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Four cases of serious genital infections in connection with the application of intrauterine contraceptive devices and the therapeutic methods are reported. Criteria of indication and contra-indication on the application of intrauterine contraceptive devices are mentioned.
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A case of probable cervical perforation and extra-peritoneal migration of a Copper-T device into the space of Retzius is hereby reported. The mechanism of this exceptional kind of translocation, its outcome and the management of the patient are discussed.
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.
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.
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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.
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.
The incidence of intrauterine device (IUD)-associated cervicovaginal actinomycosis was evaluated. Papanicolaou-stained cervicovaginal smears from 1,520 women with IUDs were reviewed for the presence of Actinomyces-like organisms. The overall colonization rate was 11.4%. The colonization rates for the Progestasert, plastic IUDs and copper IUDs were 14.3%, 10.8% and 6.69%, respectively. The colonization rate appeared to increase with the duration of IUD use. The relatively high cervicovaginal Actinomyces colonization rate suggests that all patients with IUDs should undergo annual cytologic smears, with specific attention given to the presence of Actinomyces-like organisms.
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BACKGROUND: This study describes the Norplant prescribing experience, training, and attitudes of South Carolina family practice and general practice (FP/GP) physicians. METHODS: A survey was mailed to all FP/GP physicians licensed in South Carolina, with two follow-up mailings to nonrespondents. RESULTS: Responses were received from 520 physicians, representing 43% of all licensed FP/GP physicians and 73% of all board-certified FP physicians. Norplant had been inserted by 39% of the respondents, and fewer than 10% reported encountering complications during the insertion process. Norplant removal was reported by 135 physicians, averaging 4.4 removals per year. Complications during removal were reported by 52% of physicians, with the most common problem being difficulty finding the capsules. Some degree of training in Norplant insertion was reported by 82% of physicians; 69% reported having had some training, formal or informal, in removal; but only 57% reported having received formal training either during residency or at a workshop. Training reduced insertion time but did not affect removal time or the number of complications encountered. Formal training was more likely to prepare physicians to successfully manage procedural complications. CONCLUSIONS: FP/GP physicians are important providers of Norplant. Improved training is needed to ensure that insertion is performed properly and to disseminate effective removal techniques.
Report on 18 patients who were treated in hospital during the last 4 years because of a lost intrauterine contraceptive device. Carbon dioxide hysteroscopy was found to be a more advantageous diagnostic procedure in the search than radiography. In 14 cases, the intrauterine contraceptive device was grasped and removed under hysteroscopic control. In 4 cases the uterine cavity was empty on hysteroscopy. The device had perforated into the uterine muscle or into the peritoneal cavity. These 4 cases are reported in detail.
AIM: To evaluate the long term clinical performance of the Schering Nova-T 200 intrauterine contraceptive device. METHOD: From 1982 to 1990, 446 women were fitted with their first Nova-T IUD's and followed up until December 1994. By this cut off data, 21 (4.7%) were lost to follow up. These were excluded to simplify analysis. RESULTS: Of the remaining 425 women, there were 383 multipara and 42 nullipara. Thirty one percent were fitted with a new Nova-T after 4 years of use. The method was uncomplicated in 70% of multiparous women, but in nulliparous users, the removal rate for unacceptable bleeding and/or pain was found to be 40% compared to 19% for the multipara. An expulsion rate of 4.9% was recorded. The overall cumulative accidental pregnancy rate was 3.5% with a Pearl Index of 1.2 per hundred woman years, a lower rate in older users being the only age related event in the study. Possible pelvic inflammatory disease was recorded in 2.8% with a Pearl index of 0.96. There was no evidence of subfertility after removal in any of the 53 women where a pregnancy was desired. CONCLUSION: The Nova-T 200 IUCD is safe and cost effective and should continue to be offered as a contraceptive option for properly selected women. Although poorly tolerated by nullipara, it proved to be very satisfactory for multiparous women, particularly nursing mothers and those over 40 years of age.
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A new type of imperfection in condom latex, present during moderate stretching, was observed by low magnification scanning electron microscopy. The normally smooth surface of relaxed natural latex was transformed into an accordion-like arrangement of ripples in addition to tears. A corollary experiment with Alcian blue dye placed into both stretched and unstretched condoms leaked no dye. These surface features are consistent with latex acting as a molecular barrier. The tears may represent areas of lowered mechanical resistance and raise questions concerning quality control.