Intrauterine device and upper-genital-tract infection

Concern about upper-genital-tract infection related to intrauterine devices (IUDs) limits their wider use. In this systematic review I summarise the evidence concerning IUD-associated infection and infertility. Choice of an inappropriate comparison group, overdiagnosis of salpingitis in IUD users, and inability to control for the confounding effects of sexual behaviour have exaggerated the apparent risk. Women with symptomless gonorrhoea or chlamydial infection having an IUD inserted have a higher risk of salpingitis than do uninfected women having an IUD inserted; however, the risk appears similar to that of infected women not having an IUD inserted. A cohort study of HIV-positive women using a copper IUD suggests that there is no significant increase in the risk of complications or viral shedding. Similarly, fair evidence indicates no important effect of IUD use on tubal infertility. Contemporary IUDs rival tubal sterilisation in efficacy and are much safer than previously thought.     

Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.     

Spontaneous bacterial peritonitis associated with an intrauterine device

Intrauterine contraceptive devices (IUD) have been associated with the induction of chronic anaerobic endometritis as well as superimposition of exogenous sexually transmitted diseases and unilateral tubo-ovarian abscesses. We report an unusual case of spontaneous bacterial peritonitis in a patient with ascites and an IUD. Bacteriological data support the concept that the source of infection was a chronic mixed endometritis induced by prolonged use of an IUD (16 years). In the presence of ascites, a localized endometritis with its reservoir of bacteria provided the medium for systemic disease.     

Effect of intrauterine device use on cervical shedding of HIV-1 DNA.

OBJECTIVE: Hormonal contraception has been associated with an increased prevalence of cervical shedding of HIV-1 DNA among infected women. We conducted this study to evaluate the effect of the use of an intrauterine device (IUD) on the detection of HIV-1 DNA in cervical secretions. DESIGN: A prospective study of HIV-1-seropositive women undergoing IUD insertion at two public family planning clinics in Nairobi, Kenya. METHODS: Cervical swab samples were collected before IUD insertion and approximately 4 months thereafter for the detection of HIV-1-infected cells using polymerase chain reaction (PCR) amplification of HIV-1 gag DNA sequences. RESULTS: Ninety-eight women were enrolled and followed after IUD insertion. The prevalence of HIV-1 DNA cervical shedding was 50% at baseline and 43% at follow-up [odds ratio (OR) 0.8, 95% confidence interval (CI) 0.5-1.2]. There was no statistically significant difference between the baseline and follow-up shedding rates in a multivariate model that controlled for previous hormonal contraceptive use, condom use, cervical ectopy, friable cervix, cervical infections at an interim visit, and CD4 lymphocyte levels (OR 0.6, 95% CI 0.3-1.1). CONCLUSION: The insertion of an IUD did not significantly alter the prevalence of cervical shedding of HIV-1-infected cells. The use of IUDs, in conjunction with condoms, may be an appropriate method of contraception for HIV-1-infected women from the standpoint of potential infectivity to the male partner through exposure to genital HIV-1.     

Intrauterine contraceptive device appendicitis： A case report

Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 IUD inserted previously. This is a rare complication and only fourteen previous cases were recorded in the literature.     

Problems posed by birth control in cardiac and hypertensive patients (author's transl)

It is possible these days to prescribe oral contraceptives (OC) to patients suffering from hypertension or from cardiac diseases. Up to now OC was contraindicated for such atients, due to the harmful side effects of progestational agents, estrogen in particular. The use of an IUD was also contraindicated, due to the risk of endometrial infection, or of hemorrhage. The minipill, containing 30 mcg of estrogen, has been used for cardiac and for hypertensive patients for a number of years, and with good results. Continuous surveillance is, however, essential. The new progestin micropill not containing estrogen, when administered without interruption seems not to present any contraindication to cardiac patients, and to be as effective as the IUD. Sexual sterilization should be considered in very serious cases of hypertension or of cardiac diseases.     

