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PubMed1993

Intrauterine contraceptive devices--a reappraisal.

The intrauterine contraceptive device (IUD) is a highly effective and safe form of reversible contraception. It does not cause pelvic inflammatory disease, ectopic pregnancy or infertility; it could be used by most nulligravidae; in its latest form it can be used to treat excessive menstrual loss, and it acts by preventing fertilisation not implantation. These statements contrast sharply with many of our long-standing prejudices about the method. New IUDs contribute to this change in perception. Nevertheless, patients selection, limiting use to mutually monogamous relationships, care with fitting and access to expert help with problems (including rare failure pregnancies and removal difficulties) are all required to maintain the acceptability and usefulness of this method.

Adolescent↗

PubMed1996

Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: randomized study.

OBJECTIVE: The purpose of the investigation was to compare the 1-year expulsion and efficacy rates of the GYNE-T 380 and the GYNE-T 380 Postpartum intrauterine contraceptive devices when inserted within 10 minutes after expulsion of the placenta in a term pregnancy. The two intrauterine contraceptive devices were identical, except that one was inserted by means of a temporary fundal suspension system and the other was placed directly into the uterine cavity. STUDY DESIGN: The study was a multicenter, randomized trial of intrauterine contraceptive devices in which 300 subjects accepted the GYNE-T 380 IUD and 292 subjects the GYNE-T 380 Postpartum IUD in clinics with adequate follow-up. RESULTS: At 1 year the gross cumulative expulsion rate was 13.2 per 100 cases (39 expulsions) with the GYNE-T 380 intrauterine contraceptive device and 16.2 per 100 cases (46 expulsions) with the GYNE-T 380 Postpartum device. There was no significant difference in the rate of expulsion between the two devices at any time during the year. There was one first-year intrauterine pregnancy, which occurred in a subject using the GYNE-T 380 device. The continuation rate for each device was above 80 per 100. CONCLUSION: The results indicate that both the GYNE-T 380 Postpartum and the standard GYNE-T 380 intrauterine contraceptive devices are safe and effective when inserted immediately after delivery of the placenta.

Female↗

PubMed1988

Effect of butoconazole nitrate cream and wax insert on the barrier property of contraceptive devices.

A new method was developed to assess the quality of the barrier property of several types of commonly used contraceptive devices (diaphragm, cervical cap, and condom). Our data showed that butoconazole nitrate cream and wax inserts did not affect the barrier property of the contraceptive devices when the products were placed in contact with the devices for up to 72 hours at 37 degrees C.

Antifungal Agents↗

PubMed1987

Significant bacteremia associated with replacement of intrauterine contraceptive device.

Blood culture samples were taken from 23 women at different stages when an intrauterine contraceptive device was replaced. Transient bacteremia resulting from vaginal organisms was found in 13% of women 4 to 6 minutes after insertion of the new device. Previous reports have failed to demonstrate bacteremia associated with either first insertion or removal of intrauterine contraceptive device. Our results show that replacement of an intrauterine contraceptive device, a more traumatic procedure, causes significant bacteremia, and chemoprophylaxis should be given to patients in the groups at risk.

Female↗

PubMed1981

[Ministry of Justice issues circular on sanctions against people who sabotage birth control plans by removing women's intrauterine contraceptive devices].

