Introduction: IUD is one of the most common reversible forms of female contraception, with Mirena  being the most popular IUD  choice. A rare complication of IUD insertion is uterine perforation, with reported incidence ranging from 0.5 to 2.5/1000. Recognised risk factors for uterine perforation include insertion in the post-partum period, lactation, uterine retroversion, tight cervical os and unsatisfactory  insertion technique.

Case report: a woman had Mirena insertion at the 6-week postpartum visit after undergoing elective C-section delivery. She had encountered partial C-section abdominal wound haematoma in the immediate postoperative phase. At the time of IUD insertion, she experienced momentary sharp pain and dizziness. Due to intermittent lower back pain, she returned for assessment 8 weeks later. As the  IUD string was not seen at cervical os, she was referred for pelvic ultrasound and AXR which demonstrated that the IUD was lying free in the abdominal cavity.

Discussion: . The preoperative evaluation and counselling suggest the case was a potential medico-legal risk. A team approach was instigated preoperatively, combined with successful intra-operative  laparoscopic retrieval of the migrated IUD embedded in the omentum and prompt repair of the dehisced C-section scar resulted in a happy outcome to the case.

Conclusion: Mitigation of potential litigation risk requires careful preoperative and peri-operative counselling and team approach.