放置TCu220c宫内节育器15年左右子宫内膜形态学的研究

目的：探讨国产TCu220c宫内节育器（IUD）放置15年左右（13－17年）子宫内膜的形态学改变及其安全性，并为临床放置年限提供科学依据。方法：采用光镜、透射电镜，从组织病理学和超微结构病理学角度，对24例放置国产TCu220cIUD15年左右妇女的子宫内膜进行形态学研究。结果：TCu220cIUD放置15年左右，铜离子的作用在逐渐减弱，对子宫内膜的影响也在逐渐减轻，但TCu220cIUD仍然具有抗生育作用。子宫内 膜没有癌变倾向。对进入更年期的妇女，放置TCu220cIUD15年左右，子宫内膜仍无间变和癌变。结论：TCu220cIUD放置15年左右是较为安全的。     

GyneFix IN与TCu 380A宫内节育器的随机比较性临床研究

目的观察新型ＧｙｎｅＦｉｘＩＮ宫内节育器（ＩＵＤ）的临床性能。方法采用随机对比性多中心临床研究方法,对６０７例健康经产妇女由经过培训的专人以随机方法于月经间期放置ＧｙｎｅＦｉｘＩＮＩＵＤ３２０例（ＧｙｎｅＦｉｘＩＮ组）及ＴＣｕ３８０ＡＩＵＤ３０５例（ＴＣｕ３８０Ａ组）,于放器后１、３、６和１２个月随访,以生命表法统计两种ＩＵＤ的终止情况。结果ＧｙｎｅＦｉＸＩＮ组使用１年无妊娠发生,脱落和因症取出率分别为每百妇女２６７和１０２,与ＩＵＤ使用有关的终止率为每百妇女３６６,明显低于ＴＣｕ３８０Ａ组的每百妇女７８８（Ｐ＜００５）。ＧｙｎｅＦｉｘＩＮ组疼痛的主诉率也低于ＴＣｕ３８０Ａ组。结论此种无支架、铜表面积大并有固定系统的ＩＵＤ,由经过培训的人员放置,具有低脱落率和改善疼痛副反应的特点,有推广前景。     

Absence of bacteremia after insertion or removal of intrauterine devices.

A prospective study of the risk of bacteremia in 84 women having insertion and in 16 women having removal of intrauterine devices was performed. Bacteremia was not found in any of these 100 women at 1 to 3, 15, or 30 minutes after the procedure or in any of 57 women studied again 1.5 hours later. Because of the remote risk of bacteremia, the presence of congenital or valvular heart disease need not be an absolute contraindication to the use of an intrauterine device for contraception in an otherwise healthy young woman. Prophylactic antimicrobial therapy during insertion or removal of an intrauterine device appears to be unnecessary in the absence of evident pelvic infections. The risk of bacteremia during removal of an intrauterine device from an infected uterus cannot be determined from this study.     

The benefit of endometrial biopsy before IUD insertion

131 patients aged 25-35 followed from 1969-84 underwent endometrial biopsies under antibiotic cover preliminary to insertion of IUDs. 125 subsequently had IUDs inserted, including 10 Dalkon Shields, 50 Gravigards, and 66 copper 200, Gyne-T, or Nova T devices. All IUDs were inserted in the 1st 10 cycle days under a 3-day antibiotic cover. The 131 biopsies revealed 18 simple endometrial hyperplasias, 1 glandulo- cystic hyperplasia, and 5 endometrial polyps. The hyperplasias were treated with a progestin on cycle days 15-25 for 3-6 months and a curettage was performed for the polyps. No cases of endometritis were found in nulligestes. The 11 patients with latent endometritis were treated with antibiotics for 10 days and were vaccinated with an antipyogenic. A repeat endometrial biopsy was done to confirm disappearance of the endometritis before the IUD was inserted. The 126 IUD users were followed for 6 years on average. 2 cases of salpingitis and an adnexal reaction were observed. 2 of the 3 were treated with antibiotics and had no complications. The 3rd underwent tubal microsurgery after which she became pregnant. The IUD was removed in all 3 cases at the onset of symptoms. 1 of the 3 patients did not have a preliminary endometrial biopsy before the IUD was inserted. Despite the small sample size, it appears that a preliminary endometrial biopsy can reduce the infection rate among IUD users to that of the general female population.     

The effect on intrauterine device position and performance of a modified TCu380A insertion technique.

