Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion / Conhecimento, atitude e prática de médicos brasileiros sobre inserção de dispositivo intrauterino no pós-parto e pós-aborto imediatos

Abstract Objective To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Methods Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. Results One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Conclusion Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

Resumo Objetivo Avaliar o conhecimento, atitude e prática de médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos. Métodos Estudo transversal com inquérito online envolvendo médicos plantonistas de hospitais públicos brasileiros. Os participantes responderam a um questionário anônimo com perguntas fechadas para avaliar seu conhecimento, atitude e experiência sobre a inserção de dispositivos intrauterinos de cobre no pós-parto e pós-aborto imediatos. Resultados Cento e vinte sete médicos de 23 hospitais localizados nas 5 regiões do Brasil preencheram o questionário. A maioria era do sexo feminino (68,5%) e trabalhava em hospitais de ensino (95,3%). O escore médio (desvio padrão) de conhecimento (escala 0-10) foi 5,3 (1,3); apenas 27,6% tiveram escore ≥7,0. A maioria (73,2%) faria inserção de dispositivo intrauterino no pós-parto imediato em si mesma/familiares. Cerca de 42% dos participantes declararam não ter recebido nenhum treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos. Nos últimos 12 meses, 19,7%, 22,8% e 53,5% declararam não ter inserido nenhum dispositivo intrauterino durante uma cesárea, após um parto vaginal ou um aborto, respectivamente. Conclusão A maioria dos participantes tem uma atitude positiva em relação à inserção de dispositivos intrauterinos no pós-parto imediato, porém tem um conhecimento limitado sobre esse método. Uma grande porcentagem dos respondentes não teve treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos e não fez nenhuma inserção desse tipo nos últimos 12 meses. São necessárias estratégias para melhorar o conhecimento, o treinamento e a experiência dos médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos.

Remoção histeroscópica de sistema intrauterino em gestação inicial: revisão de literatura / Hysteroscopic removal of the intrauterine system in early pregnancy: a literature review

Os dispositivos intrauterinos (DIUs) são os métodos contraceptivos reversíveis de longa duração mais utilizados no mundo, apresentando altas taxas de eficácia e segurança. Na presença de gestação, o DIU pode ser retirado com uma leve tração dos fios, quando visíveis. Na impossibilidade de visualização dos fios, há a opção de retirada por histeroscopia, que tem se mostrado segura e eficaz para a retirada de DIU retido na cavidade. Foram pesquisados os termos: "intrauterine device", "pregnancy" e "hysteroscopy". Dos 378 artigos encontrados, foram selecionados 18 artigos que cumpriam os objetivos desta revisão. A presença de DIU durante a gestação se mostra um fator de risco independente para desfechos desfavoráveis como abortamento, corioamnionite, parto prematuro e maior taxa de admissão em unidade de terapia intensiva neonatal. A histeroscopia ambulatorial se mostra uma alternativa segura e eficaz na retirada do DIU no primeiro trimestre.(AU)

Intrauterine devices (IUDs) are the most widely used reversible contraceptive methods in the world, with high rates of efficacy and safety. In the presence of pregnancy, the IUD can be removed by gently traction of the threads, when visible. If the wires cannot be visualized, we have the option of hysteroscopy removal, which has been shown to be safe and effective for the removal of an IUD retained in the cavity. The terms "intrauterine device", "pregnancy" and "hysteroscopy" were searched. Of the 378 articles found, 18 articles were selected that met the objectives of this review. The presence of IUDs during pregnancy is an independent risk factor for unfavorable outcomes such as abortion, chorioamnionitis, premature birth and a higher rate of admission to a neonatal intensive care unit. Ambulatory hysteroscopy is a safe and effective alternative for IUD removal in the first trimester.(AU)

Translocación de dispositivo intrauterino de cobre a vejiga y litiasis vesical secundaria ­ Reporte de caso clínico / Translocation of Copper Intrauterine Device to Bladder and Secondary Vesical Lithiasis ­ Clinical Case Report