T药铜宫内节育器临床效果观察

为观察了Ｔ药铜宫内节育器（ＴｍＩＵＤ）的临床效果及副反应,采取随机放置方法,分别放置ＴｍＩＵＤ２８０例,ＴＣｕ２２０ＣＩＵＤ２７６例,并随访６０个月。结果显示置器后６０月末,ＴｍＩＵＤ及ＴＣｕ２２０Ｃ ＩＵＤ的累积续用率分别为９４．６６／每百妇女及８５．２４／每百妇女（Ｐ〈０。０１）,因症取出率分别为０．５３／每百妇女及５．８／每百妇女（Ｐ〈０．０１）,血置器后３￣３６个月,ＴｍＩＵＤ各种副反应率     

Chlamydia trachomatis antigen positivity in women in risk groups and its relationship with the use of antibiotics

The present study examined the use of antibiotics with respect to the rate of Chlamydia trachomatis positivity. Our subjects were 282 sexually active Turkish females between the ages of 15 and 42. Endocervical samples were investigated in 60 women with pelvic inflammatory diseases (PIDs), 90 infertile patients (IPs), 92 registered commercial sex workers (CSWs), and 40 intrauterine device (IUD) users. All samples were analyzed using direct immunofluorescence test techniques for the presence of C. trachomatis antigen, which was found in 12.7% of our subjects, with positive results as high as 26% in patients between 21 and 30 years of age. C. trachomatis positivity was found to be 16.6% in PID patients, and 23.3% in IPs, and 5.4% in CSWs; however, it was not found among IUD users. The rate of positivity was highest in IPs; and lowest in registered CSWs (P < 0.05), who are periodically examined for the presence of sexually transmitted diseases, as required by Turkish authorities. Interestingly, the usage of therapeutic or prophylactic antibiotics such as tetracycline and ceftriaxon was found to be quite high among IUD users (90% use of tetracycline) and CSWs (100% use of both antibiotcs). Our results show that C. trachomatis positivity in the southeast region of Turkey is not significantly higher than that found in previous studies on sex workers of other countries. Additionally, our results indicate the use of prophylactic antibiotics decreases the rate of chlamydial infections.     

Adolescent inhalant use, abuse and dependence

Aims To compare adolescent inhalant users without DSM‐IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross‐sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid‐adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11–20); more than one‐third (38.6%, n = 279) reported life‐time inhalant use. Measurements Antisocial behavior, temperament, trauma‐exposure, suicidality, psychiatric symptoms and substance‐related problems. Findings Among life‐time inhalant users, 46.9% met criteria for a life‐time DSM‐IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non‐users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past‐year antisocial behavior and life‐time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant‐dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non‐users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance‐related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed.     

Effect of an intrauterine device on the gene expression profile of the endometrium

CONTEXT: The human endometrium acquires the ability to allow embryo attachment just for a specific period of time during each menstrual cycle. Understanding of the opposite functional status, referred to as refractoriness, can potentially be used to improve receptivity in infertile patients or as an interceptive approach to prevent gestation. OBJECTIVE: The objective of the study was to analyze the endometrial gene expression profile induced by an inert intrauterine device (IUD) at the time of implantation. DESIGN: We used a microarray containing more than 16,000 cDNAs to investigate the gene expression profile of receptive vs. refractory endometrium in the same women induced by the presence of an IUD. We compared the gene expression profile of endometrium obtained at LH+7 (window of receptivity) from the same women (n = 5) at the following time points: month 1, corresponding to the natural cycle before IUD insertion; month 3, just before IUD removal; and months 5 and 15. Data were validated by quantitative RT-PCR for IGF binding protein-3, peroxisome proliferative activated receptor-gamma, glycodelin, and leukemia inhibitory factor and immunohistochemistry for glycodelin. RESULTS: We identified 147 genes significantly dysregulated in the refractory endometrium (78 up- and 69 down-regulated). Interestingly, 52 of these genes have previously been reported to be regulated during window of implantation. Surprisingly, the majority of genes (96.6%) remained dysregulated 2 months after IUD removal, but 1 yr later most of them (80%) returned to normal. CONCLUSIONS: Our results reveal that a refractory endometrium in a fertile woman produced by an IUD is induced by preventing the normal transition to a receptive gene expression profile through effects on a specific subset or cluster of genes that impact on endometrial receptivity.     

