What Is a Perforated Uterus? Causes, Signs & Treatment

A perforated uterus is a hole or tear through the wall of the uterus, most often caused by a medical instrument or device passing through the muscular layer and into the abdominal cavity. The perforation can be partial, meaning the instrument or device lodges within the uterine wall itself, or complete, meaning it passes all the way through into the surrounding space. While the term sounds alarming, most uterine perforations are small, and the majority heal without lasting harm when recognized and managed promptly. The story gets more complicated, though, when a perforation goes undetected or when nearby organs are involved.

What Happens When the Uterine Wall Is Breached

The uterus is a muscular organ roughly the size and shape of an upside-down pear. Its wall has three layers: an inner lining (the endometrium), a thick muscular middle layer (the myometrium), and a thin outer coating (the serosa). When clinicians talk about perforation, they are really talking about what happens to that thick middle layer. One widely used classification system treats the myometrium as the defining barrier and describes three compartments: the uterine cavity itself, the muscular wall, and the peritoneal cavity beyond it. A partial perforation means a device or instrument has entered the muscular wall but hasn’t emerged on the other side. A complete perforation means it has passed entirely through and reached the abdominal cavity.

This distinction matters because it determines what can go wrong next. A device that sits partly within the muscle may cause pain or bleeding but is still somewhat contained. One that has migrated fully into the abdomen can, over time, drift toward the bowel, bladder, or omentum, sometimes embedding itself in tissue far from where it started.

IUD Insertion and Perforation Risk

Intrauterine device insertion is the single most commonly discussed cause of uterine perforation, in part because IUDs are used by tens of millions of people worldwide and in part because the perforation sometimes isn’t caught until much later. Estimates of how often it happens vary, but one well-known study from a region in the Netherlands found an incidence of roughly 2.6 per 1,000 insertions of a hormonal IUD, with breastfeeding at the time of insertion standing out as a strong risk factor.

Several factors raise the odds. A large case-control study found that higher parity (having had more deliveries), fewer follow-up visits after insertion, and having the device placed by a less experienced provider were all significantly linked to perforation risk. Breastfeeding and recent delivery have repeatedly surfaced as concerns in the research: a Lancet analysis confirmed that breastfeeding at the time of IUD insertion and insertion within about 36 weeks after delivery are both associated with increased perforation risk. The likely explanation is that the postpartum, breastfeeding uterus is softer and thinner than usual, making it easier for the inserter to push through the wall.

The reassuring side of this picture is that IUD-related perforation is still uncommon in absolute terms. And many cases are partial perforations that cause no symptoms at all. But when it does happen, the consequences range from simply needing the device removed to requiring surgery if it has migrated into the abdomen.

Other Procedures That Can Cause Perforation

IUDs get the most public attention, but several other gynecological procedures carry perforation risk as well.

Dilation and Curettage

D&C is one of the most commonly performed gynecological procedures, used to manage miscarriage, remove retained tissue after delivery, or obtain a tissue sample for biopsy. A study of over 5,000 nonobstetric D&C procedures found a perforation rate of about 0.9%, with nearly all perforations occurring at the top of the uterus (the fundus). The same analysis identified a retroverted uterus (one that tilts backward), postmenopausal status, and never having been pregnant as significant predictors of complications. A retroverted uterus changes the angle the instrument must follow, making it easier to accidentally push through the wall if the clinician isn’t aware of the anatomy.

Operative Hysteroscopy

Hysteroscopy involves inserting a thin camera and sometimes a cutting instrument into the uterus. In a series of over 2,100 operative hysteroscopies, perforations occurred in about 1.6% of cases. Almost all of those were caught during the procedure itself, and most happened either during cervical dilation or while the resecting instrument was being used inside the cavity. When a perforation was detected, the procedure was stopped, ultrasound was used to check for fluid leaking into the abdomen, and in a small number of cases a diagnostic laparoscopy was performed to rule out injury to nearby organs.

