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PubMed1980

The response of endometrial blood vessels to intrauterine contraceptive devices: an electron microscopic study.

The ultrastructure of the vascular supply of the endometrium in uteri containing inert and copper bearing intrauterine contraceptive devices (IUCDs) has been compared with that in uteri removed at comparable stages of the menstrual cycle for dysfunctional uterine bleeding. In the endometrium from all uteri containing inert and copper IUCDs, stromal capillaries below the devices showed extensive microthrombosis with platelet and fibrin aggregations filling gaps in the endothelial linings of the vessels. Considerable stromal haemorrhage and erosion of surface epithelium was associated with this vascular pathology. In the uteri removed for dysfunctional bleeding, microthrombosis was a rare occurrence. In the stromal vessels of the endometrium not in contact with the devices, the surface epithelium was usually intact and the underlying stromal capillaries often showed breaks in the endothelial lining but without a haemostatic plug. Leucocyte migration into the stroma was more evident in association with the copper IUCDs than the other devices. The ultrastructural changes in the microvasculature of the endometrium associated with IUCDs did not appear to be related to a stage of the menstrual cycle. The extent and type of microvascular changes appeared to be related to the proximity and surface area of the IUCD and to the presence or absence of copper in the device.

Adult↗
PubMed1977

Absence of circulating chorionic gonadotropin in wearers of intrauterine contraceptive devices.

Daily measurements of human chorionic gonadotropin (HCG) beta subunit, luteinizing hormone (LH), and progesterone were carried out in 24 subjects wearing intrauterine contraceptive devices. Detectable HCG was not found in any subject, but in four subjects delayed LH pulses resulted in apparent low levels of HCG because of cross-reactivity in the HCG beta subunit radioimmunoassay.

Adult↗
PubMed1994

The use of transvaginal ultrasonography compared to routine gynecological examination to check the location of an intrauterine contraceptive device.

The objective of this study was to evaluate the use of transvaginal ultrasonography compared with a routine gynecological examination to check the location of an intrauterine contraceptive device (IUCD). Fifty-two women attending the antenatal cure unit at Lundby hospital for contraceptive guidance were included in the study. All women had an IUCD inserted at this visit and were examined bimanually and by speculum. The same examination was repeated and a transvaginal ultrasound scan was carried out at 1 week and then 3 months later. In 51 women, the threads of the device could be identified at the time of the gynecological examination and the IUCD was considered to be correctly positioned. In one woman, the threads could not be seen, but transvaginal ultrasonography confirmed that the position of the device was at the fundus of the uterus. Forty-eight women were judged by ultrasound examination to have the device optimally placed in the uterine cavity. In four women, although the IUCD was apparently correctly located according to the gynecological examination, the device was shown by ultrasonography to be misplaced.We suggest that transvaginal ultrasonography should replace the conventional gynecological examination as the best method of checking the location of an IUCD.

Journal Article↗
PubMed1989

Human papillomavirus in cervical smears taken from women wearing an intrauterine contraceptive device.

Cervical cells were screened for human papillomavirus (HPV) infections by in situ filter hybridization in 108 patients wearing intrauterine contraceptive devices. The cells were tested for the presence of HPV 6, 11, 16, 18 DNA. In 86 cases (79.6%) no reactions were obtained with 32P-labeled HPV DNA probes. 22 smears (20.3%) were positive for HPV: type 6 and 11 sequences were demonstrated in 17 cases (3 of them carried both). 4 smears hybridized with the probe for oncogenic HPV 16 and one with that for oncogenic type 18. All these five patients had normal smears and no abnormality on colposcopy.

Female↗
PubMed1990

Pelvic actinomycosis associated with intrauterine contraceptive devices--a review of 6 cases.

We analysed the clinicopathologic aspects of 6 cases of pelvic actinomycosis associated with intrauterine contraceptive devices seen and treated at Mackay Memorial Hospital between 1987 and 1989. All of them had IUD for a period from 5 to 20 years. The incidence of pelvic actinomycosis among all our gynecological admission number during the same period was 0.08%. The most frequent presenting symptoms were lower abdominal pain and abnormal vaginal bleeding. An abdominal total hysterectomy with a bilateral or unilateral salpingoophorectomy was performed on all 6 cases due to a tubo-ovarian abscess or a pelvic mass. We do not find any relation between the presence of pelvic actinomycosis and the type of IUD. However, the study number was too small to make a definitive statement, but the length of time of IUD insertion is of greater significance.