The relevant document recently issued by the Ministry of Justice pointed out that to protect women's lives and health and to facilitate birth control, severe punishments should be meted out in accordance with the relevant provisions of the criminal law to those who are guilty of the wicked practice of removing women's intrauterine contraceptive devices to defraud money and belongings, bringing about serious consequences as a result. Recently, the Ministry of Justice received a letter from the birth control office in Fuling Prefecture, Sichuan Province, reporting repeated instances in the prefecture of some people sabotaging the birth control plan by illegally removing women's intrauterine contraceptive devices to defraud the women of their money and belongings, and some women had even died as a result. The letter appealed to the judicial organs to ban these activities. In its document in answer to the letter, the Ministry of Justice pointed out, that out of greed for pecuniary and material gains, some people illicitly made iron wire hooks to remove women's intrauterine contraceptive devices, and serious consequences and even deaths have occurred. These activites have not only seriously sabotaged the birth control plan, but also constituted criminal offenses of fraud, unpremeditated injury, and manslaughter in violation of the criminal law. It called on the judicial departments throughout the country to punish the offenders according to the laws. The document also pointed out that some comrades called the illegal activities of illicitly removing women's intrauterine contraceptive devices "inappropriate removal of intrauterine rings," or said that "there are no concrete provisions about it in the laws," the result being that criminals have been allowed to go scot-free. To protect women's lives and health and to facilitate birth control, the judicial organs at all levels should coordinate with the departments concerned to ban such illegal activities and to carry out large-scale education among the masses. Severe judicial punishments should be meted out in accordance with the relevant provisions of the criminal law to those guilty of the illegal and wicked practice of removing women's intrauterine contraceptive devices to defraud money and belongings, bringing about serious consequences as a result.

Asia↗

PubMed1996

The missing forgotten intrauterine contraceptive device.

Failure to locate the strings of an intrauterine contraceptive device may mean that the device is within the uterine cavity, was expelled or, worst of all, has perforated the uterine wall. We describe a 36-year-old woman complaining of infertility in whom two missing devices were found within the pelvis after having perforated the uterus. This report demonstrates the need to investigate every case of a missing intrauterine contraceptive device. An algorithm for the proper management of such cases is suggested.

Adult↗

PubMed1983

A scanning and transmission electron microscopic study of the surfaces of intrauterine contraceptive devices.

We studied 10 intrauterine contraceptive devices by scanning and transmission electron microscopy. All the devices had material adherent to them. The amount of this material varied considerably. Many different morphologic types of bacteria were observed adherent to the devices, often buried in a thick biofilm. Occasionally a microcolony containing only a single bacterial morphotype was observed. Electron microprobe analysis revealed the presence of calcium in the biofilm formed by bacterial colonization. Very few types of bacteria were recovered by our cultural technique, suggesting that material must be scraped from the surface of the device, homogenized, and then cultured by means of selective media. An understanding of the mechanisms of adherence of bacteria to these devices could lead to the development of a device which will resist bacterial colonization.

Actinomyces↗

PubMed1981

Pseudo-sulfur granules associated with intrauterine contraceptive devices.

A structure resembling a sulfur granule found in histologic sections of endometrium from patients with intrauterine contraceptive devices is described. It is distinguished from a true sulfur granule on morphologic grounds and is further characterized as a foreign substance, most probably fragments of the synthetic contraceptive device. It is not associated with clinical disease. Microbiologic cultures of removed intrauterine contraceptive devices show no consistent or predominant growth pattern.

Actinomyces↗

PubMed1975

Large bowel perforation by intrauterine contraceptive devices.

Two cases of large bowel perforation by intrauterine contraceptive devices are presented. Both the Lippes LoopTM and Dalkon ShieldTM have the potential of evoking omental adhesions and causing bowel perforation. These serious complications justify the immediate removal of a contraceptive device from the peritoneal cavity by either laparoscopy or laparatomy.

Adult↗

PubMed1996

Penetration of the bladder by a perforating intrauterine contraceptive device: a sonographic diagnosis.

We describe a case of penetration of the urinary bladder by an intrauterine contraceptive device with perforation of the uterine wall. This finding was discovered incidentally during an ultrasound examination for an earlier nonspecific mild abdominal pain of short duration. No abnormality had been noted on pelvic examination, during which the device's strings were found to protrude through the patient's cervix; a short laboratory workup including urinalysis, urine culture, blood count and blood sedimentation rate was also negative. The sonographic diagnosis was confirmed by cystoscopy. The device was retrieved transcervically. No complications were observed on follow-up. Bladder perforation by an intrauterine contraceptive device is very rare, and only a handful of such cases have been described. In all previous cases, the diagnosis followed a rather prominent clinical presentation, whereas, in this case, the patient complained of intermittent low abdominal pain of short duration. We therefore suggest that pelvic ultrasound examination be performed in every patient with unexplained low abdominal pain who is known to carry an intrauterine contraceptive device.

