Dr Richardson correctly states that we advocate hysterography as the procedure of choice for demonstrating uterine perforation by an IUD.In Dr Richardson's patient, whose IUD string was missing six days after insertion of a Cu-7 IUD, intracavitary exploration did not reveal an IUD, and plain x-ray films (anteroposterior and lateral) showed that it was in the pelvis. At this stage, we would have immediately proceeded to hysterography, which can reliably distinguish between complete perforation, partial perforation, and deep embedding— distinctions that influence the therapeutic approach.1,2 Sonography cannot distinguish between a normally placed IUD and deep embedding; it can diagnose partial perforation, but cannot give the extent or variety (which is easily determined with hysterography); and it can diagnose complete perforation only when the IUD is close to the uterus.In this particular case, sonography, which was first resorted to, should theoretically have been diagnostic, since the
Zakin D, Stern WZ, Rosenblatt R. Uterine Perforation by Intrauterine Devices-Reply. JAMA. 1982;248(14):1710–1711. doi:10.1001/jama.1982.03330140024020
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