Uterine perforation by the multiload CU250 intra-uterine device.

A case of perforation of the uterus by the Multiload Cu250 IUD in a 28 year old Malay woman is presented. The Multiload Cu250 is a newer device, introduced in 1974, and the mode of insertion (withdrawal) makes perforation with this IUD unlikely and to date no such case had been reported. The patient, para 3, had a period of amenorrhea of 7 weeks. A menstrual regulation procedure was performed, and a Multiload Cu250 IUD was inserted. A right lower abdominal cramp was experienced by the patient soon after insertion. She continued to have this pain off and on thereafter, which compelled her to consult her general practitioner again 2 weeks later. On examination the nylon thread was not visible at the cervical os. A plain X-ray abdomen was performed and showed the stem of the IUD to be just above the level of the right iliac crest. At laparoscopy the IUD was found superficially embedded in the omentum at the right iliac fossa. Removal of the IUD was done with the aid of a Palmer biopsy forceps inserted through a separate incision suprapubically. The uterus appeared normal with no evidence of perforation. The postoperative recovery was uneventful. The Multiload IUD is unique in that its shape is broad and the withdrawal technique of insertion is unlikely to cause perforation at the time of insertion. The most likely predisposing cause of translocation in this patient is the soft postabortal uterus. Thus, caution is advised against immediate postabortal insertion of this IUD.