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2.
Peer Reviewed

Title: Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants.
Author: Taneepanichskul S; Reinprayoon D; Thaithumyanon P; Praisuwanna P; Tosukhowong P
Source: Contraception. 2006 Apr;73(4):368-371.
Abstract: The study objectives were to compare the effects of an etonogestrel-releasing implant (Implanon) and a nonmedicated intrauterine device (IUD) on parameters of lactation in breast-feeding women and on the growth of their breast-fed infants over a 3-year period. Healthy lactating women (28-56 days postpartum) chose either the implant (n =42) or the IUD (n =38). Infant growth during a 3-year follow-up period is reported here. Total duration of breast-feeding coinciding with the mothers' treatment was 421.0 and 423.4 days in the Implanon and IUD groups, respectively. There were no differences between the infant groups in terms of body length, biparietal head circumference and body weight. No abnormalities were reported in psychomotor development or during physical examination. No treatment-related side effects were observed in either group. In conclusion, there were no differences in the growth of breast-fed infants of women treated with Implanon or a nonmedicated IUD. Implanon, therefore, appears to be a safe contraceptive option for breast-feeding women and their infants. (author's)
Language: English
Keywords:
THAILAND | RESEARCH REPORT | FOLLOW-UP STUDIES | MOTHERS | INFANT | BREASTFEEDING | CONTRACEPTIVE IMPLANTS | IUD, UNMEDICATED | SIDE EFFECTS | GROWTH | CONTRACEPTIVE SAFETY | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Contraceptive Methods | Contraception | Family Planning | IUD | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Child Development | Biology | Safety | Public Health
Document Number: 298532

3.
Title: Risks and benefits, advantages and disadvantages of levonorgestrel-releasing contraceptive implants.
Author: Sivin I
Source: Drug Safety. 2003;26(5):303-335.
Abstract: Levonorgestrel-releasing implants are long acting contraceptives, approved for 5 years of continuous use. Two marketed systems, the six capsules Norplant and the two rod Jadelle, have essentially equal rates of drug release, pregnancy and adverse events over 5 years of use. Randomized clinical trials and controlled cohort observations indicate that for the first 3 years, when pregnancy rates are at or almost zero, no other contraceptive system is more effective, although etonogestrel implants provide equal effectiveness. Annual pregnancy rates rise in the fifth year of continuous use but remain below 1 per 100 women. Annual pregnancy rates of Norplant users remain below 1 per 100 throughout 7 years of continuous use. Levonorgestrel implants provide low progestogen doses; 40-50 �gg/day at 1 year of use, decreasing to 25-30 �gg/day in the fifth year. Serum levels of levonorgestrel at 5 years are 60-65% of those levels measured at 1 month of use. Adverse effects with levonorgestrel implants are similar to those observed with progestogen only and combined oral contraceptives. Risks of ectopic pregnancy, other pregnancy complications and pelvic inflammatory disease are reduced in comparison with those of women using copper or non-medicated intrauterine devices. Risks of developing gallbladder disease and hypertension or borderline hypertension, although small, are about 1.5 and 1.8 times greater, respectively, in women using levonorgestrel implants than in women not using hormonal contraception. Other serious diseases have not been found to occur significantly more frequently in levonorgestrel implant users than in women not using hormonal contraception. The great majority of levonorgestrel implant users experience menstrual problems, but serious bleeding problems are not more frequent than in controls. Other health problems reported more frequently by levonogestrel implant users than by women not using hormonal contraception in a study of 16 000 women included skin conditions, headache, upper limb neuropathies, dizziness, nervousness, malaise, minor visual disturbances, respiratory conditions, arthropathies, weight change, anxiety and non-clinical depression. Clinical depression is not more frequent in women using implants compared with those not using hormonal contraception (i.e. using intrauterine devices, sterilization). Removal problems occur less frequently with Jadelle than with Norplant. The mean removal time for Jadelle is half that of Norplant. Levonorgestrel implants in nationally representative scientific samples, in randomized trials, and in controlled cohort studies have continuation rates as high as or higher than any other reversible contraceptive over a duration of 5 years. This would imply that the satisfaction women derive from the contraceptive effectiveness of levonorgestrel implants greatly outweighs the dissatisfaction that may accompany menstrual disturbances and other adverse effects associated with implants.
Language: English
Keywords:
UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | CONTRACEPTIVE SAFETY | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE IMPLANTS | LEVONORGESTREL | LONGTERM EFFECTS | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRACEPTIVE AGENTS, PROGESTIN | IUD, COPPER RELEASING | IUD, UNMEDICATED | COMPLICATIONS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Safety | Public Health | Health | Contraception | Family Planning | Contraceptive Methods | Contraceptive Agents, Female | Contraceptive Agents | Time Factors | Population Dynamics | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | IUD | Diseases
Document Number: 340157

4.
Title: [Emergency contraception] La contraception d'urgence.
Author: Arous F; Benalla M; Ettayebi Z; Lakhdar A; Kharbach A; Chaoui A
Source: Cahiers du M�decin. 2002 May;5(52):41-42.
Abstract: Emergency or postcoital contraception is a method of contraception used on an exceptional or compensatory basis, after a poorly protected or unprotected sexual contact. It allows unwanted pregnancies, which often end by elective abortions, to be avoided. It is indicated in the absence of any other contraception, in the event of accident during the use of a condom or in the event of forgetting to take an estrogen-progestagen pill, but with precise conditions. The methods of emergency contraception include hormonal methods, of which there are two: the Yuzpe method which consists in the combination of high doses of estrogen and progestagen, its prescription does not require a gynecological examination, merely a properly conducted interview is sufficient if it targets personal history of thromboembolism and the date of last menses. Its efficacy varies between 56 and 75%; and the method without estrogen which uses a progestagen alone, levonorgestrel at a dose of 0.75 mg then 2 times at 12 hour intervals in 72 hours following unprotected contact. Its efficacy is at least equivalent to that of the Yuzpe method, varying from 75 to 80% according to the trials. The prescription of levonorgestrels does not require a gynecological examination and has no contraindication. The inert or copper IUD is the second method of emergency contraception, and represents an extreme 99% efficacy and the possibility for use beyond 72 hours unlike emergency hormone contraception. However, it presents certain disadvantages: its placement is painful, especially in young, nulliparous women, and may be cause a pelvic infection. Hence, it requires vaginal sampling, if there is a doubt, and the patient should be placed on antibiotic therapy while waiting for the result.
French Abstract: La contraception d'urgence ou post-co�tale est une m�thode de contraception d'exception ou de rattrapage, utilis�e apr�s un rapport mal ou non prot�g�, permettant d'�viter les grossesses non d�sir�es, qui se terminent souvent par des interruptions volontaires de grossesse. Elle est pr�conis�e en absence de toute contraception, en cas d'accident lors de l'utilisation du pr�servatif ou en cas d'oubli de pilules estroprogestatives mais, avec des conditions pr�cises. Les m�thodes de la contraception d'urgence comprennent les m�thodes hormonales qui sont au nombre de deux: la m�thode de Yuzpe qui consiste en l'association de fortes doses d'estrog�ne et de progestatif, sa prescription ne n�cessite pas un examen gyn�cologique, seul un interrogatoire bien conduit, portant sur les ant�c�dents personnels thromboemboliques et sur la date des derni�res r�gles suffisent. Son efficacit� varie de 56 � 75% et la m�thode sans estrog�ne qui utilise un progestatif seul, le l�vonorgestrel � la dose de 0,75 mg puis 2 fois � 12 heures d'intervalle dans les 72 heures suivant le rapport non prot�g�. Son efficacit� est au moins �quivalente � celle de la m�thode de Yuzpe, variant de 75 � 80% selon les essais. La prescription des l�vonorgestrels ne n�cessite pas un examen gyn�cologique et ne comporte aucune contre-indication. Le st�rilet inerte ou au cuivre est la deuxi�me m�thode de contraception d'urgence, repr�sentant une efficacit� extr�me de 99% et une possibilit� d'utilisation au del� des 72 heures contrairement � la contraception hormonale d'urgence. Cependant, il pr�sente certains inconv�nients. En effet sa pose est douloureuse surtout chez les jeunes nullipares et peut �tre �ventuellement � l'origine d'une infection pelvienne. Ainsi, il impose d'effectuer un pr�l�vement vaginal, s'il y a un doute, et de mettre la patiente sous antibiotiques en attendant le r�sultat.
Language: French
Keywords:
MOROCCO | ADULTS | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES, COMBINED | LEVONORGESTREL | CONTRACEPTIVE EFFECTIVENESS | IUD, COPPER RELEASING | IUD, UNMEDICATED | INSERTION | CONTRAINDICATIONS | SIDE EFFECTS | Developing Countries | Africa, North | Africa | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Oral Contraceptives | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | IUD | Treatment
Document Number: 182865

