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1.
Title: Intrauterine devices: an effective alternative to oral hormonal contraception.
Source: Prescrire International. 2009 Jun;18(101):125-30.
Abstract: (1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | IUD | CONTRACEPTIVE MODE OF ACTION | IUD COMPLICATIONS | IUD EXPULSION | INSERTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | UTERINE PERFORATION | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Pregnancy Complications | Diseases | Perforations
Document Number: 342301

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Title: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding.
Author: Benacerraf BR; Shipp TD; Bromley B
Source: Ultrasound In Obstetrics and Gynecology. 2009 Jun 29;34(1):110-115.
Abstract: OBJECTIVE: To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices. METHODS: Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones. RESULTS: Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms wasonly detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal. CONCLUSION: A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ULTRASONICS | IUD COMPLICATIONS | IUD MIGRATION | BLEEDING | PAIN | MYOMETRIUM | CERVIX | INSERTION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment
Document Number: 341864

4.
Title: [Actinomycosis of the caecum simulating carcinoma in a patient with a long-term intrauterine device]
Author: Colovic R; Grubor N; Micev M; Latincic S; Matic S; Colovic N
Source: Srpski Arhiv Za Celokupno Lekarstvo. 2009 May-Jun;137(5-6):285-7.
Abstract: INTRODUCTION: Actinomycosis of the caecum is a rare, but most frequently an abdominally localized disease. It often simulates inflammatory malignancy, rarely a periappendicular abscess or Chron's disease and is only exceptionally the cause of intestinal obstruction or bleeding. CASE OUTLINE: The authors present a 35-year-old woman with an intrauterine device which remained inserted for over three years, causing the development of pain, fever, vaginal secretion and bleeding that continued even after the device was removed. Ultrasonography showed a tumorous mass of irregular form located close to the uterus, which after a few months developed into a colliquation filled with pus requiring incision. Bacteriological examination failed to show actinomycosis. Due to the tumorous lesions involving the terminal ileum, appendix, caecum, ascending colon and omentum, a right hemicolectomy was performed. Based on histolopathological findings of the resected sample the diagnosis of actinomycosis was made. Therefore, after surgery the patient began treatment with antibiotics resulting in full recovery. CONCLUSION: Although rare, actinomycosis of the caecum should be taken into consideration in the differential diagnosis of tumorous lesions of the caecoascending part of the colon, particularly if the tumour is associated with inflammation.
Language: Serbian
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | CLIENTS | IUD COMPLICATIONS | BLEEDING | PAIN | SIGNS AND SYMPTOMS | SURGERY | TREATMENT | Developed Countries | North America | Americas | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342607

Peer Reviewed

Title: What is the fate of the missing intrauterine contraceptive device?
Author: Ibitoye BO; Aremu AA; Onuwaje MA; Ayoola OO
Source: Tropical Doctor. 2009 Oct;39(4):221-3.
Abstract: An intrauterine contraceptive device (IUCD) is one of the most common forms of contraception in use worldwide today. It is associated with a myriad of problems and complications, one of which is the missing IUCD. It is a known fact that IUCDs can perforate the uterus resulting in its subsequent relocation in other organs within the pelvis and the abdomen. This study showed that more than 50% of clinically diagnosed cases of a missing IUCD are still located within the endometrial cavity. It is therefore being proposed that a clinical diagnosis of 'missing string' be made until adequate radiological investigations, such as ultrasonography, plain X-rays and computerized tomography, have been carried out.
Language: English
Keywords:
GLOBAL | NIGERIA | RESEARCH REPORT | INCIDENCE | WOMEN | IUD | IUD COMPLICATIONS | IUD MIGRATION | EXAMINATIONS AND DIAGNOSES | ULTRASONICS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342764