Brachytherapy Applicator Placement

In cervical cancer treatment, a radioactive applicator called a tandem is inserted into the uterus. This is another setting where perforation can occur, and one where real-time ultrasound guidance has made a measurable difference. Studies from centers that adopted intraoperative ultrasound found that the technique substantially reduced perforation rates compared to placement without imaging, and in one series guided placement was associated with no confirmed perforations at all.

Spontaneous Perforation Without a Procedure

Though rare, the uterus can perforate on its own. The most recognized scenario involves pyometra, a condition in which pus accumulates inside the uterus, typically in postmenopausal women whose cervical canal has become blocked. The blockage may be caused by a tumor, a polyp, or simple narrowing of the cervix with age. As pressure builds, the weakened, atrophic uterine wall eventually gives way. When the infected contents spill into the abdominal cavity, the result is peritonitis, which can rapidly progress to sepsis.

Case reports describe postmenopausal women arriving at the emergency department with abdominal pain, fever, and vomiting, only to have imaging reveal free fluid in the abdomen and a perforation at the top of the uterus. In one reported case of an 87-year-old woman, surgeons found a perforation roughly two centimeters across at the fundus. These cases are surgical emergencies that require laparotomy, washout of the abdominal cavity, and often hysterectomy.

What Perforation Feels Like, and When It Doesn’t

The signs of uterine perforation depend entirely on when it happens and how much damage is involved. During a procedure, a sudden loss of resistance in the instrument, unexpected pain, or the instrument advancing farther than the measured depth of the uterus can all signal perforation to the clinician. For the patient, acute abdominal pain, heavy vaginal bleeding, and signs of internal bleeding such as a drop in blood pressure or a racing heart rate are the classic warning signs.

But a striking number of perforations produce no symptoms at all. In a systematic review of IUD-related cervical perforations, seven out of eight women were completely asymptomatic. A larger study of IUD perforations found that roughly 30% of women had no symptoms; their perforations were discovered only because the IUD strings couldn’t be found during a routine check or because the woman became pregnant unexpectedly. A case report describes a woman with a copper IUD that had silently perforated the uterus after a cesarean section, discovered only on fluoroscopic imaging.

This silent presentation is one of the more unsettling aspects of the condition. If you have an IUD and can no longer feel the strings, or if a provider can’t locate them, that doesn’t automatically mean perforation has occurred. But it does warrant imaging, typically an ultrasound, to confirm the device is still in the right place.

How Perforation Is Diagnosed

Ultrasound is the first-line imaging tool. It can reveal secondary signs of a wall injury, including free fluid in the pelvis, an IUD located outside the uterine cavity, or an irregularity in the uterine wall itself. Sometimes the actual perforation site is visible; more often, the diagnosis is inferred from where the device has ended up or from the presence of fluid that shouldn’t be there.

When ultrasound findings are inconclusive or when clinicians suspect that nearby organs like the bowel may be involved, CT scanning provides a more comprehensive picture. CT is especially valuable in emergency situations, where it can show the exact position of a migrated device, detect bowel injury, and reveal abscesses or fluid collections that ultrasound might miss. In some cases, a plain X-ray of the abdomen is enough to confirm that an IUD has left the uterus, though it won’t show soft-tissue detail.

Treatment Approaches

Not every uterine perforation requires surgery. Management depends on how severe the injury is, whether the patient is stable, and whether any surrounding organs are involved.

Conservative Management

When a small perforation is recognized during a procedure and the patient’s vital signs are stable, close observation may be all that’s needed. The uterus has a good blood supply and muscular tissue that contracts and heals relatively well. Clinicians will typically monitor for worsening pain, signs of infection, or drops in blood counts. A case report from sub-Saharan Africa documented successful conservative management of a perforation with omental herniation after D&C: because the patient remained stable with normal lab values, surgery was avoided.

