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Objectives More than 60,000 hysteroscopies are performed every year in the UK for common reasons such as heavy menstrual bleeding (HMB) or postmenopausal bleeding. A significant number of women requiring hysteroscopy receive oral anticoagulants and there is often a reluctance to perform these procedures due to bleeding concerns. Study Design We are presenting the first proof of concept cohort of patients undergoing minor hysteroscopic procedures while on anticoagulant or antiplatelet medication. A variety of minor procedures such as cervical dilatation, targeted endometrial biopsies, Pipelle endometrial biopsies and insertion or removal of intrauterine contraceptive devices were performed alongside hysteroscopy. Results Completion of planned procedures was feasible in all women due to minimal bleeding despite the ongoing anticoagulation or anti-platelet treatment. Conclusion More research is needed to establish the safety of performing diagnostic and operative hysteroscopies without bridging or interrupting anticoagulation or antiplatelet treatment.

Objective To compare TCu380Ag and TCu380A intrauterine contraceptive devices after 1 year of use. Methods A prospective randomized controlled trial was conducted among healthy married women aged 20-35 years who attended the family planning clinics of three tertiary centers in India between August 1, 2015, to March 31, 2018. The TCu380Ag group (n=300) received one of three sizes of this device depending on uterocervical length: maxi (8.0-9.0 cm), normal (7.0-8.5 cm), or mini (6.0-7.5 cm). The remaining 300 participants received TCu380A. Follow-up was conducted at 3-monthly intervals to assess continuation rate, acceptability, efficacy, adverse effects, and complications. Results The TCu380Ag group had a higher continuation rate than the TCu380A group at 1 year (84.0% vs 75.8%; P=0.01), with an efficacy of 99.6% versus 100.0% (P>0.05). Overall estimated continuation rates were 94.5% (95% confidence interval [CI] 91.7%-96.4%) and 88.4% (95% CI 83.2%-91.5%), respectively (P=0.026). Use of TCu380Ag was associated with fewer adverse effects (heavy menstrual bleeding, abdominal pain, or expulsion) when compared with TCu380A (P>0.05 for all comparisons). Discontinuation rates owing to adverse effects were 6.59% for TCu380Ag versus 13.26% for TCu380A (P=0.01). Conclusions Varying sizes of TCu380Ag could provide an alternative to TCu380A.

Background: To investigate the hypothesis that increased uptake of long-acting reversible contraception (LARC) by women played a role in the declining abortion rates observed in New Zealand between...

Objective As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions — expulsion and infection — for physicians and nurses/midwives to generate evidence for task sharing. Study design We analyzed secondary data from the PPIUCD program in seven states using a case–control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January–December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors. Results In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82–4.12] or infection (OR 0.73; 95% CI: 0.39–1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86–2.89) and on-the-job training (OR 1.23, 95% CI: 1.11–1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27–0.75) and on-the-job training (OR 0.31, 95% CI: 0.25–0.37). Conclusion Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians. Implications Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.

OBJECTIVE To assess the effects of strengthening family planning capacity on the uptake of long acting reversible contraceptive (LARC) methods at two primary health centers. METHODS Between April 2016 and March 2017, the Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) increased the capacity of two primary health centers in Ouagadougou, Burkina Faso, to offer LARC methods by training staff and providing family planning equipment and commodities. Uptake of LARC methods was compared between the year preceding the intervention and the year during the intervention. RESULTS Within a year, the number of new users of family planning increased 2.8-fold from 2936 new users before the intervention to 8267 during it. The rate of new users of contraception increased 1.9-fold (14.9% vs 28.1%; P

Intrauterine contraception (IUC) is one of the more effective contraceptive methods for women at highest risk of unintended pregnancy. This includes younger, often nulliparous, women; however, uptake has been relatively low in this group.In February 2017 we conducted a systematic review of randomised controlled trials, prospective and retrospective observational studies to identify barriers to IUC use in nulliparous women.Study quality was poor. No differences in rates of infection or expulsions between nulliparous and parous were seen. Fertility rates following removal appeared no different from the general population. Higher rates insertion difficulty, insertion failure and pain during insertion were observed in nulliparous women.A long-acting reversible contraceptive method such as IUC reduces the risk of unintended pregnancy since user failure is minimised. Evidence-based information about the advantages and disadvantages of IUC is required to inform decision-making and dispel any myths and misperceptions. Potential barriers to IUC use in nulliparous women, particularly concerns around infection, significantly higher rates of device expulsion and adverse effects on fertility, do not appear to be justified. IUC is appropriate for all medically-eligible women, including nulliparous women, and should be included in the range of contraceptive options discussed during counselling.

Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms. When she again complained of vaginal discharge, vaginal stones and a vesicovaginal fistula were found on physical examination and CT urography. The patient underwent stone removal and concurrent vesicovaginal fistula repair. IUD fragments were found in the vesicovaginal and rectovaginal spaces. No abnormalities were found at follow-up 6 months after surgery.In any woman undergoing surgery to remove a migrated IUD, complete exposure and removal of the IUD are necessary to avoid fracturing of the IUD, secondary breakage and residue.

BACKGROUND: In spite of many advantages intrauterine contraception (IUC) is underutilised in Australia: only 5% of Australian women using contraceptive methods in 2011 were using IUC. AIMS: In 2012 Family Planning New South Wales (FPNSW) commenced training registered nurses (RNs) to insert IUC. This article reports outcomes of insertion attempts by the first four trained RNs and suggests strategies for increasing IUC utilisation in Australia. MATERIALS AND METHODS: Data regarding client characteristics and outcomes of insertion attempts including relevant adverse events that occurred during a 6-month follow-up period after the IUC insertions were retrospectively extracted from the FPNSW clinical record system and analysed in SPSS. RESULTS: Of 207 insertion attempts by RNs 91% were successful without Medical Officer (MO) assistance. The likelihood of insertion attempts being successful did not differ significantly between nulliparous and parous clients. Incidence of a postinsertion adverse event was equal to or less than rates in previous studies. All adverse events involved parous clients. CONCLUSIONS: We have shown that RNs who undertook competency-based IUC insertion training had a high rate of successful insertions and a low rate of adverse outcomes. Utilisation of IUC in Australia could be increased by engaging RNs as inserters and it is timely to review the barriers that make it difficult for private medical services to employ RNs to insert IUC.

Objectives To assess the prevalence of anemia and VulvoVaginal Candidiasis (VVC) in women before and 3 months after copper Intra Uterine Device (IUD) insertion. Methods Longitudinal prospective study was performed with 101 women aged 15–45 year who wanted to use the IUD at six health centers in Tehran, Iran from November 2011 to August 2012. The pattern of bleeding, Hemoglobin and Hematocirt levels, and Candida colony count/cultures in the women were assessed before and after 3 months of IUD insertion. Data analysis was performed by descriptive and analytical statistics using the SPSS software for Windows. Results At the end of 3 months, a significant increase in menstrual blood loss and a significant decrease of Hb and HCT ( P = 0.047 and 0.001, respectively) were reported. Moreover, no difference in the prevalence of anemia before and after IUD insertion was observed. The mean ± SD Candida colony counts significantly increased ( P = 0.001), but positive Candida cultures were not significantly different before and 3 months after IUD insertion. Also, no clinical VVC was reported 3 months after IUD insertion. While BMI ≥ 29 had a positive relationship with Candida colony counts, the results remained unchanged after adjusting for potential risk factors. Conclusions Despite an increase in bleeding and Candida colony counts in copper IUD users in this study, clinical VVC or anemia cases were not increased, which indicates relative safety of this contraception method. The study findings can be helpful to healthcare professionals and midwives to counsel women who want to start using IUD and also current users who are contemplating IUD removal due to its complications.

Rationale: Intrauterine contraceptive devices (IUDs) are recommended as a means of contraception. Translocation of IUD is a rare and serious complication. Colonic inflammatory mass caused by translocated IUD initially misdiagnosed as a colonic polyp is extremely rare and has not been reported yet. Patient concerns: This report presents a case of sigmoid colon translocation of intrauterine device on a 37-year-old female patient. Colonoscopy was performed due to her complain of repeated blood in stools and subsequently the patient was misdiagnosed as a sigmoid colon polyp. Nonetheless, the “polyp” was not able to be removed endoscopically. Diagnoses: Sigmoid colon translocation of an intrauterine device. Interventions: To further clarify the diagnosis, computed tomography (CT) scan was performed and the “polyp” was confirmed to be caused by a translocated IUD. Outcomes: The translocated IUD was removed easily by surgery, and the patient recovered soon after the operation. Lessons: The present case indicates that an annual gynaecologic examination is necessary to determine the position of the IUD, and a CT examination may help confirm an ectopic IUD.