6.
Title: The role of three-dimensional imaging in the investigation of IUD malposition.
Author: Kalmantis K; Daskalakis G; Lymberopoulos E; Stefanidis K; Papantoniou N; Antsaklis A
Source: Bratislavske Lekarske Listy. 2009;110(3):174-7.
Abstract: OBJECTIVES: The aim of this study was to present a systematic review of the use of three-dimensional ultrasound for the detection and evaluation of intrauterine device malposition in a patient of our department. BACKGROUND: Transvaginal sonography failed to detect IUD misplacement in about 9% of cases. Whereas the three-dimensional ultrasound (3D), a new emerging technology, that could provide precise evaluation of IUD malposition. METHODS: The data were extracted from the literature using computerised Medline system. The use-effectiveness and acceptance of three-dimensional imaging in the detection of IUD malposition was examined as an alternative method to two-dimensional ultrasound. RESULTS: Three-dimensional ultrasound was more accurate than two-dimensional for the identifying IUD device. Three-dimensional technique enables assessment of IUD length in the longitudinal section synchronically with imaging arms of the device. Examination with 2D ultrasound is limited to transverse views of the shaft. The arms or other smaller parts cannot be investigated completely because of the frontal view of an IUD is rarely presented. CONCLUSION: Three-dimensional ultrasound is a new and promising imaging tool which provides much better view of the endometrial cavity. This is especially useful in uterus examination and in the detection of IUDs because structures that are not located in one single plane can be imaged simultaneously. Three-dimensional ultrasound is considered to be more secure and safer diagnostic technique to determine the location of IUDs than hysteroscopic evaluation (Fig. 2, Ref. 17). Full Text (Free, PDF) www.bmj.sk.
Language: English
Keywords:
GREECE | RESEARCH REPORT | LITERATURE REVIEW | ULTRASONICS | IUD | INSERTION | IUD COMPLICATIONS | Europe, Southern | Europe | Developed Countries | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Treatment
Document Number: 342596

Peer Reviewed

Title: Study on a novel copper-containing composite for contraception.
Author: Li J; Suo J; Huang X; Jia L
Source: Contraception. 2009 Jun;79(6):439-44.
Abstract: BACKGROUND: The copper-containing intrauterine devices (Cu-IUDs) are being increasingly used worldwide as an effective contraception for family planning. To avoid abnormal bleeding, pain, partial and complete expulsion, which are associated with the burst release of cupric ions during the first few days, a novel cross-linked composite based on polyvinyl alcohol (PVA) that contained cupric ions, but not metallic copper, was developed by our research team. STUDY DESIGN: As a logical extension of our previous work, the corrosion products and release behavior of this composite after immersing in simulated body fluid (SBF) for 1 year were studied by X-ray fluorescence spectroscopy (XRF), X-ray diffraction (XRD) and atomic absorption spectrophotometry (AAS). RESULTS: No other new elements, such as P, Cl and Ca, appeared on the surface of the composite, and no Cu(2)O was formed after immersing in SBF for 1 year, indicating that the effectiveness of copper can be greatly improved. Furthermore, no significant change on time dependence was found for the release rates of cupric ions in the composite compared with that of metallic copper, suggesting the absent burst release of cupric ions in the composite. CONCLUSION: The present in vitro long-term data suggest that this novel copper-containing composite has potential as a substitute for conventional materials used in the manufacture of IUDs.
Language: English
Keywords:
CHINA | RESEARCH REPORT | ANALYSIS | WOMEN IN DEVELOPMENT | IUD, COPPER RELEASING | IUD COMPLICATIONS | TIME FACTORS | CONTRACEPTIVE MODE OF ACTION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Economic Development | Economic Factors | IUD | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population
Document Number: 341102

10.

