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While ultrasound is the primary modality for localization of an intrauterine contraceptive device, plain films are often employed if the ultrasound examination is negative. A case is reported in which loss of radiopacity hampered identification of an intrauterine device.
We measured the rate of release from copper-bearing intrauterine contraceptive devices (IUDs) with varying copper surface areas. Over 135 days of observation the release rate decreased exponentially. This decrease in the release rate was associated with the deposition of a protein layer on the surface of the metal. The bioavailability of copper on IUDs was not related to the volume of copper remaining on the device. Consequently any increase in the copper surface area of an IUD is unlikely to affect the duration of its copper-dependent contraceptive action.
This presentation brings into perspective the most recent information on intrauterine contraceptive devices. A comprehensive review of the literature is presented in a manner meaningful to the clinician. The advantages and disadvantages of this method of contraception, the problems that arise and the recommended methods of management are discussed. An updated review of the literature with regard to bleeding, pain, expulsion of the device, infection, uterine perforation and pregnancy is also presented.
The in vitro sonographic appearance of the four currently available intrauterine contraceptive devices (IUDs) now used in the United States and Canada were analyzed and compared with in vivo scans. While plastic IUD limbs demonstrated entrance-exit echoes in all scan planes, copper IUDs showed posterior reverberation when optimal gain settings were used. Regardless of the transducer used, posterior acoustic shadowing was only seen when IUD limbs were scanned perpendicular to their long axis and at the junction of long and short limbs. The authors feel that these refined ultrasound characteristics will be helpful in accurately identifying IUDs within the uterus.
Reports in the contraceptive literature and our own data concerning the MLCu375 intrauterine device indicate that the high-load ML model is effective, safe, and well tolerated. It is more effective than the MLCu250 without increase in the other cardinal event rates. Consequently, we consider the MLCu375 an improved ML model.
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Migration of an intrauterine contraceptive device (IUD) to the urinary bladder is very rare. We describe a case in which transabdominal sonography demonstrated such migration of an IUD in a 30-year-old woman who sought treatment for pelvic pain and dysuria. The IUD had originally been inserted 10 years earlier, and the patient had given birth without complications 2 years before the onset of her symptoms. Cytoscopic examination confirmed the diagnosis and allowed removal of the IUD.
Thirty-one consecutive pregnant women with intrauterine contraceptive devices in situ were studied. The devices consisted of the coil, loop, or bow. The pregnancies showed a high incidence of abortion, ectopic pregnancy, premature labor, premature rupture of the membranes, sepsis, and hemorrhage. Associated with these maternal complications was a high incidnece of fetal wastage. A recommendation is made for early interruption of the pregnancy.
A 32-year-old woman carried a copper intrauterine contraceptive device (IUCD) or intrauterine pessar (IAP) for more than 5 years. She had acyclic menstrual bleedings and underwent a corpus abrasio after explantation of IUCD. The histological study of paraffin sections showed an actinomycotic endometritis with brown to black deposits in or around typical actinomyces druses, but there was no carcinoma. The electron microscopic study of these accumulations by electron energy loss spectroscopy (EELS) in TEM demonstrated copper deposits in the shell and matrix of these druses as well as inside the bacteria. With scanning electron microscopy (SEM) and Energy Dispersive X-Ray Analysis (EDX), the electron-dense accumulations revealed high signals for copper and sulfur, but also of phosphorus and oxygen in a lower extent. This copper accumulation is discussed as an active uptake and concentration by these actinomyces bacteria.
To detect the association between the use of an intrauterine contraceptive device (IUCD) and the presence of Trichomonas vaginalis (Tv), vaginal smears of 1110 women were examined cytologically. Among 45 IUCD users, 10 women were positive for Tv (22.22%). Forty six of 1065 non-users were also positive for Tv (4.32%). There was a significant correlation between the use of IUCD and the presence of Tv (p < 0.05). The data also indicated that the prolonged use (> or = 3 years) of copper-IUCD may promote the growth of Tv in the vaginal mucosa. This result will be a clue to diagnose asymptomatic patients for Tv.
Over a 6 year period, 67 women had a translocated intrauterine contraceptive device (IUCD) removed from the peritoneal cavity or uterovesical fold under general anaesthesia. In 40 patients removal of the IUCD at laparoscopy succeeded, whereas in 24 laparotomy proved necessary and three IUCD were removed per vaginam. Compared with the inert plastic device a larger proportion of copper-containing IUCD in the peritoneal cavity required laparotomy for removal, however, 44% could be removed by laparoscopy, the less traumatic procedure.
The notion that the intrauterine contraceptive device (IUCD) has a central, as well as a local action, is examined. Although the IUCD undoubtedly has a local action, certain IUCD related side effects, e.g. galactorrhoea, bloating and premenstrual syndrome and inadequate luteal function can be explained if the IUCD has some central action. The powerful postcoital anti-fertility effect of both copper-bearing and plain plastic IUCDs probably also depends to some extent on a central action. The central action of the IUCD is probably due to initiation of reflex hypothalamic activity following intrauterine reflex stimulation. The hypothalamic response to IUCD insertion consists of release of beta-endorphin accompanied by raised levels of prolactin, vasopressin and oxytocin.
