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February 11, 1983

Perforated and Embedded Intrauterine Devices-Reply

JAMA. 1983;249(6):728-729. doi:10.1001/jama.1983.03330300020018

In Reply.—  Dr Wright used cervical hysterotomy in removing an IUD, which, from his description, appears to have been a type 1-2 partial perforation. He is to be congratulated on the fortunate outcome. Although the method served him well, we do not believe that it can be recommended as a routine or usual procedure in cases of partial perforation, particularly with the inadequate information provided by ultrasonography. In our series of 22 verified cases of perforated and embedded IUDs (unpublished data), there were eight cases of complete perforation, which need not concern us further, as well as seven cases of partial perforation and seven cases of deep embedding. Only one case was treated by cervical hysterotomy; a postoperative roentgenogram showed that a fragment of the IUD (metallic) had been left behind.Cervical hysterotomy goes a step beyond dilation and curettage by replacing the less accurate instrumental palpation by the more