THE INTRAUTERINE CONTRACEPTIVE DEVICE.
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Bladder stones occasionally develop because of foreign bodies in the bladder. Bladder stones in a 30-year-old woman were found to have formed around an intrauterine contraceptive device that had gone missing many years previously and had migrated into the bladder. Plain abdominal radiograms should be a part of the evaluation in patients with a history of an unretrieved intrauterine contraceptive device.
The Medical Devices Agency (MDA), an executive agency of the Department of Health, has responsibility for the safety of medical devices within the UK. The MDA is responsible for enforcing the European Medical Devices Directive (MDD) within the UK. Contraceptive devices such as copper-containing IUDs and condoms are regulated by the MDD, and this brief report is an introduction to it.
Insertion of one of three types of intrauterine contraceptive device--the Lem, copper 7, and 'Progestasert' system--was carried out in 274 obstetric patients. These devices were all inserted within 20 min of delivery of the placenta and membranes, with a special 25 cm inserter. The expulsion-rate was low (less than 7%), and there were no uterine perforations. There was no difference in puerperal morbidity between these patients and a matched control group, and no cases of pelvic sepsis developed.
A team of the family planning centre at the Research Institute of Obstetrics and Gynecology carried out a trial on a new Bulgarian intrauterine contraceptive device (ICD), produced by the firm Venus in the town of Varna: Venus Cu 300. This is a T-shaped device with horizontal arm of 30 mm, vertical arm of 34 mm, a copper thread with an area of 300 mm2 and two control threads. It is produced from PVC. Purity of copper is over 99.9% in the copper thread. The construction of Venus Cu 300 has the positive properties of other intrauterine contraceptive devices, used in our country during the last 15 years. 87 women have been followed in 320 cycles for a period of 6 months. A larger part of them are parous, mainly with one or two children. Venus Cu 300 has been used in seven nulliparas, presenting risk for frequent abortions. Three Venus Cu 300 have been placed immediately after abortion. No pregnancy occurs, which is explained by the careful choice of the patients. Extraction of ICD has been made only in one case due to medical causes: bleeding and pain. More abundant menstruation after ICD has been found in 11.5% of women, but there has been no need to extract ICD. Inferences are made that Venus Cu 300 is in every way equal to the known models of ICD, that the trial should include a larger group of women to accumulate data in dynamics, in order to improve Venus Cu 300 eventually.
A comprehensive questionnaire to assess acceptability was sent to 106 participants (and their partners) in a study on the safety and effectiveness of the Femcap. Participants were asked to rate their satisfaction with various aspects of the method, and were also asked about complaints such as vaginal infections, urinary tract infections, or other irritation. Eighty-one percent of the study sample either returned the mailed questionnaires or completed telephone interviews. Results were encouraging in that none of the study subjects or their partners reported any discomfort, trauma, or interference in sexual spontaneity with the cap. Vaginal irritation and infections were infrequently reported. The feature best liked by most participants was the absence of hormones associated with the method; the feature least liked was removal of the device. The Femcap may be an acceptable alternative to currently available barrier contraceptive devices.
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Removal of an intrauterine contraceptive device (IUCD) in nonpregnant patients under ultrasonic guidance has previously been reported, but results of the method in pregnancy are controversial. In the present study removal of the IUCD was performed in 16 women who conceived with the device in place. Four women were scheduled for pregnancy termination and 12 women wished to continue their pregnancy. Removal was successful in all 16 patients with minimal complications. Fetal loss occurred in one case out of the 12 who wished to continue their pregnancy. The procedure was found to be feasible even in cases with the IUCD located behind the gestational sac. We suggest ultrasonic guided removal of the IUCD during pregnancy to be the method of choice.
The sonographic features of intrauterine contraceptive devices (IUD), which allow identification of their intrauterine location, were evaluated in vitro and clinically in 50 patients. Posterior acoustic shadowing was seen in 90% of patients, entrance-exit reflections in 65%, and type-specific morphology in 94% of patients with Lippes Loops and in 81% with Copper 7 devices. Recognition of the characteristic features of the IUD and identification of endometrial mucosa around the IUD will allow unequivocal and accurate determination of its correct intrauterine location.
A case of intrauterine perforation by a GyneFix contraceptive device in a 29-year-old parous woman is described. It is the first report of uterine perforation by the frameless, anchored GyneFix in the UK since its introduction here in 1997. Perforation was diagnosed 12 days after insertion and was complicated by visceral perforation and infection.
Transuterine migration of an intrauterine contraceptive device (IUCD) is a rare complication. The authors report a case of IUCD that migrated into the bladder and subsequently became calcified, leading to a false diagnosis of bladder stones. A 38-year-old woman with an IUCD for 3 years presented with haematuria and signs of bladder irritation. Ultrasound and plain abdominal x-rays suggested a diagnosis of bladder stones. The positive diagnosis of migrated and calcified IUCD was only established after surgical extraction of the stone.
In order to analyse the relationship between intrauterine contraceptive device (IUCD) usage and Candida infection, we planned to examine cytologically the cervico-vaginal smears of 600 patients stained with Papanicolou method. Among 56 IUCD users 8 women had Candida infection (14%) while 44 of 544 non-users (8%) were infected by this fungus. Our detailed analyses indicated that the prolonged usage of Cu-IUCD may predispose the cervico-vaginal flora for Candida especially for the infectious "hyphae" form although statistically the correlation between IUCD usage and candidiasis was not significant (p>0.05). These findings imply the importance of controlled IUCD usage against Candida infection and its removal for treatment if necessary. Because retained IUCD may cause serious clinical complications especially in pregnant women such as "fetal candidiasis" which may lead to miscarriage, premature labor or ectopic pregnancy. For these reasons, the possibility of candidiasis should be considered in patients wearing IUCD for a long period.
A case of actinomycosis following insertion of an intrauterine contraceptive device is reported. The patient was treated successfully by antibiotic therapy and conservative surgery.
Swabs from 112 removed intrauterine contraceptive devices (IUCD), endocervical swabs from these women and from 65 women with pelvic inflammatory disease (PID) were studied for actinomyces, using direct fluorescent antibody test and culture. Endocervical swabs from 50 control subjects were also studied. Actinomyces species could be detected in 23 (20.5 percent) of IUCD wearers and 8 (12.3 percent) of patients with PID. In control cases, no actinomyces were detected. The isolation rate using a selective medium (Actino Blood Agar) was 71.4 percent. Actinomyces israelii, Actinomyces naeslundii and Actinomyces viscosus were isolated.
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