Adult↗

PubMed1997

Intrauterine contraceptive devices and antigestagens as emergency contraception.

Although the Yuzpe regimen of emergency contraception is the one most commonly used, there are alternatives. Copper-containing intrauterine devices are very effective and can be inserted for at least 5 days after unprotected intercourse and sometimes longer. They may, however, transmit pre-existing infection into the upper genital tract and cause discomfort when being fitted. Progestogen-only emergency contraception appears, from WHO studies, to be a useful adjunct to current therapies. Mifepristone has been studied in various doses and has been shown to be very effective but is not yet commercially available. Health services should provide a full range of methods including emergency contraception by appropriately trained people in an acceptable environment.

Contraceptives, Oral, Synthetic↗

PubMed1975

Hysteroscopic removal of occult intrauterine contraceptive device.

Dilatation and curettage or hooking an occult intrauterine contraceptive device (IUD) may fail to recover the device on occasion. Theoretically, endoscopic observation should enable the controlled removal of this type of device. Of 200 patients who underwent hysteroscopic examination, 10 had an occult IUD. In 8 cases, the device was visible through the hysteroscope, and in 6 patients a successful removal was accomplished with this endoscopic technic. Failures and problems are discussed, and the importance of adequate preoperative study is stressed. Hysteroscopy is an effective procedure in the recovery of the occult intrauterine contraceptive device in selected nonpregnant patients.

Adult↗

PubMed1992

Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices.

OBJECTIVES: The objectives were to measure rates of planned pregnancy and factors affecting these rates after use of very-long-acting contraceptive methods (Norplant or Norplant II implants, a levonorgestrel-releasing intrauterine contraceptive device, or the copper T (model TCu 380Ag) intrauterine contraceptive device. STUDY DESIGN: The design was a concurrent, multicenter prospective study of 372 women who stopped contraception for planned pregnancy. Analysis was by life-table, log-rank, and standard chi 2 methods. RESULTS: Pregnancy rates 12 and 24 months after cessation of contraceptive use were 82 and 89 per 100, respectively. Age at removal and family planning intentions at initiation of contraception were both significantly correlated with pregnancy rates (p less than 0.05), but former contraceptive regimen and duration of contraceptive use were not. Pregnancy outcomes did not deviate from normal limits and did not differ by contraceptive formerly used. CONCLUSION: Contraceptive implants releasing 30 micrograms/day of levonorgestrel or intrauterine contraceptive devices releasing 20 micrograms/day of levonorgestrel or having copper surface areas of 380 mm2 are associated with normal fertility after use for women seeking pregnancy at termination. Durations of use do not affect pregnancy rates.

Adult↗

PubMed2000

Color Doppler sonographic study of the uterine artery in patients using intrauterine contraceptive devices.

A transvaginal Doppler sonographic examination of uterine artery blood flow was performed. Resistance and pulsatility indices were measured in 101 women, 74 of whom were using an intrauterine contraceptive device, and 27 controls, who were not using any contraceptive method. The intrauterine contraceptive device users were divided into three groups: those with normal bleeding (n = 34); those with abnormal uterine bleeding without medication (n = 16); and those with abnormal bleeding corrected with use of prostaglandin inhibitors (n = 24). The resistance and pulsatility values were significantly lower in the group of women using intrauterine contraceptive devices who had abnormal bleeding than in all other groups (P<0.001). All other comparisons were nonsignificant. A pulsatility index of less than 2 may be associated with a higher risk for development of intrauterine contraceptive device-induced bleeding.

Adult↗

PubMed1980

Actinomyces-like organisms in cervical smears from women using intrauterine contraceptive devices.