5.
Title: [The intrauterine device (IUD)] Le dispositif intra-ut�rin.
Author: Noun M; El Mansouri M; Samouh N; Himmi A
Source: Cahiers du M�decin. 2002 Jan;5(48):14-16.
Abstract: This article reviews a modern contraception method, the Intra Uterine Device (IUD), whose two main advantages are its simplicity and the absence of any sort of participation from the user. It is made of plastic and barium salts and it is radio-opaque, therefore easily located when X-rayed. There are two types of IUD: the inert IUD, made of polyethylene and active through contact surface, outdated by the active IUD improved by the addition of silver and copper or the addition of hormones. The contraceptive action of the IUD is linked to a certain number of reactions from the endometrium to a foreign object and to the release of metallic copper, that not only ensure an adequate contraception, but also allows an X-ray visualization. The best time for the insertion of an IUD is the last day of the period or the first following day. After an abortion or a delivery, the insertion can be performed after 6 weeks, but in the case of a C-section, a delay of 12 weeks must be observed. Before the insertion, the cervix and the vagina are carefully disinfected; then follows the hysterometry that is the essence of the fitting. It allows the verification of the permeability of the cervical canal, the appreciation of the height and depth of the uterus, and the verification of the direction of the uterus. The article mentions also the indications and the contra-indications of the IUD, its adverse reactions, and its complications such as ectopic pregnancy, uterine perforation, pelvic imflammation, and expulsion. The article also mentions the length of its utilization, its monitoring, its observance or abandonment rate, and finally, its removal. In conclusion, the IUD is a very efficient, cheap, practical and harmless contraceptive method, provided that it is inserted using high quality health care centers and services.
French Abstract: Cet article aborde la m�thode moderne de contraception � savoir le dispositif intra-ut�rin (DIU), qui a pour principal avantage l'absence de toute coop�ration de l'utilisatrice et la simplicit� de son emploi. Il est con�u d'une mati�re plastique et � base de sels de baryum et il est radio-opaque, donc r�parable aux clich�s radiologiques. Il existe deux types de DIU : les inertes qui sont en poly�thyl�ne et agissent par leur surface de contact, d�pass�s par les actifs, qui sont am�lior�s gr�ce � l'ajout des m�taux : cuivre et argent, ou d'hormone. L'action contraceptive du DIU est li�e � un certain nombre de r�actions de l'endom�tre � l'�gard du corps �tranger et � la lib�ration de cuivre m�tallique, qui ne se borne pas seulement � assurer une contraception ad�quate, mais permet aussi la visualisation de la tige aux rayons X. Le moment le plus favorable � l'insertion d'un DIU, est les derniers jours des r�gles ou les premiers jours apr�s celles-ci. Apr�s avortement ou accouchement, cette insertion s'effectue au terme de 6 semaines, mais apr�s une c�sarienne, elle ne peut �tre effectu�e qu'apr�s 12 semaines. Cette op�ration est pr�c�d�e d'une d�sinfection soigneuse du col ut�rin et du vagin, puis d'une hyst�rom�trie qui est le temps essentiel de la pose. Elle permet de v�rifier la perm�abilit� du canal cervical, d'appr�cier la hauteur ou la profondeur ut�rine et de v�rifier la direction de l'ut�rus. L'article �voque aussi les indications du DIU, ses contre indications, ses effets ind�sirables, ses complications telles que : la grossesse extra-ut�rine, la perforation ut�rine, les inflammations pelviennes et l'expulsion. Il �voque �galement la dur�e de son utilisation, sa surveillance, son observance ou taux d'abandon et enfin son retrait. En conclusion, le DIU est une m�thode tr�s efficace, peu co�teuse, pratique et sans danger, � condition qu'elle soit dans des centres de prestations de services de haut qualit�.
Language: French
Keywords:
MOROCCO | ADULTS | WOMEN | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | IUD, UNMEDICATED | IUD | IUD SIDE EFFECTS | IUD COMPLICATIONS | CONTRACEPTIVE MODE OF ACTION | INSERTION | CONTRACEPTIVE REMOVAL | CONTRACEPTIVE USAGE | CONTRAINDICATIONS | Developing Countries | Africa, North | Africa | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Treatment
Document Number: 188533

6.
Title: Effects of contraceptives on hemoglobin and ferritin.
Author: World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force for Epidemiological Research on Reproductive Health
Source: CONTRACEPTION. 1998 Nov;58(5):261-73.
Abstract: A cross-sectional study investigated the association between hemoglobin and serum ferritin levels and use of a range of contraceptive methods in populations with a high prevalence of iron-deficiency anemia. In addition, a longitudinal component of the same study assessed whether use of these contraceptive methods was associated with changes in hemoglobin and serum ferritin concentrations 3, 6, and 12 months after method initiation in the subset of women with hemoglobin values below 120 g/l. The study was conducted in 1988-92 in 9 centers in 8 countries: China, Thailand, Bangladesh, Nigeria, Pakistan, Chile, the Dominican Republic, and Tunisia. In the cross-sectional study of 1295 current contraceptive users and 1212 women about to initiate contraceptive use, current users of hormonal methods had higher hemoglobin and serum ferritin levels than noncontraceptors. The differences between these 2 groups in mean hemoglobin and serum ferritin ranged 3-6 g/l and 2-18 g/l, respectively. Current users of the copper IUD had higher hemoglobin levels than noncontraceptors (difference in mean levels of 3 g/l), but lower ferritin levels (difference of 10 g/l). In the longitudinal study of the 285 anemic women, significant mean increases of hemoglobin at 12 months were observed among users of combined oral contraceptives and depot medroxyprogesterone acetate, but not among copper or stainless steel ring IUD users. Overall, the results showed largely beneficial effects of combined oral contraceptives, depot medroxyprogesterone acetate, and Norplant implants, an adverse effect for the stainless steel ring IUD, and ambiguous findings for the copper-releasing IUD. These findings will be useful for updating institutional norms for medical eligibility criteria for contraceptive methods.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | LONGITUDINAL STUDIES | ORAL CONTRACEPTIVES, COMBINED | MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE IMPLANTS | IUD, COPPER RELEASING | IUD, UNMEDICATED | HEMOGLOBIN LEVEL | SERUM IRON LEVEL | ANEMIA | CHANGES | Research Methodology | Studies | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | IUD | Hemic System | Physiology | Biology | Diseases | Social Change
Document Number: 138306

7.
Title: Primary carcinoma of fallopian tube after prolonged retention of Lippes loop.
Author: Sanyal C; Pahari K; Sharma M
Source: JOURNAL OF THE INDIAN MEDICAL ASSOCIATION. 1998 Jan;96(1):25-6.
Abstract: Although a small number of uterine malignancies have been reported in long-term IUD users, a cause-effect relationship is difficult to establish. This article presents a case of primary carcinoma of the fallopian tubes with a coexisting Lippes loop. The 50-year-old patient presented to Seth Sukhlal Karnani Memorial Hospital (Calcutta, India) 5 years after menopause with complaints of occasional vaginal bleeding for the past 2 months. A Lippes loop had been inserted 20 years earlier, with no follow-up after the first year of use. Total hysterectomy was performed. Gross cut-section revealed the Lippes loop inside the uterine cavity. The distal parts of both fallopian tubes showed multiple small cystic spaces filled with fluid, with features of papillary adenocarcinoma arising from mucosa infiltrating the wall and projecting into the lumen. The distorted tubes also showed features of hydrosalpinx follicularis. Although the ovaries were adherent to the tubes, they were not malignant. The atrophic endometritis present in this case suggests that carcinoma was preceded by salpingitis, in turn possibly initiated by prolonged IUD retention.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CASE STUDIES | FALLOPIAN TUBES | CANCER | IUD, UNMEDICATED | LONGTERM EFFECTS | SIDE EFFECTS | IUD SIDE EFFECTS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Neoplasms | Diseases | IUD | Contraceptive Methods | Contraception | Family Planning | Time Factors | Population Dynamics | Demographic Factors | Population | Treatment
Document Number: 135993