Actinomycosis↗
PubMedDate not supplied

The cells from intrauterine contraceptive devices: with special reference to the occurrence of mast cells.

A study of cytologic smears from 26 women using intrauterine contraceptive devices (IUDs) confirmed our previous findings for mast cells and further defined the averages, proportions and types of cells in IUD smears. The average number of cells was found to be 65.5 x 10(4), with a range of 1.3 x 10(4) to 280 x 10(4). The cellular proportions found were 49.0% macrophages, 42.7% polymorphonuclear leukocytes, 4.0% endometrial glandular cells, 1.3% mast cells and 3.0% other cells. Total nucleated-cell counts showed one group with a large number of cells (greater than 5 x 10(5) cells) and another group with a smaller number of cells (less than or equal to 5 x 10(5) cells). These groups showed significant differences in cell types, with a predominance of polymorphonuclear leukocytes in the former and macrophages in the latter. The mast cell counts were similar in both groups. The data suggest that mast cells have a role in IUD functioning. It may be based on an immunologic mechanism.

Adult↗
PubMed1994

In situ characterization of leukocytes in the fallopian tube in women with or without an intrauterine contraceptive device.

Histological evaluation of sections from the human fallopian tube revealed an inflammatory reaction in 21 of 31 women using an intrauterine contraceptive device (IUCD) and in four of 29 controls (non-IUCD users). The inflammatory cells were mainly localized at the epithelium-lamina propria interface and at the center of the mucosal folds. The immunohistochemical study revealed leukocytes (CD45+), T lymphocytes (CD3+), T helper cells (CD4+), T suppressor/cytotoxic cells (CD8+), B lymphocytes (CD22+, CD19+), granulocytes, monocytes and null cells (CD11b+) mainly localized at the lamina propria in both groups. T lymphocytes were the predominant cell type, and the ratio between T helper and T suppressor/cytotoxic cells was fairly close to one both in IUCD-users and controls. B lymphocytes were the least frequent cell type identified. In IUCD users, the numbers of the different leukocytes were increased. In both groups, IgA-, IgG- and IgM-positive cells were demonstrated and were predominantly located at the lamina propria of the mucosal folds. The IgA-positive cells dominated in both groups, whereas IgG- and IgM-positive cells were less frequent. Cell positive for IgA, IgG or IgM were significantly increased in number in the IUCD users. The data confirm the presence of an immune system in the normal human fallopian tube and indicate that the IUCD can induce a prominent recruitment of inflammatory cells, with a tubal inflammation as the result. The IUCD may disturb the immunological function of the fallopian tube and its rôle in fertilization.

Adult↗
PubMed1993

Intrauterine contraceptive device and pelvic inflammatory disease.

Comprehensive, mainly epidemiological data has helped us to recognize the strongest risk factors of pelvic inflammatory disease during intrauterine contraceptive device use. These are user's exposure to sexually transmitted diseases, young age and insertion of the device. Moreover, parity of the user and type of device may affect the risk of pelvic infection.

Adult↗
PubMedDate not supplied

Cytologic atypias in the uterine fluid of intrauterine contraceptive device users.

A peculiar cell pattern, characterized as an atypical glandular cell cluster (AGCC), was found in the uterine fluid from women using intrauterine contraceptive devices (IUDs). This atypia can mimic adenocarcinoma. Since the atypical cells were present in much higher frequency in the uterine fluid than in the cervical mucus, it is suggested that they originated in the endometrium.

Body Fluids↗
PubMed1981

Effects of a progesterone-releasing intrauterine contraceptive device on endometrial blood vessels: a morphometric study.

