Coil Insertion Should Only Be Performed By Experienced Gynaecologists. If Not, It's Deadly.

by Dr. Ahmed Ismail

A coil is a secondary line of contraceptive method, mainly used by women who cannot take contraceptive pills due to factors including high blood pressure; grossly overweight; history of deep vein thrombosis or pulmonary embolus; uncontrolled diabetes; experienced blood clots during pregnancy; or have had children and want a good method of contraception but won't remember to take pills; or have previously experienced severe side effects from contraceptive pills and are seeking a reliable alternative.

It always surprises me how many women have been wrongly informed that a hormonal coil is better than a copper coil purely because it's expensive. This is completely untrue. A hormonal coil is designed to treat certain gynaecological problems that require a hormone to be slowly released by an intrauterine device.

The coil has been a well-recognized method of contraception for many years - dating back to the ancient Egyptians. Over time, the materials used, the shape and method of insertion have all been improved. This development was necessary for two important reasons. Firstly, the initial failure rate in the use of plastic coils was quite high; which was why the copper coils were developed to great success. Secondly, the coil has undergone numerous shape amendments. For example, the spiral and Dalkon shield coils were used until we developed Copper 7 and Nova T, which are commonly used today.

During these developments, scientists also considered women with bleeding problems who require the implantation of hormones to improve their condition. This led them to develop a brilliant coil that was adapted with progesterone hormones and that, when inserted inside the uterus, would slowly release the hormone. This particular coil is only prescribed for certain patients who are unable to use the non-hormonal devices.

As the coil is one of the more invasive contraceptive methods, it has always interested me whether the public benefits from a non-gynaecologist inserting them, without properly assessing the uterus by ultrasound scan and inserting the coil with the scan's guidance. It took me many years to realise that the insertion of a coil device inside the uterus had to be conducted by a very experienced gynaecologist who has experience in using an ultrasound to guide him whilst inserting the coil and to ensure that he doesn't cause a major problem by incorrect positioning. I was recently shocked by the gravity of such problems when a journalist informed me that one of her friends had died suddenly following a perforation of uterine body with the coil, aged just 23. This was performed by an inexperienced non-gynaecologist and, unfortunately, the perforation remained undetected until it was too late.

This is a warning to all women considering having a coil inserted. Please seek advice from an experienced gynaecologist. Here's why...

  • A coil is a foreign body introduced inside a cavity of a uterus. It's a sensitive area and very important for the patient's future fertility. Therefore, the procedure must be performed under complete aseptic technique and the length of the uterus must be measured precisely. An experienced gynaecologist knows that as soon as the coil is inserted and has reached the fundus of the uterus, he must stop movement immediately and not proceed further; otherwise he will perforate the uterine body.
  • Another common situation is when the uterus is acutely retroverted. This is experienced by 20% of women and, importantly, if the person inserting the coil is not thoroughly familiar with the uterus, they may not be able to assess when this occurs. If this happens, he may direct the coil into the body of the anterior wall of the uterus and that is the fastest way to perforate the uterus.

    What happens if you do? WOW! It is a BIG problem. If recognised immediately, the coil must be removed laparoscopically under general anaesthetic as a matter of emergency. However, if it was not recognised immediately, the woman may start to experience abdominal pain and some rigidity on abdominal examination due to infection. This can lead to peritonitis and that is an extremely severe matter.
  • Other potentially problematic factors for physicians who are inexperienced in women's healthcare are intrauterine adhesions. If the woman has any intrauterine adhesions inside her uterus, this can lead to false passage. A gynaecologist would recognise this straight away and deal with it but an inexperienced person may proceed, again, causing perforation of the uterine walls.

    The definition of a gynaecologist is someone who specialises in women's healthcare and only treats female genital organs. Therefore, to limit disasters in modern medicine, specific medical problems should only be treated by physicians who specialise in that specific area of the body. You don't just need to be able to insert the coil correctly, you need to be able to identify and deal with problems should they arise to prevent major complications.

My conclusion is that one case of fatal death due to a coil insertion and uterine perforation from an inexperienced non-gynaecologist is too many. I believe that we should be very clear that a coil's insertion must only be performed by an experienced gynaecologist with ultrasound guidance. This is the safest method of inserting a coil in modern society.

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