Title: Serious morbidity with long-term IUD retention [letter]
Author: Pillai M; Van de Venne M; Shefras J
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):131-2; author reply 132.
Abstract: This letter to the editor examines serious health problems resulting from long-term IUD retention in women experiencing menopause and in the years following. It recommends that current guidelines be revised to include some emphasis on the importance of timely removal of an IUD once its contraceptive properties are no longer required for the IUD user.
Language: English
Keywords:
UNITED KINGDOM | SUMMARY REPORT | CASE HISTORIES | CLIENTS | IUD, COPPER RELEASING | IUD COMPLICATIONS | TIME FACTORS | PELVIC INFECTIONS | Developed Countries | Europe, Western | Europe | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Infections | Diseases
Document Number: 341648

11.
Title: Pelvic actinomycosis: a malignant appearing mass. A case report.
Author: Pirenne Y; Bouckaert W; Vangertruyden G
Source: Acta Chirurgica Belgica. 2009 Mar-Apr;109(2):250-2.
Abstract: Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.
Language: English
Keywords:
BELGIUM | SUMMARY REPORT | CASE STUDIES | CLIENTS | IUD COMPLICATIONS | BACTERIAL AND FUNGAL DISEASES | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | HISTOLOGY | ULTRASONICS | ANTIBIOTICS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Drugs | Treatment
Document Number: 342597

12.

Title: [Abdominal migration of a levonorgestrel-releasing intrauterine device. Case report and review of the literature] Efficacite d'un sterilet au levonorgestrel migre en intra-abdominal. A propos
Author: Pont M; Lantheaume S
Source: Journal De Gynecologie, Obstetrique Et Biologie De La Reproduction. 2009 Apr;38(2):179-81.
Abstract: We report the case of a 27-year-old woman in amenorrhea after the installation of a levonorgestrel releasing intra-uterine device, 3 years previously. In front of pelvic continuing pains, paraclinic explorations diagnosed the DIU-LNG in intra-abdominal situation. An exploratory laparoscopy was realized and allowed its ablation. The authors discuss the systemic distribution of the levonorgestrel and the impact of the DIU-LNG in intra-abdominal situation by a review of the literature.
Language: French
Keywords:
CHINA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | AMENORRHEA | LEVONORGESTREL | IUD MIGRATION | PAIN | IUD COMPLICATIONS | Asia, Eastern | Asia | Developing Countries | Demographic Factors | Population | Menstruation Disorders | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Signs and Symptoms
Document Number: 342412

13.
Title: Asymptomatic missing Intrauterine Contraceptive Device found incidentally at laparatomy.
Author: Rahman GA; Yusuf IF
Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):255-6.
Abstract: The aim of this presentation is to report an asymptomatic missing intrauterine contraceptive (IUD) found in the omentum at surgery for cholecystectomy. Patient presented with clinical features of chronic calculus cholecystitis. Missing IUD was found at exploratory laparatomy for cholecystectomy. Excision of omentum was done and the patient did well. IUD providers should not only screen potential users and insert IUD correctly, but also ensure adequate follow-up.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | WOMEN | IUD COMPLICATIONS | SIGNS AND SYMPTOMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases
Document Number: 341535

14.

Peer Reviewed

Title: Migration of levonorgestrel IUS in a patient with complex medical problems: what should be done?
Author: Soleymani Majd H; El Hamamy E; Chandrasekar R; Ismail L
Source: Archives of Gynecology and Obstetrics. 2009 Mar;279(3):385-6.
Abstract: Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG-IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | IUD MIGRATION | LEVONORGESTREL | IUD, HORMONE RELEASING | OBESITY | SIGNS AND SYMPTOMS | IUD COMPLICATIONS | ANTIBIOTICS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Body Weight | Physiology | Biology | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses
Document Number: 331038

15.

