Pelvic Actinomycosis Following Insertion of an Intrauterine Contraceptive Device

Summary: A case of actinomycosis following insertion of an intrauterine contraceptive device is reported. The patient was treated successfully by antibiotic therapy and conservative surgery.     

A Spinal Epidural Abscess Complicating an Intrauterine Contraceptive Device

Summary: A case of spinal epidural abscess as a complication of the use of an intrauterine device is presented and the management of same discussed.     

Determinants of Intrauterine Contraceptive Device Discontinuation Among Indian Women

Objective

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012.

Methods

387 women who had an intrauterine device (IUD) inserted during the last 1–5 years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation.

Results

The incidence of IUD discontinuation in the first year following insertion was 16.79 %. Approximately 31 % of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 387 women, 56 % discontinued IUD use because of a desire to conceive, 27.7 % because of side effects, 15.36 % because of opposition from the woman’s family, and 1.5 % because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use.

Conclusions

The crude cumulative rate of IUD discontinuation was 16.79 % during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36 months (45 %), thereby fulfilling its objective of spacing between children as laid down by the WHO (2 years spacing between pregnancies). About 31 % of the women continued using IUCD even after 5 years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.     

Small Bowel Perforation by a Shield Type Intrauterine Contraceptive Device

Summary: A case of asymptomatic perforation of the small intestine by an intrauterine contraceptive device (a Dalkon shield) is presented. This is believed to be the first reported case of such an occurrence.     

An Effective Method Combining Various Endoscopes in the Treatment of Intravesical Migrated Intrauterine Device

ObjectiveTo introduce an effective method combining various endoscopes in the treatment of intravesical migrated intrauterine device (IUD).DesignA step-by-step explanation of the surgery using video, approved by the Shengjing Hospital of China Medical University.SettingShengjing Hospital of China Medical University.InterventionsA 39-year-old young woman, in whom an IUD was inserted 2 months prior, presented with frequent urination after IUD insertion. Cystoscope and pelvic computed tomography were performed, and the results showed an IUD in the bladder. The migrated IUD was found partly in the uterus and partly in the bladder by hysteroscope and cystoscope. Management of the migrated IUD consists of 4 steps: (1) lysing the adhesion between the bladder and uterus, (2) suturing the bladder and taking the IUD part out of the bladder, (3) removing the IUD part in the uterus, and (4) suturing the bladder again to reinforce it and suturing the uterus.ConclusionThe migrated IUD in the bladder was successfully and completely extracted by the method combining various endoscopes; operative time was 56 minutes. In the follow-up period the patient did not report any symptoms of frequency urination. This surgical process has the following characteristics: Preoperative examination should be performed to clarify the ectopic site of the IUD, various endoscopes should be combined for diagnosis and treatment, and endoscopic surgery is an effective treatment method for migrated IUD.     

利多卡因在特殊人群放置宫内节育器中的应用

目的:探讨利多卡因在特殊人群放置宫内节育器的临床应用。方法:200例自愿要求放置IUD的特殊人群(因剖宫产、宫颈疾病接受过宫颈物理治疗),随机分为观察组和对照组,每组100例,观察组在放置宫内节育器手术中采用20mg/ml利多卡因进行宫颈注射,对照组则按常规放置,比较组间放置成功率、并发症等。结果:观察组放置IUD成功率100%,对照组失败23例,成功率77%,观察组无1例发生并发症,对照组发生探针穿孔2例,宫颈损伤4例,心脑综合反应12例。术中出血量组间无差异(P<0.05),但观察组手术时间(2.0±0.6min)明显短于对照组(3.5±0.8min)组间差异显著(P<0.05)。结论:对特殊人群放置IUD手术,采用20mg/ml利多卡因注射软化宫颈和镇痛的方法,可减轻疼痛、减少子宫损伤等并发症,同时提高了手术的成功率和放置IUD手术的质量及安全性。     

记忆合金药铜宫内节育器对兔子宫内膜超微结构的影响

目的:研究记忆合金药铜节育器对兔子宫内膜超微结构的影响。方法:雌性日本大耳白兔随机分为3组,实验组记忆合金药铜节育器和对照组不锈钢药铜节育器各18只,假手术对照组6只,通过手术放置节育器于兔子宫腔内,术后1、3、6个月处死兔,取出子宫,扫描和透射电子显微镜下观察放置节育器处的子宫内膜。结果:放置节育器的兔子宫内膜均可见上皮细胞的形态和结构发生改变。扫描电子显微镜下,上皮细胞的变化随节育器放置时间和受压程度的增加而增加,可逐渐出现细胞表面压平、变形,微绒毛稀疏、消失;较长时间放置,可引起上皮细胞损坏、脱落。透射电子显微镜下2种节育器引起的细胞形态和结构的改变相似,主要是内质网扩张,细胞核肿胀,质膜溶解,严重的可见上皮细胞脱落现象。细胞内超微结构的损伤亦随节育器放置时间和受压程度的增加而加重。但基膜始终损伤较轻微,基膜下的间质未观察到明显异常的形态学变化。结论:记忆合金药铜节育器与不锈钢药铜节育器对兔子宫内膜超微结构的影响相似。     

Migration of an Intrauterine Contraceptive Device during the Course of Pregnancy: A Case Report

Uterine perforation by a contraceptive intrauterine device (IUD) is a relatively rare event. These events may result secondary to mechanical force applied during placement (primary perforation) or migration by uterine contractions or surgical manipulation after placement (secondary perforation). A 33-year-old woman with an IUD placed 9 years before admission visited the emergency department with an early pregnancy and a 3-day history of vaginal bleeding. Vaginal examination revealed IUD strings visible at the cervical os, and transvaginal ultrasound confirmed the presence of an IUD in the lower uterine segment and upper cervix. The IUD migrated spontaneously to the fundal myometrium at 15 weeks’ gestation. Premature rupture of membranes ensued at 20 weeks’ gestation, and, at delivery, the IUD could not be retrieved. Subsequent computed tomography confirmed that the IUD was incompletely embedded in the fundal myometrium and partially extending into the peritoneal cavity. At laparoscopic sterilization 6 weeks later, the IUD had perforated the small bowel, and the device was removed with concomitant bowel repair. This case documents spontaneous migration of a copper IUD from the lower uterine segment through the fundus during early pregnancy and supports removal of asymptomatic ectopic IUDs whenever possible.     