Surgical Intervention

When a device has migrated into the abdomen, when there’s active internal bleeding, or when bowel or bladder injury is suspected, surgery becomes necessary. The standard recommendation for a perforated IUD is removal, and laparoscopy (keyhole surgery) is typically the preferred approach unless bowel perforation or severe infection is present. In one reported case, surgeons used laparoscopy to remove an IUD that had migrated into the fat surrounding the rectum. In another, a device that had embedded in the intestinal wall required a segment of bowel to be resected, but surgeons were still able to perform the procedure laparoscopically using specialized retraction devices.

For spontaneous perforations caused by pyometra, the situation is more urgent. These patients often present with sepsis and need emergency laparotomy, abdominal washout, antibiotics, and frequently a hysterectomy to remove the source of infection.

Fertility and Future Pregnancies After Perforation

One of the first questions many patients ask after experiencing a uterine perforation is whether they’ll be able to become pregnant again. The evidence here is largely reassuring, with some caveats. A study tracking 50 women who became pregnant after a prior uterine perforation documented 71 deliveries. The vast majority went smoothly, with no major complications. However, one woman experienced a uterine rupture at 24 weeks of a later pregnancy. Her original perforation had occurred during postpartum curettage, and the rupture happened at the same site. An emergency cesarean section was performed, but the baby did not survive due to complications of extreme prematurity.

That case is sobering but also appears to be exceptional in the published data. The same study found no other major complications among the remaining pregnancies. A separate review examining pregnancies after operative hysteroscopy noted that the combination of prior perforation and the use of electrosurgery raised the risk of rupture in a subsequent pregnancy, though neither factor alone was considered an independent risk factor. The takeaway for someone planning a pregnancy after a perforation: it’s possible and usually safe, but your obstetric team needs to know about the history so they can monitor the uterine wall during pregnancy, particularly in the third trimester.

How Providers Work to Prevent Perforation

Prevention centers on training, technique, and technology. For IUD insertion, knowing the depth and orientation of the uterus before placement is fundamental. Using a uterine sound (a thin measuring rod) to gauge cavity depth, proceeding slowly, and being especially cautious in postpartum or breastfeeding patients all reduce risk. Provider experience matters: as the case-control study noted earlier found, devices placed by less experienced clinicians were more likely to result in perforation.

For operative hysteroscopy and other intrauterine procedures, real-time ultrasound guidance has emerged as one of the most effective safeguards. By watching the instrument’s position on an ultrasound screen as it moves inside the uterus, the surgeon can see when the tip approaches the outer wall and stop before going through. Studies on both resectoscopic surgery and brachytherapy applicator placement have documented reduced perforation rates when intraoperative ultrasound is used. One early study described ultrasound guidance as providing “the exact location of the instruments within the uterine cavity and uterine wall,” offering a noninvasive way to prevent inadvertent perforation.

When Perforation Leads to Legal Claims

Uterine perforation is the leading reason patients file malpractice claims related to hysteroscopy. A retrospective review of hysteroscopy-related legal cases found that perforation accounted for about 53% of all claims, far outpacing other complications. The most common outcome prompting a lawsuit was the need for additional corrective surgery, which occurred in roughly 71% of claimants. Among those who needed follow-up surgery, the vast majority required emergency procedures. More troubling, about 24% of the total cases involved permanent brain damage or death, typically from unrecognized injury that progressed to internal bleeding or sepsis.

These numbers don’t mean perforation itself is usually catastrophic. They mean that when perforation goes unrecognized or is managed poorly, the consequences can be severe enough to generate litigation. The legal data underscores the importance of informed consent: patients should be told before any intrauterine procedure that perforation is a known risk, how likely it is, and what would happen if it occurred. A patient who understands the risk in advance and receives timely treatment is far less likely to pursue legal action than one who feels blindsided.

Emotional Fallout and the Psychological Dimension

Medical literature on uterine perforation focuses almost entirely on the physical injury and its surgical management. What gets much less attention is the psychological impact, especially for women who still want to become pregnant. Research on the emotional aspects of gynecological surgery in general has found that women who desire future pregnancies report significantly more intense anxiety symptoms and greater difficulty relaxing around the time of their procedures compared to women who have completed their families. They also show higher levels of hostility in the perioperative period. While this research wasn’t specific to perforation, it captures the emotional landscape that a perforation diagnosis sits within: a sense that your reproductive future has been put at risk by something that wasn’t supposed to happen.

