Table 2.

Perforation

Author, year, location, sources of support	Study design, follow-up	Population, intervention	Type(s) of IUD	Outcomes of interest	Results	Strengths	Weaknesses	Grade
Alton, 2012 [11] United States Source of support not stated	Retrospective cohort, 3 sites Up to 7 years follow-up: Up to 80.88 person-years among women age <18 years; Up to 330.52 person-years among women age 18–21 years	Women aged ≤ 21 years having IUD inserted Age <18 years: n=69 Age 18–21 years: n=164 Range: 11–21 years, Median age: 16 years	LNG-IUD (n=222) CuT380A (n=11)	Perforation	No perforations in either group	Multicenter trial	Small sample and few events; no information on study power All data from chart review; outcomes may be underestimated if women sought care from other sites No information on mean time to follow-up or on those lost from database	II-2, poor
Aoun, 2014 [12] United States  No financial disclosures	Retrospective cohort Mean follow-up 37±11 months (range 19–57 months)	Women age 13–35 years who had LNG-IUD or Cu-IUD inserted for contraception (n=2138) Age 13–19 years: n=249 Age 20–24 years: n=750 Age 25–35 years; n=1139	LNG-IUD n=1746 Cu-IUD n=392	Perforation	Crude Rates: Age 13–19 years: 0/249 Age 20–24 years: 3/750 (1%) Age 25–35 years: 0/1139 p=.09	Multicenter Reviewed charts from office, emergency department and hospitals including laboratory and imaging results Multivariate analysis adjusted for age, race and IUD type Excluded those with no follow-up	Small number of events No power calculation	II-2, fair
Berenson, 2013 [14] United States Society for Family Planning; NIH	Retrospective cohort (claims data) Nationwide US health insurance program 12 months (58% of those with IUD insertion also had 12 months of continuous insurance coverage and included in the analysis)	Women age 15–44 yearswith a claim for IUD insertion by procedure code (n=90,489) Age 15–19: LNG-IUD: n=1528 CuT IUD: n=307 Age 20–24: LNG-IUD: n=7860 CuT IUD: n=2027 Age 25–44: LNG-IUD: n=61,197 CuT IUD: n=17,570	LNG-IUD CuT IUD	Perforation	Crude Rates: 15–19 years: LNG-IUD: 0/1528 CuT IUD: 0/307 20–24 years: LNG-IUD: 2/7860 (0.0%) CuT IUD: 0/2027 25–44 years: LNG-IUD: 29/61,197 (0.0%) CuT IUD: 7/17,570 (0.0%)	Large database Several outcomes Multivariate analysis, adjusted for age, intrauterine device type, health care provider specialty, region and year of IUD insertion Excluded women without 12 months of continuous insurance coverage	Limited by diagnostic coding; potential underreporting of outcomes not captured in database Did not include parity as potential confounder No information on whether those not included in analysis were different from sample	II-2, fair
Teal, 2015 [24] United States Source of funding NR	Retrospective cohort 6 months	All successful IUD insertions for women age 13–24 years at adolescent family planning clinic (n=1132) with 6 month IUD status known (n=796)	LNG-IUD CuT380A	Perforation	No identified perforations	Large sample size	All data from chart review from single site; outcomes may be underestimated if women sought care from other sites High attrition (able to ascertain IUD status at 6 months for 70%) Outcome and diagnostic criteria not described Potential confounders not assessed for these two age groups	II-2, poor

NR= not reported; Cu IUD= copper intrauterine device; IUD= intrauterine device; LNG-IUD= levonorgestrel intrauterine device; LNG-IUS= levonorgestrel intrauterine system; NIH= National Institutes of Health