Color Doppler sonographic study of the uterine artery in patients using intrauterine contraceptive devices.

A transvaginal Doppler sonographic examination of uterine artery blood flow was performed. Resistance and pulsatility indices were measured in 101 women, 74 of whom were using an intrauterine contraceptive device, and 27 controls, who were not using any contraceptive method. The intrauterine contraceptive device users were divided into three groups: those with normal bleeding (n = 34); those with abnormal uterine bleeding without medication (n = 16); and those with abnormal bleeding corrected with use of prostaglandin inhibitors (n = 24). The resistance and pulsatility values were significantly lower in the group of women using intrauterine contraceptive devices who had abnormal bleeding than in all other groups (P<0.001). All other comparisons were nonsignificant. A pulsatility index of less than 2 may be associated with a higher risk for development of intrauterine contraceptive device-induced bleeding.     

Migration of an intrauterine contraceptive device to the ovary

We present the case of a 37-year-old woman with a history of 2 consecutive insertions of intrauterine contraceptive devices (IUDs) 3 years before she was referred to us for sonographic evaluation of lower abdominal pain. The first of the IUDs was presumed to have been expelled spontaneously, and 3 months after insertion of the second device, the patient had begun experiencing lower abdominal pain. Medical treatment with antibiotics and spasmolytics had been unsuccessful. We performed transvaginal sonography, which revealed the presence of an IUD in the uterus and a 2-cm linear metallic echogenic area in the left ovary, believed to represent another IUD. Anteroposterior radiography confirmed that there were 2 IUDs in the pelvis, and CT demonstrated 1 IUD in the uterus and another in the left ovary. The patient underwent laparoscopic removal of the ovarian IUD and was discharged in good condition. To our knowledge, this is the first report of migration of an IUD to the ovary detected on transvaginal sonography. We recommend consideration of this possibility during evaluation of women with unexplained chronic pelvic pain.     

Ultrasonographic evaluation of uterine perforation by an intrauterine device.

A case is reported of a 31-year-old woman who had a copper-7 IUD inserted two years prior to admission but became pregnant and had a normal delivery a year prior to admission. The IUD had not exited her body during delivery, and she was asymptomatic. Ultrasonography was used to locate the IUD, which was extending through the wall of the uterus. Upon mini-laparotomy, the IUD was found to be completely outside of the uterus, embedded in the omentum. This represents the first reported case which documents the use of ultrasonographic technology to locate an IUD extending through a uterine wall.     

Doppler color flow analysis of the uterine arteries before and after intrauterine device insertion: a prospective study.

OBJECTIVE: An intrauterine device (IUD) is one of the most frequently used methods of birth control around the world. Although a relationship between its use and menstrual disorders has been well documented, only a few studies have tried to show whether there are any vascular modifications. The aim of our study was to evaluate the influence of an IUD on uterine artery blood flow using Doppler assessment. METHODS: A total of 100 patients selected for IUD use were prospectively evaluated with Doppler analysis before and 30 days after insertion. The resistive index (RI) and pulsatility index (PI) were used to evaluate uterine artery vascular resistance. Patients were allocated in 2 groups according to whether they were (group 2) or were not (group 1) lactating.RESULTS: The PI and RI of the patients in groups 1 and 2 before and after IUD insertion were not statistically significantly different (P = .298 and .23). When we compared uterine artery blood flow indices before and after IUD insertion for groups 1 and 2 separately, we observed in group 1 that the mean +/- SD PI values were 2.45 +/- 0.62 and 2.55 +/- 0.55 (P = .38) and the RI values were 0.87 +/- 0.08 and 0.87 +/- 0.06 (P = .88) before and after IUD insertion, respectively. In group 2, the PI values were 2.31 +/- 0.55 and 2.37 +/- 0.69 (P = .68) and the RI values were 0.85 +/- 0.07 and 0.86 +/- 0.07 (P = .44) before and after IUD insertion. Finally, we used the mean blood flow indices of the uterine arteries of all patients to compare the effect of IUD insertion. Results were also not statistically significant when we compared PI and RI before and after IUD insertion. CONCLUSIONS: The presence of an IUD does not interfere with the vascular resistance of the uterine arteries that can be shown by Doppler flow assessments 1 month after insertion.     

