IUCD liability.

Abstract

In the UK the marketing and quality control of all intrauterine devices (IUCDs) is controlled by the Medicines Act (1968). Training is supervised by the Joint Committee of Contraception (JCC), and Trainers have to ensure that the trainee has acquired safe standards before the JCC certificate is granted. Patients must be adequately counselled and consent obtained. There is no unequivocal evidence of its mode of action in humans, which might limit its acceptability to certain individuals. There are a number of problem areas. How long should a copper-containing IUCD be retained when there is clinical evidence of continued effectiveness for more than the statutory 2 years? Perforation of the uterus and the resulting abnormal situation of an IUCD can be potentially dangerous. Sound technique minimizes its occurrence but if perforation occurs there must be defined and documented action. Because the IUCDs' primary intrauterine action is to prevent implantation, should pregnancy occur, there is an increased likelihood of ectopic gestation. Awareness of this, and appropriate early action, should prevent a disastrous outcome. There is clear evidence that ascent of organisms relates to the cervical thread. Perhaps tailless devices should be made available for women who are at risk of developing pelvic inflammatory disease? Other potential problem areas, where there might be legal liability involving practitioners, include the management of abnormal bleeding and difficult removals.