Pregnancy with Intrauterine Device Perforation: A Case Report

Although intrauterine devices (IUDs) are known for their low failure rate in pregnancy prevention, potential risks associated with their use include uterine perforation and migration through the abdomen. In this particular case, the patient experienced simultaneous IUD failure and perforation, with the device becoming embedded in an omentum. A 28-year-old woman who was 39 weeks plus one day gestation presented for caesarean section. During the caesarean section, it was discovered that the IUD had entered the omentum through a hole in the posterior part of the uterus. The result of the birth was a live boy. IUD perforation is most commonly observed during the insertion procedure; however, it may rarely occur at a later stage. IUD perforations are frequently asymptomatic and remain undetected until follow-up assessments are conducted or clinical manifestations become apparent. The presence of gastrointestinal symptoms is commonly observed in cases with intraperitoneal migration of the IUD. Although the occurrence of abdominal pain, diarrhoea, and fever with a missing IUD are indicative, they may not always be present. Nonspecific signs and symptoms lead to misdiagnosis and the consequent delay in initiating appropriate treatment. In the present case, the co-occurrence of IUD embedded in the omentum and pregnancy posed a challenge due to the device's rapid and imprecise shift, which complicated its accurate localisation. In such scenarios, ultrasonographic guidance can serve as a valuable tool to enhance accuracy and decrease adverse outcomes.