El dispositivo intrauterino (DIU), ha sido utilizado en nuestro medio y en el mundo durante muchos años como método anticonceptivo. Una complicación infrecuente posterior a su inserción es la migración fuera del útero. La localización vesical y complicación con la vesicolitiasis, forman parte de las complicaciones asociadas a la migración. Presentamos un caso de migración de un DIU a la vejiga asociado a la formación de un cálculo entorno a ese dispositivo. Se describe el cuadro clínico, los estudios realizados y el tratamient

The intrauterine device (IUD) has been used in our environment and in the world for many years as a contraceptive method. One of the complications is the migration outside the uterus, being the bladder location unusual and much more the secondary bladder stone. We present a case of migration of an IUD to the bladder associated with the formation of a calculus around this foreign body. The clinical record, study and treatment are described.

Sexual function and quality of life in a cohort of brazilian users of two kind of intrauterine contraceptives / Função sexual e qualidade de vida em uma amostra de brasileiras usuárias de dois tipos de contraceptivos intrauterinos

Abstract Objective To compare sexual function and quality of life (QOL) among intrauterine contraceptive (copper-intrauterine device [Cu-IUD] or the 52-mg 20 μg/day levonorgestrel- releasing intrauterine system [LNG-IUS]) users. Methods This was part of a cross-sectional study. Women aged between 18 and 49 years old, in a heterosexual relationship, reporting sexual intercourse in the previous 4 weeks, using Cu-IUD (Group 1) or LNG-IUS (Group 2) responded to a questionnaire with sociodemographic information, to the Female Sexual Function Index (FSFI), to the World Health Organization QOL Questionnaire Abbreviated Version (WHOQOL-BREF), and to a questionnaire about the contraceptive method used. The Student t-test, the Pearson χ2 test or the Fisher exact test, and the Mann-Whitney test were used for the analysis. For the adjusted comparison, we have used the analysis of covariance (ANCOVA). A multiple regression analyzing factors related to FSFI 26.55 was done. Significance was established at p < 0.05. Results A total of 347 women in Group 1 (mean age of 32.3 ± 7.5 years old) and of 298 in Group 2 (mean age of 32.7 ± 6.4 years old) completed the questionnaires.Most women had ≥ 8 years of schooling, were in amonogamous relationship, and had had ≤ 2 pregnancies. A total of 122 Cu-IUD and of 87 LNG-IUS users scored ≤ 26.55 on the FSFI. Significant lower scores in physical, environmental, and overall QOL domains in the WHOQOL-BREF questionnaire were found in Group 1. More women using the Cu- IUD were not satisfied with the method. Conclusion We did not find significant differences in sexual function; there was a lower score in some domains of QOL among women who used the Cu-IUD. It was not possible to ensure that those differences were related to the contraceptive method.

