The evaluation of 318 intrauterine pregnancy cases with an intrauterine device

Objective?To determine the factors affecting the pregnancies with intrauterine devices.

Design and Methods?The intrauterine device (IUD) locations in pregnancies with IUDs referring to SSK Aegean Maternity Hospital were determined by ultrasonography (USG) in a 6 year period. Three hundred and eighteen pregnancy cases (pregnancy group) were observed together with intrauterine devices. All intervally applied IUDs were CeT380A. All demographic characteristics of the cases together with determination of IUD localizations were recorded, and these cases were compared with 300 cases (control group) using CuT380A and under routine follow-up in our clinic.

Results?Ultrasonographic examination revealed IUD dislocation in 64% of 318 cases, whereas only 11% of the control group had dislocated IUDs. The difference between two groups was statistically significant. Especially in cases where the pregnancy group was less than 20 years old, IUD dislocations were recorded in 87.5%. The statistical analysis revealed a significant correlation in the distribution of IUD pregnancies according to years. When the demographic characteristics of two groups were compared, no statistically significant correlation was observed between the demographic characteristics and pregnancies with IUDs. There were 89 cases (27.9%) who decided on the continuation of IUD pregnancies. Unfortunately, 40% of these cases resulted in abortion. Only in 27% of 56 cases after IUD extraction because of IUD dislocation was miscarriage recorded. Meanwhile, 77% of the 26 cases with IUD left in the uterine cavity presented with miscarriage. Of the total of 36 miscarriages, 33% were ≤6 weeks pregnancy, and 27% were over 10 weeks.

Conclusion?IUD dislocation is a significant factor affecting IUD pregnancies. The fact that dislocation is most common in the first year reveals the necessity for more frequent controls in this period.     

A misplaced intrauterine device: a case report

A 26-year-old woman consulted our Family Planning Unit because she could not locate the thread of her intrauterine device (IUD), which was placed 16 months earlier. Attempts to remove the IUD under fluoroscopy failed. A hysterography showed the IUD to be in the pelvis away from the uterus. At laparotomy, the IUD was found hidden in the omentum and its removal was done by resection of a piece of the omentum. The patient became pregnant three months later and gave birth to a healthy baby at term.     

User satisfaction with a levonorgestrel-releasing intrauterine system (LNG-IUS): Data from an international survey

Objectives?To identify the characteristics of an international population of women using the levonorgestrel-releasing intrauterine system (LNG-IUS) and their experiences with this contraceptive.

Methods?Women who had used the LNG-IUS for six months or more completed a standardised questionnaire on reasons for use, user satisfaction and other aspects.

Results?A total of 8680 questionnaires were completed by survey participants in 18 countries across Europe and the Near East. The average woman using the LNG-IUS was 38 years old, was married or lived with her partner, and had two children. Overall, 95% of patients were satisfied with the LNG-IUS; the percentage rose to 99% among those using their second LNG-IUS. Reasons mentioned for using the LNG-IUS included the need for contraception (68%), its high efficacy (59%) and the shorter/lighter menstrual bleeding (55%). Of the women with prior bleeding problems, 93% reported an improvement in their symptoms with the LNG-IUS. Participants also rated the reliability, tolerability and convenience of the method highly.

Conclusions?This survey provides insight into the profiles of LNG-IUS users. High levels of satisfaction with this method of contraception were reported by both first and second-time users. Our data suggest that the LNG-IUS is well accepted and that it provides considerable benefits beyond contraception alone.     

Fallopian tube insertion into the uterine cavity discovered accidentally during laparoscopic retrieval of a misplaced coil from the pelvic cavity

This article presents for the first time in the literature a case of fallopian tube insertion into the uterine cavity discovered accidentally during laparoscopic retrieval of a misplaced coil from the pelvic cavity.     

A study of delta intrauterine devices in Ankara, Turkey

Delta devices, modifications of standard Lippes Loop D and TCu 220C IUDs, were designed for postpartum insertion. A study of the Delta T and the Delta Loop was conducted at Hacettepe University School of Medicine in Ankara, Turkey. The IUDs were randomly allocated to 246 immediately postpartum women (less than 10 min postplacenta). Twelve-month expulsion rates were low for both devices; 3.7 for Delta Loop users and 7.6 for Delta T users.     

Colonoscopic retrieval of a lost intrauterine contraceptive device: A case report and review of articles

A case of translocated intrauterine contraceptive device (IUCD) lying partly in the bowel wall at the rectosigmoid junction and its removal by colonoscope is described. This case highlights the possibility of safe retrieval of an IUCD by colonoscopy when it is partly embedded in the bowel wall. Routine sigmoidoscopy alongside other investigations is recommended for translocated IUCDs. Its use can select those patients for whom rectal recovery of the IUCD is feasible, thus avoiding unnecessary surgical intervention.     

