Intrauterine rupture of the intrauterine device “ML Cu 250” : an uncommon complication: presentation of a case

Abstract

We have reported on fragmentation on removal of an ML Cu 250. The patient's management is discussed and the possible causes of fragmentation presented, with special reference to the IUD materials and/or design.This paper presents a case of fragmentation on removal of an ML Cu 250 IUD. This device, which was introduced in 1974, has been widely and successfully used in multiparous and nulliparous women. The device is built as a small idented crown over a vertical copper-coiled stem. The patient in this case, a 36-year old woman with 3 previous vaginal deliveries, was seen for removal of the device 26 months after insertion. When vaginal extraction was attempted, the nylon string of the IUD broke. Ecotomography and x-rays revealed the IUD to be in a transversal position on the uterine fundus. A hysterectomy was deemed necessary for removal. At 1st effort, only the stem was removed. Further attempts yielded a fragment of the crown. Other fragments were not found after repeated trials. Although shedding of the IUD's copper coil is not uncommon in longterm IUD users, intrauterine fragmentation of the IUD frame is a rare complication. The literature includes 3 other reports of this complication in ML Cu 250 acceptors. This device is thought to be vulnerable to intrauterine fragmentation because of the combined effect of deep adhesions to the endometrium and low resistance points of the device frame. It is hypothesized that the adhesion is dependent on the crown teeth, which become embedded in the endometrial mucosa and determine both stiffness and high resistance to extraction. Comparative resistance trials are currently being conducted on several IUDs. Until the results of these trials become available, selective use and very cautious removal of the ML Cu 250 are advised.