Secondary Perforation with Post Placental Intra Uterine Device: A Case Report

Contraception is an essential component of safe motherhood initiative, especially in countries having high fertility rate. Family planning is key to improved maternal health and provision of quality care in family planning services is critical to support higher levels of contraceptive uptake. Introduction of post-partum IUCD has opened opportunity to popularize its use. Several researches have established the Post-partum insertion of IUCD to be safe and effective contraceptive method for most women.^[1] Simplicity of insertion with few contraindications attracts both providers and clients. However, with exponential increase in its use many serious complications associated with the PPIUCD have also been described recently. The incidence of perforation with interval IUCD is between 1.3 and 1.6 per 1000 insertions^[2,9] although some studies report higher rates of up to 13 per 1000 insertions.^[2] Perforation can either be iatrogenic (primary) during insertion caused by inappropriate applied mechanical force or secondary which occurs spontaneously causing migration of the device.^[3] probably because of uterine spasm.^[4] Risks of perforating the uterus depend on the position of the uterus, insertion technique and the experience of the operator inserting IUD. Up to 15% of the perforation involves adjacent organs notably the bladder, small and large intestines.^[4] In this report, we present an unusual complication of the IUCD in which the device perforated the uterus with both of its arms.