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PubMed1982

Copper intrauterine contraceptive device event rates following insertion 4 to 8 weeks post partum.

There is a consensus in the literature that intrauterine contraceptive devices (IUDs) should not be inserted within 8 weeks post partum because of reported greater rates of pregnancy, expulsion, and perforation. This greater incidence of event rates was observed in certain clinics that used large plastic IUDs, mainly the loops. In an effort to determine whether the interval from delivery to insertion of a copper-bearing IUD caused altered event rates, an analysis of studies of parous women who were using five different copper-bearing IUDs was undertaken. During the time of these studies, 411 women had an IUD inserted between 4 and 8 weeks post partum, whereas 1,197 women had the IUD inserted more than 8 weeks after a term delivery. At the end of 1 and 2 years of use, there were 4,164 and 6,816 woman months of experience, respectively, in the women with postpartum insertion, and 11,647 and 19,733 woman months of experience with insertion more than 8 weeks post partum. There were no uterine perforations in this experience, and there were no significant differences in the termination rates of any event between the two groups. This retrospective analysis indicates that copper IUDs can be inserted at the time of the routine postpartum examination without concern that the rate of accidental pregnancy, expulsion, or removal for bleeding and/or pain will be increased in comparison with a later insertion.

Female↗
PubMed1992

Hysteroscopic findings in complicated and non-complicated IUD users.

The hysteroscopic findings in 100 IUD users have been evaluated. 50 women had no IUD-related problems and requested removal of the device, while the other 50 complained of either bleeding and/or pain or lost strings. Of the 29 cases with IUD-related bleeding and/or pain, hysteroscopy revealed malposition (n=6), partial expulsion (n=3), partial perforation (n=2), embedding (n=1), or disproportion (n=6). Disproportion presented as crumpling of the device in the uterine cavity or protrusion of the tip of the transverse arm inside the tubal ostia. Endometrial lesions were also more commonly seen in the study group than the control group, i.e., endometrial hyperplasia (n=8), endometrial polyps (n=8), intrauterine adhesions (n=5), and submucous fibroids (n=2). Of the 21 IUD patients with missing strings, there were previous failed trial of blind removal in 11 cases. Most lost IUDs were found inside the uterine cavity (81%) with curling and ascending strings. Partial perforation, abdominal translocation, and unnoticed complete expulsion were detected in 19% of the patients. Direct visualization of the endometrial cavity is invaluable in treating IUD users who complain of pain and/or bleeding and in locating and retrieving missing IUDs.

Africa↗
PubMed1997

[Medicated stainless steel ring-165, medicated gamma-intrauterine devices and TCu220C: a multicenter comparative study].

OBJECTIVE: A five-year multicenter comparative study was conducted to observe the clinical efficacy, side effects, and menstrual blood loss (MBL) of medicated stainless steel ring 165 (MSSR-165), medicated gamma-Intrauterine devices (gamma-IUD) (both containing indomethacin and copper) and TCu220C for exploring new kinds of IUD to reduce MBL after IUD insertion. METHODS: MSSR-165 and medicated gamma-IUD, with TCu220C as a control, were randomly inserted (one thousand in each group) in women 12 hospitals nation wide in October 1988. Follow-ups were performed at the time of 3, 6, 12, 24, 36, 48 and 60 months after IUD insertion. The efficacy of the IUDs was calculated with life table method. A quantitative comparison of MBL was made before and 3, 6, 12, 24, 36 and 60 months after the IUD insertion in 20 volunteers. RESULTS: At the end of 5 years, the pregnancy rates of MSSR-165, medicated gamma-IUD and TCu220C were 3.2, 2.7 and 3.2. The expulsion rates were 7.7, 2.3 and 2.4, while the removal rates for medical reasons were 5.0, 3.8 and 6.4. The cumulative continuation rates were 79.8, 88.7 and 84.9 per 100 women respectively. The average total bleeding time in the first year of MSSR-165 was 22 days, the shortest one among the three IUDs. The quantitative comparison of MBL showed that the gamma-IUD reduced the MBL and the TCu220C increased the MBL apparently. CONCLUSION: With good clinical efficacy, short menstrual bleeding time, as well as the same appearance and insertion technic as stainless steel ring, the MSSR-165 will be easily accepted at the grass root level. The gamma-IUD had good clinical efficacy and higher continuation rate, whereas the side effect of bleeding was not obvious. Both medicated SSR165 and gamma-IUD could be recommended for promotion.