Title: Informed consent for IUD fitting [letter]
Author: Stillwell S; Searle S
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):132-3.
Abstract: Perforation of the uterus is a rare complication of intrauterine device (IUD) fitting. It is quoted as occurring in up to 2 in 1000 IUD fittings. Risk factors for perforation include previous caesarean section and postpartum insertion up to 6 months after delivery. Perforation may occur during the sounding of the uterus or the device itself may perforate the uterus. This can lead to the device being free in the abdominal cavity, necessitating removal by laparoscopy or laparotomy. Faculty Guidance tells IUD fitters that they should explain the risk of perforation to women considering an IUD and document this discussion in the clinical record. This fits with General Medical Council (GMC) guidance on informed consent. I dealt with a complaint from a woman who had a perforation of the uterus following an IUD change; this lady required laparoscopy to remove a missing IUD. The perforation was diagnosed at her IUD check, when the threads were found to be missing. Despite a clinical record showing "perf" followed by a tick this lady alleged that she had not been made aware of the risk of perforation and that if she had been aware she would not have had an IUD fitted. Dealing with this complaint led me to review my own clinical practice and to seek the opinions of other IUD fitters. Using a questionnaire, 15 instructing doctors were asked about the manner in which they (1) explain perforation risk to women and their confidence doing this and (2) assess their patients' understanding of the risk of perforation. These doctors all explained the risk of perforation to all women on their first IUD fitting but only 80% did on subsequent fittings. They commonly used an explanation along the lines of: "There is a small chance -1 in a 1000 -of perforation. This means making a hole in the wall of the womb. This is not serious but if the IUD goes into the tummy outside the womb it has to be removed with keyhole surgery". An explanation such as this would meet GMC consent guidance (i.e. you must tell patients if an investigation or treatment might result in a serious adverse outcome, even if the likelihood is very small). Although 50% of doctors found perforation easy to explain only 20% felt that their patients had understood the risk of perforation. If this is the case then this would not meet guidance that "you should check that a patient understands the terms that you use, particularly when describing the seriousness, frequency and likelihood of an adverse outcome". No doctor felt that patients were deterred from having an IUD fitted by the risk of perforation. More than 50% of the doctors felt that they would like further training in the discussion of risk of perforation of the uterus and of explanation of risk in general. It sometimes takes a review of everyday practice to identify a learning need. In this case it was prompted by a complaint from a woman who unfortunately did experience uterine perforation following an IUD change. All the doctors questioned did discuss the risk of perforation at a first IUD fitting but not all did at a subsequent IUD change. We should not assume that a woman will remember the potential complications of IUD fitting from a previous consultation. The management of this particular complaint and the results of this survey have changed the way in which I discuss perforation risk with women, and I now incorporate this into a fuller explanation of how the device is introduced and why a problem might occur potentially leading to perforation. (full-text)
Language: English
Keywords:
UNITED KINGDOM | SUMMARY REPORT | CASE HISTORIES | INFORMED CONSENT | IUD COMPLICATIONS | INSERTION | UTERINE PERFORATION | PHYSICIAN-PATIENT RELATIONS | Developed Countries | Europe, Western | Europe | Data Collection | Research Methodology | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Perforations | Diseases | Interpersonal Relations | Behavior
Document Number: 341646

16.

17.

Peer Reviewed

Title: The Femilis LNG-IUS: contraceptive performance-an interim analysis.
Author: Wildemeersch D; Janssens D; Andrade A
Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):103-10.
Abstract: OBJECTIVE: To provide an update on the experience with the Femilis levonorgestrel-releasing intrauterine system (LNG-IUS) used for up to five years by parous and nulliparous women, particularly with regard to its contraceptive performance. STUDY DESIGN: An interim, open, prospective non-comparative study of the Femilis LNG-IUS releasing 20 microg of levonorgestrel/day. RESULTS: Two-hundred and eighty insertions were carried out in women with a mean age of 35.7 years (range 17-48), 60% of whom were parous and 40% nulliparous. Twenty-four women with uterine pathology (e.g., fibroids, menorrhagia) were included in the study. The cumulative gross discontinuation life table rates were determined. The total observation period was 8,028 woman-months. The LNG-IUS was easy to insert in 95.7% of the cases, and no perforations occurred. No pregnancies were observed and only one expulsion took place (rate 0.4/100 women at five years). The cumulative total use-related discontinuation rate was 14.7/100 at five years. There were nine removals because of pain, six of which were in nulliparous women. Four women requested removal of the IUS for bleeding problems. Fourteen removals were done for 'other' medical reasons among which mood disturbances (five cases) were the most frequent, and 12 for non-medical reasons. Fifteen removals were requested for pregnancy wish. Twelve of these women became pregnant within one year and all had uneventful pregnancies. The Femilis LNG-IUS was equally well accepted by nulliparous as by parous women. Most women with heavy menstrual bleeding prior to insertion, whether associated with fibroids or not, reported much less bleeding, scanty bleeding or even no bleeding at all after insertion. CONCLUSION: This study suggests that the Femilis LNG-IUS, which releases 20 microg LNG/d, is a highly effective, well tolerated and well retained contraceptive both in parous and nulliparous women. The shorter crossarm of the LNG-IUS has simplified its insertion technique, which may contribute to its safety. This could promote use by non specialist providers and enhance the application of the method.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | LIFE TABLE METHOD | WOMEN IN DEVELOPMENT | IUD, HORMONE RELEASING | LEVONORGESTREL | IUD COMPLICATIONS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION TERMINATION | METRORRHAGIA | CONTRACEPTIVE SAFETY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Demographic Analysis | Economic Development | Economic Factors | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Bleeding | Signs and Symptoms | Diseases | Safety | Public Health | Health
Document Number: 330932

