Complications among adolescents using copper intrauterine contraceptive devices

Objective

To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents.

Methods

A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital, Egypt, between July 1, 2008 and December 31, 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1, 3, and 6 months. Odds ratio and χ² square tests were used to compare the rates of complications at each visit.

Results

Of 1512 patients eligible for IUD insertion, 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain, bleeding, displacement, expulsion, and removal of IUDs were significantly higher in adolescents (P < 0.05). The rates of these complications were high in adolescents younger than 16 years; the rates then decreased with age and became comparable with the adult rates at 18 years of age.

Conclusions

IUD-associated complications were high in adolescents up to the age of 17 years. Our data suggest that adolescents younger than 18 years of age should be counseled carefully before IUD insertion, and examined more frequently to detect displacement or expulsion of the device.     

Factors influencing discontinuation of intrauterine contraceptive devices: an assessment in the Indian context

Sociocultural and behavioral factors are associated with decision to use and the selection of a contraceptive method, continuation of use and reasons for discontinuation of a contraceptive. This paper tries to distinctly outline the determinants of discontinuation of the intrauterine contraceptive device (IUCD), especially in the Indian context. Data on medical reasons for discontinuation are available through clinical trials. However, sociodemographic studies provide one with a wider spectrum to analyze the factors associated with the discontinuation of IUCDs. Information on service providers can be used to improve the quality of family planning services in the country. In India, a thorough review of birth spacing methods, especially the IUCD, is needed since the surveys show a high rate of discontinuation. The emphasis in this paper is upon compilation of reasons for discontinuation of the IUCD and research thereof. The review of the literature is directed towards giving a new direction to assessment of family planning programs, especially in India where population control is largely dependent upon permanent methods. Delineation of factors is important to improve the family planning program.     

Use of intrauterine contraceptive devices in nulliparous women: personal experience over a 12-year period

Objective To evaluate the use of intrauterine contraceptive devices (IUDs) in nulliparous women compared to their use in parous women.

Methods A comparative cross-sectional study was carried out to determine the reasons for removal of IUDs inserted between 1985 and 1996 in a sample of 227 nulliparous women and 2080 parous women. The statistical analysis was performed using the χ² test; the differences were considered to be significant when p < 0.05.

Results The reasons for removal of IUDs in the two groups were: expiry, 49.1% in the nulliparous group vs. 48.2% in the parous group; planned pregnancy, 21.7% vs. 15.4%; accidental pregnancy, 4.8% vs. 6.3%; expulsion, 1.6% vs. 5.1%; pelvic inflammatory disease, 1.6% vs. 1.1%; pain and/or bleeding, 14.5% vs. 10.2%; other, 6.4% vs. 6.3%; vasectomy or tubal sterilization, 0% vs. 7%.

Conclusion Our data suggest that nulliparity is not a contraindication for the use of an IUD, and that the use of an IUD in nulliparous women is as safe and effective as in parous women.     

Uterine perforation by the levonorgestrel-releasing intrauterine device: case report

The authors demonstrate a case report of the uterine perforation by the levonorgestrel-releasing intrauterine device (LNG-IUD) in a 33-year-old asymptomatic woman after an 18-month period after insertion. The device was not localized in utero during routine control with transvaginal sonography. After abdominal radiography examination the device was removed by laparoscopy. The possibilities of transuterine migration of IUD are discussed.     

Intrauterine contraception: from silver ring to intrauterine contraceptive implant

Gräfenberg introduced his silver ring in 1928 and by his classic paper, published in 1931, provided intrauterine contraception with a scientific basis. For largely non-medical reasons, the Gräfenberg ring vanished from the scene a few years later, and it took almost 30 years before the method was rehabilitated as a result of a change in mental attitude toward birth control, the awareness of world population explosion, and the introduction of improved intrauterine devices (IUDs). The United States became the epicenter of IUD research in the 1960s but, due to adverse publicity and the threat of litigation, the pendulum swung and European investigators took over the job of improving the IUD. Proceeding from Dr Gräfenberg’s classic paper, the major steps in the evolution of the intrauterine devices are retraced with focus on the scientists who were innovative in the field.     

