Uterine Perforation Research Articles

Transvaginal small bowel evisceration after cervical loop electrosurgical excision procedure: a case report

Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.

Hubungan Pengetahuan Ibu Menyusui Dengan Pemberian Kolostrum Di Wilayah Kerja Puskesmas Pargarutan Tapanuli Selatan Tahun 2023

Abortion can endanger the mother's health because it can cause bleeding, uterine perforation, infection and shock. Bleeding occurs due to not yet releasing all the products of conception from the endometrial wall, so that the blood vessels are always open to empty the uterus of the remaining products of conception. The next consequence of abortion is perforation, perforation occurs when scraping/curettage, if this happens it is necessary to carry out a laparotomy according to the extent of the perforation. Infection can occur due to the accumulation of dead and rotting products of conception in the body, causing infection, shock, can occur in cases of abortion due to severe infection or profuse bleeding. The incidence of abortion in Indonesia in 2012 was 4%. The aim is to determine the relationship between gestational age and distance with the incidence of abortion in 2023. termination of the pregnancy process before the gestational age is less than 28 weeks (Manuaba, 2010). Abortion is the ending of a pregnancy through any means, spontaneous or artificial, before the fetus is able to survive with limitations based on gestational age and body weight. This research is an observational analytical research with a research design control cases. The samples taken to support this research were all abortion patients at the Pargarutan Health Center, South Tapanuli, totaling 30 people.

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device.

To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)-cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management. Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success , defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red blood cell, intensive care unit admission, and hysterectomy) were evaluated by blood loss before insertion. To assess safety, serious adverse events (SAEs) and adverse device effects were collected. All outcomes were summarized by mode of delivery; treatment success was summarized by bleeding cause (all causes, any atony, isolated atony, nonatony). In total, 800 individuals (530 vaginal births, 270 cesarean births) were treated with the device; 94.3% had uterine atony (alone or in combination with other causes). Median total blood loss at device insertion was 1,050 mL in vaginal births and 1,600 mL in cesarean births. Across all bleeding causes, the treatment success rate was 92.5% for vaginal births and was 83.7% for cesarean births (95.8% [n=307] and 88.2% [n=220], respectively, in isolated atony). Median indwelling time was 3.1 hours and 4.6 hours, respectively. In vaginal births, 14 SAEs were reported among 13 individuals (2.5%). In cesarean births, 22 SAEs were reported among 21 individuals (7.8%). Three (0.4%) SAEs were deemed possibly related to the device or procedure. No uterine perforations or deaths were reported. For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was achieved with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The safety profile was consistent with that observed in the registrational trial (NCT02883673), and SAEs or adverse device effects were of the nature and severity expected in the setting of PPH. This device is an important new tool for managing a life-threatening condition, and timely utilization may help to improve obstetric hemorrhage outcomes. ClinicalTrials.gov , NCT04995887.

EFFICACY AND SAFETY OF INTRA CAESAREAN IUCD

The objective of this study was to evaluate the effectiveness and complications of post-partum intrauterine contraceptive device (PPIUCD) insertion during cesarean delivery. The study was conducted at Nishtar Medical Hospital from June to December 2022. A total of 150 women were included in the study. In the first phase, medical eligibility for the intervention was assessed, while in the second phase, WHO Medical Eligibility Criteria were evaluated. The IUCD was manually inserted after delivery with its string towards the cervix. The patients were followed up at 2 and 6 months. After 6 months, 9 (6%) cases reported abdominal pain, 22 (15%) had menorrhagia, and 23 (15.3%) had missed threads with the IUCD in place. None of the patients reported pregnancy or perforation of the uterus. After 6 months, 133 (88.6%) patients continued to use this method of contraception, while 9(6%) were lost to follow-up, 4 (2.6%) had the device removed due to complications, and 4 (2.6%) had spontaneous expulsion. The study concluded that PPIUCD is a safe and effective long-term contraceptive method. Clinicians should evaluate patients' eligibility for PPIUCD and counsel women on adopting this method.

Use of uterine manipulator and uterine perforation in minimally invasive endometrial cancer surgery.