Background A wide variety of complications due to the extrauterine migration of intrauterine contraceptive devices have been reported in the literature. Here we describe the case of a large bladder stone formed around a migrated Copper T380A device that was neglected and detected 15 years after insertion. Case presentation A 48-year-old Sri Lankan woman underwent a workup for lower urinary tract symptoms and recurrent urinary tract infections over the previous 6 months. The radiographs showed a large bladder stone with an imprint of an intrauterine contraceptive device in the center of it. The device had been inserted 15 years previously. Two years after the insertion, it was considered to be missing, but our patient did not comply with the recommended follow-up. She had been completely asymptomatic until she developed lower urinary tract symptoms. After confirming the location of the stone via ultrasonography, a vesicolithotomy was performed, revealing a stone with three limbs corresponding to the shape of the Copper T380A device. The device and the threads were fully covered with the stone material. Our patient was asymptomatic following the surgery. Conclusions A migrated intrauterine contraceptive device can act as the nidus for the formation of a secondary bladder stone. The detailed imprint of the device inside the stone and the laminated appearance of the stone material were characteristic of a secondary bladder stone formed around an intrauterine contraceptive device. Radiography and ultrasonography are adequate for the diagnosis of intravesical migration of intrauterine contraceptive devices.

Intrauterine contraceptive devices (IUCD) are a safe and cost-effective contraceptive method for medically eligible women. Despite this, the utilisation rate for IUCDs is relatively low in many high-income countries, including Australia. Provision of education and training regarding IUCDs to healthcare providers, including nurses and midwives, is one approach to overcome some of the barriers that may prevent wider uptake of IUCDs. This study aims to explore the types and impact of IUCD insertion training for healthcare providers. A systematic review was undertaken in January 2017 to determine the effectiveness of IUCD training for healthcare providers in relation to provision of IUCDs to women. The databases MEDLINE, EMBASE, CINAHL, COCHRANE and SCOPUS were searched to identify studies from high-income countries relating to IUCD training for healthcare providers and relevant outcomes. A total of 30 studies were included in the review. IUCD training for healthcare providers contributed to increased knowledge and improved positive attitudes towards IUCDs, high rates of successful insertions, low complication rates, and increased provision of IUCDs. Successful insertions and low complication rates were similar across different healthcare provider types. No notable differences between provider types in terms of knowledge increase or insertion outcomes were observed. Different training programs for healthcare providers were found to be effective in improving knowledge and successful provision of IUCDs. Increasing the number of healthcare providers skilled in IUCD insertions in high-income countries, including nurses and midwives, will enhance access to this method of contraception and allow women greater contraceptive choice.

Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We evaluated whether a provider-targeted intervention to increase LARC access negatively impacted dual method use and STI incidence among an at-risk patient population. We conducted a cluster randomized trial in 40 reproductive health centers across the United States from May 2011 to May 2013. After training providers at 20 intervention sites, we recruited 1500 sexually-active women aged 18-25years who did not desire pregnancy and followed them for one year. We assessed intervention effects on dual method use, condom use and STI incidence, modeling dual method use with generalized estimating equations and STI incidence with Cox proportional hazard regression models, accounting for clustering. We found no differences between intervention and control groups in dual method use (14.3% vs. 14.4%, aOR 1.03, 95% CI 0.74-1.44) or condom use (30% vs. 31%, aOR 1.03, 95% CI 0.79-1.35) at last sex at one year. STI incidence was 16.5 per 100 person-years and did not differ between intervention and control groups (aHR 1.20, 95% CI 0.88-1.64). A provider training intervention to increase LARC access neither compromised condom use nor increased STI incidence among young women. Dual method use was very low overall, highlighting the need to bolster STI prevention efforts among adolescents and young women.

OBJECTIVE: To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents. METHODS: A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital Egypt between July 1 2008 and December 31 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1 3 and 6 months. Odds ratio and chi(2) square tests were used to compare the rates of complications at each visit. RESULTS: Of 1512 patients eligible for IUD insertion 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain bleeding displacement expulsion and removal of IUDs were significantly higher in adolescents (P

This commentary describes a variety of tools and procedures available for retrieval of intrauterine contraceptive devices (IUCs) with missing strings. In addition it presents an algorithm for the management of the missing strings. Copyright © 2011 Elsevier Inc. All rights reserved.

Migration of therapeutically implanted intrauterine contraceptive devices and foreign bodies pose challenges in accurate localization and removal through the least invasive method. Laparoscopic removal is the desired method of treatment due to the lessened surgical and anesthetic morbidity and accurate and rapid localization of the devices are imperative in aiding an endoscopic removal. Difficulties in locating the device leads to prolonged intraoperative times and at times culminate in a laparotomy with its attendant increased morbidity. We present a case series where rapid and accurate localization of the devices was achieved by intraoperative usage of the fluoroscopic image intensifier. The image intensifier can view images in real time and can be used intraoperatively, increasing the diagnostic accuracy. We propose that intraoperative imaging by the fluoroscopic image intensifier is a cost effective, rapid, and accurate method of localizing a migrated contraceptive device, thus enabling optimal endoscopic treatment.