8.
Title: Design of an IUD removal hook leading to its impaction in the uterine cavity.
Author: Bacon L; Morris EP; Watson CM
Source: British Journal of Family Planning. 1996 Jul;22(2):101-3.
Abstract: Reported is a case in which an IUD removal hook became impacted in the uterine cavity. A 35-year-old Chinese woman presented to a British family planning clinic for removal of an stainless steel ring-type IUD fitted 10 years earlier in China. The request for removal was prompted by right iliac fossa pain, yellow vaginal discharge, and frequent heavy menstrual periods. At removal, scheduled for the beginning of the next cycle, an IUD removal hook was passed into the uterus; resistance to traction indicated it had engaged in the intrauterine ring. Although the hook could be freely moved within the uterine cavity, it could not be withdrawn, even after the internal cervical os was dilated to Hegar 6. Thus, a second hook was used to remove the IUD, leaving the original hook impacted in the uterine cavity with its stem in the vagina. Dilatation to Hegar 9 under general anesthesia enabled removal. Examination revealed that this hook was 1.4 mm thick with a terminal hook length of 9 mm; the standard IUD removal hook is 1.6 mm thick with a terminal hook length of 5 mm. It was postulated that the lower gauge stainless steel had been insufficiently strong to prevent the hook from opening out when traction was exerted and too wide to pass through the internal os once it was pried open into a position at right angles to the stem. Additional problems associated with this hook included insufficient smoothness of the terminal end of the hook to prevent damage to the uterine wall, failure to close the ring on the hook's proximal end with solder to avoid damage to surgical gloves, and absence of a collar soldered onto the shaft to indicate uterine depth. Although removal hooks are less expensive than disposable thread retrievers or forceps, this case demonstrates the potential hazards associated with use of non-standard equipment.
Language: English
Keywords:
UNITED KINGDOM | CASE STUDIES | IUD, UNMEDICATED | CONTRACEPTION TERMINATION | SURGICAL EQUIPMENT | COMPLICATIONS | United Kingdom | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Equipment and Supplies | Diseases
Document Number: 118161

9.
Title: Clinical performance of the TCu 380A and Lippes Loop IUDs in three developing countries.
Author: Farr G; Amatya R; Acosta M; Ekwempu C; Kisninci H
Source: CONTRACEPTION. 1995 Jul;52(1):17-22.
Abstract: A randomized clinical trial conducted at collaborating research sites in Peru, Nigeria, and Turkey found no significant differences between the performance of the Copper T 380A (TCu 380A) IUD and the Lippes Loop at 12 months post-insertion. The Lippes Loop is one of the few unmedicated IUDs still in use in developing countries, while the TCu 380A is steadily gaining in favor because of its longer effective life-span. Included in the analysis were 356 TCu 380A acceptors and 354 Lippes Loop users. The accidental pregnancy rate was 0.7/100 women-months of exposure for the TCu 380A and 2.1/100 for the Lippes Loop (p = 0.25); the expulsion rates were 3.5% and 6.7%, respectively, and the discontinuation rates were 15.6% and 15.8%, respectively. More women in the TCu 380A group (18.8%) than in the Lippes Loop group (14.3%) reported genitourinary tract infection during the 12-month study period, but this difference was not significant (p = 0.15). In addition, a nonsignificantly greater number of women in the former group (36.9%) than the latter group (31.8%) experienced dysmenorrhea, intermenstrual bleeding, or intermenstrual pelvic pain (p = 0.20). These findings are generally consistent with previous research.
Language: English
Keywords:
PERU | NIGERIA | TURKEY | DEVELOPING COUNTRIES | COMPARATIVE STUDIES | IUD, COPPER RELEASING | IUD, UNMEDICATED | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION TERMINATION | SIDE EFFECTS | IUD SIDE EFFECTS | South America, Western | South America | Latin America | Americas | Africa, Western | Africa, Sub Saharan | Africa | Europe, Southeastern | Europe | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment
Document Number: 106290

10.
Title: [Risk factors and safety of intrauterine devices?] Risiken und Sicherheit von Intrauterinpessaren?
Author: Grospietsch G; Barthel R
Source: MEDIZINISCHE MONATSSCHRIFT FUR PHARMAZEUTEN. 1994 Apr;17(4):114-6.
Abstract: Injuries of the endometrium can manifest themselves in bleeding anomalies (menorrhagia, metrorrhagia, hypermenorrhea, or spotting) and in pain as a consequence of local inflammation. Injury of the uterine mucous membrane can also result in perforation of the uterine wall. The frequency of bleeding with an in situ IUD is about 2.3% in nulliparous women who have changed the IUD after two years of use. Other studies indicate a range of 5-20%. The blood loss with copper-containing IUDs is considerably less than with inert IUDs. Pain can be the cause of inflammation and was found to be the main cause of removal of the IUD in nulliparous women. According to a 1992 study based on World Health Organization data, the total rate of inflammatory ailments of the true pelvis was 1.6 cases per 1000 women years with 51,399 women years and 22,908 IUD insertions. The rate of uterine perforation ranges from 0.4 to 1.1 per 1000 insertions. IUDs such as the Cu-7 and Cu-T, which are inserted with the push-in method, are associated with increased primary perforation risk. The most frequently used IUDs with active ingredients are the Multiload Cu250, the Cu-7 (Gravigard), the Cu-T-200, the Nova-T, and the progesterone IUD releasing 65 mcg a day. The lowest pregnancy rate is attributed to the Multiload IUD with 0.3 per 100 patients after one year compared to 1.9 for parous and 2.5 for nulliparous women with the progesterone IUD. The rates are 0.7 for the Nova-T, 1.6 for the Cu-T-200, and 2.9 for the Cu-7. The continuation rate after one year is 87.6% with Multiload-Cu-50, 79.1% for parous women with Progestasert, 72% for Nova-T, 72.3% for Cu-T, and 62.6% for Cu-7. The removal rate because of complications was 3.7% for Multiload-Cu-50, 12.3% for Nova-T, 8.5% for Cu-T-200, and 10.9% for Cu-7. The progesterone IUD was removed in 9.7% of parous and 12.1% of nulliparous women because of bleeding and/or pain.
Language: German
Keywords:
IUD, COPPER RELEASING | IUD, HORMONE RELEASING | IUD, UNMEDICATED | INSERTION | BLEEDING | PAIN | CONTRACEPTION FAILURE | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Signs and Symptoms | Diseases | Contraceptive Usage
Document Number: 099166