For women who experience a perforation during a routine procedure like IUD insertion or D&C, the emotional reaction can include shock, anger, loss of trust in the medical system, and anxiety about future pregnancies. These feelings are entirely valid and often go unaddressed in clinical follow-up that focuses on the wound rather than the person. If you’ve experienced a perforation, asking your provider about counseling resources or connecting with patient communities can be as important as the physical follow-up visits.

Adhesions and Other Long-Term Concerns

Beyond the immediate injury and the question of future fertility, perforations can leave behind adhesions, which are bands of scar tissue that form between internal organs or between organs and the abdominal wall. One study of IUD-related perforations noted that adhesions were among the most common surgical findings when perforated devices were later removed. Copper IUDs in particular seemed to provoke more adhesion formation than hormonal devices. Adhesions can cause chronic pelvic pain, bowel symptoms, or fertility problems of their own, so their presence adds another layer to the long-term picture after a perforation.

In rare cases, a migrated IUD can become embedded in the omentum (the fatty apron that drapes over the intestines), the bladder wall, or the bowel itself. These situations almost always require surgical retrieval, and the complexity of the surgery depends on how deeply embedded the device has become and how much surrounding tissue is involved. Omental incarceration, where a loop of omentum gets caught in the perforation site, has also been described and may require operative management even when the patient initially appears stable.

¹ ² ³ ⁴ ⁵

Wait, I need to redo this. The citations should be inline, not dumped at the end. Let me rewrite properly.

A perforated uterus is a hole or tear through the wall of the uterus, most often caused by a medical instrument or device passing through the muscular layer and into the abdominal cavity. The perforation can be partial, with the device or instrument lodging within the uterine wall, or complete, with it passing all the way through into the surrounding peritoneal space.² While the term sounds alarming, most uterine perforations are small, and the majority heal without lasting harm when recognized and managed promptly. The picture gets more complicated when a perforation goes undetected or when nearby organs are involved.

What Happens When the Uterine Wall Is Breached

The uterus is a muscular organ roughly the size and shape of an upside-down pear. Its wall has three layers: an inner lining (the endometrium), a thick muscular middle layer (the myometrium), and a thin outer coating (the serosa). When clinicians talk about perforation, they are really talking about what happens to that thick middle layer. One widely used classification system treats the myometrium as the defining barrier and describes three compartments: the uterine cavity itself, the muscular wall, and the peritoneal cavity beyond it.¹ A partial perforation means a device or instrument has entered the muscular wall but hasn’t emerged on the other side. A complete perforation means it has passed entirely through and reached the abdominal cavity.

This distinction matters because it determines what can go wrong next. A device sitting partly within the muscle may cause pain or bleeding but is still somewhat contained. One that has migrated fully into the abdomen can drift toward the bowel, bladder, or omentum over time, sometimes embedding itself in tissue far from where it started.

IUD Insertion and Perforation Risk

Intrauterine device insertion is the most commonly discussed cause of uterine perforation, partly because IUDs are used by tens of millions of people worldwide and partly because the perforation sometimes isn’t caught until much later. Estimates of how often it happens vary by study design and device type, but one well-known analysis from a region in the Netherlands found an incidence of roughly 2.6 per 1,000 insertions of a hormonal IUD.³ That same study identified breastfeeding at the time of insertion as a strong risk factor, even when the insertion took place more than six weeks after delivery.

Several other factors raise the odds. A case-control study found that higher parity, fewer follow-up visits after insertion, and having the device placed by a less experienced provider were all significantly linked to perforation.⁴ A large Lancet analysis confirmed that breastfeeding at the time of IUD insertion and insertion within 36 weeks postpartum are both associated with increased perforation risk.⁵ The likely explanation is that the postpartum, breastfeeding uterus is softer and thinner than usual, making it easier for the inserter to push through the wall.