Objective To investigate a novel method for in-office fitting of intrauterine contraceptive devices (IUCDs) by comparing it to the traditional non-guided technique. Methods A prospective cohort study comparing the application of intrauterine contraceptives was conducted between January 1, 2013 and January 31, 2015 at a university contraception clinic, in Alexandria, Egypt. Patients aged 20–45 years who were parous, had previously undergone vaginal or abdominal deliveries, and were requesting device insertion were included. Patients were randomly assigned to have devices fitted using the non-guided approach, with vaginal ultrasonography to plan and confirm device placement, or by the abdominal ultrasonography-guided technique. The primary outcomes were successful IUCD insertion and ideal device position 1 week after insertion. Participants, counselors, and data analysts were masked to treatment assignments. Results Analyses included 40 patients in each treatment arm. Successful fitting was achieved in 32 (80%) patients in the non-guided arm and 39 (98%) patients in the ultrasonography-guided arm ( P = 0.04). Ideal placement was achieved in 38 (95%) patients in the ultrasonography-guided arm compared with 27 (68%) patients in the non-guided arm ( P = 0.02). Conclusion Ultrasonography-guided IUCD insertion demonstrated improved success and fitting accuracy in comparison with a traditional, non-guided approach. ANZCTR trial ID: ACTRN12615000526572

Since more than 30 years, intrauterine contraceptive devices (IUCD) have been used for a contraceptive opportunity. Although they are termed to be a safe and effective method for contraception, they also have some type of complications and uterine perforation, septic abortion, pelvic abscess are the serious complications of these devices. The incidence of uterine perforation is very low, but in the literature nearly 100 cases were reported about the extra uterine localization of IUCD. Migration may occur to the adjacent organs. We here in describe a case of a 31 year-old woman who had an IUCD with stone formation in the bladder. In the literature all of the cases were reported as IUCD migration, but although it seems technically impossible, IUCD placement into the bladder should also be considered in misplaced IUCDs.

Objectives: To evaluate the acceptance of postpartum intrauterine contraceptive devices (PPIUCD) among the inhabitants of Assiut governorate, Egypt and to study the factors that influence this acceptance. Subjects and Methods: Contraceptive counseling was given to 3,541 clients: 1,880 and 1,661 during the antenatal visits and postpartum hospitalization, respectively. Acceptors during antenatal counseling were to receive IUCDs via postplacental insertion in the case of vaginal delivery or transcesarean insertion in case of abdominal delivery. The clients who refused PPIUCD and chose interval IUCD insertion were referred to the Family Planning Clinic after the end of puerperium. Among postpartum counselees, PPIUCD acceptors received predischarge insertion within 48 h of delivery and the interval IUCD were referred to have IUCD inserted after the end of puerperium. The acceptance rate of both PPIUCD and interval IUCD and the percentage of actual insertions were recorded. The causes of both acceptance and refusal were also recorded. Results: Of the 3,541 clients, 1,024 (28.9%) accepted the use of IUCD after delivery. Acceptance was approximately the same during antenal and postpartum counseling: 26.4 and 31.8%, respectively. Verbal acceptance was higher among women with formal education than among illiterate women. Planning another pregnancy in the near future, preference for another contraceptive method, namely lactational infertility, and complications from previous use of IUCD were the most common reasons for refusing the use of IUCD. Of the 1,024 verbal acceptors, only 243 (23.7%) had the actual insertion of IUCD. Conclusion: Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. For these women, the only opportunity to receive information about contraceptives is during childbirth when they are in contact with medical personnel. Hence, it is suggested that family planning should be integrated with maternal and child-care services in order to effectively promote the use of contraceptive devices in these women who otherwise would not seek the use of such a device.

Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115 controls (IUCD continuers) were randomly selected based on the data obtained from the user’s record of a family planning center in Kathmandu. Matching criteria were age during insertion and date of insertion of IUCD. Logistic regression was used to analyze the data. When cases were compared with controls, the results showed that place of residence, sex of last child, reproductive intention, experience of side effects, and follow-up practice were associated with discontinuation of the IUCD. Experience of side effects has been seen as the major reason for discontinuation. The results suggest that side effects after IUCD insertion should be properly discussed and promptly treated to reduce the discontinuation rate.