Safety of the uterine manipulator (UM) within endometrial cancer (EC) surgery is being questioned. Its use might be one of the issues for potential tumor dissemination during the procedure, especially in the case of uterine perforation (UP). No prospective data on this surgical complication, nor on the oncological consequences exist. The aim of this study was to assess the rate of UP while using UM when performing surgery for EC and the impact of UP on the choice of adjuvant treatment. We conducted a prospective single-center cohort study from November 2018 to February 2022, considering all EC cases surgically treated by a minimally invasive approach with the help of a UM. Demographic, preoperative, postoperative and adjuvant treatment corresponding to the included patients were collected and comparatively analyzed according to the absence or presence of a UP. Of the 82 patients included in the study, 9 UPs (11%) occurred during surgery. There was no significant difference in demographics and disease characteristics at diagnosis that may have induced UP. The type of UM used or the approach (laparoscopic vs. robotic) did not influence the occurrence of UP (p=0.44). No positive peritoneal cytology was found post hysterectomy. There was a statistically significantly higher rate of lymph-vascular space invasion within the perforation group, 67% vs. 25% in the no perforation group, p=0.02. Two out of nine (22%) adjuvant therapies were changed because of UP. The median follow-up time for patients was 7.6 months (range 0.5-33.1 months). No recurrence was found in the UP group. Our study found a uterine perforation rate of 11%. This information needs to be further integrated to consider the usefulness of MU for EC surgery.

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices.

The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making. APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding. Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19-0.23%] at 1 year and 0.61% [95% CI 0.56-0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80-9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0-3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47-6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66-3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs. Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion. Bayer AG. EU PAS register, EUPAS33461.

Transvaginal Evisceration Following Uterine Perforation by Abortion Procedure: About a Case Treated at the Reference Health Center of Commune 1 of Bamako

We report a case of bowel evisceration following uterine perforation after an abortive manoeuvre by unqualified personnel. After the procedure, there was abundant vaginal bleeding and a complication was encountered: small bowel evisceration approximately 1 metre long via the vagina, certainly following the seizure of these small bowels and their successive traction which led first to the uterine cavity, then the vagina and finally to the vulva. Given the author's fear, the patient was referred urgently for treatment. After a transfusion of two units of blood and a triple laparotomy, a 1 m resection of the small intestine with end-to-end anastomosis was performed; suture of the uterine perforation and curettage of the cavity. The patient was discharged from the centre 10 days after surgery. Conclusion: This case shows the clandestine nature of induced abortions, which are responsible for multiple complications, including visceral lesions and uterine perforations.

Intestinal obstruction in pregnancy—a rare presentation of uterine perforation

BackgroundIntestinal obstruction is an uncommon non-obstetric condition during pregnancy which may cause maternal and fetal mortality. Clinicians are confronted with challenges in diagnosis and treatment of intestinal obstruction due to the overlapping symptoms, concerns over radiological evaluation, and surgical risks.Case presentationWe reported a 39-year old, gravida 7, para 2, woman who suffered from acute intestinal obstruction at 34 weeks of gestation. Ultrasonography and abdominal computed tomography were applied for intestinal obstruction diagnose. Conservative treatment was initially attempted. But following ultrasound found the absence of fluid in the amniotic sac and the patient showed no improvement in clinical symptoms. An emergency caesarean section was then performed. Intra-operative assessment showed dense adhesion between the left wall of uterus and omentum, descending colon, and sigmoid colon. After adhesion dialysis, uterine rupture with complete opening of the uterine wall at the site of left uterine cornua was found without active bleeding. The uterine rupture was then repaired.ConclusionsAlthough uncommon during pregnancy, clinical suspicion of bowel obstruction is necessary especially in women with a history of abdominal surgery. Surgical intervention is indicated when conservative therapy fails and when there are signs of abnormal fetal conditions and worsened symptoms.

Case Report on Misplaced and Malpositioned Fragmented IUCD

IUCD is one of the preferred forms of contraception that is reliable and cost effective. Nonetheless, IUCDs are not risk free and several complications have been reported, including unintended expulsion, misplacement and uterine perforation. Uterine perforation with an IUCD is uncommon, but it may have serious consequences including intra-abdominal bleeding, bowel or bladder perforation, fistula formation, especially when IUCD migrates to pelvic peritoneal spaces invading the adjacent organs. It is rare for IUCD to break during removal and fragments lodged in uterine cavity. We present a case of retained fragment of IUCD which was diagnosed after 3 years of its so called ‘removal’. The case report emphasizes the need to train doctors not only to insert IUCD but also to educate the women about potential risks and benefits and self-examination of IUCD thread for its correct placement.