Linear measures of temporal lobe atrophy on brain magnetic resonance imaging (MRI) but not visual rating of white matter changes can help discrimination of mild cognitive impairment (MCI) and Alzheimer's disease (AD)

Clinical discrimination of the early stages of AD and MCI is challenging. MRI indices which are simple enough to be applied by non-radiologists on hard copies would be of practical importance in the discrimination. We studied 45 consecutive patients (17 with MCI, 25 with AD, 3 with normal cognitive findings) with at least one white matter lesion (WML) on axial fluid-attenuated inversion recovery (FLAIR) MRI sequences. WML load was evaluated by Fazekas' scoring system; temporal lobe atrophy by interuncal distance (IUD) measurement. WML pattern had no significant discriminative value of AD and MCI. No significant correlation between periventricular/subcortical WML scores and neuropsychological test results was observed. The mean IUD was significantly smaller in patients with MCI compared to those with AD. The cut-off value of IUD was 28.3 mm with receiver operating curve (ROC) analysis. Area under the curve was 0.925 (95% CI: 0.800-0.983). A significant negative correlation between IUD and the mini mental state examination (MMSE), verbal fluency, clock drawing, and Rey Auditory verbal learning test (AVLT) was noted. The results indicate that measurement of IUD is a clinically useful test in discrimination of AD and MCI patients with WML(s) on brain MRI. However, severity of these lesions is not useful for distinctions.     

Colonization of the uterus by the oral protozoan Entamoeba gingivalis.

Pap smears occasionally reveal protozoa of the genus Entamoeba in the uterus of intrauterine device (IUD) users, but definitive identification of the species involved has not been possible. Using riboprinting, a technique that compares ribosomal RNA gene sequences, we present evidence that the organism is Entamoeba gingivalis, an inhabitant of the mouth. Colonization most likely occurs via orogenital contact and requires the presence of an IUD and a concomitant bacterial infection.     

Contraceptive use among HIV‐positive women in Quang Ninh province,Vietnam

Objective To investigate contraceptive use among HIV‐positive women in Ha long city and Cam Pha town of Quang Ninh, a Northern province of Vietnam. Methods Cross‐sectional questionnaire study among HIV‐positive women identified through the district HIV/AIDS register. Information on socioeconomic characteristics and contraceptive use before and after HIV diagnosis was obtained through structured questionnaires. Chi‐square testing was used to assess whether the included women differed from the target population in terms of age. Crude Odds ratios (ORs) were calculated to show the association between contraceptive use and the women’s socioeconomic characteristics. Logistic regression analyses were applied to adjust for possible confounding. The women’s contraceptive use before HIV testing and after HIV testing was described and compared by Chi‐square testing, and the association between post‐test counselling and the women’s use of condom was assessed by ORs. Results Of the 351 participants, 63% stated they had used contraception before HIV diagnosis and 89% stated they had used contraception after HIV diagnosis. Forty six per cent of the women had been using either the pill or an intrauterine device (IUD) before the diagnosis whereas the same applied for only 8% of the women after diagnosis. Thirty‐nine per cent stated they had been using condom before HIV diagnosis whereas 87% stated condom use after HIV diagnosis. Condom use was more common among women who had received post‐test counselling (OR 3.03, 95% CI 1.03–8.90). Conclusions A change of contraceptive methods from IUD and oral contraception before HIV diagnosis to condom use after HIV diagnosis was observed. The women’s use of condoms after HIV diagnosis was associated with having received post‐test counselling.     

Contraceptive practice in 209 diabetic women regularly attending a specialized diabetes clinic

In order to determine their contraceptive practice, 209 diabetic women, aged 16-50 years, regularly attending the diabetic clinic of a University Hospital in Paris, France, were interviewed. 134 (64%) were current-users of contraception. Contraceptive use was significantly lower among patients with NIDDM compared to patients with IDDM (46% vs 70%, p less than 0.01). Methods used were: intra-uterine devices (IUD) (32% of users), hormonal compounds (27%, almost exclusively low-dose progestogen only pill), occlusive and natural methods (27%), and tubal ligation (14%). The major gynaecological side-effects were associated with the use of low-dose progestogens (39% with amenorrhoea vs 14% for other methods, p less than 0.01). A subsample (n = 165, age-range 20-44 years) of this diabetic population was compared with a representative sample of 8,899 French women of the same age. The proportion of current-users of contraception in this diabetic population was lower than in the French population (63.5% vs 72.2%, p less than 0.02). The diabetic patients tended to use more efficient methods of contraception (pill, IUD and tubal ligation), but 11% of them used no contraception without a stated reason, compared to 4% of the French population. It is suggested that contraceptive guidance should be reinforced in diabetic women, particularly with NIDDM, in order to promote family planning, since tight glycaemic control before and during pregnancy is now recommended.     