OBJECTIVE: To assess the validity of modifying the technique of intrauterine device (IUD) placement to decrease the incidence of incorrect positioning within the uterine cavity. METHODS: We used the current applicator in 78 women and an applicator shortened by 1.5 cm in 91 women, and examined the uterus by vaginal ultrasonography before and after application in both groups. RESULTS: Six of the 78 unmodified insertions were found to be incorrectly placed, while none of the IUDs inserted with the new technique was placed incorrectly. CONCLUSIONS: We suggest shortening the applicator or lengthening the push rod to increase the likelihood of proper IUD insertion and thereby enhance performance.     

The endometrial bacterial flora following insertion of an intrauterine contraceptive device

Bacteriological cultures of material collected on the cervix uteri and endometrium of 75 controls, 150 women using an intrauterine contraceptive device and 20 women who had undergone abdominal hysterectomy, have been studied by the authors. Positive cultures were found in all three groups of women. The difference in percentage of positive cultures in users and non-users of intrauterine contraceptive devices was not significant and this has lead the authors to conclude that the intrauterine contraceptive device does not alter endometrial flora, unless it is left in situ for a period exceeding two years and during the first two weeks of the cycle. In this study, the cultures made on the material collected on hysterectomy specimens of patients that had never used intrauterine contraceptive devices yielded the lowest percentage of positive cultures.     

Postpartum and postabortal insertion of intrauterine contraceptive devices.

One hundred forty-four patients are studied over an 18 month period. Postpartum and postabortal insertions of intrauterine contraceptive devices using the Lippes Loop and the Dalkon Shield are compared. The age, parity, previous methods of contraception, and marital status of the study group indicated a poorly motivated patient population. Although accidental pregnancy rates and expulsion rates are higher, the technique is considered worth-while in the population studied. Future research should be directed toward improved devices in order to decrease side effects and to increase appeal of the technique to those who will benefit most.     

宫内节育器宫腔形Cu300、TCu220C、TCu380A放置10年的临床比较性研究

目的 了解宫腔形宫内节育器(Cu300)及TCu220C、TCu380A3种宫内节育器(IUD)放置10年的临床效果。方法 全国7个IUD临床应用中心,对2699例随机放置Cu300、TCu220C和TCu380A的农村妇女,共观察10年。结果 使用10年时,Cu300、TCu220C和TCu380A的带器妊娠率,分别为2．56、4．82和4．01／100妇女,Cu300明显低于其他两种IUD(P＜0．05)。脱落率分别为4．54、5．46和9．68／100妇女,TCu380A显著高于其他两种IUD(P＜0．001)。因出血、疼痛取出率分别为6．71、5．58和6．80／100妇女,3种IUD比较,差异无显著意义(P＞0．05)。使用10年时,3种IUD的续用率分别为74．86、66．22和63．56／100妇女,以Cu300续用率最高,TCu380A最低(P＜0．01)。结论 Cu300、TCu220C和TCu380A的避孕效果好,可推广使用。     

Use of the bio-active intrauterine devices TCu 200 and IPCS 52 during the post-partum period

The author presents a comparative analysis of results obtained in a follow-up study of the 1st 12 months following insertion immediately postpartum (following delivery) of the TCu200 and IPCS 52 IUDs in a group of 400 women. The devices were inserted either manually or by using a plastic insertion aid at the maternity unit of the Barros Luco-Trudeau Hospital, Santiago, Chile, between November 1978-February 1980. The devices were retained during the 1st 12 months in 86.1% of the cases in which the TCu200 was inserted manually, 86.3% of cases in which they were inserted using the plastic aid, 59.3% of those cases in which the IPCS devices were inserted manually, and 57.2% of cases in which the IPCS was inserted using the aid. The different levels of retention among the 2 groups was due mainly to the high levels of expulsion in the IPCS 52 patients. The expulsion levels in the TCu200 groups were 9.2 and 8.1% respectively and 35.8 and 35.2% in the IPCS 52 groups. Although an IUD contraceptive system involving progesterone was selected in order to reduce bleeding and pain associated with the IUD, the incidence of such reactions was no lower in the IPCS 52 groups than in the others. However, specific levels of dysmenorrhea were significantly lower (p0.05) among IPCS 52 groups than among TCu200 groups. In general, results obtained with the TCu200 were better than those obtained with the IPCS 52, and the insertion method had no influence on the recorded reactions. (author's modified)     