19.

Title: Profile of intrauterine contraceptive device acceptors at the University of Uyo Teaching Hospital, Uyo, Nigeria.
Author: Abasiattai AM; Bassey EA; Udoma EJ
Source: Annals of African Medicine. 2008;7(1):1-5.
Abstract: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available, are particularly suitable for women in developing countries as they are affordable, convenient to use, do not require re-supply visits and are very costeffective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors, the pattern of insertions and complications at the University of Uyo Teaching hospital, Uyo. The record cards of all clients who had intrauterine contraceptive device inserted at the family planning clinic over a six-year period were reviewed. During the study period, there were 852 new contraceptive acceptors out of which 39.7% accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5%). Acceptance of intrauterine contraceptive device wasmost common among multiparous clients (65.1%). Majority of the acceptors were married (90.0%), Christians (98.8%) and 72.8% had at least secondary school education. Clinic personnel (65.7%) and friends/relatives (21.3%) were the most common sources of information on contraception. Most (93.5%) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5%) and vulval/vaginal itching (5.3%) were the most common complications. The acceptors of intrauterine contraceptive devices in our center were young, multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace, the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | IUD | CONTRACEPTIVE METHOD ACCEPTABILITY | IUD COMPLICATIONS | FAMILY PLANNING ACCEPTOR CHARACTERISTICS | EDUCATIONAL STATUS | AGE FACTORS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Family Planning Acceptors | Family Planning Programs | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population
Document Number: 327574

20.
Title: The acceptance rate of intrauterine contraceptive device (IUCD) amongst family planning clinic users in Lagos University Teaching Hospital (LUTH).
Author: Adegbola O; Ogedengbe OK
Source: Nigerian Quarterly Journal of Hospital Medicine. 2008 Oct-Dec;18(4):175-80.
Abstract: BACKGROUND: Intrauterine Contraceptive Device is an effective reversible long-term contraceptive method that is popular and widely used in this environment. OBJECTIVES: To determine the characteristics of women using this mode of contraception, their main reasons for acceptance, complications arising from usage and the discontinuation rate as well as reasons for discontinuing the method. METHODS: A review of case records of all the new contraceptive acceptors attending the Department of Obstetrics and Gynaecology Family Planning Clinic of the Lagos University Teaching Hospital (LUTH) from 1st January 1990 to 31st December 1994 was examined and the clients that accepted the intrauterine contraceptive device, (IUCD) during this period were identified. The records of those that opted for IUCD were thoroughly reviewed to identify the follow up events through the subsequent ten years visits to determine outcome of the contraceptive usage. RESULTS: Amongst the 2754 new contraceptive acceptors during thestudy period, 1602 (58.17%) clients accepted the Intrauterine Contraceptive Device (IUCD). Of these IUCD acceptors, the mean age was 31.3 +/- 5.5 years, mean parity was 3.9 +/- 2 and mean number of children alive was 3.6 +/- 1.8. Seven hundred and forty nine (46.8%) of them had previously used contraceptives and 1175 (73.3%) of them still wanted more children, thus child spacing was the main reasons for accepting this method. By 12 months, the discontinuation rate was 13.9% with the cumulative discontinuation rate of 47% as at forty-eighth month. The commonest reason for discontinuation was planning to get pregnant in 426 (26.6%) of the clients. Menstrual disorders accounted for 108 (6.7%). The mean duration of IUCD was 25.4 +/- 18.8 months with an accidental pregnancy rate of 0.3%. CONCLUSION: Intrauterine Contraceptive Device is widely accepted amongst women in the study group. Devices that reduce menstrual loss and also have long duration of action like Levonorgestrel intrauterine system (LNG-IUS) qualifies to be considered.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | FAMILY PLANNING ACCEPTORS, NEW | IUD | FAMILY PLANNING ACCEPTOR CHARACTERISTICS | SOCIAL CLASS | IUD COMPLICATIONS | IUD SIDE EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Family Planning Acceptors | Family Planning Programs | Family Planning | Contraceptive Methods | Contraception | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Contraceptive Usage
Document Number: 331288

