Vesico-utero-sigmoid fistula secondary to a migrated intra-uterine contraceptive device to the urinary bladder: A rare urogenital complication

@#Vesico-utero-sigmoid fistula secondary to an encrusted, transmigrated intrauterine contraceptive device (IUCD) to the urinary bladder is a rare urogenital occurrence. Reported here is a case of a 42-year-old female with 13 years of IUCD presenting with a two-year history of terminal dysuria, occasional hematuria and urinary dribbling. In the interim, she complained of persistent wet stools, pneumaturia, fecaluria and occasional urinary incontinence. Imaging revealed an encrusted IUCD with a concomitant vesico-utero-sigmoid fistula. Patient underwent a single setting colonoscopy, vagino-hysteroscopy, cystoscopy with cystostomy and extraction of encrusted foreign body (IUCD), excision and primary repair of vesico-utero-sigmoid fistula was done. The surgery proved successful, greatly improving the patient’s quality of life. This is the first reported case of a vesico-utero-sigmoid fistula caused by a foreign body both in local and international literature.

Complications after post placental insertion of Cu T 380 A in women undergoing caesarean delivery

Background: India is the second most populated country in the world after China with more than a billion people and has highest number of maternal deaths in the world. The aim of the study was to find out the complications after insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra (Rural Medical College) after taking approval of Protocol Review and Institutional Ethics Committee of the Institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: There were no major complications and only minor side effects like pain and fever were observed in 6.25 and 6.90 and 9.37 and 11.11% of women who were admitted electively and in emergency, respectively during follow-up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow-up visit and their visibilities increased with time and at 6 months follow-up in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow-up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.30% at six months post-partum follow-up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Post placental insertion of Cu T 380 A in women undergoing caesarean section was safe and effective method of postpartum family planning, the complaints and complications initially increased but decreased at 6 months follow-up.

Choice of postpartum contraception and its socio-demographic and cultural determinants

Background: Postpartum contraception is essential for avoidance of unwanted pregnancy and for adequate spacing between two pregnancies. There are many socio demographic and cultural factors that influence the choice of contraception in rural community in India. Third trimester of pregnancy is ideal time for counselling the women regarding breast feeding and contraception. The objective of the present study was to find out the choice of postpartum contraception among antenatal women and the socio demographic and cultural determinants that influence this choice.Methods: Six hundred pregnant women were interviewed regarding their choice of postpartum contraception during their antenatal visit in third trimester of pregnancy, using a pre-validated and pre-tested brief questionnaire. The choices were compiled and analysed to draw conclusions.Results: Postpartum sterilization was choice of 30% of multiparous women. Primi-parous women either opted for barrier contraception like condom (10%), intrauterine contraception (9%) or oral steroidal pills (8%). The progesterone injectable contraceptives and centchroman each were chosen by 2% respondents. There was strong influence of education, parity, sex of the living children on the choice of contraception. It was observed that 40% of women did not want to use hormonal pills and intrauterine contraceptives due to strong age old misbelieves associated with them.Conclusions: Women in rural area prefer permanent method of contraception in the form of tubectomy operation after having desired number of children. There is insufficient spacing between pregnancies due to either non-use of contraception or inconsistent use of temporary method of contraception. More than 50% women are dependent on the husband regarding the choice and practice of contraception. The level of education of woman, age at marriage, socio economic class, desired sex combination of children are strong determinants of choice of contraception.

Prospective study on outcome of post-partum intrauterine contraceptive device insertion at tertiary level rural health institute of Gujarat, India

Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partum intrauterine contraceptive device (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion).Methods: This is a prospective study conducted at one of the rural tertiary care teaching institution. A total of 150 patients with caesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures - failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant.Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non-significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.Conclusions: PPIUCD is a safe, effective and long term reversible method of contraception and should be encouraged by public awareness and community acceptance.

Acceptance, safety and complications of postpartum intra uterine contraceptive device: a prospective study in tertiary care hospital

Background: Intrauterine contraceptive device is a long acting, effective and reversible method of contraception. It can be inserted post placental during vaginal or LSCS delivery and within 48 hours of delivery.  This study evaluates the acceptance, safety, side effects and complications associated with immediate post-partum intrauterine contraceptive device (PPIUCD) insertion.Methods: The study was conducted at Hindu Rao Hospital and NDMC Medical College, Delhi for a period of 18 months. Patients admitted and delivered at Hindu Rao Hospital were counseled for PPIUCD, CuT 380 A / CuT 375 insertions and it was inserted within 10 minutes of delivery of placenta during vaginal delivery or LSCS or within 48 hours of delivery. Patients were followed at 6 weeks and then between 6 to 12 months of delivery for continuation, side effects or any complications.Results: After counseling 1253 (9.8%) patients agreed for PPIUCD insertion out of which 650 patients came for follow up. 46% women came for routine follow up while 54.06% came with one or the other complications. Missed thread was most common complications, followed by bleeding P/V and pain abdomen. Expulsion in 5.5% and CuT failure was seen in 0.92% women only. Removal of IUCD was done in 94 patients for one or other reasons. There was retention of PPIUCD in 84.5% while removal was done in 14.5% during period of 6 months to one year follow up. Missed thread was main cause of anxiety among acceptors.Conclusions: Immediate PPIUCD is safe and effective method of contraception with a high retention rate. Though acceptance in initial months was less but it gradually increased over time with increasing awareness, counseling of patients and training of health personnel.

A curious case of missing couplet IUCDs

Intrauterine contraceptive device (IUCD) is one of the most widely used family planning methods. Although considered to be generally safe, it can be associated with problems such as missing IUCD. There have been many reports of isolated missing IUCD but reports of two missing IUCDs in the same patient are very rare. We report the case of a 35-year-old lady with such an occurrence that was diagnosed incidentally on a routine kidney, ureter and bladder (KUB) radiography.

IUCD as a tool in discovering asymptomatic pathology of the lower generative tract of mothers in rural areas

1. 100 IUCD patient is hereby presented2. 32 of the 100 have objective manifestations3. 29 of the 32 have cervical lesions while 3 have vaginal pathologies4. 14 of the 32 had presented subjective manifestations, 8 of the 14 cases are infected and one of the 8 harbors 2 kinds of infections5. Two of the 100 mothers have a second degree perineal lacerations with a sequelae of uretrocystorectoceles6. Simple painting with 1:1000 Ziphiran and cautery plus treating specifically the infections had controlled and cleared the objective as well as the subjective clinical manifestations7. The knee-chest positon have help the urethrocystorectoceles victims. (Summary)