{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:01:49Z","timestamp":1762351309149,"version":"3.37.3"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bioceptive, Inc"},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["8UL1TR000105"],"award-info":[{"award-number":["8UL1TR000105"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000124","name":"Office of Research on Women's Health","doi-asserted-by":"publisher","award":["K12HD085852, K24HD087436"],"award-info":[{"award-number":["K12HD085852, K24HD087436"]}],"id":[{"id":"10.13039\/100000124","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers\u2019 placement instruments for two commercially available products and a metal sound.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Sixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p\u2009&lt;\u2009.001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3\u00a0N (SD\u2009\u00b1\u20093.8\u00a0N), followed by the copper T380A intrauterine device placement instrument 14.1\u00a0N (SD\u2009\u00b1\u20094.0\u00a0N), and highest for the metal sound 17.9\u00a0N (SD\u2009\u00b1\u20097.6\u00a0N) (p\u2009&lt;\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not.<\/jats:p>\n                <jats:p>This study received Institutional Review Board (IRB0059096) approval.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-021-01285-6","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T14:03:26Z","timestamp":1617804206000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ex-vivo forces associated with intrauterine device placement and perforation: a biomechanical evaluation of hysterectomy specimens"],"prefix":"10.1186","volume":"21","author":[{"given":"Jane","family":"Duncan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5694-9464","authenticated-orcid":false,"given":"Kathryn","family":"Fay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Sanders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Cappiello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Saviers-Steiger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Turok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"issue":"6","key":"1285_CR1","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.contraception.2018.05.016","volume":"98","author":"D Hubacher","year":"2018","unstructured":"Hubacher D, Kavanaugh M. Historical record-setting trends in IUD use in the United States. Contraception. 2018;98(6):467\u201370.","journal-title":"Contraception"},{"key":"1285_CR2","unstructured":"World Health Organization. Reproductive Health and Research, K4Health. Family planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration. Geneva Baltimore: World Health Organization John Hopkins Bloomberg School of Public Health, Center for Communication programs, Knowledge for Health Project. 2011. xii, 372 pp."},{"issue":"4","key":"1285_CR3","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.contraception.2015.01.007","volume":"91","author":"K Heinemann","year":"2015","unstructured":"Heinemann K, Reed S, Moehner S, Minh TD. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015;91(4):274\u20139.","journal-title":"Contraception"},{"issue":"4","key":"1285_CR4","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1136\/jfprhc-2016-101684","volume":"43","author":"PA O\u2019Brien","year":"2017","unstructured":"O\u2019Brien PA, Pillai S. Uterine perforation by intrauterine devices: a 16-year review. J Fam Plann Reprod Health Care. 2017;43(4):289\u201395.","journal-title":"J Fam Plann Reprod Health Care"},{"issue":"4","key":"1285_CR5","first-page":"173","volume":"5","author":"ND Goldstuck","year":"1987","unstructured":"Goldstuck ND. \u201cBowing\u201d forces with IUD inserters in vitro: relevance to difficult IUD insertions. Clin Reprod Fertil. 1987;5(4):173\u20136.","journal-title":"Clin Reprod Fertil"},{"issue":"4","key":"1285_CR6","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/0028-2243(87)90142-0","volume":"25","author":"ND Goldstuck","year":"1987","unstructured":"Goldstuck ND. Insertion forces with intrauterine devices: implications for uterine perforation. Eur J Obstet Gynecol Reprod Biol. 1987;25(4):315\u201323.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"1285_CR7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.contraception.2016.10.006","volume":"95","author":"TC Jatlaoui","year":"2016","unstructured":"Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2016;95(1):17\u201339.","journal-title":"Contraception"},{"key":"1285_CR8","unstructured":"Teva Pharmaceuticals. Paragard Package Insert [Internet]. 2005 [cited 2020 Apr 16]. http:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2005\/018680s060lbl.pdf."},{"key":"1285_CR9","unstructured":"Bayer HealthCare Pharmaceuticals. 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Liletta Package Insert [Internet]. 2018 [cited 2020 Jun 11]. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2018\/206229s007lbl.pdf."}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01285-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12905-021-01285-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01285-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T14:09:58Z","timestamp":1617804598000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-021-01285-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,7]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1285"],"URL":"https:\/\/doi.org\/10.1186\/s12905-021-01285-6","relation":{},"ISSN":["1472-6874"],"issn-type":[{"type":"electronic","value":"1472-6874"}],"subject":[],"published":{"date-parts":[[2021,4,7]]},"assertion":[{"value":"14 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Trained study staff at a single academic institution approached patients scheduled for hysterectomy to obtain written consent for uteri collection. This study received approval from the University of Utah Institutional Review Board (IRB0059096).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The University of Utah Department of Obstetrics and Gynecology Division of Family Planning receives research funding from Bayer, Bioceptive, Sebela, Medicines 360, Merck, and Cooper Surgical. BC is the CEO of Bioceptive. DT served as a consultant for Bioceptive at the time of data collection. The other authors declare that they have no competing interests. The findings and conclusions in this article are those of the authors and do not represent the views of the funders.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"141"}}