Resumo Objetivo Comparar a função sexual e a qualidade de vida (QV) entre usuárias de contraceptivos intrauterinos (dispositivo intrauterino com cobre [DIU-cobre] ou sistema intrauterino liberador de levonorgestrel [SIU-LNG 52 mg 20 μg/dia]. Métodos O presente estudo foi parte de um estudo de corte transversal. Mulheres com idades entre 18 e 49 anos, em relacionamento heterossexual, relatando relação sexual nas 4 semanas anteriores, utilizando DIU-cobre (Grupo 1) ou SIU-LNG (Grupo 2) responderam ao questionário com informações sociodemográficas, ao Índice de Função Sexual Feminino (IFSF), ao Questionário de QV da Organização Mundial de Saúde, versão abreviada (WHOQOL-BREF, na sigla eminglês), e a umquestionário sobre ométodo contraceptivo utilizado criado para o presente estudo. Os testes t de Student, o teste χ2 de Pearson, o teste exato de Fisher e o teste de Mann-Whitney foram utilizados. A análise de covariância (ANCOVA) foi utilizada para a comparação ajustada. Foi realizada a análise de regressão logística multivariada analisando fatores associados ao IFSF ≤ 26.55. O nível de significância foi p < 0.05. Resultados Um total de 347 mulheres no Grupo 1 (idade média 32,3 ± 7,5 anos) e de 298 no Grupo 2 (idade média 32,7 ± 6,4 anos) completaram os questionários. A maioria das mulheres relatou ≥ 8 anos de escolaridade, estava emrelaçãomonogâmica e teve ≤ 2 gestações. Um total de 122 e de 87 usuárias do DIU-cobre e do SIU-LNG, respectivamente, pontuaram ≤ 26,55 no IFSF. Pontuações significativamente menores nos domínios físico, meio-ambiente e QV geral no WHOQOL-BREF foram encontrados no Grupo 1. Mais mulheres do Grupo 1 estavam insatisfeitas com o método. Conclusão Não encontramos diferenças na função sexual, entretanto havia menores pontuações em certos domínios da QV entre as usuárias do DIU-cobre. Não foi possível afirmar relação dessas diferenças com os métodos.

Uso de dispositivos intrauterinos (DIU) em nulíparas / Use of intrauterine devices (IUDs) in nulliparous women

Objetivo: Avaliar as evidências para o uso de dispositivos intrauterinos (DIUs) em mulheres nulíparas. Métodos: Revisão da lteratura,com seleção de publicações relacionadas ao uso do dispositivo intrauterino de cobre e do sistema intrauterino de levonorgestrel em nulíparas no período entre 1980 e 2018. Resultados: Os DIUs utilizados em nulíparas associam-se à elevada eficácia e segurança, sem riscos adicionais de doença inflamatória pélvica e infertilidade. Não há maior risco de perfurações e expulsões em nulíparas. Os DIUs apresentam boa tolerabilidade, aceitação e continuidade de uso, embora associem-se a maior grau de dor durante a inserção quando comparados ao uso em nulíparas. Conclusão: Os dispositivos intrauterinos são eficazes e seguros para nulíparas,recomendando-se que devam ser incluídos nas opções contraceptivas oferecidas rotineiramente.

O risco de infecções genitais em mulheres usuárias de dispositivo intrauterino / The risk of genital infections in women using intrauterine device

Dispositivos intra-uterinos (DIU) são amplamente usados como método contraceptivo e têm uma possível associação com infecções do trato genital inferior. Objetivo: Avaliar se o uso de DIU está associado com infecções do trato genital e por quais patógenos. Métodos: Revisão sistemática de estudos dos bancos de dados PubMed, Highwire-Stanford e Google Scholar usando as seguintes palavras-chave: "cytology IUD" OR "IUD AND cytology" OR "cytology" OR "cytological techniques" OR "cytological AND techniques" OR "cell biology" OR "cell AND biology". Resultados: Foram encontrados inicialmente 2817 artigos e selecionados 16, que obedeciam os critérios de inclusão. Com base nestes estudos, o microorganismo associado ao uso de DIU e principal causa de doença inflamatória pélvica é o Actinomyces spp. Há risco 14 vezes maior de presença do Actinomyces spp. em usuárias de DIU em relação a não usuárias. No entanto, parece haver uma maior depuração aparente de infecção por Papilomavírus humano (HPV) entre usuárias de DIU de cobre. Conclusão: Há uma associação entre o uso de DIU e algumas infecções genitais, tal como vaginose bacteriana; no entanto, o agente mais evidentemente associado é o Actinomyces spp. Há uma possível maior depuração de infecção por HPV entre usuárias de DIU de cobre.