The systemic absorption of copper incorporated into multiload intra-uterine contraceptive devices (IUDs), as indicated by serum copper levels in users of such devices, was assessed in a prospective longitudinal study. One hundred and ten healthy Nigerian women using either multiload copper 250 (MLCU 250) or multiload copper 375 (MLCU 375) IUDs participated in the study. Their serum copper levels were estimated serially during 12 months of continuous use of the devices. The mean (+/- s.e.m.) pre-insertion serum copper levels of our subjects using MLCU 250 (17.0 +/- 3 mumol/l) and MLCU 375 (16.7 +/- 0.5 mumol/l) were found to be lower than those reported in Americans (22.2 mumol/l) and in Germans (20.2 mumol/l), although similar to levels in Indians (17.0 mumol/l). There was no significant difference in the mean serum copper levels estimated before and after 1 month of continuous use of the device. Serial estimations of the serum copper levels in users showed that there was no alteration in these levels after a period of 12 months of continuous IUD use. We therefore conclude that the copper incorporated into multiload IUDs appears not to influence the concentration of serum copper of users.
A case of true primary ovarian pregnancy with a Cu-7 intrauterine contraceptive device (IUCD) in situ was studied. All of Spiegelberg's criteria were satisfied. Review of the literature revealed an apparent increase in the frequency of ovarian pregnancy associated with the use of IUCDs.
Roentgenography and ultrasonography have been recommended for location of an intrauterine contraceptive device (IUCD) when the strings are not visible at the cervical os. Real-time ultrasound may have limited application compared to gray-scale B-scanning in certain clinical applications. Because of previous difficulty in locating an IUCD in 2 gravid and 2 nongravid patients, a blind study of 68 women was conducted. Seven patients were eliminated from the study because of inadequately filled bladders and failure to return for follow-up visits. There were 37 patients with IUCDs and 24 patients in the control group who used other forms of contraception. An incorrect diagnosis was made in 12 of 61 patients. Ten of 37 patients with an IUCD were identified as having no IUCD and 2 of 24 patients without an IUCD were identified as having an IUCD present. The accuracy of correctly identifying the presence or absence of an IUCD appears to be related to the type of device used. All of the 20 patients with a Copper-7 were correctly identified as having an IUCD, although the type was in error in 11 of the 20. Five of 7 patients with a Lippes Loop and none of the patients with a Saf-T-Coil were correctly identified as having an IUCD. Prior literature is reviewed, and possible sources of error are discussed.
One-hundred-and-ninety-eight women used a new type of levonorgestrel-releasing intracervical contraceptive device (LNG-ICD) designed to release 20 micrograms levonorgestrel/day. The insertion took place within 7 days of menstruation. Clinical performance during the first year of LNG-ICD use was evaluated. Seven pregnancies occurred during the study period; one in an epileptic woman using carbamazepine, 300 mg/day, and the other six in healthy women after unnoticed expulsion of the ICD. Sixteen spontaneous expulsions occurred. The most common reasons for removal were side effects, including bleeding disturbances, hormonal side effects and other medical reasons. The continuation rate was 72.6 per cent after one year. Three pelvic infections were observed.
The effect of the intrauterine contraceptive device (IUCD) on uterine haemostasis was studied at various stages of the menstrual cycle in a series of 46 patients by light- and electron-microscopy and by following the distribution of an infusion of 51Cr-labelled autologous platelets. The endometrium in contact with the IUCD in the majority of cases showed grooving with atrophy and mild chronic inflammation in the surrounding tissues. The adjacent stroma also showed increased vascularity and occasional foci of haemorrhage but the increased blood loss associated with the presence of the IUCD could not be attributed to mechanical erosion or stromal blood vessels by the device. During menstruation the presence of an IUCD does not appear to inhibit the formation of fibrin/platelet thrombi although both in control and IUCD patients there was a striking paucity of platelet/fibrin thrombi in circumstances where their formation should be enhanced. In contrast to other workers we have not observed that gaps or breaks in the endothelial lining of endometrial blood vessels occur with any greater frequency in patients fitted with an IUCD. The principal mechanism by which uterine haemostasis is achieved remains to be established.
This study analyzes occurrence of ectopic pregnancies in women using intrauterine contraceptive devices. During a 5-year period, 1990-1994, 524 women with ectopic pregnancies underwent surgery at our Clinic, while 22 (4.2%) had intrauterine devices. At admission most patients had signs of heavy intraabdominal bleeding, so in 77.27% cases the diagnosis was made by punction of the Douglas area, and only in 9.09% by laparoscopy, that is other methods for early detection of diseases. Rupture of the fallopian tube occurred in 50% of patients, tubal abortions in 36.36% and ovarian pregnancies in 13.64%, whereas 18 salpingectomies and 4 adnexectomies were performed. Late diagnosis and impossibility of performing conservative operations on fallopian tubes are the consequence of disregarding the possibility of getting pregnant by the users of intrauterine devices themselves, as well as by physicians whose help is asked for after symptoms appear.