OBJECTIVE: To compare the expulsion rate of Nova-T380 Multiload 375 and Copper-T380A intrauterine contraceptive devices (IUCDs) inserted during cesarean delivery. METHODS: A comparative randomized study was conducted between January 1 2013 and June 30 2014 in three maternity centers in Egypt and Saudi Arabia. All women scheduled for an elective cesarean and accepting intraoperative insertion of an IUCD were randomly allocated to receive the Nova-T380 (group 1) Multiload 375 (group 2) or Cu-T380A (group 3) using a computer-generated table. Researchers and participants were not masked to the type of IUCD. Follow-up was for 1year. The primary outcome was IUCD expulsion (complete or partial [i.e. displacement]). RESULTS: Each group contained 40 participants. At 1year expulsion had been reported for 5 (13%) women in group 1 2 (5%) in group 2 and 6 (15%) in group 3 (P>0.05 for all). The frequency of displacement was significantly lower in group 2 (5 [13%] participants) than in group 1 (15 [38%]; P=0.001) and group 3 (14 [35%]; P=0.008). CONCLUSION: Despite a comparable risk of expulsion following IUCD insertion during cesarean delivery the Multiload 375 device showed the lowest risk of displacement. Copyright (c) 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Objective To assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods A descriptive, cross-sectional study was conducted between June 28 and July 15, 2011. Specialists, residents, house officers, and nurse midwives who had been working in the Department of Obstetrics and Gynecology for at least 3 months were included. Self-administered questionnaires assessed formal training, current proficiency in IUD insertion, and attitudes toward postpartum IUD provision. Results Of 91 providers surveyed, 70 (77%) reported previous training in contraceptive counseling. Fewer than one in three respondents had ever inserted an IUD: 17 (44%) of 39 physicians and 9 (17%) of 52 midwives reported ever having inserted an IUD. A total of 33 (36%) respondents reported that they would recommend an IUD in the immediate postpartum period. Conclusion Although most maternity care providers at KATH had received training in contraceptive counseling, few felt confident in their ability to insert an IUD. Further training in postpartum contraceptive management is needed.

Heterotopic pregnancy, ie, combined intrauterine and extrauterine (ectopic) pregnancy, is a rare clinical entity that may present with acute abdominal catastrophy. Most of cases reported in literature are a consequence of medical or surgical interventions like assisted reproductive techniques, tubal surgeries, intrauterine contraceptive devices, or pelvic inflammatory disease. Heterotopic pregnancy occurring spontaneously is extremely uncommon. We describe the sonographic appearance of spontaneous heterotopic pregnancy with ruptured ectopic tubal pregnancy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Objective To evaluate the use of intrauterine contraceptive devices (IUDs) in nulliparous women compared to their use in parous women.Methods A comparative cross-sectional study was carried out to determine the reasons for removal of IUDs inserted between 1985 and 1996 in a sample of 227 nulliparous women and 2080 parous women. The statistical analysis was performed using the χ2 test; the differences were considered to be significant when p < 0.05.Results The reasons for removal of IUDs in the two groups were: expiry, 49.1% in the nulliparous group vs. 48.2% in the parous group; planned pregnancy, 21.7% vs. 15.4%; accidental pregnancy, 4.8% vs. 6.3%; expulsion, 1.6% vs. 5.1%; pelvic inflammatory disease, 1.6% vs. 1.1%; pain and/or bleeding, 14.5% vs. 10.2%; other, 6.4% vs. 6.3%; vasectomy or tubal sterilization, 0% vs. 7%.Conclusion Our data suggest that nulliparity is not a contraindication for the use of an IUD, and that the use of an IUD in nulliparous women is as safe and effective as in parous women.

The purposes of this review are to evaluate the available evidence for the mechanisms of action of copper-impregnated intrauterine contraceptive devices and to describe the informed consent consequences of those mechanisms. The medical literature was reviewed with the use of the Bioethics and Medline databases (1966 to present). Reports that supported or refuted the two major postulated mechanisms (interference with implantation of the fertilized ovum or spermicidal inhibition of fertilization) were assessed for their relative strength and support for the exclusivity of one or the other mechanism. The analysis of the evidence strongly suggests that the contraceptive effectiveness of intrauterine contraceptive devices is achieved by both a prefertilization spermicidal action and a postfertilization inhibition of uterine implantation. Patient informed consent for intrauterine contraceptive device insertion should include a discussion of these mechanisms of actions so as to avoid their use in patients with moral objections to postfertilization contraception.

Intrauterine contraceptive devices (IUDs) have not suffered from the same negative influences in the developing world as in the first world. The method has too many basic advantages to be gainsaid including, most importantly, that it has the lowest lifetime cost of any effective method of contraception, and that user compliance is not an issue once the device is in place. However, the global community is not immune from trends that are seen in selected industrialized countries. Today, better methods of contraception are requested and the discomforts associated with earlier models of IUD, which were once acceptable, are less so today. Faced with the side-effects of oral contraception and the high cost in developing countries, many women who have completed their families undergo surgical sterilization as the only long-term method available to them, notwithstanding severe cultural and economic reservations about doing so. The development of the frameless device is a response to the growing need to develop high-performing, long-acting, reversible and acceptable contraceptives with a high continuation of use and to respond to the urgent need to reverse the legacy of neglect of immediate postabortal family planning.