11.
Title: Chinese IUDs.
Author: Gu S; Zhuang L; Wu Y; Liu F
Source: In: Proceedings from the Fourth International Conference on IUDs, edited by C. Wayne Bardin and Daniel R. Mishell, Jr. Boston, Massachusetts, Butterworth-Heinemann, 1994. :308-18.
Abstract: The most common contraceptive method among women in China is the IUD (41.1% of married women of reproductive age). The most widely used IUD in China is the stainless steel ring IUD. All physicians and nurses at community-based clinics have been trained and certified in insertion and removal of the stainless steel ring IUD. The stainless steel ring IUD can be used safely and effectively for more than 20 years. To reduce short-term pregnancy and expulsion rates, Chinese family planning specialists designed new types of IUDs in the early 1960s. One specialist added copper wire (200 mm) and medicated silicone (5 mg indomethacin) to the spiral cavity of the stainless steel ring (SSR 165). Its net cumulative pregnancy rate at 24 months is 1.1%. Its 24-month expulsion rate is 6.01%. The 24-month continuation rate is 88.98%. Irregular bleeding is the most common side effect. The copper SSR 165 produces the most inflammatory and edematous changes of the endometrium followed by the medicated SSR 165 and the inert SSR 165. The Shanghai VCu 200 releases copper at a rate of 9.33 mcg/day. Its V shape probably accounts for the low expulsion rate (1-year, 2.28%). Stainless steel wire with 6 segments of coiled copper wire inside comprise the uterine cavity-shaped Cu 200 IUD (UCDCu200). It can be used successfully for 15-20 years. Its shape reduces expulsions. It comes in different sizes to conform to the length of the cervical-uterine axis. Its one-year pregnancy rate is 2.44% compared to 4.26% for the unmedicated UCD. The one-year expulsion rates for these 2 IUDs are 2.44% and 4.26%, respectively. The Ministry of Public Health and the State Family Planning Commission have developed guidelines for counseling and routine techniques for insertion and removal of all these IUDs.
Language: English
Keywords:
CHINA | LITERATURE REVIEW | IUD, UNMEDICATED | IUD, COPPER RELEASING | INSERTION | CONTRACEPTIVE EFFECTIVENESS | IUD EXPULSION | CONTRACEPTION FAILURE | CONTRACEPTION CONTINUATION | ENDOMETRIAL EFFECTS | Developing Countries | Asia, Eastern | Asia | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Contraceptive Usage | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 095976

12.
Title: The demographic impact of conversion from steel to copper IUDs in China.
Author: Li YP; Bourne KL; Rowe PJ; Zhang DW; Wang SX; Zhen HY; Wu Z
Source: International Family Planning Perspectives. 1994 Dec;20(4):124-30.
Abstract: In 1993, China's State Family Planning Commission decided to discontinue purchase of steel IUDs, which accounted for 41% of all contraceptive use during 1988-91, and to advise factories to cease production of the device. This decision was made because copper IUDs are associated with a lower failure rate, which obviates the fact that their initial cost is higher (22 cents per IUD as compared to 4 cents for the steel versions). This article examines the demographic impact of a rapid, moderate, or slow conversion to use of the copper IUD. Data were gathered through a meta-analysis of 22 published and unpublished clinical studies on the use of the steel IUD in China during 1982-92. Additional data were derived from the 1988 Two Per Thousand Fertility Survey, a 1992 study of the Second National IUD Research Group, and studies of the State Family Planning Commission. Because 6 times more pregnancies occur with the steel rather than the copper IUD in the 1st year of use and 3 times more for the 5-year average, the steel ring is far costlier than the copper device, despite the latter's higher initial price. Reducing accidental pregnancies will also benefit women physically and psychologically.
Language: English
Keywords:
CHINA | COMPARATIVE STUDIES | IUD, UNMEDICATED | IUD, COPPER RELEASING | CONTRACEPTION FAILURE | COST BENEFIT ANALYSIS | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Quantitative Evaluation | Evaluation
Document Number: 111746

13.
Title: Chlamydial serologic characteristics among intrauterine contraceptive device users: does copper inhibit chlamydial infection in the female genital tract?
Author: Mehanna MT; Rizk MA; Ramadan M; Schachter J
Source: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. 1994 Sep;171(3):691-3.
Abstract: In Alexandria, Egypt, clinicians compared data on 54 women who were either current or prior IUD users with data on 60 pregnant women who had never used any contraception to examine the association between IUD use and the level of antichlamydia antibodies. The IUD users had a history of ectopic pregnancy (29), intact intrauterine pregnancy (22), nontubal-factor infertility (2), and tubal factor infertility (1). The cases and controls had essentially the same geometric mean serum antibody titers for Chlamydia trachomatis (10.47 vs. 6.17). Yet, women who used copper-releasing IUDs had a lower geometric mean titer than did those who used the Lippes Loop IUD, but the difference was only significant for IUD only users and IUD users with a history of ectopic pregnancy. Specifically, among women who had used a copper IUD, the geometric mean serum antibody titers for those who only used 1 type of IUD, had used an IUD just for contraception, and those who had a history of ectopic pregnancy were 4, 5.9, and 3.8, respectively, while they were 24, 25.1 and 25.1, respectively, for their Lippes Loop counterparts (p < 0.05). Among IUD users who had had an intrauterine pregnancy, the titer for women using a copper IUD was 5 compared to 14.8 for those using a Lippes Loop. When the researchers used a serum titer of 1:64 as a cutoff point for the 2 subgroups of IUD users, the Lippes Loop group had a higher proportion with titers above 1:64 than did the copper IUD group (47.6% vs. 9.09%; odds ratio [OR] = 9.09). Further, a higher proportion of Lippes Loop users had a titer greater than 1:128 than did copper IUD users (OR = 10.5). These results suggest that copper either inhibits the biologic effect of C. trachomatis or suppresses the immune response to chlamydia. Based on these findings and those of previous studies, the researchers believe the former is the most likely explanation.
Language: English
Keywords:
EGYPT | RESEARCH REPORT | COMPARATIVE STUDIES | CASE CONTROL STUDIES | IUD, COPPER RELEASING | IUD, UNMEDICATED | CHLAMYDIA | ANTIBODIES | Africa, Northern | Africa | Developing Countries | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology
Document Number: 099015

14.
Peer Reviewed

Title: Menstrual bleeding pattern and iron status in women fitted with copper and non-medicated intrauterine contraceptive devices.
Author: Oyelola OO; Okonofua FE; Adediran TO
Source: East African Medical Journal. 1994 Apr;71(4):268-70.
Abstract: A prospective study of the menstrual bleeding pattern and iron status was conducted in 42 healthy Nigerian female volunteers before and after being fitted with either a medicated copper T (TCu200B; n = 20) or a nonmedicated Lippes loop (n = 22) IUD. After about 6 months of use, the mean fasting serum iron and packed cell volume (PCV) were significantly higher (+32% and +6%, respectively), mean serum ferritin was significantly decreased (-14%) compared to the pre-insertion levels in the copper T IUD users. In the Lippes loop IUD users, mean fasting serum iron was significantly lower (-11%), mean PCV was higher (+5%). The changes observed in the mean levels of serum ferritin and the duration of menstrual bleeding did not reach a statistical significant level. Among the two groups, only the changes in the mean fasting serum iron was significant (p < 0.01). In all, only the women fitted with Lippes loop IUDs had a decrease in the levels of both serum iron and body iron stores (ferritin), however, no clinical anemia was observed at 6 months of use. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | SERUM IRON LEVEL | MENSTRUATION | MENSTRUAL CYCLE | IUD, COPPER RELEASING | IUD, UNMEDICATED | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Hemic System | Physiology | Biology | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning
Document Number: 102435

15.
Title: Blood pressure changes and hormonal contraceptives.
Author: Shen Q; Lin D; Jiang X; Li H; Zhang Z
Source: CONTRACEPTION. 1994 Aug;50(2):131-41.
Abstract: In China, family planning specialists recruited 764 women, 22-40 years old, from 4 hospitals in Shanghai for a study to compare the effects of oral contraceptives (OCs) and hormonal contraceptive implants (Norplant) on blood pressure changes with those not using hormonal contraception. They followed the women for 48 weeks. The experimental groups comprised 238 women using the OC (Chinese Pill No. 1 containing 35 mcg ethinyl estradiol + 600 mcg norethisterone) and 267 using Norplant (216 mg levonorgestrel released over 5 years). The control group included 259 women accepting a stainless steel ring IUD. No woman in any group discontinued contraceptive use due to hypertension. OC users had higher increases in diastolic blood pressure than IUD users. The increases were 1.8 mm Hg at 12 weeks, 2.1 mm Hg at 24 weeks, 2.3 mm Hg at 36 weeks, and 1.9 mm Hg at 48 weeks (p < .05 for all but 36 weeks; p < .01 for 36 weeks). At the end of 48 weeks, when the researchers adjusted for confounding variables, the diastolic blood pressure increased by about 1 mm Hg with OC use (p < .05). This increase is clinically insignificant, however. OC users also had higher increases in systolic blood pressure than IUD users (1.3, 1.7, 1.5, and 1.3 mm Hg, respectively), but the increases were not significant. The Norplant implant did not change either diastolic or systolic blood pressure. Women's age, obesity, and family history of hypertension were associated with an increase in blood pressure. These variables did not have any interactive effects on blood pressure changes with hormonal contraceptive use, however. These findings show that low estrogen OC use slightly increases diastolic blood pressure and that Norplant implants have no effect on systolic and diastolic blood pressures.
Language: English
Keywords:
CHINA | RESEARCH REPORT | COMPARATIVE STUDIES | ORAL CONTRACEPTIVES, LOW-DOSE | CONTRACEPTIVE IMPLANTS | LEVONORGESTREL | IUD, UNMEDICATED | BLOOD PRESSURE | HYPERTENSION | CHANGES | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | IUD | Hemic System | Physiology | Biology | Vascular Diseases | Diseases | Social Change
Document Number: 097911

