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PubMed2004

Intrauterine contraceptive devices and risk of pelvic inflammatory disease: standard of care in high STI prevalence settings.

The intrauterine contraceptive device (IUD) is highly effective and cost-effective. IUD use is limited in some regions, however, due to concerns about increased risk of pelvic inflammatory disease (PID) and subsequent complications such as infertility and ectopic pregnancy. Recent reviews suggest that the overall risk of PID with modern IUDs is lower than previously thought, at least in regions with a low prevalence of sexually transmitted infections (STIs). Risk of PID may be higher, however, in places where gonorrhoea and chlamydia are prevalent, where screening for STIs is limited and where aseptic conditions for insertion are difficult to ensure. A World Health Organization multi-centre study and other studies have confirmed regional differences in STI prevalence, and the WHO study established that PID risk is temporally related to IUD insertion procedures. Studies of the effectiveness of antibiotic prophylaxis to prevent infectious complications are inconclusive due at least in part to use of sub-therapeutic regimens for pathogens commonly implicated in PID. In summary, the IUD can be safe and effective if inserted under aseptic conditions in women free of cervical infection. Further study is needed to define appropriate standards of care for IUD insertion where STI prevalence is high and ability to rule out infection is limited. Even with safe insertion, IUD promotion in areas of high STI/HIV prevalence must address women's needs for dual protection from infection and unwanted pregnancy.

Attitude to Health↗
PubMed1976

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↗
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↗
PubMed2001

Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence.

OBJECTIVE: Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion. DESIGN: Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators. POPULATION: Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion. METHODS: Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze-Potter gross life table probabilities with denominators of person-time of exposure. MAIN OUTCOME MEASURES: Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation. RESULTS: Complication rates for immediate post-abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1,000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates. CONCLUSIONS: Post-abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.

Abortion, Induced↗
PubMed1986

Management of translocated and incarcerated intrauterine contraceptive devices.

Thirty-seven consecutive patients who reported with absent or snapped strings and failed attempts at removal of intrauterine contraceptive devices (IUCD) by hooks or curette were posted for hysteroscopy/laparotomy following a plain X-ray of the pelvis to exclude unrecognized spontaneous expulsion. Direct visualization of the endometrial cavity was invaluable in locating and removing IUCDs, particularly the embedded and fragmented ones. Translocated medicated devices were associated with dense adhesions, suggesting the need for their prompt removal. There appears to be an increased risk of translocation in lactating women.

Adult↗
PubMed2004

Transuterine migration as a complication of intrauterine contraceptive devices: six case reports.

OBJECTIVES: We retrospectively analyzed six cases between 1986 and 2002 that had been operated within our unit with the diagnosis of migration of an intrauterine contraceptive device (IUD). Although an IUD is an effective contraceptive method, the migration of one is a rare but serious complication. The aim of this report is to emphasize the management and therapy of this complication. CASES: Out of six patients, three patients with occurring pregnancy, two with pelvic pain and one with a missing IUD incidentally diagnosed during a routine follow-up gynecological examination, were admitted to our clinic. The diagnosis of perforation and transuterine migration of the IUD was confirmed with a plain abdominal X-ray with a hysterometer placed in the uterus, hysterosalpingography and ultrasound. One patient was diagnosed as having a perforated rectosigmoid bowel intraoperatively and one presented with perforation of the bladder. In the remaining four cases, the IUD only migrated into the abdominal cavity without any organ perforations. One IUD was extracted laparoscopically, one was removed through the vagina by colpotomy and, in the other four cases, a laparotomy had to be performed. Patients were discharged without any complications. CONCLUSION: The most serious potential complication of IUD use is uterine perforation and this can cause severe morbidity. When an IUD is located in the abdominal cavity, it should be carefully managed and removed, even in an asymptomatic patient.

Adult↗
PubMed1982

Rectal strictures associated with the intra-uterine contraceptive device.

Two cases of stricture of the mid-rectum following extensive pelvic cellulitis due to the use of an intra-uterine contraceptive device (IUCD) are presented. The resulting dense circumferential extrarectal strictures failed to respond to treatment by proximal colostomy and antibiotic therapy and required difficult corrective resection. These are contrasted with an example of the more common upper rectal strictures associated with intraperitoneal sepsis of gynaecological origin, in this case pyosalpynx. Circumferential and transmural spread of inflammation tends to be limited by peritoneal reaction and the resulting strictures (which may be radiologically as severe as those in the mid-rectum) are often readily managed by simple removal of the source of infection. Thus, it appears that simple anatomical factors may be responsible for the differing pathologies seen in the two sites, and different management problems encountered within the two types of strictures.

Adult↗
PubMed1979

Vessel density in endometrium of women with and without intrauterine contraceptive devices: a morphometric evaluation.

Increased vascularity was found in the endometrial functionalis in uteri of women wearing intrauterine contraceptive devices (IUDs) as compared to uteri of women without IUDs (control subjects). Vessel concentration was highest in endometrial tissue adjacent to that tissue which was depressed by the IUD. In control tissues there was a significant variation in vascularity according to geographic location in the following order of magnitude: fundus greater than corpus greater than cornua greater than isthmus. No significant variation was found, however, among different phases of the ovarian cycle in either control or IUD cases. Increased endometrial vascularity could be a reaction to vessel damage caused by the IUD and for several reasons may contribute to IUD-induced endometrial bleeding.

Arterioles↗