Intra-operative tumor spillage in minimally invasive surgery for endometrial cancer and its impact on recurrence risk

ObjectiveThe prognostic impact of intra-operative tumor spillage (ITS) during minimally invasive surgery (MIS) for endometrial cancer (EC) is not well studied. The objective of this study was to determine if there is an association between ITS and EC recurrence. MethodsWe performed a case-control study of patients with a laparoscopic or robot-assisted hysterectomy with EC on final pathology between 2017 and 2022 and compared those with (case) and without (control) a subsequent EC recurrence. Electronic medical records were reviewed for demographic, intra-operative and pathologic details, and recurrence status. ITS was defined as uterine perforation with a manipulator, presence of extra-uterine tumor after colpotomy or specimen delivery, exposure of uncontained specimen into peritoneum, and/or pathology/operative reports noting specimen fragmentation. Conditional logistic regression was used to determine odds ratios for the association of cancer recurrence with ITS. We adjusted for >50% myoinvasion, tumor size, and adjuvant treatment. Results1057 patients underwent MIS for EC. Approximately 8% (n = 86) developed recurrent cancer and 172 patients were selected as controls. Twenty percent of recurrent cases (17/86) had ITS compared with 4% of nonrecurrent controls (7/172). When adjusted for tumor size, deep myoinvasion, and adjuvant treatment, patients with ITS had a 5.6 times increased odds (aOR 5.63, 95% CI 1.52–20.86) of recurrence compared to patients without ITS. ConclusionsIn patients with EC, we found an association between ITS and cancer recurrence. These findings warrant further investigation to determine if adjuvant therapy or surgical technique should be altered to improve outcomes.

P-531 Effectiveness and safety of uterine septum division: An updated systematic review and meta-analysis

Abstract Study question To evaluate whether division of uterine septum improves reproductive outcome as compared to no intervention and is a safe procedure. Summary answer While septal division doesn’t seem to improve live birth and clinical pregnancy rates or reduce miscarriage rates, it has improved preterm birth and malpresentation rates. What is known already Septate uteri are common congenital uterine malformations and are seen in about 1% of women. While most women with septate uterus have normal reproductive outcome, studies have reported increased risk of adverse reproductive outcome including miscarriages in women with septate uterus. Hysteroscopic metroplasty or hysteroscopic transcervical division of the uterine septum has been regularly done with an intention to improve the outcome, although evidence on its effectiveness is conflicting. A systematic review of controlled studies done in 2014 has shown a potential benefit, but later studies including a recent randomized controlled trial (RCT) has shown no benefit. Study design, size, duration In this systematic review and meta-analysis, Medline and Cochrane Library databases were searched from commencement to December 2022. We identified 13 eligible studies of which 12 were non-randomised controlled studies and one RCT, comprising 1855 women. Participants/materials, setting, methods We included comparative studies of septal division versus non-intervention in women having septate uterus with a history of infertility or recurrent miscarriage. The outcomes assessed were live birth, clinical pregnancy, miscarriage, preterm birth, malpresentation and complications. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Statistical analysis was performed using Review Manager 5.4.1 software. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random effects models. Main results and the role of chance The live birth rates were similar for the septal division and non-intervention groups (OR: 1.48; 95% CI 0.86-2.56). The clinical pregnancy rates (OR: 1.24; 95% CI 0.64-2.39) and miscarriage rates (OR: 0.61; 95% CI 0.35-1.06) were also similar. The preterm birth rates (OR: 0.67; 95% CI 0.47-0.95) and malpresentation at birth (OR: 0.34; 95% CI 0.23-0.53) were lower in patients managed surgically. The complication rates were reported in four studies and were ranging between 2.6% and 9.4% with the main reported complication being uterine perforation. Limitations, reasons for caution While the review included comparative studies, only one was RCT. High level of heterogeneity between studies was observed. Many had different inclusion and/ or exclusion criteria and used different diagnostic modalities and criteria. Wider implications of the findings The findings of our review help in counselling women seeking septal division, particularly of lack of benefit in improving live birth rates or reducing miscarriage, but may reduce preterm births and malpresentation. Due to the heterogeneity of the included studies and low-quality evidence, large multicentre RCTs are warranted. Trial registration number not applicable

P-530 Which evacuation method for missed abortion is preferred by women with recurrent pregnancy loss?

