Abstract
BackgroundThis biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound.MethodsWe obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available products and a metal sound.ResultsSixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p < .001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3 N (SD ± 3.8 N), followed by the copper T380A intrauterine device placement instrument 14.1 N (SD ± 4.0 N), and highest for the metal sound 17.9 N (SD ± 7.6 N) (p < 0.01).ConclusionsIn this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not.This study received Institutional Review Board (IRB0059096) approval.
Highlights
This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauter‐ ine device placement
This study aims to assess the forces involved in Intrauterine device (IUD) placement by examining the force generated by the placement instruments of two common IUDs and that of a metal sound
The number of observations per instrument varied as the available IUD placement instruments were used for three attempts unless damage to the device occurred
Summary
This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauter‐ ine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound. Manufacturer instructions and educational texts advise pelvic examinations, use of a uterine sound to measure cavity depth, and, if needed, an ultrasound as part of standard IUD placement practice [8,9,10]. The use of the rigid metal sound is suspected to be the most frequent mechanism of perforation, as IUD placement instruments use plastic tubing that is flexible and is suspected to bow when obstructed [6, 11]
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