Maternal anaemia and its impact on perinatal outcome

OBJECTIVE: To find out the relationship between maternal anaemia and perinatal morbidity and mortality. METHOD: A cohort of 629 pregnant women was studied from October 2001 to October 2002. Of these, 313 were anaemic (haemoglobin <11 g/dl in labour and on two previous occasions in current pregnancy). A total of 316 women had haemoglobin >11 g/dl at all times in pregnancy and were labelled as non-anaemic. Perinatal outcomes included preterm delivery, low birth weight (LBW) at delivery, intrauterine growth restriction, perinatal mortality, APGAR score at 1 and 5 min, intrauterine foetal demise (IUD). RESULTS: The risk of preterm delivery and LBW among exposed group was 4 and 1.9 times higher among anaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of <5 at 1 min and the risk of IUD was 3.7 times higher for anaemic women. CONCLUSION: Low maternal haemoglobin levels are associated with increased risk of preterm delivery, LBW babies, APGAR score <5 at 1 min and IUD.     

米索前列醇配伍利多卡因在绝经妇女取环术中的临床效果观察

目的探讨米索前列醇配伍利多卡因在绝经妇女取环术中的临床效果。方法对绝经半年以上宫内带无尾丝节育环要求取环的95例妇女随机分为2组：A组为试验组,B组为对照组。A组52例,在取环术前2 h给予阴道放置米索前列醇0.4 mg,术中予2%利多卡因5 ml宫颈注射;B组43例,术前2 h给予阴道放置安慰剂甲硝唑片400 mg,术中予2%利多卡因5 ml宫颈注射,术后应用数字模拟疼痛评分法（VAS）对疼痛程度（无痛0分,疼痛难忍10分）进行评估,且对2组手术效果进行比较观察。结果A组妇女取环成功率（98.1%）显著高于B组（83.7%）（P〈0.05）,手术时需扩张宫颈者显著少于B组（P〈0.05）,以及手术时疼痛程度也低于B组（P〈0.01）。结论绝经妇女取环术前给予阴道放置米索前列醇配伍2%利多卡因5 ml宫颈注射效果满意,值得临床推广使用。     

Effect of Amniotic Fluid on Blood Coagulation

Amniotic fluids from, normal subjects and from patients with intrauterine death (IUD) were studied for their ability to shorten the clotting-time of blood in vitro . The IUD amniotic fluid was different in that it seemed to require the presence of factor VII for its action whereas normal amniotic fluid did not. In this it resembled tissue factor in its action, whereas normal amniotic fluid resembled Russell Viper venom.     

Menorrhagia from a haematologist''s point of view. Part II: management

The management of menorrhagia has until recently been the domain of the gynaecologist. As haematologists, we are now addressing the issue of optimal management of menorrhagia in our patients with bleeding disorders. Addressing three life periods, the menarche, reproductive years, and postchildbearing years, this review will discuss the use of oral contraceptive agents, antifibrinolytics, non-steroidal anti-inflammatory drugs, intranasal DDAVP and the new levonorgestrel-impregnated IUD. Management of specific bleeding disorders will also be reviewed for von Willebrand disease, haemophilia A and B carriers, women with factor XI deficiency and PAI-1 deficiency.     

Contraception for Cancer Survivors

Women who have survived cancer may need guidance in choosing a method of contraception. This paper reviews the evidence supporting the safety and efficacy of available methods of contraception for cancer survivors and concludes that the Copper T380A intrauterine device (IUD), a highly effective, reversible, long-acting, hormone-free method should be considered a first-line contraceptive option for women with a history of a hormonally mediated cancer. However, the levonorgestrel-containing IUD may be preferable for women being treated with tamoxifen and women who have survived non-hormonally mediated cancers. Women with IUDs can undergo all forms of imaging, including computed tomography and magnetic resonance imaging.     

A comparison of lung lamellar body phospholipids from premature and term infants: Is sphingomyelin a contaminant of surfactant?

Lamellar bodies were isolated from homogenates of lungs obtained at autopsy from premature infants (n = 9), and compared to lamellar bodies from three full term reference groups including 55 infants with sudden infant death syndrome (SIDS), 14 control infants, and 3 who succumbed to intra-uterine death (IUD) at term. Analysis of the phospholipids was expected to reveal a high proportion of sphingomyelin (Spm) in the lamellar bodies isolated from the lungs of premature infants (24 to 33 weeks gestational age) since at this stage of their development the percentage of Spm in the amniotic fluid is high. However, Spm was either absent or a small proportion of the total phospholipid in lamellar body surfactant from these premature infants. Spm was also a small percentage of phospholipid in the lamellar body surfactant of infants with SIDS and from control and IUD specimens. It is suggested that Spm may not be a normal constituent of lamellar body surfactant but rather a contaminant from membranes.