The reassuring side of this picture is that IUD-related perforation is still uncommon in absolute terms. And many cases are partial perforations that cause no symptoms whatsoever. But when it does happen, the consequences range from simply needing the device removed to requiring surgery if it has migrated into the abdomen.

Other Procedures That Can Cause Perforation

IUDs get the most public attention, but several other gynecological procedures carry perforation risk.

Dilation and Curettage

D&C is one of the most commonly performed gynecological procedures, used to manage miscarriage, remove retained tissue after delivery, or obtain tissue for biopsy.⁶ A study of over 5,000 nonobstetric D&C procedures found a perforation rate of about 0.9%, with nearly all perforations occurring at the top of the uterus (the fundus). That analysis identified a retroverted uterus (one that tilts backward), postmenopausal status, and never having been pregnant as significant predictors of complications.⁷ A retroverted uterus changes the angle the instrument must follow, making it easier to accidentally push through the wall.

Operative Hysteroscopy

Hysteroscopy involves inserting a thin camera and sometimes a cutting instrument into the uterus. In a series of over 2,100 operative hysteroscopies, perforations occurred in about 1.6% of cases. Almost all were caught during the procedure itself, and most happened either during cervical dilation or while the resecting instrument was being used. When a perforation was detected, the procedure was stopped and ultrasound was used to check for fluid leaking into the abdomen. In a small number of cases, a diagnostic laparoscopy was performed to rule out injury to nearby organs.⁸

Spontaneous Perforation Without a Procedure

Though rare, the uterus can perforate on its own. The most recognized scenario involves pyometra, a condition in which pus accumulates inside the uterus, typically in postmenopausal women whose cervical canal has become blocked. The blockage may be caused by a tumor, a polyp, or simple narrowing of the cervix with age. As pressure builds, the weakened, atrophic uterine wall eventually gives way.⁹ When the infected contents spill into the abdominal cavity, the result is peritonitis, which can rapidly progress to sepsis.¹⁰

Case reports describe postmenopausal women arriving at the emergency department with abdominal pain, fever, and vomiting, only to have imaging reveal free fluid in the abdomen and a perforation at the top of the uterus. In one reported case of an 87-year-old woman, surgeons found a perforation roughly two centimeters across at the fundus during emergency laparotomy.¹¹ These cases are surgical emergencies that require abdominal washout, antibiotics, and often hysterectomy.

What Perforation Feels Like, and When It Doesn’t

But a striking number of perforations produce no symptoms at all. In a systematic review of IUD-related cervical perforations, seven out of eight women were completely asymptomatic.¹³ A larger study of IUD perforations found that roughly 30% of women had no symptoms; their perforations were discovered only because the IUD strings couldn’t be found during a routine check or because the woman became pregnant unexpectedly.¹⁴ Another case report describes a woman with a copper IUD that had silently perforated the uterus after a cesarean section, discovered only on fluoroscopic imaging.¹⁵

This silent presentation is one of the more unsettling aspects of the condition. If you have an IUD and can no longer feel the strings, that doesn’t automatically mean perforation has occurred. But it warrants imaging to confirm the device is still in the right place.

How Perforation Is Diagnosed

Ultrasound is the first-line imaging tool. It can reveal secondary signs of a wall injury, including free fluid in the pelvis, an IUD located outside the uterine cavity, or an irregularity in the uterine wall. Sometimes the actual site of perforation is visible; more often, the diagnosis is inferred from where the device has ended up or from the presence of fluid that shouldn’t be there.¹⁶

When ultrasound findings are inconclusive or when clinicians suspect that nearby organs may be involved, CT scanning provides a more complete picture. CT is especially valuable in emergency situations, where it can show the exact position of a migrated device, detect bowel injury, and reveal abscesses or fluid collections that ultrasound might miss.¹⁷ In some cases, a plain abdominal X-ray is enough to confirm that an IUD has left the uterus, though it won’t show soft-tissue detail.

