Intrauterine breakage of a Multiload Cu250 intrauterine device: report of a case

A case of intrauterine breakage of a Multiload Cu250 IUD is reported. After a failed attempt to remove the IUD in which the IUD strings broke, the body of the IUD without the side arms was expelled spontaneously.

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Resumen Se relata un caso de rotura intrauterina de un DIU Multiload Cu250. Luego de un intento fallido para quitar el DIU, del que se rompiera la cola, el cuerpo del DIU sin sus brazos transversales, fue espontáneamente expelido.

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Resumé Ce rapport étudie un cas de rupture intra-utérine d'un DIU Multiload Cu250. Après avoir essayé sans succès de retirer le dispositif dont les filaments s'étaient rompus, le corps du DIU a été expulsé spontanément sans les bras latéraux.

     

Penetration of the gastric wall by an intrauterine device: a case report

A 31-year-old woman with epigastric pain underwent a “pi”-shaped copper bearing intrauterine device placement 11 years prior while lactating approximately 14 months after delivery. The patient experienced intermittent epigastric pain caused by the intrauterine device penetrating through the gastric wall. Removal required partial gastrectomy.     

Case-series report: management of post-menopausal bleeding in the presence of an intrauterine device

Post-menopausal bleeding in the presence of prolonged use of an intrauterine device should be investigated with hysteroscopy and endometrial sampling to rule out endometrial pathology. Here, we present two cases of prolonged use of intrauterine contraceptive device (IUCD), both associated with endometrial pathology, to illustrate the importance of these investigations.     

Immediate postpartum intrauterine device insertion — a report on the Chinese experience

Immediate postplacental insertion (IPPI) of the intrauterine device (IUD) has been practiced in China for at least 17 years. This presentation reviews and integrates the clinical experiences of IPPIs at five Chinese centers. The stainless-steel ring IUD was the most commonly used device for this procedure.Our review indicates that: (a) IPPIs-both after vaginal delivery and at cesarean section-are medically safe and effective in preventing accidental pregnancies (given careful patient selection), and (b) the one-year life-table expulsion rates of IUDs inserted at cesarean section are lower than the rates for vaginal insertions after normal delivery. This review also discusses other issues, such as factors influencing expulsion rates.Generally, IPPIs, whether performed via vagina or cesarean section, seem to be a method of choice for postpartum contraception. Some findings are, however, tentative; thus, further studies are needed.

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Resumen La inserción del dispositivo intrauterino (DIU) inmediatamente después de la expulsión de la placenta (método denominado IPPI) se realiza en China desde hace al menos 17 años. Se examina aquí la experiencia clínica con el IPPI en cinco centro chinos. El DIU de tipo anillo de acero inoxidable es el que más se utiliza en este procedimiento.Nuestro estudio indica que (a) este procedimiento-tanto después del parto por vía vaginal o cesárea-no presenta peligros desde el punto de vista médico y es eficaz en la prevención de embarazos accidentales (con selección cuidadosa de pacientes) y que (b) las tablas de supervivencia al cabo de un año indican que los DIU insertados después de cesáreas son menos frecuentemente expulsados que los insertados por vía vaginal después de un parto normal. En este estudio se examinan asimismo otros problemas, tales como los factores que influyen sobre las proporciones de expulsión. El IPPI-por vía vaginal o después de una cesárea-parece ser en general en método de elección para la anticoncepción posparto. Sin embargo, algunos resultados son preliminares y se necesitan estudios más profundos.

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Résumé Il y a au moins 17 ans que se pratique en Chine l'insertion du dispositif intra-utérin (DIU) immédiatement après l'expulsion du placenta (méthode dite IPPI). Nous passons ici en revue l'expérience clinique de l'IPPI dans cinq centres de Planning familial en Chine. On utilise le plus souvent pour cette opération le stérilet en anneau d'acier inoxydable.Notre étude met en évidence que (a) cette procédure-qu'elle fasse suite à un accouchement par voie vaginale ou par césarienne-ne présente aucun danger sur le plan médical et prévient véritablement les grossesses accidentelles (les patientes étant soigneusement sélectionnées) et que (b) les tables de survie sur un an indiquent que les stérilets mis en place lors de césariennes sont moins souvent expulsés que ceux qui ont été insérés par voie vaginale après accouchement normal. Cette étude examine également d'autres problèmes, comme par exemple les facteurs ayant une incidence sur les taux d'expulsion.L'IPPI-par voie vaginale ou faisant suite à une césarienne-semble généralement être une méthode de choix pour la contrception post-partum. Certains résultats manquent cependant encore de précision, ce qui rend nécessaire une étude plus poussée.

