Perforation of the Cervix by the Strings of An Intrauterine Device (IUD): А Novel Case Report and Systematic Review of the Literature

Abstract Purpose Since their introduction, intrauterine devices (IUDs) have been associated with various complications. Avery rare complication is the perforation of the cervix by the strings of the IUD. Purpose of the current study is to present a novel case of cervical perforation by the strings of a copper IUD and to perform a systematic review of the literature. Materials and Methods The patient a 43-year-old attended the gynecology clinic in order to remove her copper IUD. Speculum examination revealed that both the strings of the IUD perforated the anterior lip of the cervix. Management options were offered, the patient opted for a hysteroscopic removal. We searched the electronic databases: MEDLINE, Cochrane Library,Google Scholar,EBSCO for similar cases. Results Electronic search yielded 1821 articles; 8 were selected for inclusion. Mean age of the women was 35,37±7,781, range (26-47) years. One woman (12.5%) was nulligravida;3 women were multigravida (37,5%). Seven women (87,5%) were asymptomatic. Three IUDs (37,5%) were LNG-IUS; 5 IUDs (62,5%) contained copper. Conclusions Cervical perforation by the strings of IUD is an extremely rare clinical entity. It is asymptomatic in general and in most cases the strings of the IUD may be returned back to the endocervical canal after surgical maneuvers.