16.
Title: China changes from the stainless steel ring to modern IUDs.
Source: PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1993;(27):7.
Abstract: 41% of all contraceptives used in China are IUDs. This accounts for more than 80% of Chinese reversible contraception. Although they are more effective than the stainless steel ring (SSR), copper IUDs, such as the TCu380A and the TCu220C, have a high production cost. But this cost may be lower than that associated with the high failure rate of the SSr. In 1991, a United Nations Population Fund study was begun that utilized data from clinical, survey, and economic sources in order to compare costs and benefits of SSRs with those of the TCu220C and the TCu380A. If China converted to copper IUDs in 1993, according to the study, over the next 10 years 55,600,000 pregnancies, 18,400,000 live births, 35,600,000 induced abortions, 16,300 maternal deaths, 365,000 infant deaths, and 28,800 child deaths could be averted. Use of copper IUDs would also reduce the number of nonfetal complications associated with pregnancy. The general welfare of women and of their families, in terms of lost physical and psychological health, money, and opportunity due to unplanned pregnancy, is reflected in the development of society. In view of this, in September, 1992, the government of China decided to convert from the SSR to copper IUDs (TCu220C and TCu380A) beginning in 1993.
Language: English
Keywords:
CHINA | IUD, UNMEDICATED | STAINLESS STEEL | IUD, COPPER RELEASING | FAMILY PLANNING POLICY | INORGANIC CHEMICALS | Developing Countries | Asia, Eastern | Asia | IUD | Contraceptive Methods | Contraception | Family Planning | Metals | Vitamins and Minerals | Physiology | Biology | Population Policy | Social Policy | Policy | Ingredients and Chemicals
Document Number: 092512

17.
Title: Lost IUD thread as a possible cause of infertility [letter]
Author: Caspi B; Weissman A; Elchalal U
Source: International Journal of Gynecology and Obstetrics. 1993 Oct;43(1):65-6.
Abstract: In Israel, an unusual finding on pelvic ultrasonography necessitated hospitalization for a 41-year old female patient at Kaplan Hospital, in the Rehovot. During her 1st marriage, she had undergone 4 abortions. During her 2nd marriage, she delivered a healthy infant who was 10 years old at the time of hospitalization. A physician had inserted a Lippes Loop IUD 1 month postpartum. 6 years after its insertion, she suffered from a difficult IUD removal and subsequently developed some episodes of sever pelvic inflammatory disease at which time she was hospitalized and received iv antibiotics. She did not conceive throughout the 4 years after IUD removal. Gynecologists at Kaplan Hospital used diagnostic hysteroscopy to identify the intense intrauterine echoes earlier detected (echogenicity was like that of an IUD) by ultrasound. They found and removed a calcified 3 cm long IUD string in the uterine cavity. The woman was a tourist to Israel so the physicians could not determine her subsequent fertility, however. Nevertheless, they believed that the polyethylene thread had the same effect as an inert IUD, therefore making it responsible for her secondary infertility. This case study reinforces the importance of completely removing a IUD.
Language: English
Keywords:
ISRAEL | CASE STUDIES | INFERTILITY | IUD, UNMEDICATED | ADNEXITIS | ULTRASONICS | SIDE EFFECTS | IUD SIDE EFFECTS | Middle East | Developed Countries | Studies | Research Methodology | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Treatment
Document Number: 090568

18.
Title: Serum and endometrial copper, zinc, iron and cobalt with inert and copper-containing IUCDs.
Author: Fahmy K; Ghoneim M; Eisa I; El-Gazar A; Afifi A
Source: CONTRACEPTION. 1993 May;47(5):483-90.
Abstract: Serum and endometrial copper (Cu), zinc (Zn), iron (Fe) and serum cobalt (Co) were determined on menstrual cycle Day 6-9 or 9-22 in 30 women with Lippes loops, 30 with CuT-200 IUDs, and 24 controls. The women were clients of the family planning and gynecology clinic of Benha University Hospital, Egypt. Endometrial samples were obtained with a fine Sharmans currette. In controls, the only differences between the mid-follicular and mid-luteal phase were higher Cu and lower Fe levels in the endometrium in the luteal phase. Lippes loop users had lower follicular serum Zn, lower mean endometrial Zn and Fe, and higher mid-luteal endometrial Fe than controls. The CuT-200 IUD group had higher follicular serum Zn and lower luteal serum Co and higher follicular endometrial Cu and lower follicular endometrial Fe levels. The CuT-200 group also had higher follicular serum Co and endometrial Cu and Zn and lower follicular endometrial Fe than did the Lippes loop group.
Language: English
Keywords:
EGYPT | DATA ANALYSIS | CASE CONTROL STUDIES | IUD, COPPER RELEASING | IUD, UNMEDICATED | MENSTRUAL CYCLE | SERUM COPPER LEVEL | SERUM IRON LEVEL | SERUM ZINC LEVEL | ENDOMETRIUM | METALS | INORGANIC CHEMICALS | Africa, North | Africa | Developing Countries | Research Methodology | Studies | IUD | Contraceptive Methods | Contraception | Family Planning | Menstruation | Reproduction | Hemic System | Physiology | Biology | Uterus | Genitalia, Female | Genitalia | Urogenital System | Vitamins and Minerals | Ingredients and Chemicals
Document Number: 082673

19.
Title: Inserting intrauterine devices without clamping the cervix.
Author: John AP
Source: British Journal of Family Planning. 1993 Oct;19(3):225-7.
Abstract: 19 years' experience inserting IUDs without clamping the cervix, by the author and 20 of his trainees, are summarized. From October 1971 to 1991, 497 women were fitted with one or more IUDs, for 879 attempts, with a 3.1% fitting failure rate. 733 were by the author and 119 were done by 20 trainees. This technique was effective for Novagards, Nova-Ts, Gyne-T Slimlines, and previously available IUDs such as Gravigards, Lippes Loops and Saf-T-Coils, but it is not advised for Multiloads. After a bimanual pelvic exam, the cervix was visualized with a Cusco bivalve speculum and the are cleansed with an antiseptic. Sounding the uterus and inserting the IUD were managed by movements of the speculum only. In some cases the direction of bend of the sound of inserter was changed, always protected by sterile gauze or the sterile package. In a few situations the woman's position could be changed to facilitate insertion. The rate of failure in fitting an IUD was higher in nulliparous women and in those with prior history of failure to be fitted with an IUD. There were no known uterine perforations. Difficult removals were significantly more rare in this series (1.4%) than in women with IUDs inserted by another practitioner in the clinic (3.6%). Since use of the cervical tenaculum risks pain, vasovagal shock, laceration, and infection, this method is safer.
Language: English
Keywords:
UNITED KINGDOM | METHODOLOGICAL STUDIES | IUD, UNMEDICATED | FITTING | INSERTION | FAMILY PLANNING CENTERS | PHYSICIANS | FORCEPS | CERVICAL EFFECTS | United Kingdom | Europe, Western | Europe | Developed Countries | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Health Facilities | Delivery of Health Care | Health | Health Personnel | Surgical Equipment | Equipment and Supplies | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 091557