Treatment Approaches

Not every uterine perforation requires surgery. Management depends on the severity of the injury, whether the patient is stable, and whether surrounding organs are involved.

Conservative Management

When a small perforation is recognized during a procedure and the patient’s vital signs are stable, close observation may be all that’s needed. The uterus has a robust blood supply and muscular tissue that contracts and heals relatively well. Clinicians typically monitor for worsening pain, signs of infection, or drops in blood counts. A case report documented successful conservative management of a perforation with omental herniation after D&C: because the patient remained stable with normal lab values, surgery was avoided entirely.¹⁸

Surgical Intervention

When a device has migrated into the abdomen, when there is active internal bleeding, or when bowel or bladder injury is suspected, surgery becomes necessary. The standard recommendation for a perforated IUD is removal, and laparoscopy is typically the preferred approach unless bowel perforation or severe infection is present.¹⁹ In one case, a device that had embedded in the intestinal wall required a segment of bowel to be resected, but surgeons were still able to perform the procedure laparoscopically using specialized retraction and anastomosis techniques.²⁰

For spontaneous perforations caused by pyometra, the situation is far more urgent. These patients often present with sepsis and need emergency open surgery, abdominal washout, antibiotics, and frequently a hysterectomy to remove the source of infection.

Fertility and Future Pregnancies After Perforation

One of the first questions patients ask after a uterine perforation is whether they’ll be able to become pregnant again. The evidence is largely reassuring, with some important caveats. A study tracking 50 women who became pregnant after a prior perforation documented 71 deliveries. The vast majority went smoothly with no major complications. However, one woman experienced a uterine rupture at 24 weeks of a later pregnancy. Her original perforation had occurred during postpartum curettage, and the rupture happened at the same site. An emergency cesarean was performed, but the baby did not survive due to complications of extreme prematurity.²¹

That case is sobering but appears to be exceptional in the published data. A separate review examining pregnancies after operative hysteroscopy noted that the combination of prior perforation and the use of electrosurgery raised the risk of rupture in a subsequent pregnancy, though neither factor alone was considered an independent risk factor.²² If you’re planning a pregnancy after a perforation, your obstetric team needs to know about the history so they can monitor the uterine wall, particularly in the third trimester.

How Providers Work to Prevent Perforation

Prevention centers on training, technique, and technology. For IUD insertion, knowing the depth and orientation of the uterus before placement is fundamental. Using a uterine sound to gauge cavity depth, proceeding slowly, and being especially cautious in postpartum or breastfeeding patients all reduce risk. Provider experience matters: as noted earlier, devices placed by less experienced clinicians were significantly more likely to result in perforation.

For operative hysteroscopy and other intrauterine procedures, real-time ultrasound guidance has emerged as one of the most effective safeguards. By watching the instrument’s position on an ultrasound screen as it moves inside the uterus, the surgeon can see when the tip approaches the outer wall and stop before going through. One study described the technique as providing the exact location of instruments within the uterine cavity and wall, offering a noninvasive way to prevent inadvertent perforation during resectoscopic surgery.²³ In brachytherapy for cervical cancer, adopting intraoperative ultrasound substantially reduced perforation rates compared to placement without imaging.²⁴ One series found that ultrasound-guided tandem placement was associated with no confirmed cases of perforation at all.²⁵

When Perforation Leads to Legal Claims

Uterine perforation is the leading reason patients file malpractice claims related to hysteroscopy. A retrospective review of hysteroscopy-related legal cases found that perforation accounted for about 53% of all claims, far outpacing other complications. The most common outcome prompting a lawsuit was the need for additional corrective surgery, which occurred in roughly 71% of claimants. Among those who required follow-up surgery, the overwhelming majority needed emergency procedures. About 24% of total cases involved permanent brain damage or death, typically from unrecognized injury that progressed to internal bleeding or sepsis.²⁶

These numbers don’t mean perforation itself is usually catastrophic. They reflect what happens when perforation goes unrecognized or is managed poorly. The legal data underscores the importance of informed consent: you should be told before any intrauterine procedure that perforation is a known risk, how common it is for that specific procedure, and what the plan would be if it occurred.