Abstract Study question Is medical or surgical evacuation for missed abortion (MA) preferred by women with recurrent pregnancy loss (RPL)? Which factors are determining for the women’s preference? Summary answer Sixty-seven percent of the participants preferred surgical evacuation. Side effects and a history of unsuccessful medical evacuation in their first MA were determining factors. What is known already Guidelines currently recommend medical rather than surgical evacuation after MA. The success rates defined as adequate evacuation of the uterine cavity after MA without further intervention are reported to be 80% and 97% for medical and surgical evacuation, respectively. Medical evacuation is associated with heavier and longer duration of bleeding and higher intensity of pain. Surgical evacuation increases the risk of uterine perforation and Asherman’s syndrome. Studies have found that women are more satisfied and have better subsequent mental health when they can decide themselves which method they would choose. Study design, size, duration An online questionnaire was sent October 5th, 2022, to 157 RPL patients who had experienced both medical and surgical evacuation for MA admitted to a center for RPL between January 2016 and September 2022. Eighty-seven (55.4%) patients completed the survey before deadline after being sent reminders. Sixty (69%) of the women had received a medical evacuation and 27 (31%) surgical evacuation for their first MA. Participants/materials, setting, methods The mean age of the respondents was 37 years (SD ± 0.5) and they had had at least three pregnancy losses. The questionnaire featured questions regarding the women’s experiences with medical and surgical evacuation, preferred evacuation method if they would have another MA, and determining factors for their preference. Categorical variables were compared using χ2 test and Wilcoxon Signed Rank Test. Analyses were conducted to determine associations between potential determining factors for preferred evacuation method. Main results and the role of chance A significantly higher intensity of pain was experienced, and analgesics were required for a significantly longer period after a first medical evacuation compared to a first surgical evacuation (p < 0.001 and p = 0.006). Bleeding, pain, sick leave, and mental discomfort had a significant impact on the choice of another evacuation method at the time of next MA in women who experienced a medical abortion first. As many as 40% had experienced failure of the first medical evacuation with need for subsequent surgical evacuation for complete evacuation; this was confirmed by consulting the patient’s medical records. The odds ratio (OR) for preferring medical evacuation at next MA was 3.3 if the women had given birth before (p = 0.011). The OR for preferring medical evacuation at next MA was 0.3, if the women had received medical evacuation for their first MA (p = 0.015). There were no statistically significant associations between preferring medical evacuation and the following factors: BMI, age at first evacuation and menstrual pain. Two thirds (66.7%) of the women would prefer surgical evacuation for their next MA, while the remaining women (33.3%) would prefer medical evacuation. Limitations, reasons for caution The response rate of 55.4% was lower than expected 70% which implicates a risk of sampling bias such as a predominance of patients with a history of complicated evacuations responding to the questionnaire. Due to the retrospective design, recollection bias could also impact the results. Wider implications of the findings In this study population, medical evacuation was associated with a stronger experience of side effects and a higher failure rate than expected, which may explain why more women preferred surgical evacuation for their next MA. This may suggest current evacuation recommendations for MAs should become more individualized than currently. Trial registration number Not applicable

Complication rate after termination of pregnancy for fetal defects.