20.
Title: Hysteroscopic findings in women with IUD-induced menorrhagia [letter]
Author: Lei ZW; Xie L
Source: International Journal of Gynecology and Obstetrics. 1993 Aug;42(2):173-4.
Abstract: In Chengdu, China, the Sichuan Family Planning Research Institute compared changes of the IUD and/or the endometrium detected by hysteroscopy with changes detected by hysterography or ultrasonography in 105 women, 24-40 years old, suffering from menorrhagia following IUD insertion. 44 women used the TCu220 C IUD, 34 the VCu 200 IUD, and 27 a stainless steel ring. 43.81% of the women had an abnormal IUD and/or endometrium (8.57% IUDs, 32.38% endometrium, and 2.45% both). There were significant differences in abnormal hysteroscopic findings between stainless steel ring users, VCu 200 users, and TCu220 C users (18.52%, 32.35%, and 68/18%, respectively; p < .01). Hysterography or ultrasound and hysteroscopy agreed on detection of distortion and/or displacement in 3 cases (25% positive consistency). Yet. hysteroscopy detected distortion and/or displacement in 9 cases that hysterography or ultrasound identified as normal. When women begin to have menorrhagia after IUD insertion, hysterography or ultrasound can be used to examine the IUD. If they do not find abnormal IUD displacement, practitioners should use hysteroscopy.
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | HYSTEROSCOPY | ULTRASONICS | HYSTEROSALPINGOGRAPHY | IUD, COPPER RELEASING | IUD, UNMEDICATED | INSERTION | MENORRHAGIA | ENDOMETRIUM | SIDE EFFECTS | IUD SIDE EFFECTS | Developing Countries | Asia, Eastern | Asia | Research Methodology | Studies | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Menstruation Disorders | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 084690

21.
Title: Intrauterine contraceptive devices [letter]
Author: Rowlands S
Source: BRITISH JOURNAL OF GENERAL PRACTICE. 1993 Apr;43(369):175.
Abstract: A physician in Bedfordshire, England, believes that inert IUDs should not be reintroduced into the market place. He acknowledges that larger IUDs, but women who use them have a high incidence of pain and bleeding problems. The new copper-releasing IUDs have a better efficacy rate than inert IUDs. The lowest failure rate of any IUD is the levonorgestrel-releasing IUD and its efficacy is almost as good as that of the combined oral contraceptive. Medicated IUDs sometimes require periodic reinsertions, but this is insignificant when compared with the reduced pain and bleeding associated with their use, especially among low parity women. An Israeli study shows that 63% of inert IUD users suffered pain, bleeding, or discharge and more than 50% of them wanted the IUD removed. The availability of better IUDs makes this high rate unacceptable. Copper releasing IUDs remain effective and safe for as long as 8 years. Some physicians suggest that women of at least 40 years of age can use them indefinitely. Published reports show that the incidence of pelvic inflammatory disease (PID) is essentially the same for both inert IUDs and copper IUDs, e.g., 2 studies examining infertility reveal that the risks of tubal blockage are lower with copper IUDs than with inert IUDs. Besides the insertion process and background risk of sexually transmitted diseases are linked to PID and not the inherent property of the IUD. One 3-year study finds that a levonorgestrel releasing IUDs have a protective effect against PID. In the practice of the Bedfordshire physician, just 8 of 98 current IUD users use the inert IUD. He allows them to continue using their IUDs as long as they are satisfied and their hemoglobin levels remain stable. He proposes that clinicians should discard any remaining stock of inert IUDs and use only medicated IUDs.
Language: English
Keywords:
UNITED KINGDOM | CRITIQUE | IUD, UNMEDICATED | IUD, HORMONE RELEASING | IUD, COPPER RELEASING | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION FAILURE | ADNEXITIS | SIDE EFFECTS | IUD SIDE EFFECTS | United Kingdom | Europe, Western | Europe | Developed Countries | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Treatment
Document Number: 090562

22.
Title: Does infection occur with modern intrauterine devices? [editorial]
Source: Lancet. 1992 Mar 28;339(8796):783-4.
Abstract: It is difficult to determine if the IUD increases the risk of pelvic inflammatory disease (PID) because simple clinical features are not consistently predictive and can have low specificity and sensitivity. The C-reactive protein and the erythrocyte sedimentation rate tests help with PID diagnosis, but only a laparoscopy can determine tubal involvement. In 1970, WHO's Cooperative Statistical Programme found 2-year combined PID rates to range from 3.8 to 5.2/100 women with an IUD. Then WHO and various US organizations agreed IUD use did not necessarily cause PID. During the 1970s, however, a large rise in sexually transmitted diseases (STDs), especially chlamydia and gonorrhea, occurred and were associated with PID incidence. Many believed the growing rate of PID was attributable to the increasing use of IUDs. Many studies were biased because of overdiagnosis of PID. A 1990 review of 28 articles revealed that the overall PID rate was 1.49/100 woman years (lower than what many believed earlier). Some researchers used multicountry data on 22, 908 IUD insertions from WHO's data base for IUD studies to determine PID risk in IUD users. This risk was somewhat high during the 1st 20 days postinsertion which may be related to insertion, but PID rates in IUD users corresponded with those from the general population. PID rates did increase with age, however, and they did vary with geographical area. In addition, rates were 62% lower in women whose IUD was inserted after 1980. The PID rate was associated with background risk of STDs. These results and those of other studies suggest that health staff must adequately assess all patients before fitting the IUD and insert it only under strict aseptic conditions. IUDs that release copper and levonorgestrel pose a lower risk of PID than nonmedicated IUDs.
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | LITERATURE REVIEW | IUD, UNMEDICATED | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | PELVIC INFECTIONS | PHYSICAL EXAMINATIONS AND DIAGNOSES | SEXUALLY TRANSMITTED DISEASES | WHO | ADNEXITIS | Developed Countries | North America | Americas | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Examinations and Diagnoses | Reproductive Tract Infections | UN | International Agencies | Organizations | Pelvic Inflammatory Disease
Document Number: 071775

23.
Title: Removal of intrauterine devices with missing tails during early pregnancy.
Author: Assaf A; Gohar M; Saad S; El-Nashar A; Abdel Aziz A
Source: CONTRACEPTION. 1992 Jun;45(6):541-6.
Abstract: IUDs were successfully removed from 46 of 52 pregnant women bearing IUDs with retracted tails, from December 1985 to November 1991, at the Department of Gynecology and Obstetrics, Benha University Hospital, Egypt. The presence and location of the IUD was confirmed with ultrasonography, excluding 3 patients who did not have retracted IUD tails, and 8 who were >12 weeks' gestation. After paracervical block or short-acting IV anesthesia, the 7 mm Storz hysteroscope was introduced, using cervical dilatation only if needed. CO2 gas, up to 200 ml, was injected into the internal os with a Hysteroflator (Wiest, Berlin). The IUD was carefully removed with a grasping forceps. The women received the antiprostaglandin endomethasin (sic) by suppository the night before, and after the procedure. Patients were observed for 5 days, and ultrasound was repeated 2 weeks later to confirm fetal viability. There were 6 failures to remove an IUD, 2 involving disturbance of the gestational sac, and 2 where the IUD lay beneath the sac. 2 spontaneous abortions resulted in the series. 24 Lippes Loops, 12 Copper Ts, 8 Copper 7s, and 6 Nova T devices were removed. It is recommended that the operator gain experience on women having their pregnancy terminated before attempting to remove an IUD from a pregnant woman wishing to continue her pregnancy.
Language: English
Keywords:
EGYPT | CLINICAL RESEARCH | IUD, UNMEDICATED | IUD, COPPER RELEASING | PREGNANCY, FIRST TRIMESTER | ABORTION, SPONTANEOUS | PREGNANCY COMPLICATIONS | CONTRACEPTION TERMINATION | HOSPITALS | PHYSICIANS | PROSTAGLANDIN ANTAGONISTS | FORCEPS | HYSTEROSCOPY | ULTRASONICS | CERVICAL DILATATION | RETENTION | PREOPERATIVE PROCEDURES | POSTOPERATIVE PROCEDURES | Africa, North | Africa | Developing Countries | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Pregnancy | Reproduction | Diseases | Health Facilities | Delivery of Health Care | Health | Health Personnel | Prostaglandins | Endocrine System | Physiology | Biology | Surgical Equipment | Equipment and Supplies | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Treatment | Surgery
Document Number: 073684