Cervical smears from 293 users of intrauterine contraceptive devices attending family planning clinics in East Fife, Dundee, and Angus were stained by Papanicolaou and Gram's methods and examined for actinomyces-like organisms. Of the 128 women using plastic devices, 40 gave smears positive for these organisms. In contrast only two positive smears were obtained from the 165 women using devices containing copper and none from a control group of 300 women taking oral contraceptives. Colonisation was more common in women whose plastic devices had been in situ for over two years. Correlations between the presence of these organisms and recorded incidences of pain and both clinical and cytological evidence of inflammation of the lower genital tract were highly significant (p = 0.00001, p < 0.00001, and p < 0.00001 respectively). The results suggest that plastic intrauterine contraceptive devices predispose to colonisation by actinomyces-like organisms, particularly after long-term use. Hence if the apparently bacteriostatic action of copper devices is confirmed these should probably be more widely used.

Actinomyces↗

PubMed2000

The effect of low-dose 3-keto-desogestrel added to a copper-releasing intrauterine contraceptive device on menstrual blood loss: a double-blind, dose-finding, placebo-controlled study.

OBJECTIVE: We sought to establish the lowest dose of 3-keto-desogestrel, when added to a copper-releasing intrauterine contraceptive device, that is needed to reduce menstrual blood loss to a very low level and to treat (essential) menorrhagia successfully. STUDY DESIGN: A double-blind group comparative study was designed in which 203 healthy women with or without menorrhagia were enrolled and randomized to four different Multiload Cu250 intrauterine contraceptive devices, releasing 0 (control), 1.5, 3, or 6 microg of 3-keto-desogestrel daily. Menstrual blood loss, hemoglobin, and serum ferritin levels were determined before and during treatment. RESULTS: All 3-keto-desogestrel-copper intrauterine contraceptive devices reduced menstrual blood loss significantly, causing a reduction of up to 30 to 40 mL after 12 months of use. All women with essential menorrhagia were considered to have been successfully treated after 6 months of use. Serum ferritin levels rose with all three 3-keto-desogestrel-loaded devices. CONCLUSION: A Multiload Cu250 intrauterine contraceptive device releasing 1.5 microg of 3-keto-desogestrel daily is able to reduce menstrual blood loss to a very low level and to replete body iron stores in women with or without menorrhagia. Higher doses have no superior effect.

Adolescent↗

PubMedDate not supplied

Association of amoebae and actinomyces in an intrauterine contraceptive device user.

A patient wearing an intrauterine contraceptive device (IUD) was diagnosed as being colonized by Actinomyces and amoebae by examination of a routine Papanicolaou smear. The patient received vaginal treatment with metronidazole, which temporarily eliminated the protozoa; however, it was necessary to remove the IUD to definitively eradicate the microorganisms. Follow-up Papanicolaou smears taken after removal of the IUD have been normal and free of both microorganisms.

Actinomyces↗

PubMed1976

The Copper T 220C: a new long-acting copper intrauterine contraceptive device.

The Copper T(TCu) intrauterine contraceptive device (IUD) has been found to be an effective method of contraception but has the disadvantage of needing periodic replacement due to loss of copper through dissolution and fragmentation of the copper wire. Modification of the Copper T to overcome this disadvantage involved substitution of copper sleeves for wire on the vertical arm and the addition of copper sleeves to the horizonal arms to give an effective surface area of 220 sq. mm. of copper and an estimated life span of 20 years. A randomized comparative study was undertaken in 999 women to determine if the new model performed as well as the wire-wound Copper T 300. Net cumulative first-event rates at one year were as follows: TCu 220C-pregnancy 0.9, expulsion 3.7, removal for pain or bleeding 14.4; TCu 300-pregnancy 1.1, expulsion 3.1, removal for pain or bleeding 9.3. None of the differences in event rates were significant. If long-term follow-up confirms these findings, this new long-lasting copper intrauterine device could become the IUD of choice for all women.

Adolescent↗