Adhesions, Migration, and Other Long-Term Concerns

Beyond the immediate injury and the question of future fertility, perforations can leave behind adhesions, bands of scar tissue that form between internal organs or between organs and the abdominal wall. One study of IUD-related perforations noted that adhesions were among the most common surgical findings when perforated devices were later removed. Copper IUDs in particular seemed to provoke more adhesion formation than hormonal devices.¹⁴ Adhesions can cause chronic pelvic pain, bowel symptoms, or fertility problems of their own, adding another layer to the long-term picture after a perforation.

In rare cases, a migrated IUD can become embedded in the omentum, the bladder wall, or the bowel itself. These situations almost always require surgical retrieval, and the complexity depends on how deeply embedded the device has become and how much surrounding tissue is involved.¹² Women who experience gynecological surgery and still desire future pregnancies tend to report significantly more anxiety and greater difficulty relaxing around the time of their procedures compared to those who have completed their families.²⁷ If you’ve experienced a perforation, asking your provider about counseling resources can be as important as the physical follow-up visits.

1
PubMed. Complete and partial uterine perforation and embedding following insertion of intrauterine devices. I. Classification, complications, mechanism, incidence, and missing string
2
PubMed Central. Intrauterine devices and risk of uterine perforation: current perspectives
3
PubMed. Uterine perforation in women using a levonorgestrel-releasing intrauterine system
4
PubMed Central. Risk factors of uterine perforation when using contraceptive intrauterine devices
5
The Lancet. Association of the timing of postpartum intrauterine device insertion and breastfeeding with risk of uterine perforation
6
PubMed Central. A Rare Occurrence of Uterine Perforation Following the Dilation and Curettage for Missed Abortion
7
Obstetrics & Gynecology. The Intraoperative Complication Rate of Nonobstetric Dilation and Curettage
8
The Journal of the American Association of Gynecologic Laparoscopists. Risk of Uterine Perforation during Hysteroscopic Surgery
9
PubMed Central. Spontaneous uterine perforation due to pyometra: A rare cause of acute abdomen in a postmenopausal woman
10
PubMed Central. Generalized Peritonitis Secondary to Perforated Uterine Pyometra
11
PubMed Central. Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis
12
PubMed Central. Uterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review
13
PubMed Central. Perforation of the Cervix by the Strings of an Intrauterine Device (IUD): a Novel Case and Systematic Review of the Literature
14
Human Reproduction. Uterine perforation caused by intrauterine devices: clinical course and treatment
15
PubMed Central. Silent uterine perforation by an IUCD inserted during the puerperium
16
PubMed. Imaging evaluation of uterine perforation and rupture
17
PubMed Central. Iatrogenic uterine perforation with abdominal extrusion of fetal parts: a rare radiological diagnosis
18
PubMed Central. Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa
19
PubMed Central. Laparoscopic removal of a perforated intrauterine device from the perirectal fat
20
PubMed Central. Laparoscopic removal of migrated intrauterine device embedded in intestine
21
PubMed Central. Obstetric Outcomes after Perforation of Uterine Cavity
22
PubMed. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy
23
PubMed. Intraoperative ultrasound guidance for intrauterine endoscopic surgery
24
International Journal of Gynecological Cancer. Intraoperative Ultrasound Guidance During Intracavitary Brachytherapy Applicator Placement in Cervical Cancer
25
PubMed. Ultrasound-guided tandem placement for low-dose-rate brachytherapy in advanced cervical cancer minimizes risk of intraoperative uterine perforation
26
PubMed Central. Legal Lens on Hysteroscopy: A Retrospective Review of Medical Malpractice Claims of Hysteroscopic Procedures
27
PubMed Central. Clinical-Psychological Aspects Involved in Gynecological Surgery: Description of Peri-Operative Psychopathological Symptoms and Illness Behavior