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(this paper was prepared while the principal author was a visiting research fellow at Family Health International, Research Triangle Park, NC, USA)     

Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review

BackgroundUterine perforation by intrauterine devices (IUDs) is a rare but well recognized complication. In the past, the presence of adhesions and perforation of viscera often resulted in the need for a laparotomy to remove the IUD. However, advances in laparoscopic technique have allowed surgeons to safely retrieve perforated IUDs. In this review, we analyze uterine perforation by an IUD and assess laparoscopic vs. open methods for removal of a perforated IUD.Study DesignA systematic search strategy was applied to several electronic bibliographic databases: Medline/Pubmed, Embase, Cochrane Library, and OCLC PapersFirst. Key words used were IUD, laparoscopy, and uterine perforation.ResultsOne hundred seventy-nine cases of attempted laparoscopic removal of perforated IUDs were identified in the English literature between 1970 and 2009. Patient age ranged from 17 to 49 years. Diagnostic laparoscopy was performed in all 179 cases reported. Laparoscopic removal of perforated IUDs was achieved successfully in 64.2% (115/179) of cases.ConclusionThis systematic review highlights how advances in laparoscopic technique and skill have allowed surgeons to safely retrieve IUDs without laparotomy. We recommend an attempt at laparoscopic removal as first-line treatment in symptomatic patients and as a reasonable treatment option in asymptomatic patients.     

Exacerbation of Crohn's disease after insertion of a levonorgestrel intrauterine system: a case report

The case report describes a relapse of Crohn's disease in a woman soon after the fitting of a levonorgestrel intrauterine system (IUS). Whilst the published evidence on the effects of levonorgestrel IUS in patients with pre-existing inflammatory bowel disease is limited, reports to date suggest that caution should be exercised when considering fitting an IUS in such women, even if there appears to be much to gain from an expected reduction in menorrhagia.     

Effective contraception with the levonorgestrel-releasing intrauterine device: 12-month report of a European multicenter study

The use-effectiveness of an intrauterine contraceptive device releasing 20 mcg of levonorgestrel daily (Lng-IUD), and of a Nova T copper-releasing IUD, were studied in a randomized, comparative multicenter trial. The Lng-IUD was inserted in 1821, and the Nova T in 937 women. The 12-month net pregnancy rate with the Lng-IUD (0.1 per hundred women) was significantly lower than that with the Nova T (0.9 per hundred). Removal rates for menstrual problems and/or pain were similar for the two methods (net rates 7.5 and 8.7, respectively). The 12-month continuation rates were 82.2 for the Nova T and 79.7 for the Lng-IUD. The reduction of the bleeding led to oligomenorrhea and amenorrhea in users of the Lng-IUD; the removal rate for these reasons was 1.4. The removal rate for hormonal side effects with the Lng-IUD was 2.4. Blood hemoglobin concentrations increased among users of the Lng-IUD and decreased among users of the Nova T. The results show that the Lng-IUD was a highly effective contraceptive method which reduced menstrual bleeding. It is a promising alternative for women desiring a highly effective method for long-term use.     

Assessment of workload: intrauterine device/intrauterine system provision

The Faculty of Family Planning and Reproductive Health Care (FFPRHC) has recently published Service Standards for Workload in Contraception, which state that a minimum of 20 minutes should be made available for intrauterine device/hormonal system (IUD/IUS) provision. This document acknowledges that there is currently little formal evidence relating to assessment of time taken for providing various contraceptive methods. The Abacus Clinics in Liverpool, UK provide an average of 1,300 IUD/IUS fittings in a year. We monitored the time taken for IUD/IUS provision over a 4-week period. Our study revealed that the average time taken for all types of IUD/IUS provision is significantly more than the minimum recommended by the FFPRHC.     

Risk factors for intrauterine device failure: a review

After reviewing the literature on intrauterine devices (IUDs) published over the last 30 years, we selected and analyzed recent and most relevant (with appropriate methodology design) articles dealing with the risk factors for IUD failure. There is sufficient evidence to conclude that the TCu380 and levonorgestrel-releasing (LNG) IUD are the most effective, with a cumulative pregnancy rate of less than 2% at 12 years for the TCu380 and around 1% for the LNG IUD at 7 years. In addition, advancing age increases IUD effectiveness, and displacement of the IUD decreases effectiveness. The IUDs with the highest copper concentrations are clearly less prone to failure than those with lower copper concentrations.     

Perforation of the cervix by the threads of a levonorgestrel-releasing intrauterine system: a case report

Asymptomatic retraction of intrauterine device (IUD) threads into the cervical canal or uterine cavity is a common complication. We present the rare case of a 44-year-old woman with the threads protruding through an opening in the anterior cervical lip about 1?cm above the external cervical os. Despite this presentation, her management was straightforward. We review the literature and discuss the possible antecedents of the phenomenon in this patient.     

Hypersensitivity reaction to parenteral nutrition in an intrauterine growth-restricted newborn: a case report

Hypersensitivity reaction to parenteral nutrition (PN) in infants is a rare condition, especially in the neonatal period. The authors report the case of a neonate with intrauterine growth restriction (IUGR) who presented symptoms of anaphylaxis while receiving standard PN. Given the very common practice of neonatal PN use, especially in newborns with IUGR, clinicians should be alerted about possible acute reactions to this useful therapy.     

宫内节育器现状

目前使用的宫内节育器种类较多,且各有特点,均为活性宫内节育器.关于宫内节育器避孕机理方面的研究近年没有大的进展,在临床效果、安全性及副反应方面的研究较多.宫内节育器不仅用于避孕,也逐渐地试用于治疗妇科疾病,如月经过多、子宫内膜异位症等.该文分别就宫内节育器的作用机理、效果和安全性及避孕以外的其他用途进行综述.