Migration of an intrauterine contraceptive device to the urinary bladder: sonographic findings

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.     

Perforation of uterus by the GyneFix intrauterine contraceptive device

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.     

Far migration of an intrauterine contraceptive device from the uterus to the small bowel

A sexually active, asymptomatic 44‐year‐old presented for Intrauterine device (IUD) removal that had been in place for 13 years. IUD removal was unsuccessful as the strings could not be located. Imaging revealed an extrauterine IUD and at surgical removal of the abdominal IUD a small bowel perforation requiring bowel resection was required. Uterine perforation is a rare complication of IUD use occurring in approximately 1–1.3 in 1000. Risk factors for perforation include provider inexperience, retroverted uterus, immobile uterus, and myometrial defect from a previous cesarean delivery or myomectomy.     

经阴道三维超声诊断宫内节育器变形及异位

目的 探讨经阴道三维超声成像技术在诊断宫内节育器(IUD)变形与异位中的应用价值.方法 对32例二维超声检查怀疑IUD异常的患者行经阴道三维超声成像检查,通过对子宫腔与IUD的三维超声图像分析,明确IUD的形状与位置.将三维超声成像诊断结果 与官腔镜、腹腔镜或剖腹探查术结果 进行对照.结果 31例患者(96.9%)获取满意的三维超声声像图,可清晰显示IUD的形状、位置及其与子宫腔的关系.29例行宫腔镜、腹腔镜或剖腹取器手术,均一次取器成功,术中所见与三维超声诊断结果 一致.结论 经阴道三维超声成像技术在诊断IUD变形和异位中具有很高的应用价值.     

Study on the uterine mucosubstances accompanying the infertility effect of an intrauterine device

Endometrial mucosubstances (glycoproteins and mucopolysaccharides) have been investigated accompanying the infertility effect of an intrauterine device (IUD) under hormonal treatment.

1.

(1) The relative amounts of the total endometrial mucosubstances were increased with estrogen, but decreased with progesterone. Furthermore, higher values were observed in the IUD horns than in the non-IUD horns in the hormone-treated animals.     

Ultrasonically controlled retrieval of an intrauterine contraceptive device (IUCD) in early pregnancy

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.     

应用经阴道三维超声检查宫内节育器分析

目的探讨经阴道三维超声检查宫内节育器的临床应用价值。方法应用阴道三维超声检查宫内节育器152例,首先使用二维超声进行矢状切面及冠状切面的检查,然后开启三维功能进行子宫及宫内节育器观察范围的三维超声表面模式和透明模式取样。结果152例宫内节育器三维图像透明模式取样完整显示率100%(152/152),表面模式取样完整显示率96.05%(146/152),二维超声完整显示率42.76%(65/152)。结论三维超声透明模式和表面模式合并使用探测宫内节育器有助于宫内节育器异常的明确诊断。     

宫内节育器异常的超声检测

目的 评估B超诊断宫内节育器异常的价值。材料与方法 对781倒置节育器的育龄妇女作超声检查,观察了各种节育器异常与子宫位置、节育器类型、合并子宫肌瘤的关系。结果 中位子宫、金属单环、合并子宫肌瘤者节育器异常率较高、结论 B声是监测宫内节育器发挥避孕效果的一种有效方法。     

Repeatability of measurement of uterine artery pulsatility index using transvaginal color Doppler.

OBJECTIVE: To assess the repeatability of measuring the pulsatility index of the uterine arteries using transvaginal color Doppler at 23 weeks of gestation. PATIENTS AND METHODS: The pulsatility index was measured in 100 women with singleton pregnancies attending for routine transvaginal Doppler examination of the uterine arteries at 23 weeks. To assess the repeatability of different components of variability, six measurements of the uterine artery pulsatility index were made on one of the uterine arteries in each patient. RESULTS: Six measurements of the pulsatility index were successfully measured in all 100 patients, resulting in a total of 600 measurements. The repeatability was unrelated to the pulsatility index. On 95% of occasions the intraobserver, interobserver and waveform tracing repeatability was less than 0.24, 0.27 and 0.14, respectively. CONCLUSIONS: Measurement of the pulsatility index using transvaginal color Doppler is highly reproducible when the examination is carried out by well-trained operators.