21.

Peer Reviewed

Title: Colon penetration by a copper intrauterine device: A case report with literature review.
Author: Arslan A; Kanat-Pektas M; Yesilyurt H; Bilge U
Source: Archives of Gynecology and Obstetrics. 2008 Jul 1;:[3] p.
Abstract: The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). A 29-year-old multiparous woman, who presented with vague abdominal pain, had a TCu 380A inserted at her postpartum third month visit. The T-shaped segment of the IUD was found to be lodged within the lumen of a colon segment which was 60 cm far from the ileocecal valve. The vertical copper-bearing limb of the IUD extruded from the colon wall beyond the mesenteric edge and partially penetrated the fundal wall. After the aVected colon segment was resected, an end-to-end anastomosis was made. Recovery period was uneventful. The incidence of uterine penetration is aVected by the IUD type, the timing of insertion related to pregnancy termination, the position of uterus, insertion technique, the experience of the operator and the follow-up period. The location of missing IUDs can be determined by ultrasonography, X-ray or computed tomography imaging. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CASE STUDIES | IUD | IUD COMPLICATIONS | GASTROINTESTINAL EFFECTS | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology
Document Number: 327930

22.

Peer Reviewed

Title: Can intrauterine contraceptive devices be a Candida albicans reservoir?
Author: Chassot F; Negri MF; Svidzinski AE; Donatti L; Peralta RM
Source: Contraception. 2008 May;77(5):355-359.
Abstract: The in vitro adherence of Candida albicans isolated from vaginal exudates of patients with vulvovaginal candidiasis (VVC) to intrauterine contraceptive devices (IUDs) and biofilm formation capacity were evaluated. This research was conducted with two vaginal C. albicans isolates. The adherence on IUD by both radiomarked adhesion assay and scanning electron microscopy, and the biofilm production capacity by spectrophotometric method were determined. The yeasts adhered strongly to different parts of the IUD (covered with copper wire, without copper wire and tail), and there was no significant difference in the rates of adhesion to the different parts (p=.7771). The vaginal yeasts showed a high capacity to produce biofilm. Two vaginal yeasts evaluated showed a high capacity to produce biofilm on IUD. It was confirmed that all parts of the IUD allow the adherence of yeasts. The adherence of C. albicans to different parts of the IUD and its formation of biofilm seems to be important attributes influencing the occurrence of VVC and recurrent VVC. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | IUD, COPPER RELEASING | CANDIDIASIS | VAGINA | LABORATORY PROCEDURES | IN VITRO | IUD COMPLICATIONS | POLYETHYLENE | South America, Eastern | South America | Latin America | Americas | Developing Countries | IUD | Contraceptive Methods | Contraception | Family Planning | Bacterial and Fungal Diseases | Infections | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinical Research | Research Methodology | Polymers | Ingredients and Chemicals
Document Number: 325973

