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Prenatal ultrasound diagnosis of fetal candida infection: a complication of a retained intrauterine contraceptive device.

A 32-year-old woman was referred complaining of abdominal pain and bleeding at 18 weeks' gestation. The striking finding on ultrasound examination was of symmetrically enlarged echogenic fetal lungs. In addition, mediastinal compression, increased echogenicity of the kidneys and bowel, an enlarged liver of decreased echogenicity, and hydrops fetalis, as evidenced by ascites and skin edema, were all present. The differential diagnosis included upper respiratory tract obstruction and cystic kidney disease. The presence of fetal hydrops together with the other findings suggested a poor outcome, and on these grounds therapeutic abortion was recommended and performed. Subsequent postmortem findings explained all the ultrasound abnormalities on the basis of extensive fetal candida infection. The presence of a retained intrauterine contraceptive device was considered to be the likely cause and the implications of this, together with the ultrasound abnormalities and differential diagnoses, are discussed.

Journal Article↗

Epidemiology and aetiology of acute non-tuberculous salpingitis. A comparison between the early 1970s and the early 1980s with special reference to gonorrhoea and use of intrauterine contraceptive device.

More patients were hospitalised for acute salpingitis at the Department of Obstetrics and Gynaecology, Orebro Medical Centre, Orebro, Sweden, during the 5 year period 1970-1974 (period I) as compared with that of 1980-1984 (period II), 666 patients and 524 respectively, a decrease of 22%. The majority of cases, 92% in period I and 85% in period II, occurred among women 15-34 years of age, that is a relative increase of patients aged over 34 from 8% in period I to 15% in period II. Concomitant urogenital gonorrhoea occurred in 26.2% of the patients in period I compared with 12.0% in period II, a highly significant decrease (p less than 0.001) mainly confined to the age group 15-24, whereas there was no relative difference for the two periods in the age group 25-34 years. The number of patients using intrauterine contraceptive device (IUCD) was 96/666 (14.4%) in period I compared with 113/524 (21.6%) in period II (p less than 0.001). There were also relatively more IUCD users among the patients with gonorrhoea and acute salpingitis in period II (15.5%) compared with period I (10.4%) but this difference was not statistically significant. From 1981 to 1984 370/424 patients were cultured for Chlamydia trachomatis and 27.8% (103/370) were positive. Thus Chlamydia trachomatis is at present, at least in the Orebro area, the most frequently isolated STD agent among acute salpingitis patients while gonorrhoea is of much less importance.

Acute Disease↗

Copper levels & reactive oxygen species in uterine flushings in copper intrauterine contraceptive device users.

Copper levels were estimated in the uterine flushings in 15 copper 'T' 200 device acceptors. There was a statistically significant difference in the preinsertion and one week post insertion values (P < 0.001). This also corresponded to a high level of generation of reactive oxygen species. The levels of reactive oxygen species were similar to preinsertion values at 4 and 12 wk. The copper values declined over the 3 months but were still higher at 12 wk as compared to preinsertion levels and this difference was statistically significant. Hence addition of copper to the intrauterine device besides enhancing the contraceptive efficacy, perhaps also plays an important role in microbicidal activity and helps in overcoming the infection introduced at the time of insertion.

Adult↗

The radiology of the intrauterine contraceptive device.

Some intrauterine devices are of low radiographic density and require careful technique for their demonstration. The main indications for radiology are to exclude deformity, which reduces the loop's efficiency, perforation of the uterus, or expulsion of the loop.

Cervix Uteri↗