Although the Yuzpe regimen of emergency contraception is the one most commonly used, there are alternatives. Copper-containing intrauterine devices are very effective and can be inserted for at least 5 days after unprotected intercourse and sometimes longer. They may, however, transmit pre-existing infection into the upper genital tract and cause discomfort when being fitted. Progestogen-only emergency contraception appears, from WHO studies, to be a useful adjunct to current therapies. Mifepristone has been studied in various doses and has been shown to be very effective but is not yet commercially available. Health services should provide a full range of methods including emergency contraception by appropriately trained people in an acceptable environment.

The purpose of the investigation was to compare the 1-year expulsion and efficacy rates of the GYNE-T 380 and the GYNE-T 380 Postpartum intrauterine contraceptive devices when inserted within 10 minutes after expulsion of the placenta in a term pregnancy. The two intrauterine contraceptive devices were identical, except that one was inserted by means of a temporary fundal suspension system and the other was placed directly into the uterine cavity.The study was a multicenter, randomized trial of intrauterine contraceptive devices in which 300 subjects accepted the GYNE-T 380 IUD and 292 subjects the GYNE-T 380 Postpartum IUD in clinics with adequate follow-up.At 1 year the gross cumulative expulsion rate was 13.2 per 100 cases (39 expulsions) with the GYNE-T 380 intrauterine contraceptive device and 16.2 per 100 cases (46 expulsions) with the GYNE-T 380 Postpartum device. There was no significant difference in the rate of expulsion between the two devices at any time during the year. There was one first-year intrauterine pregnancy, which occurred in a subject using the GYNE-T 380 device. The continuation rate for each device was above 80 per 100.The results indicate that both the GYNE-T 380 Postpartum and the standard GYNE-T 380 intrauterine contraceptive devices are safe and effective when inserted immediately after delivery of the placenta.In clinics in Belgium, Chile, and the Philippines, data on 300 healthy, sexually active acceptors of the GYNE- T 380 IUD were compared with data on 292 healthy, sexually active acceptors of the GYNE-T 380 Postpartum IUD in order to compare the 10-year expulsion and efficacy rates of these 2 IUDs when inserted within 10 minutes of delivery of the placenta in a term pregnancy. The IUDs were identical, except that the GYNE-T 380 Postpartum IUD was inserted by a temporary fundal suspension system, while the GYNE-T 380 IUD was inserted directly into the uterus. No perforations occurred. The minimal complications that did occur were the same as those associated with interval IUD insertion: irregular spotting, menorrhagia, and uterine cramping. The rates for IUD discontinuation due to bleeding or pain and for other medical reasons were the same for both copper- releasing IUDs (3%). The removal rate for other medical reasons was less than 1% for each IUD. The only intrauterine pregnancy occurred in a woman using the nonsuspended, standard GYNE-T 380 IUD. The IUD continuation rate was greater than 80% for each IUD. Within each clinic, no statistically significant difference in the IUD expulsion rate existed at any time during the 12-month study period. Overall, the expulsion rates for the 2 IUDs were similar (e.g., at 12 months, 16.2% for GYNE-T 380 Postpartum IUD and 13.2% for GYNE-T 380 IUD). The Philippine clinic had significantly higher 1-year IUD expulsion rates regardless of IUD type than the Chilean clinic (24-32% vs. 5-6%). The Belgian clinic had moderately high 1-year IUD expulsion rates regardless of IUD type (8-16%). The different expulsion rates between clinics suggest differences in techniques used during insertion. These findings show that both IUD types inserted immediately after placental delivery are safe and acceptable. If the techniques associated with the low expulsion rates in Chile can be taught, these IUDs can be a practical, safe, convenient, and acceptable contraceptive method.

