Perforation with the GyneFix<SUP>®</SUP> intrauterine implant: is there a common factor?

Abstract

This report describes an asymptomatic perforation with the GyneFix ® intrauterine contraceptive implant. A review of all other reports of this complication has been performed. Analysis of these reports suggests prolonged amenorrhoea secondary to continuous progestogen use as a possible common predisposing factor. Case studyA 22-year-old nulliparous woman underwent fitting of a GyneFix ® intrauterine contraceptive device (IUD) at a family planning clinic. She had previously been using DepoProvera ® continuously for 4 years. Chlamydia screening at that time was negative and the procedure was carried out without incident by a clinician experienced in the insertion of this type of IUD. Two months later she returned to have the device removed in order to start a family but the threads could not be visualised. An ultrasound scan showed no evidence of the device within the uterus and an abdominal radiograph showed an extrauterine IUD in the midline above the pelvic brim (Figures 1 and 2).One month later the woman was seen in the gynaecology outpatient department and her only complaint was mild left iliac fossa pain. She was listed for laparoscopic removal of the device.At operation the GyneFix device was seen in an omental adhesion in the midline attached to the anterior abdominal wall. The omentum was dissected away revealing the GyneFix with its knot embedded in the abdominal wall. The device was retrieved laparoscopically and the patient was discharged home the same day.

Safety of Birth Control and Contraception: Pharmaceutical Companies on the Testing Bench

“…In their publication devoted explicitly to perforations with GyneFix, the authors not only discussed six cases of perforation but drew attention also to adhesions as one of the most common adverse events of copper-containing intrauterine devices. "Copper IUDs such as the GyneFix are thought to predispose the patient to adhesions once inside the peritoneal cavity [14]." As can be seen from the analysis of the information leaflet provided by the manufacturer of GyneFix, there is sufficient reason for the consumer to question the safety of the product and to turn to alternatives.…”

Intrauterine Contraception

“…53 However, numerous case reports of perforations with this device are published. [54][55][56][57][58][59][60][61][62]…”