To assess the risk of complications in women undergoing termination of pregnancy (TOP) for fetal defects and to examine the impact of gestational age on the complication rate. This was a retrospective study of women with a singleton pregnancy undergoing TOP at the University Hospital of Tübingen, Germany, between 2018 and 2021. TOP was performed by experienced operators according to the national protocol; dilatation and curettage (D&C) or evacuation (D&E) was used in the first and early second trimesters and induction was used later in pregnancy. The following were considered to be significant procedure-related complications: blood loss of more than 500 mL, uterine perforation, need for blood transfusion, allergic reaction, creation of a false passage (via falsa), systemic infection, readmission to hospital, any unplanned surgical procedure, such as repeat D&C/D&E or hysterectomy, and maternal death. The search of the hospital database identified 416 pregnancies that met the study criteria. Median maternal and gestational age at termination were 34.1 years and 17.4 weeks, respectively. In the first, second and third trimesters, respectively, 84 (20.2%), 278 (66.8%) and 54 (13.0%) pregnancies were terminated, for which D&C or D&E was used in 80 (95.2%), 21 (7.6%) and 0 (0.0%) cases. Seventy-seven (18.5%) women had at least one previous Cesarean section and 169 (40.6%) had at least one previous spontaneous delivery. Overall, 95 (22.8%) women had complications during or after TOP. A significantly higher complication rate was noted for terminations performed later in pregnancy. The median gestational age at termination was 16.6 weeks in women who did not experience complications and 20.7 weeks in those with complications (P < 0.001). The respective complication rates in the first, second and third trimesters were 6.0%, 27.0% and 27.8%. In women undergoing TOP for fetal defects, the risk of complications increases with advancing gestational age. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge

Spontaneous uterine perforation resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. Definitive diagnosis can be made with laparotomy or laparoscopy. We report a case of 62 years old female patient who presented with acute generalized peritonitis with pneumoperitoneum having history of pigtail insertion right kidney for right non-functional kidney with gross hydronephrosis two days back, which was more complicating the clinical picture. This case report aims to alert surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation.

Laparoscopic management of an invasive mole combined with iatrogenic uterine perforation

ObjectiveHydatidiform mole is a common placental proliferative disease which is harmful to women's reproductive health. It is characterized by abnormal fertilization and subsequent trophoblastic proliferation. Invasive mole originates from hydatidiform mole, but its pathogenesis is still unclear. It has been reported that hydatidiform mole mainly develop with the uterine cavity. Invasive mole caused by iatrogenic uterine perforation is rarely reported. Here, we reported a rare case of invasive mole initially presented with uterine iatrogenic perforation after suction curettage. Case reportA 25-year-old nulliparous woman (gravida 1 para 0) who presented with acute hemoperitoneum was admitted to our hospital. Her clinical manifestation was mimicked by uterine iatrogenic perforation, and mole tissues were found on the left posterior wall of uterus. Laparoscopic management was performed to clear the lesions away thoroughly and repair the uterus. The operation was successful, and the reproductive function was preserved. The patient gave a birth to a healthy baby four years after the operation. ConclusionLaparoscopic minimally technique plays a very good therapeutic effect on invasive mole initially presented with iatrogenic uterine perforation.

P-012 GARENGEOT'S HERNIA WITH ACUTE APPENDICITIS: A RARE CASE

Abstract Garengeot's hernia is a rare entity that refers to the herniation of the vermiform appendix through the femoral canal, being even rarer the presence of acute appendicitis in a Garengeot hernia as presented in the clinical case, with an overall incidence of 0,08%-0,13%. A 52 years old female patient, attended the Emergency Service complaining of abdominal pain in the right lower quadrant and fever for the last 2 days. As pathological background, she had bilateral tubal ligation, right crural hernioplasty and iatrogenic uterine perforation after placement of a intrauterine device (IUD). On physical examination, she complained of pain in iliac fossa/right inguinal region showing a positive Blumberg sign. Abdominal ultrasonography revealed acute appendicitis. In the laparoscopic approach, we identified the ileocecal appendix contained in a right crural hernia with abscessed acute appendicitis. We proceeded with appendectomy and, given the soiling of operative field, we chose not to correct the hernia at that moment. Empirical antibiotic therapy with Amoxicillin/Clavulanic acid was performed and patient was discharged after 3 days. Diagnosis of Garengeot hernia with acute appendicitis is difficult, being more frequently diagnosed intraoperatively. There's no standard therapeutic approach regarding hernia repair simultaneously, being licit not to do it due to the risk of postoperative infection.