The paper describes the cases of 3 female health operators with implanted copper IUDs, developing menometrorrhagia some months after an increase of the working time in a Magnetic Resonance Imaging (MRI) Unit (1.5 T), that progressively disappeared when the previous organization, involving discontinuous work shifts at MRI, was re-established. No known factors possibly related to menometrorrhagia were evidenced in the 3 operators, supporting the hypothesis of a role of the exposure to the electromagnetic fields (EMF) induced by the MRI system in symptoms induction. The possible mechanism remains unsettled, but menometrorrhagia might be triggered by a phlogistic stimulus caused by EMF, possibly the low-frequency currents induced in the wires of the IUD during the movements of the operator inside the static magnetic field generated by the MRI permanent magnet. Until now, the problem of possible interactions between copper IUDs and EMF induced by MRI has been considered in patients undergoing imaging, but the possible risk in MRI Units operators has been largely neglected. To our knowledge, the occurrence of menometrorrhagia is not routinely checked in health surveillance of MRI operators, so these symptoms can pass unnoticed, especially if they are transitory. Therefore, underreporting is rather possible. The cases described here support the need for further research on this topic, especially considering the progressive diffusion of more powerful MRI scanners (3 T and more), and of the interventional magnetic resonance imaging, both potentially involving higher EMF exposures, and a large number of MRI female operators, possibly using IUDs. The possibility that MRI operators with implanted metallic IUDs can be included in the group of “workers at particular risk” according to the EU Directive 2004/40/EC should be considered.

Levonorgestrel-containing intrauterine contraceptive devices may be involved with uterine perforation. The authors note that an experienced gynecological laparoscopist should be able to safely remove an intraperitoneal device without complication., Levonorgestrel-containing intrauterine contraceptive devices, marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc. Australia) are widely used in contemporary gynecology, primarily as an effective method for contraception and for control of menstrual disorders like menorrhagia and dysmenorrhea. In this article, the authors report 2 cases of Mirena migration following intrauterine insertion by general practitioners (family physicians). In the first case, the contraceptive device had moved to the patient's right iliac fossa just anterior to the cecum and, in the second, within the peritoneal cavity close to the left leaf of the diaphragm. Both patients underwent uneventful laparoscopic retrieval of the devices.

A transvaginal Doppler sonographic examination of uterine artery blood flow was performed. Resistance and pulsatility indices were measured in 101 women, 74 of whom were using an intrauterine contraceptive device, and 27 controls, who were not using any contraceptive method. The intrauterine contraceptive device users were divided into three groups: those with normal bleeding (n = 34); those with abnormal uterine bleeding without medication (n = 16); and those with abnormal bleeding corrected with use of prostaglandin inhibitors (n = 24). The resistance and pulsatility values were significantly lower in the group of women using intrauterine contraceptive devices who had abnormal bleeding than in all other groups (P

For several years, intrauterine contraceptive devices have played a prominent role in fertility regulation in some countries. Recent advances made in this field have enhanced the efficacy and reduc...

Missing Intrauterine contraceptive devices can migrate to various regions intra-abdominally. Plain radiography usually confirms that the devise is still within the abdominal cavity, while other specific studies may define its relationship with the organ imaged. This is a case of a Migrated IUCD resulting in urinary symptoms. Nigerian Quarterly Journal of Hospital Medicine Vol. 17 (2) 2007: pp. 67-68

[1] Baessler K, Hewson AD, Tunn R, Schuessler B, Maher CF. Severe mesh complications following intravaginal slingplasty. Obstet Gynecol 2005;106:713–6. [2] Wai CY, Nihira MA, Drewes PG, Chang JS, Siddiqui MT, Hemsell DL. Actinomyces associated with persistent vaginal granulation tissue. Infect Dis Obstet Gynecol 2005;13:53–5. [3] Mali B, Joshi JV, Wagle U, Hazari K, Shah R, Chadha U, et al. Actinomyces in cervical smears of women using intrauterine contraceptive devices. Acta Cytol 1986;30:367–71.

Background 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. Study Design 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. Results 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. Conclusions 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.

Despite its nearly 100-year history, intrauterine contraception is a modern method even in the 21st century and its development is still going on. The aim of innovations is to optimize the contraceptive efficacy and to suppress as much as possible side effects and unwanted events (e.g. menstrual irregularities, expulsion). It is important that this method be made available to all those who could not resort to it earlier (young women, nulligravidae, nulliparae). Currently three areas are more particularly being investigated: (1) flexible, frameless intrauterine implants, (2) levonorgestrel-releasing intrauterine systems, and (3) metal alloy intrauterine devices. Partly relying on the author's own clinical experience and based on the literature of recent years, this article reviews the present state and possibilities with regard to further development of intrauterine contraceptive devices.