23.
Title: [Intrauterine device migration to the bladder: four case reports] Migracion de dispositivo intrauterino a vejiga: aportacion de cuatro casos.
Author: Ebel L; Foneron A; Troncoso L; Canoles R; Hornig A; Corti D
Source: Actas Urologicas Espanolas. 2008 May;32(5):530-2.
Abstract: The intrauterine device has been commonly used in our population for many years as contraceptive method. One of the complications is the device migration out of the uterus. One of the most uncommon fait of this migration is the bladder, with few reports on the literature. In this work, four cases are reported with their clinical presentation, study and treatment.
Language: Spanish
Keywords:
RESEARCH REPORT | CASE STUDIES | WOMEN | IUD MIGRATION | IUD COMPLICATIONS | TREATMENT | Studies | Research Methodology | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328917

24.

25.

26.

Title: Intrauterine devices and adolescents.
Author: Gold M; Johnson L
Source: Current Opinion in Obstetrics and Gynecology. 2008 Oct;20(5):464-469.
Abstract: This article reviews adolescents' knowledge of and attitudes toward IUDs; the mechanism of action of copper-releasing and levonorgestrel-releasing IUDs; the benefits of using IUDs with adolescents; and the IUD's safety, side effects, and noncontraceptive benefits such as management of menstrual disorders and endometriosis. The authors conclude that IUDs are a safe and effective long-term contraceptive method with no increase in risk of pelvic inflammatory disease, tubal infertility, or ectopic pregnancies. Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity. The levonorgestrel-releasing intrauterine system is a particularly good choice for adolescents because of associated noncontraceptive benefits such as decreased menstrual bleeding, dysmenorrhea, and decreased pain associated with endometriosis. There is a clear need for more studies in the use of the IUD among adolescents.
Language: English
Keywords:
UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | KAP SURVEYS | ADOLESCENTS | IUD | IUD EXPULSION | INFERTILITY | IUD COMPLICATIONS | TUBAL EFFECTS | PELVIC INFLAMMATORY DISEASE | CONTRACEPTIVE SAFETY | CONTRACEPTIVE EFFECTIVENESS | IUD SIDE EFFECTS | ATTITUDES | Developed Countries | North America | Americas | Research Methodology | Surveys | Sampling Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Reproduction | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Reproductive Tract Infections | Infections | Diseases | Safety | Public Health | Health | Psychological Factors | Behavior
Document Number: 322768

27.

Peer Reviewed

Title: Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion.
Author: Goodman S; Hendlish SK; Benedict C; Reeves MF; Pera-Floyd M
Source: Contraception. 2008 Aug;78(2):136-142.
Abstract: We hypothesize that barriers to IUD insertion are central to low utilization in the USA. This study evaluates methods to minimize barriers, including post-abortal insertion, staff training and simplified screening. We obtained data on IUD utilization during three study periods: a control period (Period 1), a period after initiating postabortal insertion and staff training (Period 2), and a period with these interventions plus simplified screening for interval insertions (Period 3). We evaluated IUD utilization, associated complications and utilization at a similar local agency in which the interventions were not implemented. We inserted 2172 IUDs during the study, including 1493 interval and 679 post-abortal insertions. In the control period, there were 28 monthly IUD insertions on average, compared to 71 (a 151% increase) and 122 (a 334% increase) in Periods 2 and 3, respectively. IUD utilization at the nearby agency remained relatively constant. Complications remained low. IUD utilization can besubstantially increased through relatively simple, low-cost interventions, with significant potential to reduce unintended pregnancy. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | IUD | IUD COMPLICATIONS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTERVENTIONS | CONTRACEPTIVE SAFETY | PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | Developed Countries | North America | Americas | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Programs | Organization and Administration | Safety | Public Health | Health
Document Number: 327966

28.