Contraceptive problems unique to the United States

An overview of the distinctive milieu regarding contraceptive methods available in the U.S. considers declining method options, future prospects, reasons for the poor current climate, factors affecting future options, global ramifications, and proposed reforms that may improve the U.S. situation. In the last 3 years, the U.S. lost 3 safe IUDs, and lawsuits now threaten the existence of both spermicides and their associated barrier methods. Meanwhile 2 new IUDs and the cervical cap have been introduced. Future possible methods include Norplant, transdermal patches and a disposable spermicide-releasing diaphragm. The chief reason for loss of contraceptives is the legal system in the U.S. which permits peer juries to evaluate a method's side effects relative to the claimant's former health, rather than actual risk- benefit ratios or medical data. Adverse legal decisions have escalated or eliminated liability insurance. The public is ignorant of the benefits of contraceptives, but misinformed by prominent coverage in the media of preliminary adverse findings. Even the F.D.A., for unstated political reasons, has failed on 2 occasions to approve Depo-Provera, used safely in over 80 countries and approved by the drug agencies of most western nations. Other political factors have cut government funding for contraceptive development steadily for 15 years. Apathy for contraceptive research extends from congress to donor support to numbers of new Ph.D.s entering the field. Ramifications include the highest unplanned pregnancy rate, abortion rate and adolescent pregnancy rate in the developed world in the U.S., and a suspicious stance on the part of developed countries toward U.S. contraceptives, especially those not approved here. Proposed ways of reversing the legal and insurance blocks include reform of tort law and no-fault compensation decided by arbitration.     

活性元宫型药铜365宫内节育器体外释放吲哚美辛的研究

目的:建立国产活性元宫型药铜365宫内节育器中吲哚美辛体外释放度测定方法。方法:以模拟宫腔液为释放介质,控制温度(37.0±0.1℃),匀速磁力搅拌,控制速度为70r/min,采用紫外分光光度法测定药物含量及释放量。结果:吲哚美辛的吸收度与浓度呈良好的线性关系,吲哚美辛的释放于d3达到平衡。结论:建立的吲哚美辛释放度测定方法简便、准确,可用于质量控制。     

Obstructed Labour Due to a Vesical Calculus

EDITORIAL COMMENT: We accepted this short case report because although the condition is rare it is appropriate for obstetricians to know that a vesical calculus can cause obstructed labour as in this primipara.     

The Use of an Ultrasound Bladder Scanning Device in Women Undergoing Urogynaecologic Surgery

Objective: To compare the accuracy of using a bladder scanner to measure post-voiding residual urine volume with measurement by intermittent catheterization in a postoperative urogynaecology population.Methods: Prior to implementation of the study, nurses were trained in the use of a bladder ultrasound scanner. Post-void residual urine volume in postoperative patients was assessed by a nurse with the scanner; a second nurse, blinded to the scanner result, then catheterized the patient’s bladder. Each patient rated the pain experienced with bladder scanning and with catheterization. A prospective comparison of the volumes assessed by ultrasound and measured by catheterization used 127 pairs of data; each woman served as her own control. The correlation of urine volumes was determined, and the difference in pain score was calculated using the Student t test.Results: The mean age of patients was 56.5 years (range 40–79). All four bladder quadrants were visualized in 34.4% of scans. The correlation coefficient for volumes measured by scanning and catheterization was 0.70 (P < 0.001; range -349 mL to + 692 mL). Consistently, using the scanner resulted in underestimation of the urine volume. The sensitivity of the bladder scanner (0.58 for residual volumes> 200 mL) therefore makes it a poor tool for assessing postoperative urinary retention in women undergoing urogynaecologic surgery. Pain scores recorded with catheterization (2.9/10) were significantly less than those recorded with bladder scanning (4.2/10) (P < 0.001).Conclusions: Bladder scanning by staff nurses had limited value in assessing postoperative residual urine volumes. The accuracy of assessment might increase with greater experience with the procedure. The greater discomfort reported by patients with use of the scanner supports continued use of catheterization to assess residual urine volume.     

Patient-Centered Contraceptive Counseling: Evidence to Inform Practice

Patient centeredness is an increasingly recognized aspect of quality health care. The application of this framework to contraceptive counseling and care has not been well described. We propose a definition of patient-centered contraceptive counseling that focuses on and prioritizes each patient’s individual needs and preferences regarding contraceptive methods and the counseling experience. Guided by this definition, we review recent research that has advanced our understanding of how patient-centered contraceptive counseling can be delivered in practice, focusing on how women decide on a contraceptive method, their preferences for counseling, and their experiences with counseling. This research provides evidence that women have diverse preferences around attributes of their contraceptive methods and value personal, supportive relationships with their family planning providers that focus on their individual preferences. We discuss the implications of this research for practice and review recent interventions that incorporate patient centeredness to varying degrees.