Almost half a million women currently use the intrauterine contraceptive device in the United Kingdom (estimate of Family Planning Association based on data from manufacturers, clinics, and family practitioner committees). The complications associated with these devices are well described, and should be outlined to any woman considering their use.' Rarely, however, serious and even fatal complications occur, and in many cases avoidable factors are present. We describe four deaths associated with the use of an intrauterine contraceptive device and one tragic near fatality. Case reports Case 1-In 1978 a 26 year old woman presented to her general practitioner with mild lower abdominal pain, for which he found no cause. Two days later she complained of nausea and occasional vomiting but not of pain. Abdominal examination was again unremarkable, as it was the next day, when she complained of vague epigastric symptoms and was seen by a third doctor. Twenty tour hours later, after reporting only persistent anorexia and lethargy, the patient died in her own home. Seven months previously she had had a copper 7 intrauterine contraceptive device (Gravigard) inserted. The tail of this device had disappeared by the time of an examination at two months, but its presence within the pelvis had been confirmed by x ray examination, and pelvic examination at that time showed no abnormality. The patient died while waiting for curettage to remove the device. At necropsy, a loop of terminal ileum had strangulated round the thread attached to the perforated intrauterine contraceptive device, which had adhered to the lateral pelvic wall. The loop of bowel was isolated deep in the pouch of Douglas, accounting for the minimal symptoms and the lack of signs in the abdomen. A pelvic examination had not been performed. Case 2-In 1976 a 42 year old woman complained to her general practitioner of recent heavy and painful periods. A Saf-T-coil had been in situ for about 12 months. No evidence of pelvic disease was found on examination, and in an attempt to alleviate her symptoms the Saf-T-coil was removed and replaced with a copper 7 (Gravigard). Two days later she was admitted to hospital with gross pelvic sepsis, which progressed to peritonitis and septicaemia and resulted in her death.

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