Adult↗
PubMed2000

Immediate postabortal insertion of the frameless IUD: review of current experience.

Experience with the frameless Gynefix intrauterine device (IUD) for immediate postabortal insertion is growing. Reports confirm that the design characteristics of the frameless IUD (fixed, frameless and flexible) are responsible for the low expulsion, high effectiveness and high continuation rates. Insertion is easy and safe in the hands of trained providers and appears to be as reliable and effective as when inserted at interval. The results suggest that the frameless IUD may be an important new and affordable option to prevent repeat abortion.

Abortion, Induced↗
PubMed1992

A randomized comparative trial of the MLCu375, TCu220C, steel ring and uterine cavity-shaped IUDs.

The Stainless Steel Ring, Uterine Cavity-Shaped Device, TCu220C and MLCu375 IUDs were evaluated in a randomized trial of 1536 women in Guangdong Province, China. The first-year continuation and expulsion rates were significantly lower (p less than 0.05) for the latter 3 IUDs than for the Stainless Steel Ring. The first year pregnancy rates for the MLCu375 (0.76 per 100 women) and TCu220C (1.2 per 100 women) were significantly lower (p less than 0.05) than those of the other two devices (6.1 and 4.1 per 100 women). The results of the study show that the MLCu375 and TCu220C are the most suitable IUDs for women in Guangdong Province.

Adult↗
PubMedDate not supplied

Comparative clinical performances of 4 copper-releasing IUDs.

Clinical performances of the Copper 7, Gyne T 200, MLcu 250 and Tcu 200 were compared on 203 patients in this random study conducted over a period of 18 months. Insertion-linked events, tolerance (markers were bleeding or spotting, IUD-linked pain and partner discomfort) and causes for removal (spontaneous expulsion, pregnancies and pelvic infection) were considered. Randomization was performed at the beginning, using prescriptions that came from a randomized pool. Validity of the randomization method was checked against four criteria: number of models inserted per IUD type, prevalence of IUD type per age group, per previous gravidities and per previous means of contraception. No major difference in clinical performance among the four IUD types appeared upon analysis of the resulting data.

Adult↗
PubMed1980

Five years private practice experience of nulliparous women using copper IUD's.

This is a study of 296 nulliparous women who used Copper IUD's as their method of contraception. At the time of first insertion the women had an average age of 21.6 years. The gross cumulative pregnancy rate rose to 11.8 over 5 years. The gross cumulative expulsion rate rose to 13.6 over 5 years and the removal rate for bleeding and pain to 20.4. The net rates were lower over 5 years (pregnancy 8.6, expulsion 11.2 and bleeding and pain 17.3). 29 women expelled their IUD's, of whom 20 underwent reinsertion. 43 women requested removal of their IUD's because of bleeding and pain, of whom 6 requested a reinsertion at a later date. Taking reinsertions into account, the continuation rate over 5 years was 55.2. Inability to insert the IUD was encountered in 28 women (8.6%). In 20 of the women cervical stenosis precluded the insertion of the IUD without local anesthetic, and in the other 8, the pain and/or syncope encountered during sounding the uterus precluded the continuation of the procedure. Insertion problems were encountered in 31 women (10.5%). Syncope occurred in 4 women and one of the women developed a 'grand mal' seizure. Clinically significant pelvic infection occurred within 30 days of insertion in 5 women (approximately 1% of insertions), and one woman developed pelvic infection from gonorrhoea.