24.
Title: Intrauterine devices.
Author: Chaudhuri SK
Source: In: Practice of fertility control: a comprehensive textbook. 3rd ed., [edited by] S.K. Chaudhuri. New Delhi, India, B.I. Churchill Livingstone, 1992. :69-94.
Abstract: Excessive bleeding, pain, expulsion, and infection prevent many women from using the IUD, a safe, inexpensive, effective, and convenient, contraceptive method. Other IUD complications include vaginal discharge, ectopic pregnancy, and uterine perforation. The 1st year continuation rate ranges from 70-90. Almost 70% of the 85 millions IUD users live in China. IUD use differs among married women of reproductive age (4% in India vs. 30% in China and at least 25% in France, Hungary, Norway and Finland vs. at the most 5% in Canada, US, Australia, New Zealand, and Japan). The most common IUD in China is the single coil stainless steel ring without any tail whereas the copper releasing IUD. TCu-200, is the most common IUD in India. IUDs mainly prevent pregnancy by inhibition of sperm migration and fertilization of ovum, but can also prevent implantation of a fertilized ovum. IUDs are classified as either unmedicated (inert) or medicated. The inert IUDs include ring IUDs, the Lippes loop (the most widely used IUD today), and the Saf-T-coil. The medicated IUDs contain either copper or hormones. The only available hormone-releasing IUD is Progestasert. Levonorgestrel IUD-20 (LNG-20), presently undergoing redesign and trials, is another hormone releasing IUD which should be marketed soon. Physicians and trained paramedicals can insert and remove IUDs in women with no contraindications, e.g., active pelvic infection. It should be inserted during or soon after menstruation. Prior to insertion, health staff should counsel women about the advantages and disadvantages and never tell them it is 100% safe. Most women do not require analgesics during insertion. After insertion, the health personnel should request that the patient feel the thread in the vagina. They should also review with her conditions which require immediate attention, e.g., severe pain and excessive bleeding.
Language: English
Keywords:
DEVELOPING COUNTRIES | CHINA | INDIA | DEVELOPED COUNTRIES | UNITED STATES OF AMERICA | CANADA | NEW ZEALAND | AUSTRALIA | FINLAND | NORWAY | HISTORICAL REVIEW | IUD | IUD SIDE EFFECTS | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | IUD, UNMEDICATED | INSERTION | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USAGE | TIME FACTORS | COUNSELING | BLEEDING | PAIN | UTERINE PERFORATION | PELVIC INFECTIONS | PREGNANCY, ECTOPIC | CONTRACEPTION FAILURE | CONTRACEPTION CONTINUATION | CONTRAINDICATIONS | SIDE EFFECTS | Asia, Eastern | Asia | Asia, Southern | North America | Americas | North America, Northern | Oceania | Europe, Northern | Europe | Contraceptive Methods | Contraception | Family Planning | Treatment | Population Dynamics | Demographic Factors | Population | Clinic Activities | Program Activities | Programs | Organization and Administration | Signs and Symptoms | Diseases | Perforations | Infections | Pregnancy Complications
Document Number: 079630

25.
Title: Long term use of inert intrauterine contraceptive devices in 94 women in Israel.
Author: Dafni L; Tamir A; Spenser T; Spenser S
Source: BRITISH JOURNAL OF GENERAL PRACTICE. 1992 Oct;42(363):423-5.
Abstract: A retrospective study of 94 Israeli women who had worn an inert IUD for 5-19 years was made from records in a family practice including 1 Arab village, 2 Jewish coops, and 3 Jewish kibutzim. The IUDs, 74 Lippes Loops and 26 Saf-T-Coils, were inserted at a mean age of 34 years and at mean parities of 3-6. Removals for an IUD-related event, such as bleeding, pain, vaginal discharge, broken IUD or positive cervical smear, were very common in the first 60 months, less so between 60 and 108 months, and even less common up to 168 months. After 168 months only 1 was removed for a medical event at 226 months. Of the 94 first IUDs, 27 were in place between 5 and 19 years. 20 were removed for bleeding or pain between 5 and 9 years, and only 4 between 10 and 19 years. 50 women complained of side effects, but only 32 requested removal. There was 1 spontaneous expulsion at 8 years, 2 intrauterine pregnancies at 60 and 82 months, and 1 case of pelvic inflammatory disease treated without removal and 3 broken IUDS. 2 IUDS were difficult to remove, one requiring curettage. 11 of the 14 women who requested removal were known to have conceived within 9 months. These data, and those cited in the discussion, suggest that the long-term safety of inert IUDs should be re-examined.
Language: English
Keywords:
ISRAEL | CASE STUDIES | IUD, UNMEDICATED | CONTRACEPTION CONTINUATION | CONTRACEPTIVE METHOD ACCEPTABILITY | TIME FACTORS | CONTRACEPTION TERMINATION | PELVIC INFECTIONS | BLEEDING | PAIN | Middle East | Developed Countries | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Population Dynamics | Demographic Factors | Population | Infections | Diseases | Signs and Symptoms
Document Number: 081652

26.
Title: The intrauterine device and primary tubal infertility [letter].
Author: Daling JR; Weiss NS; Voigt LF; McKnight B; Moore DE
Source: NEW ENGLAND JOURNAL OF MEDICINE. 1992 Jan 16;326(3):203-4.
Abstract: The results of a population-based retrospective case-control study published in 1985 on the link between prior use of an IUD and primary tubal infertility have been re-analyzed. The original results set the relative risk of tubal infertility at 2.6 for ever users of an IUD, but 6.8 for users of the Dalkon shield. The new calculations eliminated cases of infertility due to abnormalities verified by hysterosalpingography such as bicornuate uterus or uterine polyps; included 15 cases for whom no matched controls with the same matching criteria. The new data set included 487 of 518 potential controls for 161 cases. The new computation yielded a relative risk of 3.7 for ever-use of any IUD, 3.9 for ever-use of a copper IUD, 6.0 for ever-use of a Dalkon shield, and 3.4 for ever-use of any IUD except the Dalkon shield. These results did not change the original interpretation of the study: that while the risks of infertility is heightened after use of the Dalkon shield, it is still higher after use of any IUD for nulligravid women.
Language: English
Keywords:
WASHINGTON | UNITED STATES OF AMERICA | DATA ADJUSTMENT | CASE CONTROL STUDIES | IUD COMPLICATIONS | IUD, UNMEDICATED | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | INFERTILITY | RISK ASSESSMENT | NULLIPARITY | COMPLICATIONS | Developed Countries | North America | Americas | Research Methodology | Studies | IUD | Contraceptive Methods | Contraception | Family Planning | Reproduction | Evaluation | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Diseases
Document Number: 070088

27.
Title: [A comparative study of performance of four IUDs inserted after menstruation]
Author: Ho JL
Source: REPRODUCTION AND CONTRACEPTION. 1992 Jun;12(3):37-43.
Abstract: The use-effectiveness of 4 IUDs--the stainless steel ring (SSR), TCu 220C, the MLCu 375, and the uterine-cavity shaped device (UCSD)--inserted at intervals was compared randomly in 5 cooperating centers in Guangdong, China province, and this paper presents preliminary results for 18 months of use. A total of 1536 cases were recruited with 384 subjects from March 1988 to May 1989. The MLCu 375, the TCu 220C, and the UCSD had much higher gross cumulative continuation rates (90.38, 87.93, and 85.32) as well as much lower expulsion rates (5.62, 6.39, and 5.07), respectively, than the SSR for (70.66 and 20.43) for 12 months of use. Also, the MLCu 375 and the TCu 220C showed much lower gross cumulative pregnancy rates (0.76, 1.17) than the SSR (6.10) and the UCSD (4.12) for 1 year of use. All of these differences achieved a highly statistical significance (as shown in a table). A survival analysis with covariates of IUD contraception was conducted and is shown in another table. (author's modified) (summaries in ENG, CHI)
Language: Chinese
Keywords:
CHINA | COMPARATIVE STUDIES | CONTRACEPTIVE USE-EFFECTIVENESS | CONTRACEPTION CONTINUATION | CONTRACEPTIVE METHOD ACCEPTABILITY | PREGNANCY RATE | IUD, COPPER RELEASING | IUD, UNMEDICATED | CONTRACEPTION TERMINATION | DATA ANALYSIS | STATISTICS | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Contraceptive Effectiveness | Contraception | Family Planning | Contraceptive Usage | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | IUD | Contraceptive Methods
Document Number: 074058