The concentration of microscopically detectable blood vessels was significantly lower in endometrium exposed to progesterone-releasing intrauterine contraceptive devices (IUDs) than in control endometrium (mean vessel density 2.39 and 3.92, respectively). The percentage of vessels with defects was significantly higher in IUD samples (35.0%) than in control samples (13.4%). There was no significant difference in hemostatic response to vessel injury between the IUD and control samples. Although they were more defective than in controls, the blood vessels of progesterone IUD-exposed endometrium were far fewer in number, which may account for significantly less uterine blood loss in the users of these devices. In addition, the progesterone IUDs do not appear to inhibit hemostasis in the endometrium so that blood loss from injured vessels may be minimized.

Endometrium↗
PubMed1991

The intrauterine contraceptive device, "Multiload Cu 250": a regulatory problem.

Reports to the control agencies in Sweden and Australia of fractures of the intrauterine contraceptive device. Multiload Cu 250, led to a review of the safety of this device in these countries. The review revealed that fractures of the device had occurred in 15 other countries but in these countries only 5% of reports had been directed to the relevant national control authorities. The remainder either had been reported to the sponsor or had appeared in the published literature. An additional problem identified was one of thread rupture with the resultant difficulty in removal and the need for surgical intervention. It is apparent that the sponsor of the device was aware of the problems for some time since it made several significant changes to the device marketed in Sweden. These changes were made in 1983, without informing the Swedish agency and without its approval. These were 1622 Multiload Cu 250 devices returned to the Swedish agency for examination from 1988 to 1989. An analysis of 1516 of them found that the overall incidence of device fracture was 1:405 and of broken threads, 1:8. However, evidence suggests that the modifications conducted in 1983 and 1984 resulted in a device with very much less chance of fracture and/or ruptured threads on removal. Stress testing of 106 used devices suggested that the risk of fracture may increase with the length of time left in utero. Regulatory action in both Sweden and Australia involved changes in the information provided to physicians and patients. In Sweden, the additional step of withdrawing all earlier devices suspected of being associated with fracture and/or ruptured threads was taken.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed2006

Ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device user.

We report herein a case of ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device (IUD) user. A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. Magnetic resonance showed swelling of the uterus wall and left parametria, but did not reveal the presence of an IUD. Subtotal hysterectomy, bilateral salpingo-oophorectomy and left nephronureterectomy was performed. The IUD was then found in the uterine cavity. The results of pathological and bacteriological findings for Actinomyces infection were negative. Therefore we diagnosed this case as ureteral obstruction associated with pelvic inflammatory disease. Ureteral obstruction associated with pelvic inflammatory disease in a long-term IUD user is extremely rare.

Diagnosis, Differential↗
PubMed1975

Comparison of three intrauterine contraceptive devices: the Antigon-F, the Ypsilon-Y, and the Copper-T 200.

A comparative study of three intrauterine contraceptive devices, the Antigon-F, the Copper-T, and the Ypsilon-Y, was carried out at The New York Hospital Cornell Medical Center during an 18-month period from March 1, 1972, through August 31, 1973. At the cutoff date of February 28, 1974, all patients had been followed for at least 6 months. During the period of study, 884 Antigon-F devices, representing 14,436 woman-months of use, were inserted. The over-all pregnancy rate was 0.88, with an explusion rate of 5.1 and a medical removal rate of 9.1/100 woman-years. This device was best tolerated by multiparous women. There was a total of 910 insertions of the Ypilson-Y, representing 14,348 woman-months of use. The over-all pregnancy rate was 1.8, with an explusion rate of 1.9 and a medical removal rate of 3.7/100 woman-years. The pregnancy rate in nulliparous women was 0.78, with a continuation rate of 88.9. The pregnancy rate in multiparous woman was higher, i.e., 2.4. Nine hundred thirty-nine Copper-T 200 devices, representing 15,558 woman-months, were inserted. The over-all pregnancy rate was 0.85, with an expulsion rate of 1.8, a medical removal rate of 4.5, and a continuation rate of 88.4/100 woman-years. The pregnancy rate was 0.82 for nulliparous women and slightly higher, i.e., 1.04, for multiparous women. Thus, all three devices had considerable merit. The Antigon-F and the Copper-T seemed the best in multiparous women; the Ypsilon-Y in the size used was best in nulliparous women. The only perforations occurred with the Copper-T.