Effects of a progesterone-releasing intrauterine contraceptive device on endometrial blood vessels: A morphometric study

The concentration of microscopically detectable blood vessels was significantly lower in endometrium exposed to progesterone-releasing intrauterine contraceptive devices (IUDs) than in control endometrium (mean vessel density 2.39 and 3.92, respectively). The percentage of vessels with defects was significantly higher in IUD samples (35.0%) than in control samples (13.4%). There was no significant difference in hemostatic response to vessel injury between the IUD and control samples. Although they were more defective than in controls, the blood vessels of progesterone IUD-exposed endometrium were far fewer in number, which may account for significantly less uterine blood loss in the users of these devices. In addition, the progesterone IUDs do not appear to inhibit hemostasis in the endometrium so that blood loss from injured vessels may be minimized.     

新型固定式宫内节育器与TCu220C的临床效果比较性研究

本文系研究新型固定式宫内节育器（Ｆｉｘ－Ｃｕ３００ＩＵＤ）的临床避孕效果，副反应和可接受性，选用目前公认较为理想的ＴＣｕ２２０Ｃ作对照，采用多中心随机比较性研究，自１９９３年２月到５月共接收合格对象２１０４例（各１０５２例）１年随访率为９９．９５％，使用１２个月结果表明：Ｆｉｘ－Ｃｕ３００ＩＵＤ累积妊娠率为０．０９％，对照组为１．４３％（Ｐ〈０．０１），脱落率分别为０．９５％和２．２８％（Ｐ〈０．     

Contraceptive effectiveness of immediate compared with delayed insertion of intrauterine devices after abortion: a decision analysis

OBJECTIVE: To model rates of pregnancy and repeat abortion among women choosing intrauterine contraception after an abortion when the intrauterine device (IUD) is inserted immediately after the procedure or at a follow-up visit. METHODS: We created an evidence-based decision model of women desiring to avoid pregnancy for the 12 months after an abortion. Base case assumptions were pregnancy rates of 0.5% with an IUD and 20% without an IUD, 1-year IUD continuation rate of 80%, an additional 5% risk of IUD expulsion with immediate insertion, and a 35% risk of not returning for a follow-up visit for IUD insertion. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS: Immediate IUD insertion after abortion prevented 52 pregnancies over the following year for every 1,000 women modeled by using base case assumptions. Sensitivity analyses show the model to be most dependent on the rate of expulsion in the immediate-insertion group and the proportion not returning in the delayed-insertion group. Monte Carlo analysis showed that immediate insertion resulted in fewer pregnancies than delayed insertion in 91% of scenarios, with an absolute mean difference of 28 pregnancies per 1,000 women in the initial year after abortion. If 20% of U.S. women undergoing abortion opted for immediate insertion, an estimated 20,000 repeat abortions would be prevented in the first year. CONCLUSION: Women who have an IUD inserted immediately after an abortion are expected to have fewer pregnancies and repeat abortions than women scheduled for insertion of an IUD at a follow-up visit.     

Contraceptive practice before and after therapeutic abortion. II. Use-effectiveness of oral contraceptives and intrauterine devices.

Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.     

The intrauterine device: a bacteriologic study of the endometrial cavity

Bacterial and histologic studies were performed on endometrium obtained by 2 methods in 2 different groups of patients wearing the IUD. The first group consisted of 75 patients schedules to have elective vaginal hysterectomies in association with culporrhaphy for symptomatic uterine and vaginal relaxation. The second group was made up of 253 patients who elected to use the IUD as a contraceptive. Cultures were obtained transfundally after hysterectomy in the first group and transcervically in the second. The incidence of sterile endometrial cultures was significantly greater when the transfundal method was employed. Using this method of obtaining cultures, it was found that positive endometrial cultures were obtained from all uteri in which the IUD had been inserted within the previous 24-hour period. The incidence of positive endometrial cultures rapidly diminished at the time after insertion increased, so that after 1 month had elapsed since insertion of the IUD, all the endometrial cavities examined were sterile . The results of the study confirm the statements of others that the occurrence of clinical infection of the upper genital tract in patients having the IUD with nylon threads protruding into the vagina is usually due to an unrelated cause such as coital infection. Even when the threads passes through contaminated endocervical mucus, sterile cultures were obtained from the portion of the threads within the endometrial cavity as well as from the loop itself.