28.
Peer Reviewed

Title: Was the Dalkon Shield a safe and effective intrauterine device? The conflict between case-control and clinical trial study findings.
Author: Mumford SD; Kessel E
Source: FERTILITY AND STERILITY. 1992 Jun;57(6):1151-76.
Abstract: 2 researchers searched MEDLARS databases for articles on clinical trials of the Dalkon Shield to compare the results of case control and cohort studies which identified its relationship with pelvic inflammatory disease (PID) with those of other clinical trials. They identified 71 useful reports. The results of clinical trials not used to incriminate the A.H. Robins Company, the manufacturer of the Dalkon Shield, showed that the Dalkon Shield was indeed safe and effective when inserted by a skilled and experienced clinician. In addition, the Dalkon Shield compared favorably with other IUDs. Further the pregnancy rate and removal rate for pain and bleeding matched those of other IUDs. Moreover the expulsion rate for the Dalkon Shield was better than that of other IUDs. In those studies that examined PID, the PID rates were essentially the same as the expected rates of other IUDs in their clinic populations. Besides, even though the case control studies suggested a considerable increased PID rates with the Dalkon Shield, increased rates of removals for pain and bleeding did not occur. Furthermore pregnancy and expulsion rates improved as did the skill and experience of the physicians who inserted the Dalkon Shield. In fact, the best rates occurred in trials conducted in centers where only a few clinicians inserted >1000 Dalkon Shields. For example, the removal rate for pain or bleeding was as low as 0.9%. This rate among inexperienced clinicians was as high as 27%. The fact that the litigation case against A.H. Robins used the results of the weaker case control studies rather than the superior randomized clinical trial resulted in removal of a safe and effective contraceptive. Further IUD studies should incorporate clinician skill as a variable to better assess the IUD's efficacy and safety.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | COMPARATIVE STUDIES | CASE CONTROL STUDIES | COHORT ANALYSIS | CLINICAL TRIALS | INFORMATION RETRIEVAL SYSTEMS | IUD, UNMEDICATED | PELVIC INFECTIONS | PAIN | BLEEDING | INSERTION | LITIGATION | BIAS | Developed Countries | North America | Americas | Studies | Research Methodology | Clinical Research | Data Storage and Retrieval | Information Processing | Information | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Signs and Symptoms | Treatment | Error Sources | Measurement
Document Number: 073586

29.
Title: Removal of retained intrauterine contraceptive devices in pregnancy.
Author: Sachs BP; Gregory K; McArdle C; Pinshaw A
Source: AMERICAN JOURNAL OF PERINATOLOGY. 1992 May;9(3):139-41.
Abstract: Physicians at leading hospitals in Boston, Massachusetts were able to remove a retained IUD from 3 women who were in their 1st trimester of pregnancy. They took cervical cultures to test for chlamydia, beta-hemolytic Streptococcus, and gonococcus before attempting to remove the IUD. They used a 3.5 MHz transducer from an Acuson 128 machine to perform a transabdominal ultrasound scan. The physicians used a transcervically introduced stone clamp to retrieve the IUD. The technique was like that used for transcervical chorionic villus sampling. The 1st case was a 36-year old gravida 3 with a copper-7 IUD whose string had disappeared from sight. She was 8 weeks' gestation. The IUD was laying below the gestational sac. She delivered a full-term healthy infant weighing 3348 gm. The 2nd patient was a 27-year old Chinese woman who had been pregnant before, but had no living children. She was 9 weeks' gestation and had a stringless metal ring IUD. It was in the lower uterus. She experienced some bleeding afterwards. She did not experience any difficulties during the rest of her pregnancy and delivered a full-term infant (2665 gm). The 3rd case was also a Chinese woman with a metal ring IUD. She was gravida 2 para 1 at 10 weeks' gestation. Like the other Chinese woman, the IUD was in the lower uterus. She experienced bleeding throughout the 1st trimester. Nevertheless, at 40 weeks' gestation, she had a healthy 2665 gm infant. This method is best accomplished by someone skilled in in utero manipulation as is done with chorionic villus sampling. The physicians recommend that other physicians should try to remove a retained IUD using this technique no matter its location, type, or the presence of a visible string or not, if the patient indeed wants to continue the pregnancy.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | CASE STUDIES | IUD, UNMEDICATED | IUD, COPPER RELEASING | RETENTION | PREGNANCY, FIRST TRIMESTER | ULTRASONICS | BLEEDING | CERVIX | ASIANS | PREGNANCY OUTCOMES | Developed Countries | North America | Americas | Studies | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Examinations and Diagnoses | Pregnancy | Reproduction | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population
Document Number: 074543

30.
Title: Intrauterine devices Wang S.S Cu 380 as compared to ML Cu 375, Nova T, T Cu 300, 7 Cu 200, Lippes Loop and Ohta Ring: clinical / physiopathological parameters.
Author: Wang FN; Hsu MC; Cheng CM; Su TP; Yeh KA; Lai WH; Hsiung CH; Karow WG; Tsai HD
Source: ADVANCES IN CONTRACEPTIVE DELIVERY SYSTEMS. 1992;8(3):267-76.
Abstract: IUDs are rigid and heavy thus irritating the endometrium. Their design accounts for many side effects and encourages pelvic infections. IUDs may even facilitate transmission of HIV. Since some health professionals and patients consider some IUDs to be harmful or unacceptable, researchers have worked on developing a newly designed IUD which meets the criteria for and ideal IUD. Some criteria include soft and flexible in nature and inside the uterus, safe, no migration, and light in weight. Taiwanese researchers have developed such an IUD. The silicone skeleton of the Wang SS (soft and safe) Copper 380 and 300 IUDs is bow-shaped with each arm of the bow tapering off from the middle and ending with a small rounded knob. Copper wire (0.31 mm x 380 sq mm or 0.31 mm x 300 sq mm) coils around the holeless vertical stem (3 cm). The monofilament nylon string is fixed in the middle of the stem by an enlarged top. Researchers designed the Wang SS Cu 300 for nulliparous women and the Wang SS Cu 380 for multiparous women. If physicians use a Wang IUD from a sterilized package, they can insert it without wearing sterile gloves. They need to clean the cervix. They must use a single tooth tenaculum to stabilize the uterus and to straighten the uterine axis. After placing the Wang IUD in the inserter, adjusting the flange, and putting the plunger on the inserter, they need to safely introduce the inserter into the uterine cavity to the point where the inserter touches the fundus or the flange touches the cervix. They then must push the plunger to insert the IUD. Insertion should be done immediately after menstruation. Clinicians need to conduct clinical trials to test the safety and effectiveness of the Wang Ss Cu IUDs.
Language: English
Keywords:
TAIWAN | RESEARCH AND DEVELOPMENT | IUD, COPPER RELEASING | SILICONE | NYLON | NULLIPARITY | MULTIPARITY | INSERTION | IUD, UNMEDICATED | POLYETHYLENE | PELVIC INFECTIONS | HIV INFECTIONS | SIDE EFFECTS | IUD SIDE EFFECTS | Asia, Eastern | Asia | Developed Countries | Technology | Economic Factors | IUD | Contraceptive Methods | Contraception | Family Planning | Silicon | Inorganic Chemicals | Ingredients and Chemicals | Polymers | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Treatment | Infections | Diseases | Viral Diseases
Document Number: 075213


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