We enjoyed reading the article by Moro et al .1 on their case series of the ultrasound-guided retrieval of lost intrauterine contraceptive devices using fine hysteroscopic grasping forceps. Like all contraception clinics we have our share of referrals with lost intrauterine devices (IUDs) and levonorgestrel intrauterine systems (IUSs). We scan all such women first. We then use a thread retriever and/or Spencer Wells artery forceps for blind retrieval as the first step in all cases. When this is unsuccessful we have been performing such retrievals in the outpatient contraceptive clinic setting under intracervical block (2 ml 1% lidocaine at 12 …

Objective Many studies have shown a disappointing periabortion contraceptive uptake. This study investigated whether the provision of dedicated and targeted contraception counselling at the pre-abortion assessment visit can improve the post-abortion contraception uptake. Methods The study comprised a 3-month prospective reaudit of the abortion clinic. Results Of the 104 women seen during the re-audit period, 96% received post-abortion contraception. The majority (73%) of the women chose and received one of the less user-dependent contraceptive methods such as intrauterine contraceptive devices, the intrauterine contraceptive system, the progestogen injectable and subdermal implants. Conclusion It was found that the provision of targeted contraception counselling by a dedicated team during the pre-abortion assessment visit can dramatically improve post-abortion contraception uptake.

The IUCD is considered one of the best methods of contraception in modern times. It has high rates of efficacy and acceptability is easily reversible and only periodic check-ups are necessary. However complications include uterine perforation and displacement of the device. Spontaneous breakage of an intrauterine contraceptive device is a very rare occurrence. This rare complication has to be kept in mind when treating cases of missing intrauterine contraceptive devices. (excerpt)

The dearth of medical personnel trained in Norplant insertion and removal can make it impossible for women to have their Norplant implant removed in rural health centers in developing countries and this situation leads to its prolonged use. The Norplant implant is the fourth most common contraceptive method in Enugu Nigeria after intrauterine contraceptive devices Depo-Provera and barrier methods. The Norplant implant used is the 6-capsule subdermal insert made of soft tubing (Leiras OY Turku Finland). It is inserted in the upper arm for 5 years but some of our clients inadvertently retained it much longer. These patients’ records were reviewed. (excerpt)

There are many potential mechanisms of action for the intrauterine device (IUD), which vary by type of IUD (inert, copper, or hormonal). This paper reviews the evidence for each potential mechanism of action. On the basis of available data for fertilization rates and clinical pregnancy rates, the relative contribution of mechanisms acting before or after fertilization were quantitatively estimated. These estimates indicate that, although prefertilization effects are more prominent for the copper IUD, both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices.

This article examines the presence of dense pinkish-brown flocculent deposits in cervical cytology samples of patients fitted with intrauterine contraceptive devices (IUCDs) specifically the Mirena levonorgestrel releasing intrauterine system (IUS).

The formation of calcified deposits on200 contraceptive intrauterine devices (IUD) was quantitated as a function of time in healthy women, pregnant women, and women with a pathologic lesion. The incrustment formation was significantly enhanced when inflammation occurred, but change could not be observed in cases of pregnancy. The incrustments were analyzed by x-ray diffraction, infrared spectroscopy, x-ray microprobe, and ultramicrochemical stone analysis techniques. Major components and their average w/w percent quantities in the incrustments are as follows: calcium carbonate 75%, apatite 5%, and organic matrix 20%. Earlier hypotheses on the chemical processes of deposit formation are discussed, and a new, ionic mechanism of calcification on IUD surfaces is suggested.Calcium incrustation on the surface of an IUD significantly increases the likelihood of side effects such as bacterial and fungoid infections. The time-dependence of calcification on IUDs and the chemical composition of calcified deposits were investigated in devices removed from more than 200 healthy women with lower abdominal complaints or a planned or accidental pregnancy. A linear relationship was found between the amount of incrustation on plastic IUDs and the duration of IUD use. Incrustment formation was faster when inflammation occurred, presumably as a result of enhanced excretion of incrustment-forming compounds, but pregnancy had no effect on this rate. Deposit formation on copper IUDs was less uniform and proceeded at a slower rate. The incrustments were characterized by x-ray diffraction, infrared spectroscopy, x-ray microprobe, and ultramicrochemical stone analysis techniques. On average, incrustments were composed of calcium carbonate (75%), organic matrix (20%), and apatite (5%). The rate of incrustation depended not only on the size and quality of the IUD, but also on the individual capability of the uterus to produce calcium ions. The growth of incrustments on IUDs can be monitored by noninvasive ultrasonography.

These effects are easily managed, and these devices are safe but underused in developed countries

Objective We sought to demonstrate the usefulness of ultrasonography for the in utero identification of different types of intrauterine contraceptive devices.Methods We used sonography to differentiate among types of intrauterine contraceptive devices.Results Each type of intrauterine contraceptive device had typical sonographic characteristics, in most cases, best demonstrated in the axial plane. Photographs of each type are shown and their sonographic appearance is discussed.Conclusion Sonographic identification of intrauterine contraceptive devices is accurate and specific. Sonography may serve as a useful method for determining the time to change the device and to identify those types that are more prone to complications.