is earlier. Subsequently after 3 months. Thereafter, once a year for the exclusion of infection, abnormal bleeding, the proper position of Copper T.[10] An IUCD user should be instructed to contact health care provider in case of: (a) IUCD threads cannot be felt, (b) she or her partner can feel the lower end of IUCD, (c) persistent abdominal pain, fever, dyspareunia, unusual vaginal discharge, (d) when she misses periods. All migrated IUCD must be removed as it can enter the peritoneal cavity and cause bowel and bladder perforation and fistula formation.

In our case report, Copper T was inserted by a health provider at peripheral hospital, and she did not have follow-up and patient came to know about missing Copper T when she was pregnant.

Conclusion