Adolescent↗
PubMed1981

[Long term experience with the IUD copper-T-200 (author's transl)].

During a period of seven years pregnancy-, expulsion- and extraction-rates of the copper-T-200 were determined for two different groups of patients in a university hospital. The first group were patients of the ambulatory care service representing an heterogenous composition. The other group were patients from a private practice representing a more homogenous population. In the first group insertions and controls were done by different physicians at various stages of their training, in the second group they were performed by an experienced clinician. In the first group there were 1397 primary IUD-insertions and 22,203 months of use, in the second group the corresponding data were 272 primary insertions an 5127 months of use. The pregnancy rates calculated according to the Pearl-index were 1.0 and 0.24, respectively. The expulsion rates were calculated as 0.8 and 0.2, respectively. The extraction rates because of unwanted side-effects were 4.4 in the first and 1.6 in the second group of patients. There seems to be an advantage in having the care of the IUD-patient being taken by an experienced physician, especially regarding the extraction rates because of unwanted side effects.

Female↗
PubMed1993

The clinical performance of the Multiload IUD. II. The influence of age.

Six thousand four hundred and sixty-two Multiload IUDs were inserted (3606 MLCu375 and 2856 MLCu250). In this study, we determined the acceptance and safety of Multiload IUD use in different age groups. Results were analyzed according to the usual life table method. The pregnancy rate was higher with the users of MLCu250 than with the MLCu375 in a clear relation to age group. Expulsion and bleeding and/or pain rates were higher with younger women in both IUD types.

Adult↗
PubMed1976

[Intrauterine contraceptive devices. Mode of action, experiences, complications (author's transl)].

Already in 1909 methods of an intrauterine contraception were indicated in Germany. Their practical use was intiated twenty years later by Ernst Graefenberg. Further development almost exclusively takes place in the USA, whereas the major part of basic investigations has been done. The introduction of copper bearing IUD's undoubtedly increased the safety of intrauterine contraception. Investigations concerning the morphology of the endometrial contact area (f.e. by SEM) and the evaluation of certain biochemical facts associated with the release of copper ions, lead to hypotheses of the mode of action. A randomized comparative study of CuT 200 verus Lippes Loop D demonstrates similar pregnancy rates with both types of IUD, but a moderate advantage of the CuT 200 in regard of the expulsion rate and the removal rates due to bleeding and/or pains. The author stresses that it might be medically indicated to terminate pregnancy when a woman has conceived in spite of a copper bearing IUD in situ. His statement is in correspondence to the recommendations of the Population Council, but nevertheless, this problem as yet is far of being solved unanimously. Most complications associated with the IUD are due to incorrect insertion. It is therefore postulated to insert the IUD menstrually, maintaining strictly sterile conditions, a non-deformed uterus being hooked on a bullet forceps. As already anticipated by Ludwig Fraenkel a careful insertion should be done by experienced doctors only, this fact counteracting the widespread use of this contraceptive method to be in the second place as compared to hormonal contraception.

Abortion, Legal↗
PubMed1987

The Ombrelle-380 IUD: a pilot study.

The initial results of a pilot trial (314 insertions and 3784 woman-months of experience at 18 months) suggest the low expulsion rate (0.0) and high clinical effectiveness (pregnancy rate 0.0) of the Ombrelle-380, a new high-load copper-releasing IUD of French origin.

Female↗
PubMed1978

Lost intrauterine devices and their localization.

With the increasing popularity of intrauterine devices for contraception, an increase in the number of IUD-related complications has been observed. A common clinical problem is loss of marker strings at the external os. It could be due to translocation or unnoticed expulsion, both of which reduce the contraceptive effectiveness of the method. Even with the most scrupulous IUD insertion technics, uterine perforation is a recognized complication. Ectopic devices should be removed because extensive sepsis and adhesions between adjacent organs with subsequent bowel strangulation have been reported. Determining the location of the device is facilitated by flat plate X-rays of the abdomen, hysterography, ultrasound or hysteroscopy. The best method of IUD removal depends upon its location, extent of adhesions and the experience of the operator.

