Prevention of uterine perforation
Actions that can help to reduce the risk of uterine perforation associated with insertion of IUDs include:
Avoidance of insertion or taking extra care (with special consent) from 48 hours to 4 weeks postpartum, especially if the woman is breast-feeding
Use of a plastic rather than a metal sound
Use of a suitable tenaculum and applying appropriate traction to it
Provision of less rigid introducers by device manufacturers
Accurate setting of the flange on the introducer according to the sounding distance and the specific instructions for the device
A pull-back, rather than a push-out, release mechanism for the device
Skilled insertion training for clinicians
Insertion by experienced clinicians
There is no evidence that use of ultrasound control during the routine insertion of IUDs reduces the risk of perforation occurring. However, complex insertions (eg, after failed insertion elsewhere as a result of acute uterine ante- or retroversion or in cases of coexisting fibroids) are carried out under ultrasound guidance in many specialist centers, which will help to minimize the risk of uterine perforation. Ultrasound is also a very useful tool in verifying the location of an IUD/IUS after insertion, especially if there is concern about possible perforation