Intrauterine contraceptive device rupture. Follow-up of a retrospective cohort and clinical protocol. RUDIUS study.

Objective: Intrauterine device fracture, as we know it today, is an infrequent event, usually described as isolated cases. The purpose of this study was to look for factors influencing intrauterine fragment retention after device rupture.

Study Design: Retrospective cohort study. A total of 135 patients were recruited, and the cohort follow-up ran for three full years from 2018 to 2020.

Results: Thirty-three percent of patients had a retained intrauterine fragment compared to 82 of 123 (66.7%) who had expelled it spontaneously. In the group of patients who had at least one intercurrent period between device fracture and confirmatory fragment persistent test, we found persistence of intrauterine fragment in 18 of 71 (25.4%) patients compared to 53 of 71 (74.6%) who did not (p = 0.047). A total of 6 of 39 (15.4%) of the patients with spontaneous rupture of the device presented with persistence of the intrauterine fragment compared to 32 of 81 (39.2%) of the group with fracture after manipulation (p = 0.006). The mean time elapsed from the fracture to the confirmatory test in the patients who had persistence of the fragment was 26.97 days (range from 0 to 116), while in those who expelled it spontaneously, a mean of 45.59 days (range 7-267) had elapsed (p = 0.003).

Conclusions: The main factors positively influencing complete expulsion of the fragmented IUD were elapsed time of 45 days or more, intercurrent menstruation or spontaneous fracture. Therefore, the proposed protocol calls for expectant management for at least 1.5 months after fracture, allowing at least one intercurrent period to elapse prior to any therapeutic manoeuvre.