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Evaluation of 24 patients with IUD-related problems: hysteroscopic findings.

The clinical and diagnostic findings in 24 patients with IUD-related abnormal uterine bleeding or missing IUDs have been evaluated with special reference to hysteroscopy. For the IUD-related abnormal uterine bleeding no gross uterine or tissue pathology has been revealed except for chronic inflammatory reaction of the endometrium. In half of the cases the IUD showed embedment, displacement within the uterine cavity or migration into the uterine wall, which may be a possible cause of the IUD-related abnormal uterine bleeding. For the detection and removal of IUDs with missing strings, partially embedded and perforated IUDs or retained broken parts of it, the hysteroscopic procedure appeared to be invaluable and in our opinion should be the method of choice.

Adult↗

The force required to remove the frameless 0-suture IUD anchoring system: comparison between pre- and postmenopausal women.

OBJECTIVE: The objective of this short communication is to measure and compare the force needed to remove the implanted "0-suture" GyneFix intrauterine contraceptive device (IUD) and the "0-suture" FibroPlant trade mark -LNG intrauterine system (IUS) from the uterus of pre- and postmenopausal women. STUDY DESIGN: A nonrandomized comparative study in 119 pre- and postmenopausal women. A dynamometer (Pesola) was used to measure the removal force in newtons. RESULTS: The results of this study show a mean removal force of 8.5 and 9.5 newtons, respectively (range, 3-11 and 4.5-11), in pre- and postmenopausal women, which is significantly different (p = 0.003). CONCLUSIONS: The force needed to remove the IUD/IUS anchored in the myometrium of the uterine fundus of pre- and postmenopausal women is higher than the removal force found in previous studies in which the IUD consisted of a slightly thinner anchoring thread (00 instead of 0 suture). The statistically significantly different removal force between the two groups has no clinical implications. The difference may reflect the increased compactness of the uterine tissue in the postmenopausal uterus.

Biomechanical Phenomena↗

An investigation of the effects of the intrauterine contraceptive device based on a longitudinal study of a self-selected sample of Barbadian women.

The results of longitudinal study of a self-selected sample of 1,790 Barbadian women who accepted the intrauterine contraceptive device (IUD) as their method of contraception are reported. The accumulated experience of 44,000 woman months of IUD use is presented. The demographic, medical, and obstetric data on admission for 2,797 IUD acceptors and 4,296 nonacceptors are contrasted. The reproductive experience of the two groups prior to the insertion of an IUD with respect to live births, stillbirths, and miscarriages is similar while the incidence of ectopic pregnancy is shown to be different. The association between the IUD and the incidence of tubal pregnancy is evaluated, and the literature dealing with this topic is reviewed. Estimates of the relative risk of an ectopic pregnancy in a woman with an IUD in utero are given.

Abortion, Spontaneous↗

Perpetuating negative attitudes about the intrauterine device: textbooks lag behind the evidence.

This study examined current textbooks and manuals to discern whether their presentations of the Copper T380A intrauterine device are accurate, current, and objective. Thirteen medical student obstetrics and gynecology texts used in the US and five from the UK were evaluated for information presented about the Copper T-380A intrauterine device. A scoring system was developed to record the presence or absence of characteristics of intrauterine device usage. The two authors independently reviewed the texts and completed code sheets. In general, advantages of the device were under-reported while disadvantages were exaggerated. Review of US texts identified inaccuracies regarding the device's mechanism of action; 5 of 13 did not include its prefertilization action. Despite evidence to the contrary, 9 of 13 texts reported an increased risk of pelvic inflammatory disease associated with intrauterine device use; 6 of 13 reported an increased risk of ectopic pregnancy; and 4 of 13 reported an increased risk of infertility. Review of UK texts yielded similar results regarding advantages and disadvantages, as well as mechanism of action. The UK texts presented fewer inaccuracies regarding intrauterine device risks. Most texts from both countries implied that the intrauterine device is a method of last resort. Texts commonly used by medical students on women's health rotations may not be evidence-based in the information presented about the intrauterine device.

Attitude of Health Personnel↗

A comparative randomized study of three different IUDs in nulliparous Mexican women.

With the aim to evaluate the clinical performance of intrauterine devices (IUDs) especially designed for nulliparous women (TCu 380 Nul and ML Cu 375 sl), a prospective randomized, single-blind study comparing them with standard TCu 380 A, was carried out. We included 1170 healthy nulliparous women randomly allocated to receive any of the three types of IUDs and conducted follow-up for 1 year of use. Continuation and termination rates were evaluated by gross cumulative life table analysis and compared by the log-rank test. Continuation rates (95% confidence interval) at the end of the study for TCu 380 A, TCu 380 Nul and ML Cu 375 sl were 29.5% (+/-12.9), 85.9% (+/-5.3) and 85.4% (+/-5.8), respectively (p < 0.001). There were six pregnancies during the first 3 months of use, for a failure rate of 1% (+/-0.6) in the TCu 380 A group, 0.5% (+/-0.3) in TCu 380 Nul, and no pregnancy in ML Cu 375 sl (p < 0.05). Especially designed IUDs for nulliparous women had a better clinical profile compared with the standard IUD. This may improve the use of IUD in this population.

Adult↗

Randomized comparison of clinical performance of two copper-releasing IUDs, Nova-T and Copper-T-200, in Denmark, Finland and Sweden.

A randomized study was conducted simultaneously in three countries to compare the clinical performance of two new IUDs, the Nova-T and Copper-T-200. Forty-four persons, midwives, general practitioners, residents and specialists in obstetrics and gynecology inserted 907 Nova-Ts and 936 Copper-Ts. The pregnancy rate of Nova-T (0.7 at one year) was significantly lower than that of Copper-T (2.2 at one year). No significant differences were observed in other termination rates. The continuation rates were 72.6 for Nova-T and 71.3 for Copper-T-200. The total experience was based on 18,035 woman months of use, with a lost to follow-up of less than 7 per cent for both IUDs.

Adult↗