Intravesical migration of levonorgestrel-releasing intrauterine system (LNG-IUS) with calculus formation

The intrauterine contraceptive device (IUD) has been in use for many years as an effective means of birth control. Migration of the device from the uterus to the pelvic cavity is not uncommon and has been reported previously, however intravesical migration and secondary calculus formation is relatively rare. We report a 28-year-old woman in whom an intrauterine contraceptive device (LNG-IUS) migrated from the uterus to the bladder and resulted in stone formation. This case shows that the newer hormone releasing IUDs may also cause bladder perforation.     

The effect of intrauterine contraceptive device (IUD) on pregnancy in the rabbit

Rabbits were inserted with 10 cm of Silastic tubing in 1 uterine horn; blastocysts were collected from the control or treated horn on Pregnancy Day 5 and transferred to the opposite horn. 16 of 22 (72%) blastocysts implanted into an IUD horn failed to survive to Day 23. 10 of 16 (62.5%) blastocysts transferred to the control horn were found implanted on Day 12 and 9 pups were delivered. In other rabbits with su rgical anastomosis between the 2 horns, 99.5% of implantations survived from Day 12 to 23 in control horns, but only 20% in IUD horns. The leukocyte counts was markedly elevated in IUD horns and only moderately in control horns. These data indicate that the antifertility effect of the IUD is largely due to its direct contact with the developing embryos and the endometrium.     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.     

Postpartum magnetic resonance imaging in a case of placenta accreta with intrauterine abscess formation

The postpartum magnetic resonance imaging (MRI) appearance of a patient with placenta accreta and abscess formation is presented here and compared to the ultrasound and CT findings. The diagnosis was confirmed on histopathologic examination and cultures of the hysterectomy specimen. On MRI, the T1-weighted acquisitions showed an enlarged uterus of mildly heterogeneous but predominantly low signal intensity. The T2-weighted images demonstrated a heterogenous area of predominantly bright signal within the uterine body and fundus. In this case, MRI was more informative than ultrasound and non-contrast CT scan in the postpartum diagnosis of placenta accreta with abscess formation. Received: 10 March 1998 / Accepted: 14 April 1998     

The role of laparoscopic dissection of the uterine artery in the surgical treatment of fibroid-related menorrhagia: a pilot study

This pilot study assessed the outcome, tissue trauma, clinical improvement and reduction in size of fibroids following laparoscopic dissection of the uterine artery (LDUA) in fibroid-related menorrhagia. Fifty-three patients with complete records were included in the prospective clinical study. Before LDUA, and 3 and 6 months following the procedure, ultrasonography or MRI was done to measure the size of the uterus and dominant fibroid. Blood samples for hemoglobin and assay of marker inflammatory response and tissue trauma were taken preoperatively on the 1st and 3rd postoperative days. All patients underwent successful LDUA using ultrasonically activated shears without intra-operative complications. Fifty (96.2%) laparoscopically treated patients with fibroids who subsequently experienced improvement in menorrhagia and anemia are described. The LDUA procedure can be completed within 30–40 min with only minimal blood loss and a short hospital stay if performed by experienced surgeons. Our study results show that single laparoscopic dissection of the uterine artery performed with ultrasonic technique is associated with an insignificant stress response. The average reductions in the uterine volume and dominant fibroid volume were 36.6 and 57.9% at 6 months after surgery, respectively. Four women conceived within 1 year, and their pregnancies were without complications during gestation.     

Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery

Abstract

Objective To investigate whether sublingual misoprostol administered one hour before intrauterine device (IUD) insertion reduces failed insertions, insertion-related complications and pain in parous women delivered only by elective caesarean section (CS).

Methods Single-blind randomised controlled trial conducted in Ismailia, Egypt, between July 2010 and December 2011. Women who had never delivered otherwise than by elective CS and desirous of using an IUD were randomly allocated to receive sublingually 400 μg misoprostol and 100 mg diclofenac (misoprostol group) or 100 mg diclofenac alone (control group) one hour before IUD insertion. Outcome measures were failed insertion, ease of insertion judged by the investigators, insertion-related complications, and patients’ satisfaction.

Results In all, 255 women (130 and 125 in the study and control groups, respectively) had an IUD inserted. Seven insertions failed: five in the control group, and two in the study group. Ease of insertion and patients’ satisfaction were comparable in both groups. Abdominal pain and nausea were the commonest side effects reported in the misoprostol group.

Conclusion Sublingual administration of misoprostol one hour before IUD insertion in parous women with no previous vaginal delivery does not facilitate the procedure and may cause undesirable side effects. This approach is not recommended as a standard treatment.     