Title: Migrated IUCD removed by sigmoidoscopy without anaesthesia.
Author: Hakmi A
Source: Journal of Obstetrics and Gynaecology. 2008 Jul;28(5):550-1.
Abstract: The incidence of IUD-associated uterine perforation has been estimated in a recent study to be 2.2/1,000 insertions (Caliskan et al. 2003). The perforating IUCD may migrate to the pelvic or abdominal cavity or into adjacent organs, such as the intestine or the bladder. Zakin et al. reviewed 356 case reports of IUCD-related uterine perforation (Zakin et al. 1981). Of these, 41 cases involved the perforation of the intestinal tract. Reviewing Medline since 1951 revealed only a few cased of IUCD perforation of the rectosigmoid colon. Migration into the lumen of the rectosigmoid colon usually creates difficulty in locating the IUCD. In almost all the cases, the management involved laparoscopy with or without laparotomy. Only a few cases presented with the string protruding from the anus. Even in these situations, doctors often dismissed this symptom and laporoscopy was still done first (Beard 1981). Our case represents one of the very rare situations where the primary and only procedure to remove thelost IUCD was sigmoidoscopy avoiding unnecessary laparoscopy and general anaesthesia. This emphasized the importance of correctly locating the IUCD before embarking on laparoscopy, assuming that the IUCD is in the peritoneal cavity. It is evident from our case that the IUCD had perforated the uterus and the wall of the sigmoid colon to the lumen without causing significant pathology or disrupting symptoms. This again opens the debate about the management of ectopic IUCD, which is somewhat controversial (Caliskan et al. 2003) Traditionally, management of migrated IUCD has been the immediate removal. In fact, the majority of authors recommend removal of copper containing devices because of the potential for inflammatory reactions that can cause bowel obstruction and perforation (Kassab and Audra 1999). The World Health Organization (WHO) recommends removal of the dislocated IUCD because of the formation of adhesions and other medicolegal and psychological indications (WHO 1987). However, there are many reports where the migrated IUCDs were accidently found in the peritoneal cavity many years after insertion, Siggard (1993) described a case of IUCD perforation of the uterus to the rectum, which was not recognised for 13 years. In addition, many authors described cases of removal of migrated IUCD where the patient was asymptomatic and IUCD was found to be causing no adhesions (Markovitch et al. 2002). On the other hand, removal of IUCD does not cause adhesions to dissolve. These observations have led many authors to advocate a conservative management in selected patients (Markovitch et al. 2002). The natural progression of a perforating IUCD may have a benign course and conservative management would lead the IUCD to settle in a more convenient site for safe and less invasive recovery. If our patient had presented earlier where the migrating IUCD was still partially in the peritoneal cavity and begun to perforate the sigmoid colon, removing the IUCD then would have require laparoscopy, laparotomy or even colostomy. Patients presenting with migrated IUCD should have careful evaluation of their symptoms and the examination should include rectal examination. In addition, investigations should include abdominal X-ray, transvaginal ultrasound scan and if necessary sigmoidoscopy. The IUCD should be removed in all symptomatic patients. On the other hand, asymptomatic patients may be suitable for conservative management and avoid unnecessary interventions that may carry greater risks than potential complications of migrating IUCD. Type and location of the IUCD and the possible surgical risks of removing the IUCD related to its location should all be considered. Patients should be counseled on the light of available information and be involved in the decision-making process of the management plan.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CASE STUDIES | WOMEN | IUD, COPPER RELEASING | IUD MIGRATION | IUD COMPLICATIONS | MEDICAL PROCEDURES | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330837

30.

Peer Reviewed

Title: Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device).
Author: Jimenez MF; Vetori D; Fagundes PA; de Treitas FM; Cunha-Filho JS
Source: Contraception. 2008 Oct;78(4):324-327.
Abstract: A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. This study has a prospective clinical trial design. There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL TRIALS | IUD | LEVONORGESTREL | IUD, COPPER RELEASING | IUD COMPLICATIONS | SIDE EFFECTS | DYSMENORRHEA | BLEEDING | Developing Countries | South America, Eastern | South America | Latin America | Americas | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Menstruation Disorders | Diseases | Signs and Symptoms
Document Number: 328084


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