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[Clinical, bacteriological and histological studies following several years of IUD use for contraception].

It is informed about clinical, bacteriological and histological examinations of 108 women who had used IUD's for 2 years. The examinations were carried out on the IUD and on the endometrium. We made use of the transcervical technic of taking out under sterile conditions. Pathological findings could only be fixed amongst 4 women in clinical view. In bacteriological view numerous germs of quite different kind were found at the same patient. Optional pathological germs as they also exist in the cervix were predominant. Of an infection was only spoken if in correspondence of the total material the same germ was found. This concerned only in 6% of the women. Histologically adequate findings resulted. Genuine inflammations were only considered in 6% of the examinated female patients.

Adult

Ovarian ectopic pregnancy in association with a copper-7 intrauterine device in situ.

A case is reported of a primary ovarian pregnancy in a patient with a Cu-7 intrauterine device. A brief review of the literature on this subject is exposed. As the action of intrauterine devices on the ovulatory mechanism and tubal transport of the ovum is still unknown, further studies should be carried out to explain this association.

Adult

Some adverse effects of copper-IUD.

Perforations and extraction problems in some 30 700 women wearing a copper intrauterine device (Cu-IUD), either a Cu-7 or Cu-T have been studied. Perforations were very rare. Judging from the literature and the present investigation, in cases of perforation the Cu-7-IUD has a tendency to penetrate the uterine wall and the Cu-T-IUD the cervical wall. Retracted and detached strings were observed somewhat more often in women wearing Cu-7-IUD's. The number of such cases was, however, not large enough to warrant a statistical comparison. The cause of retention, investigative procedures and recommendations in the removal of lodged Cu-IUD's are discussed.

Cervix Uteri

Intrauterine device and pelvic inflammatory disease.

Using a retrospective case control design on 101 women with a first episode of acute pelvic inflammatory disease (PID), it was found that 15% were wearing an intrauterine device, as compared to 7% out of a control group of 101 women matched for age, marital status, and interval since their last pregnancy termination. No statistically significant correlation between IUD usage and PID was demonstrated. A significant correlation (P less than 0.01) between previous induced abortion and subsequent PID was found. In the PID group, a significantly higher proportion of previous abdominal and pelvic operations (P less than 0.005) was found as compared to the control group, but the numbers were small. In the absence of a higher frequency of IUD wearers among PID patients as compared with matched controls, we do not believe that there is an increased risk of pelvic inflammatory disease.

Acute Disease

[Acute-phase proteins in women with a copper IUD (author's transl)].

Acute-phase (AP) proteins haptoglobin, alpha1-antitrypsin and C-reactive protein were measured in 50 women before and 10 to 30 weeks after insertion of a copper T-200. No statistically significant increase in AP proteins was found. Since these proteins are synthesized in the liver, the results indicate the lack of a systemic humoral reaction of the organism in women with a copper-containing IUD.

C-Reactive Protein

Diagnosis and treatment of acute salpingitis.

Acute salpingitis is one of the most common acute gynecologic diseases and occurs in approximately 750,000 women each year in the United States. Use of laparoscopy to confirm the diagnosis of acute salpingitis has shown that the signs and symptoms classically ascribed to this disease are not specific to it. Fever, leukocytosis, elevated ESR and adnexal masses or swelling are not necessary to make a diagnosis of acute salpingitis. Lower abdominal pain and adnexal tenderness are the most consistent findings. Microbiologic data obtained by laparoscopy and culdocentesis have raised questions about the role of N. gonorrhoeae in salpingitis and have demonstrated that, as in pelvic infections generally, acute salpingitis is associated with mixed aerobic-anaerobic bacterial flora. Good results in the treatment of acute salpingitis depend upon: (1) early diagnosis, (2) hospitalization and bed rest, (3) the use of antibiotic therapy that takes into account the polymicrobial etiology of acute salpingitis, (4) prevention of recurrent episodes of salpingitis through efforts at patient education and identification and treatment of sexual partners. Most important, we must remember that what is at stake is often the future reproductive potential of a young woman. It must be weighed against both patient and physician convenience and cost. Further investigative efforts are essential to determine the role of IUDs in pelvic infections, discover the true microbiologic etiology of salpingitis and establish appropriate antimicrobial treatment as determined by prospective, microbiologically controlled investigations.

Acute Disease