Spontaneous Uterine Perforation Mimicking Acute Abdomen

Spontaneous Uterine Perforation Mimicking Acute Abdomen

Study Participants' and Clinicians' Experiences With Placement of a Novel Low-Dose Copper Intrauterine Device With a Nitinol Frame in Nulliparous Versus Parous Participants [ID: 1374840

INTRODUCTION: Clinicians may perceive intrauterine device (IUD) placement to be more challenging for nulliparous versus parous users. This study assesses nulliparous versus parous study participants' and clinicians' experiences with placement of a novel, low-dose copper (175 mm2) IUD with a flexible nitinol frame. METHODS: This single-arm, IRB-approved, phase 3 clinical trial recruited pregnancy-capable people aged 17–45 at 42 U.S. centers. We compared nulliparous and parous participants' experiences for first IUD placement attempt including successful placement, participant-reported pain (on an 11-point numeric pain rating scale), investigator-reported ease of IUD placement (on a 5-point Likert scale), need for mechanical cervical dilation, and uterine perforation. RESULTS: Of 1,620 participants enrolled, 973 (60.1%) reported nulliparity and 647 (39.9%) parity. Successful IUD placement occurred at first attempt for 929 (96.0%) nulliparous versus 625 (96.6%) parous participants. Including second attempts, successful placement occurred for 1,601 (98.8%) participants. Nulliparous participants reported a mean pain score of 5.6 (±2.19) versus 4.0 (±2.55) for parous participants (P&lt;.001), and investigators more frequently reported hard or very hard IUD placement in 81 (8.4%) nulliparous versus 22 (3.4%) parous participants (P&lt;.001). Among nulliparous participants, 203 (21.2%) reported pain-related adverse events associated with placement versus 65 (10.1%) in parous participants (P&lt;.001). Mechanical dilation was required for 202 (20.8%) nulliparous versus 79 (12.2%) parous participants (P&lt;.001). Uterine perforation occurred in 1 nulliparous (0.10%) and 1 parous participant (0.15%). CONCLUSION: Despite experiencing more challenging IUD placements than parous participants, nulliparous trial participants experienced similar IUD placement success with this novel, low-dose copper IUD.

A RARE PRESENTATION OF PYOPERITONITIS DUE TO UTERINE PERFORATION SECONDARY TO SEPTIC ABORTION

The main objective of this study to sensitize about an issue of reproductive health which is most controversial and carries the heaviest burden of stigmatization. Although abortion services in India were liberalized more than 3 decades ago, still we are facing problems of illegal septic abortion. We are presenting a rare case of 40 year old G3P2L1D1 with 3-4 months of amenorrhea with uterine perforation secondary to septic abortion. She was taken for emergency exploratory laparotomy, we found pyoperitoneum with foul smelling pus pockets in pelvis, sub hepatic and uterovesical space, uterine rent of 4cm x 3cm. Also there was decomposed fetal skull bones adherent to bowel and omentum. In these case, patient morbidity was due to sepsis and delay in taking treatment

What Is the Most Cost-Effective Timing for Postpartum IUD Insertion? [ID: 1379571

INTRODUCTION: Postpartum intrauterine device (IUD) insertion is an effective contraception choice for reducing rates of unplanned and short-interval pregnancies. However, timing of placement is controversial, and risk of perforation and expulsion vary with timing. We aim to analyze the cost-effectiveness of postpartum IUD insertion intervals when considering risk of perforation or expulsion. METHODS: A decision-analytic model compared four intervals of postpartum IUD insertion: between 0 and 3 days, 4 days and 6 weeks, 6 and 14 weeks, or 14 and 52 weeks postpartum. A theoretical cohort of 600,000 was calculated using the estimate that 15.3% of postpartum people receive a long-acting reversible contraceptive. Probabilities, costs, and utilities were procured from the literature. Primary outcomes included IUD-related uterine perforation, expulsion, unplanned short-interval pregnancy, termination, stillbirth, ectopic pregnancy, and preterm delivery. The cost-effectiveness threshold was $100,000/quality-adjusted life-year (QALY). RESULTS: IUD insertion between 6 and 14 weeks postpartum was the cost-effective strategy despite having 1,978 and 1,982 additional perforations in intervals between 0–3 days and 14–52 weeks, respectively. All other outcomes were reduced. When compared to the intervals of 0–3 days, 4 days–6 weeks, and 14–52 weeks postpartum, this strategy resulted in 3,054, 282, and 3,816 more QALYs and decreased costs by $91 million, $22 million, and $316 million, respectively. CONCLUSION: Intrauterine device insertion between 6 and 14 weeks postpartum is the cost-effective strategy despite increased risk of perforation. Appropriately counseling patients on the risks and benefits associated with timing of IUD insertion is an important component of postpartum care.