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Management of the patient with an intrauterine device and a unilateral adnexal mass.

Patients wearing the intrauterine contraceptive device (IUD) and presenting with an unilateral adnexal mass may have a pelvic abscess in the absence of the typical dramatic stigmata that usually accompany an acute pelvic infection. Three such patients are presented, each receiving a different surgical management. An elevated erythrocyte sedimentation rate helps make the diagnosis in these relatively asymptomatic patients. IUD removal and prompt hospitalization for intravenous antibiotics are the appropriate management.

Adult↗

Complications associated with IUD use in a family practice setting.

This study compares the complication rate of intrauterine contraceptive devices (IUD) with other contraceptive measures in a residency practice. The study population included 220 randomly selected women who had IUDs inserted by residents over a five-year period. One hundred similarly selected women started on birth control pills (BCP) were used as a control group. Of the IUD patients, 8.6 percent developed pelvic inflammatory disease vs 2 percent of the BCP patients. The incidence of gonorrhea was not significantly different between the two groups: 8.2 percent for the IUD groups vs 7 percent for the BCP group. Discontinuation of IUDs for reasons other than desiring pregnancy was significantly higher than discontinuation of BCPs: 41 percent vs 12 percent. Of the total IUD insertions, there were 21 expulsions (10 percent) and one uterine perforation (0.4 percent). Five pregnancies occurred in the IUD group, yielding a pregnancy rate of 1.7 per 100 women-years. There was a four percent rate of gynecologic hospitalizations in the IUD group as contrasted with one percent rate in BCP group. IUD use in the family practice setting under study is associated with comparatively poor long-term acceptance and a relatively high rate of complications.

Adolescent↗

[IUD insertion during cesarean section and its most frequent complications].

A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction.

Adult↗

Keloid formation from levonorgestrel implant (Norplant System) insertion.

It is possible that women of certain ethnic backgrounds, specifically those more prone to keloid formation, are also more prone to the insertion site complications of levonorgesterel implants. Failure to recognize the potential for this complication and to provide adequate guidance to the patient could result in unwarranted cost and complications. It is possible that intralesional steroid injection at the first sign of a local reaction will minimize the formation of a keloid; however, specific research will need to be done before a change in practice can be recommended.

Adult↗

[The IUD and uterine perforation].

The intrauterine device (IUD) is an effective and relatively safe contraceptive. Approximately 15% of women of child-bearing age in Italy use the IUD. The major health risks associated with IUD use are perforation of the uterus, pregnancy (both intrauterine and ectopic), and pelvic inflammatory disease. Perforation of the uterus by an IUD is a serious complication and this is possible both during the insertion and later. Perforation of the uterus is rare, but potentially fatal. The incidence is of 0.12-0.68/1000 insertion. Although some patients have signs and symptoms suggestive of perforation (pain or bleeding), many are apparently asymptomatic at the time the diagnosis of perforation is made. Perforation is often suspected or diagnosed when the IUD string is no longer visible at the external os. A patient who has sustained a perforation is not protected against pregnancy. Numerous factors affect perforation: the type of IUD, the uterine size and position, timing of the insertion in relation to the last delivery or abortion and the experience of the clinical. Serious consequences have been described, such as severe damage to the viscera (i.e. bowel, kidney) and/or peritonitis. The diagnosis is clinical, ultrasonic, radiological and coelioscopic. Coelioscopic diagnosis makes it possible to choose the method of treatment. In experienced hands, this method is rapid, the hospitalization required short and the sequelae simple.

Adolescent↗