Complication Rates Associated with Levonorgestrel Intrauterine System Use in Adolescents with Developmental Disabilities

Study ObjectiveTo assess the complication rates with the use of the levonorgestrel intrauterine system (LNG IUS) in adolescents with developmental disabilities.DesignRetrospective chart review of all adolescents with developmental disabilities taken to the operating room for LNG IUS insertion between January 2000 and July 2009 at the Royal Children's Hospital, Melbourne, Australia. Cases identified from the surgical database, and medical records reviewed.Main Outcome MeasuresComplication rates with LNG IUS use in adolescents with development disabilities: non-insertion, uterine perforation, infection, and expulsion.ResultsFifty-six adolescents with developmental disabilities had an attempted LNG IUS insertion. The average age at insertion was 15.6 years (range 10.5-21.5 y). The LNG IUS was used as first line therapy in 14 cases (25%). Pre-insertion ultrasonography was ordered in 48% of cases, out of which 5 cases had uterine lengths <6 cm. Despite this, 4 of these cases had successful insertions. Two insertion attempts were abandoned intra-operatively (3.6%); one due to inadequate uterine length of 4 cm, and the other due to anatomic distortion. One spontaneous expulsion occurred at approximately 5 months (1.9%). Four IUDs were removed prematurely (7.4% withdrawal rate); 1 for persistent abdominal pain, 1 for irregular bleeding, and 2 for suspected malpositions. There were no documented cases of infection, perforation, or pregnancy.ConclusionOur experience in this population has been very positive and confirms that complication rates are comparable to that in adults.     

Comparison of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma

Objective

To compare total laparoscopic hysterectomy (TLH) using the Hohl instrument with laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma.

Study design

231 women underwent laparoscopic hysterectomy for the treatment of symptomatic leiomyoma between January 2005 and December 2007. A total of 113 women decided to undergo complete hysterectomy with removal of the cervix (TLH group) and 118 women wished to preserve the cervix; LASH was carried out in the latter group (LASH group).

Results

No ureteral or bladder injury occurred in any of the patients. Two intraoperative complications and one postoperative complication occurred in the TLH group, while no complications occurred in the LASH group. When the TLH group was compared with the LASH group, the mean loss of hemoglobin was 1.6 ± 1.1 g/dL (95% CI 1.4–1.8) vs. 1.5 ± 1.4 g/dL (95% CI 1.2–1.7); the mean operating time was 114.0 ± 33.8 min (95% CI 107.6–120.2) vs. 116.5 ± 40 min (95% CI 109.3–124.0); and the mean uterus weight was 264.8 ± 133.6 g (95% CI 239.8–289.6) vs. 286.2 ± 209.3 g (95% CI 247.4–324.4). Hospital stay and use of analgesia in both groups were equal. No statistically significant differences were found.

Conclusions

TLH using the Hohl instrument is an option comparable with laparoscopy-assisted supracervical hysterectomy for women with uterine leiomyoma. However, the complication rates may be lower when LASH is performed.     

Mesh-related complications in single-incision transvaginal mesh (TVM) and laparoscopic abdominal sacrocolpopexy (LASC)

ObjectiveFew studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.Materials and methodsThis retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.ResultsIn the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752–48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313–17.359).ConclusionPreserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.     

The effect of lateral uterine artery dissection on clinical outcomes in laparoscopic myomectomy: a prospective randomized study

This study assessed the effect of lateral uterine artery dissection (LUAD) on clinical outcomes in laparoscopic myomectomy (LM). Fifteen women with symptomatic fibroids (dominant fibroid size: 3–6 cm) were randomly allocated to laparoscopic myomectomy (group 1) and 16 women to the combined operative procedures LM and LAUD (group 2). We assessed the clinical outcomes: intra-operative and postoperative blood loss, operating time, hospital stay, hemoglobin fall, inflammatory response and tissue markers [C-reactive protein (CRP), creatinin kinase and white blood cells (WBC)]. The mean operating time was 69.5 min in group 1 and 76.5 min in the group 2, and the mean length of hospital stay was 2.6 days versus 2.1 days, respectively (P>0.05). For the laparoscopic myomectomy and combined operative procedure, respectively, the intra-operative blood loss was 134 ml (10–400 ml) and 93.7 ml (10–200 ml) (P>0.05); the difference (92.4 ml vs. 46 ml ) in estimated postoperative blood loss was statistically significant (P<0.05), and the decline in the hemoglobin level was 1.2 g/dl^-1 (group 1) versus 0.6 g/dl^-1 (group 2) on the 3rd postoperative day (P<0.05). Group 2 demonstrated a less intense stress response in terms of CRP (P<0.001) and WBC (P<0.01). The LUAD had little impact on intraoperative blood loss. This may be due to the smaller fibroid size, but the statistical difference in hemoglobin fall on the 3rd postoperative day was significant. The dissection of the uterine artery in laparoscopic myomectomy is a feasibile surgical procedure with a low rate of complication.