Copper↗
PubMed2002

[The use of three-dimensional ultrasound imaging in detecting the type and location of intrauterine contraceptive device].

OBJECTIVE: To assess the value of three-dimensional ultrasound (3DUS) imaging in detecting the type and location of intrauterine contraceptive device (IUD). METHODS: Three-dimensional ultrasound imaging examination was conducted in 30 patients suspected with abnormality of IUD based on transvaginal two-dimensional ultrasound imaging examination. Through reconstruction of transvaginal 3DUS images, the type and location of IUDs were detected, and the results of hysteroscopy, laparoscopy or laparotomy were compared with the result of 3DUS. RESULTS: Satisfactory 3DUS images were obtained in 29 cases (96.7%) in which the type and location of IUDs and the relationship between IUD and uterine cavity were distinctly shown; satisfying imaging was not obtained in one menopausal case because of thinning of endometrium, the imaging only showed incarceration of IUD and not the relation between IUD fragment and uterine cavity. It was found that 17 IUDs (10 of single metal cirque type, 3 of gamma type, 2 of uterine cavity type, and 2 of T type) remained intact and 13 became fractured. Twenty-four IUDs were incarcerated, four were rotated (3 of gamma type and 1 of uterine cavity type), and 2 T type IUDs were normal. IUD was removed by hysteroscopy, laparoscopy, or laparotomy successfully at one go in 26 of the 28 cases with IUD abnormality. The findings of operation was consistent with the results of 3DUS. CONCLUSION: 3DUS is of great value in diagnosing IUD type and location, and helps select therapeutic plan.

Adult↗
PubMed1986

Mast cells in the tubal wall in women using an intrauterine contraceptive device.

The number of mast cells in the tubal wall of 33 healthy nonpregnant women, 17 of whom had an intrauterine contraceptive device (IUCD), was investigated. Light microscopy showed that both the muscularis externa and the lamina propria of the tubal wall contained more mast cells in the 17 IUCD users than in the 16 non-users (control group). In both patient groups the mast cell concentration was higher in the muscularis externa than in the lamina propria. Most mast cells of the muscularis externa were more closely related to smooth muscle cells than to blood vessels. The increased number of mast cells in IUCD users may be a factor in the pathogenesis of pelvic inflammatory disease and the ectopic pregnancies that occur in IUCD users.

Adult↗
PubMed1987

Serum concentrations of immunoglobulins and complement components in women using an intra-uterine contraceptive device (IUCD).

Immunoglobulins A, G and M and the complement components C3, C4 and CI-INH were quantified in sera from 59 women using an intra-uterine contraceptive device (IUCD). Most of the women were using a Cu IUCD, and the mean duration of use was 7.3 years. No differences in the concentrations were detected compared with control subjects. Our data, however, do not exclude a possible temporary change in the concentrations of immunoglobulins and complement components.

Adult↗
PubMed1995

Performances of copper T 380A and multiload copper 375/250 intrauterine contraceptive devices in a comparative clinical trial.

An evaluation of the performances of copper T 380A (TCU 380A) and multiload copper 375/250 (MLCU 375/250) intrauterine contraceptive devices (IUCDS) was carried out at University College Hospital, Ibadan, Nigeria (UCH) in a clinical comparative trial. The IUCDS showed similar low vent rates at one year of continuous use. The difference in cumulative net probabilities for termination due to pelvic inflammatory disease was weakly significant at the sixth month of follow up with MLCU 250 having the highest rate. (TCU 380A-0%; MLCU 375-0%; MLCU 250-3.1%; X2 = 6.0; P < 0.05). This significant difference disappeared by the twelfth month of continuous use. Likewise, the difference in cumulative net probabilities for overall termination was significant at six months and insignificant at twelve months of follow up. The continuation rate after one year were 86%, 92% and 87% respectively for TCU 380A, MLCU 375 and MLCU 250. These rates were higher than 80% and 51% quoted for the previously available Lippes loop in the same environment [1,2]. It was therefore concluded that the three IUCDS are comparable in performances in the first year of use and could be used at our family planning clinic or any other clinic in a similar setting.

Adult↗