Immunoglobulin levels in the cervical mucus of copper intrauterine contraceptive device users.
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Since their widespread introduction in the early 1960s, IUD have been considered effective and safe. Early studies revealed the ability of the cavum uteri to regain bacteriologic sterility within 4 weeks of insertion. However, experience with long-term use indicates an enhanced risk of pelvic inflammatory disease, often of proven bacterial origin. Of these pelvic infections the most pernicious are those caused by Actinomyces. We present nine cases of actinomycotic female genital tract infection encountered in the past 3 years. The features of a distinct clinicopathology entity of IUD-associated actinomycotic pelvic disease are described. This disease is one of subtle protean manifestations and is not often diagnosed preoperatively. The most significantly pathogenic factors appear to be the duration of IUD use and the demonstrated relationship between IUD usage and infestation of the vagina with Actinomyces organisms.
We examined the relationship between use of IUD's and PID, based on 44 women who were admitted to hospitals with first episodes of PID and 259 hospital control subjects. All the women used either IUD's or oral contraceptives. The age-adjusted relative risk for those using IUD's at the time of admission was 6.5 (95% confidence interval, 3.2 to 13.0). The association remained when several variables, and particularly parity, were taken into account. There was a suggestion that users who had had an IUD in place for at least 5 years had a higher risk of PID than did users of shorter duration. The data also suggest that copper-containing IUD's may be safer than other devices.
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Follow-up study of 60 cases (group B) of post medical termination of pregnancy Cu-T insertion and 100 cases (group A) of interval Cu-T insertion revealed that menstrual complaints like dysmenorrhoea and menorrhagia were more prevalent in the 1st 3 months. These were more frequently found in group B cases. After one year the incidence reduced to almost nil in both the groups. Pain in lower abdomen and backache, a more frequent complaint in group B in 1st 3 months were also reduced remarkably after one year. Two expulsions in group B and one expulsion in group A had occurred during the 1st 3 postinsertion cycles along with menstrual flow. Failure has occurred in only one case in group B. For some reason or other Cu-T was removed in 11 cases in group A and 5 cases in group B. Desire for another pregnancy was the prime cause of removal of Cu-T in group A and along with this cause menstrual trouble was equally responsible for its removal in group B cases. There was no case of perforation, displacement or ectopic pregnancy reported in the present study, though for a short period.