Lidocaine gel vs lidocaine spray in reducing pain during insertion of the intrauterine contraceptive device

Objectives: The aim of this study was to compare the pain-relieving effect of intracervical lidocaine gel with that of lidocaine spray or no local anaesthesia in decreasing pain during insertion of the intrauterine contraceptive device (IUCD).

Methods: In a prospective multicentre non-randomised comparative study design, 420 women were divided into three groups of 140 and fitted with the same type of IUCD. Group 1 received cervical lidocaine gel, group 2 received cervical lidocaine spray and group 3 received no topical anaesthesia. A visual analogue scale was used to measure the degree of pain experienced.

Results: There were no significant differences between the three groups with regard to baseline characteristics such as age and number of deliveries. Significantly less pain was felt during cervical traction in women using a local anaesthetic. However, there were no significant differences in pain due to IUCD insertion.

Conclusions: Application of a local anaesthetic decreased the pain resulting from cervical traction but not that resulting from IUCD insertion.     

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.     

Length of the endometrial cavity and intrauterine contraceptive device expulsion

Objective

To evaluate the correlation between endometrial cavity length and expulsion rate in acceptors of the TCu380A intrauterine device (IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS).

Methods

The study included 235 nulligravida and parous women who received a TCu380A IUD or LNG-IUS and who were observed for up to 1 year. The length of the uterine cavity was measured by uterine sounding and ultrasonography.

Results

The endometrial cavity was shorter than 3.2 cm in 2 LNG-IUS users and at least 3.2 cm long in 87 LNG-IUS users, with expulsions occurring in 0 (0.0%) and 2 (2.3%) of these women, respectively (P > 0.999). Among the TCu380A IUD users, the endometrial cavity was shorter than 3.6 cm in 63 women and at least 3.6 cm long in 83 women, with expulsions occurring in 3 (4.8%) and 5 (6.0%) of these women, respectively (P > 0.999). The mean length of the endometrial cavity—evaluated via ultrasonography—among the 10 women whose devices were expelled was 3.9 ± 0.3 cm, compared with 3.9 ± 0.0 cm in those who retained their devices (P = 0.799).

Conclusion

The present results do not support the hypothesis of an association between uterine length and risk of intrauterine contraceptive expulsion.     

Ultrastructural alterations in human endometrium caused by intrauterine contraceptive devices

Biopsies of endometrium from women using intrauterine contraceptive devices (IUDs) were examined by electron microscopy to elucidate the possible cause of IUD-associated uterine hemorrhage. The findings reveal the presence of degenerated, shrunken cells in the endometrial glands of IUD users. These cells, termed pyknotic or apoptotic, are more prevalent in tissue from women with complaints of excessive bleeding than in cases without such complaints. The pyknotic cells often show discontinuities of the plasma membrane at their luminal pole, from which cell contents stream into the lumen. Sometimes erythrocytes are also observed in the lumen. A second alteration in the ultrastructure of the endometrium is an abnormal increase in microfilaments in the epithelial cells. These two changes, a large number of pyknotic cells on the one hand and increase in microfilaments on the other, are correlated with excessive bleeding but they do not explain in simple terms of outflow of erythrocytes. Probably some inflammatory mechanism is involved. The increased number of microfilaments might be helping the movement of fluid from healthy to pyknotic cells.     

Combined laparoscopic-colonoscopic approach for the removal of a migrated intrauterine contraceptive device penetrating the sigmoid colon

Uterine perforation is a rare but potentially life-threatening complication associated with the use of intrauterine contraceptive devices (IUDs). Following perforation, the IUD can migrate to the peritoneal cavity or even perforate several adjacent organs. Migration to the sigmoid colon is extremely rare. We present the case of a 28-year-old woman who had an IUD inserted soon after delivery. The patient again became pregnant, but no IUD could be detected in routine examinations. After an asymptomatic interval of 3 years, the patient suffered acute abdominal pain. Initial laparoscopy elsewhere revealed the IUD attached to the sigmoid colon, but extraction was not possible. The patient was referred to us for further treatment. Under general anesthesia, laparoscopic exploration of the abdomen was performed. The IUD had perforated the sigmoid colon and was firmly fixed. In order not to injure the sigmoid colon, laparoscopic mobilization of the IUD was assisted with a “rendez-vous” sigmoidoscopy. The IUD was removed transanally with laparoscopic and sigmoidoscopic assistance, and the patient was discharged within 24 h after the operation. Insertion of an IUD necessitates regular checks to confirm the device’s correct position. Migration of an IUD warrants prompt laparoscopic removal, even in asymptomatic patients.     