Abortion, Septic↗
PubMed1984

In vivo measurements of uterine cavities in 795 women of fertile age.

The uterine sound length, the functional length of the cervix including the zone of internal cervical os and the fundus transversal were determined in 795 fertile women in vivo using a measuring device, the Cavimeter. The functional cavity length was calculated by subtracting the functional length of the cervix from the uterine sound length. With growing parity, the uterine length and width increase, but with advance in age, the uterine cavity changes are not so distinct. The wide ranges found by the investigation demonstrate the individuality of the uterine cavity and the desire to measure it prior to fitting an IUD. The use of adapted IUDs according to the size of the uterine cavity leads to a remarkable reduction of side effects, particularly expulsion, bleeding and cramps caused mainly by dimensional incompatibility. Therefore prefit uterine cavity measurement can lead to better efficacy of IUDs, increased rates of acceptance and higher continuation rates.

Adolescent↗
PubMed2003

The 'frameless' intrauterine system for long-term, reversible contraception: a review of 15 years of clinical experience.

AIM: The development of the 'frameless' intrauterine system (IUS) is a response to the growing need to develop high-performing, long-acting, reversible, and acceptable contraceptives with a high continuation of use. METHODS: This is a review of 15 years of clinical experience in randomized controlled and non-randomized clinical trials. RESULTS: The IUS has a similar failure rate as the TCu380A Intrauterine device (IUD), considered the 'golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional 'framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15,000 woman-years experience. CONCLUSIONS: Young nulliparous/nulligravid and parous women may significantly benefit from the advantages the 'frameless' IUS, which could be strategically important to help in reducing the increasing number of unintended pregnancies and induced abortions worldwide. Furthermore, the 'frameless' IUS has been shown to be highly effective for emergency contraception and for immediate postabortal insertion. The long lifespan of the IUS could constitute a cost-effective reversible alternative to irreversible female sterilization.

Female↗
PubMed1994

The copper T380A intrauterine device in women with type II diabetes mellitus.

OBJECTIVE: To evaluate the safety and efficacy of the copper T380A intrauterine device (IUD) in women with type II, non-insulin-dependent diabetes mellitus. METHODS: From June 1988, 176 women with type II diabetes, in whom the copper T380A IUD was inserted, were followed prospectively until: study closure (June 1993); termination for pregnancy, expulsion, or removal for medical or personal reasons; or termination for loss to follow-up. RESULTS: Sixteen women never returned after initial insertion, leaving 160 women who were followed a total of 3066 months, with 117 continuing follow-up after their reexamination visit 6-12 weeks after insertion. None developed acute salpingitis. The overall removal rates per 100 woman-years were as follows: for pregnancy, 1.57; for expulsion, 1.96; for discontinuation because of medical reasons (including pain and bleeding), 4.31; and for personal reasons, 3.91. The continuation rate at the end of 3 years after insertion was 70%. CONCLUSION: The copper T380A IUD appears to be safe and effective in women with type II diabetes when standard criteria for IUD insertion are followed.

Adult↗
PubMed1995

Low-dose progestogen contraception and the nursing mother.

Breast feeding, though an important and efficient contraceptive method, suffers from one major limitation: the contraceptive protection it offers the nursing mother ends abruptly without giving any physical indication of the return of fertility. Barrier methods and progesterone-only hormonal contraceptives, either in the oral, implant or injectable form, appear to be the primary contraceptive alternative for the nursing mother today. They neither adversely affect lactation, nor does the minute quantity of progesterone (NET or LNG) transferred to the infant affect its growth and physical well-being. Puerperal insertion of IUD carries an inherent risk of pelvic inflammatory disease, high expulsion rates and menorrhagia, once menses resume. Combination contraceptives affect both the quality and quantity of breastmilk; hence they are not recommended. Sterilization is a permanent method and therefore useful only when the family has been completed.

Adult↗