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There have been 203 copper-7 IUD insertions performed in 199 women. The data from 2,230 woman-months of use have been analyzed and compared with other published reports. The copper-7 IUD was an acceptable contraceptive method in regard to effectiveness, continuation, and lack of serious complications.
Using fluorescein-conjugated globulins specific for Actinomyces israelii and Arachnia propionica, we observed large dispersed actinomycete populations in vaginal smears of several asymptomatic women. Mycelial granules, commonly revealed by the Papanicolaou stain, were not seen. These observations are discussed in regard to the threat of infection and sensitivity of the fluorescent stain.
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We analyzed the clinicopathologic aspects of 19 cases of actinomycosis associated with intrauterine devices (IUDs) seen and treated at hospitals affiliated with the State University of New York at Buffalo between 1972 and 1982. Clinical manifestations included the following: (1) asymptomatic IUD-associated Actinomyces colonization, (2) endocervicitis, (3) endometritis, (4) endometritis with salpingitis and/or tuboovarian abscesses and (5) abdominopelvic abscesses. No consistent relationship was found between the total peripheral lymphocyte count and/or degree of histologic lymphocytic reaction and the clinical picture. Abnormal uterine bleeding and/or discharge, pain, fever and abdominopelvic masses were among the symptoms and signs encountered. Patients with endocervicitis and/or endometritis responded to removal of the IUD, dilatation and curettage and antibiotic therapy for two to four weeks. Those who developed abscesses were treated successfully with surgical drainage and added antibiotic treatment.
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A group of 33 baboons was used to study the effect of various intrauterine device (IUD) assemblies on the entrance of vaginal/cervical microflora into the uterine cavity for a total experimental period of 16 months. These animals were specially prepared surgically so that intrauterine samples could be taken aseptically and percutaneously rather than transvaginally. While the insertion and presence of any of the IUD assemblies used in this study could promote intrauterine bacteria, the principal determining factor was not the device itself, but rather retrieval tail. Multifilament tails were much more effective than monofilaments. Of particular interest is the fact that many potential pathogens can be present in the uterus for long periods in a benign, almost "normal flora" fashion without producing disease.
A prospective study was conducted to assess endometrial fibrinolytic activity before and after insertion of copper 250 (Multiload) and after removal of the IUCD. Fibrinolytic activity was measured on the fibrin plate in the form of zone of lysis. Sixty two women in the control group had fibrinolytic activity of endometrium in the range of 0.3-9.5 cm2 (mean +/- SD 1.77 +/- 1.27), 40 women who wanted to have the IUCD removed, because of reasons other than bleeding had a range of 0-9.5 cm2 (mean +/- SD 2.28 +/- 1.88) while 48 women who had the IUCD removed because of subjective menorrhagia had a range of 2.24-7.56 cm2 (mean +/- SD 4.75 +/- 1.20) which was higher than in the other two groups.
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Using real-time ultrasound and clinical expertise gained from chorionic villus sampling, we describe a technique for ultrasound-guided intrauterine device removal in those cases in which the string is not visible. Utilizing a stone clamp for intrauterine manipulation, we were easily able to extract the device without interrupting the pregnancy. We concur with recent recommendations advocating all intrauterine devices can be removed if pregnancy termination is declined.
Cervical smears of 554 women using IUDs were examined. The following criteria were evaluated: 1. Age distribution, 2. maturation index of the vaginal epithelium, 3. vaginal flora, 4. cytologic criteria of inflammation, 5. period of time between insertion of the IUD and the cytological examination, 6. final cytologic diagnosis. 554 women without IUD and normal gynaecological status served as a control group. It was the goal of the study to find out, firstly if IUDs in situ produce typical and specific changes in the cytologic pattern and secondly if the rate of suspicious and positive findings is increased: In IUD using women the rate of cases with unphysiologic vaginal flora is increased, the rate of inflammatory cytologic specimen is also higher than in the control group. The rate of inflammatory smears decreases with the increasing interval of time between insertion and cytological examination. IUD typical changes could be observed only in so far as in this group the cytologic signs of chronic cervicitis were increased. Inflammatory alterations are the reason for the higher rate of "suspicious" smears in the group of IUD-users. There was no higher rate of praecancerous lesions among the IUD users. The importance of these results for the clinical management are pointed out.
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