Transuterine migration as a complication of intrauterine contraceptive devices: six case reports

Objectives We retrospectively analyzed six cases between 1986 and 2002 that had been operated within our unit with the diagnosis of migration of an intrauterine contraceptive device (IUD). Although an IUD is an effective contraceptive method, the migration of one is a rare but serious complication. The aim of this report is to emphasize the management and therapy of this complication. Cases Out of six patients, three patients with occurring pregnancy, two with pelvic pain and one with a missing IUD incidentally diagnosed during a routine follow-up gynecological examination, were admitted to our clinic. The diagnosis of perforation and transuterine migration of the IUD was confirmed with a plain abdominal X-ray with a hysterometer placed in the uterus, hysterosalpingography and ultrasound. One patient was diagnosed as having a perforated rectosigmoid bowel intraoperatively and one presented with perforation of the bladder. In the remaining four cases, the IUD only migrated into the abdominal cavity without any organ perforations. One IUD was extracted laparoscopically, one was removed through the vagina by colpotomy and, in the other four cases, a laparotomy had to be performed. Patients were discharged without any complications. Conclusion The most serious potential complication of IUD use is uterine perforation and this can cause severe morbidity. When an IUD is located in the abdominal cavity, it should be carefully managed and removed, even in an asymptomatic patient.     

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.     

Persistent subumbilical discharge associated with actinomycosis caused by intrauterine contraceptive device: a case report

Intrauterine devices are a very effective form of contraception used worldwide for more than 2 centuries. One of the serious, but rare, complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. In this report we describe, persistent periumbilical discharge associated actinomycosis caused by migration of a copper intrauterine contraceptive device. To our knowledge, this is the first report of persistent periumbilical discharge caused by migration of a copper intrauterine contraceptive device. We recommend consideration of this minor possibility during evaluation of women with chronic abdominal discharge.     

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.     

Pre-insertion uterine artery Doppler indices may predict intrauterine contraceptive device-related heavy menstrual bleeding

Objective

To test the hypothesis whether initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of copper-T 380 intrauterine contraceptive device (IUCD) could predict IUCD-related heavy menstrual bleeding or not.

A reanalysis of the Cu-7 intrauterine contraceptive device clinical trial and the incidence of pelvic inflammatory disease: A paradigm for assessing intrauterine contraceptive device safety

OBJECTIVE: We calculated and compared the incidence of pelvic inflammatory disease in a 10% random sample of the Cu-7 intrauterine contraceptive device (G.D. Searle & Co., Skokie, Ill.) clinical trial with the rates reported to the Food and Drug Administration and those in subsequent trials published in the world literature. STUDY DESIGN: A 10% random sample of the Cu-7 clinical trial was examined because calculations had demonstrated this random sample to be sufficient in size (n = 1614) to detect a difference in rates of pelvic inflammatory disease from those reported to the Food and Drug Administration. An audit of a subset of the patient files, compared with the original files in Skokie, Illinois, confirmed that the files available for analysis were complete. Standard definitions were used to identify cases of pelvic inflammatory disease and to calculate rates of pelvic inflammatory disease. The world literature on Cu-7 clinical trials was reviewed. RESULTS: The calculated crude and Pearl index rates of pelvic inflammatory disease were consistent with those rates previously reported to the Food and Drug Administration and published in the medical literature. Life-table pelvic inflammatory disease rates were not different between nulliparous and parous women and pelvic inflammatory disease did not differ from basal annual rates in fecund women. CONCLUSION: On the basis of the analysis of this 10% sample, the pelvic inflammatory disease patient rates reported to the Food and Drug Administration for the entire Cu-7 clinical trial are accurate and are similar to those published in the world literature. (AM J Obstet Gynecol 1994;170:1606-16.)     

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.