Intrauterine devices (IUDs) are widely used contraceptive methods that have a possible association with lower genital tract infections. Objective: To assess whether IUD is associated with genital tract infection and which pathogens cause it. Methods: Systematic review of studies in PubMed database, Highwire-Stanford, and Google Scholar using the following keywords: "cytology IUD," OR "IUD AND cytology" OR "cytology" OR "cytological techniques," OR "cytological AND techniques," OR "cell biology," OR "cell" and "biology". Results: Sixteen out of the 2,817 initial articles were selected using the inclusion criteria. On the basis of these studies, the microorganisms that can colonize the IUD, the main acute pelvic inflammatory disease occasioner is Actinomyces spp. There is a risk 14 times greater of the presence of Actinomyces spp. in IUD users than in non-users. However, there would be a higher apparent depuration of human papillomavirus (HPV) infection among copper T users. Conclusion: There is an association between the use of IUD and some genital infections such as bacterial vaginosis; however, more evidently associated with Actinomyces spp. There is a possible higher depuration of infection by HPV among copper T users.

La anticoncepción de emergencia es menos efectiva en mujeres con obesidad / Emergency contraception is less effective in women with obesity

La anticoncepción de emergencia se refiere al uso de medicación o a la inserción de un dispositivo intrauterino de cobre para prevenir el embarazo luego de una relación sexual no protegida o del fallo de un método anticonceptivo, en una mujer que no desea el embarazo. De entre las alternativas farmacológicas del método, se estima que el uso de levonorgestrel prevendría el 50% de los embarazos. A partir de una viñeta clínica, en la cual se describe el caso de una paciente obesa que resultó embarazada luego de utilizar anticoncepción hormonal de emergencia tras una relación sexual no protegida, se realizó una búsqueda bibliográfica para establecer la efectividad del método en pacientes con esta característica (obesidad). La búsqueda identificó un metaanálisis que relacionó al triple la probabilidad de embarazo en pacientes con índice de masa corporal superior a 30 kg/m2 que utilizaron anticoncepción de emergencia hormonal. (AU)

Emergency contraception refers to the use of medication or the insertion of a copper intrauterine device to prevent pregnancy after the occurance of unprotected sex intercourse or failure of a contraceptive method in a woman who does not desire pregnancy. Among the pharmacological alternatives of the method it is estimated that the use of levonorgestrel prevents 50% of pregnancies. From a clinical vignette, in which the case of an obese patient who became pregnant using hormonal emergency contraception after unprotected sex intercourse is described, a literature search was conducted to establish the effectiveness of the method in patients with this feature (obesity). The search identified a metaanalysis that shows an incresed probability (threetimes) of pregnancy in patients with body mass index greater than 30 kg/m2 that used hormonal emergency contraception. Emergency contraception is less effective in women with obesity. (AU)

Dispositivo intrauterino de cobre / Copper intrauterine device

O dipositivo intra-uterino de cobre (DIU) é utilizado há anos como método contraceptivo de longo prazo. É método que não necessita de uso ou lembrança diária pela mulher e apresenta poucos efeitos adversos. É bem tolerado pela maioria das usuárias com baixo índice de descontinuidade. Atua basicamente no útero (endométrio e muco cervical) sendo especialmente indicado nos casos onde não se deve administrar hormônios pelos efeitos sistêmicos. Há alguns poucos efeitos adversos que podem interferir na qualidade de vida de algumas mulheres e o texto apresenta intervenções para minimizar estes efeitos. Tecemos comentários sobre as contraindicações do método. O DIU é um excelente método contraceptivo de longo prazo com poucos efeitos colaterias, desprovido de ação sistêmica e bem tolerado pelas mulheres.(AU)

The copper intrauterine device (IUD) is used for years as long-term contraception. It is a method that does not require use or daily reminder for the woman and has few side effects. It is tolerated by most users with low discontinuation rate. Basically, acts in the uterus (endometrium and cervical mucus) being especially suitable in cases where it should not be administered hormones for systemic effects. There are a few side effects that can affect the quality of life of some women, and the text presents interventions to minimize these effects. We made comments about the contraindications of the method. The IUD is an excellent long-term contraception with few side-effects, devoid of systemic action and well tolerated by women.(AU)

Controvérsias acerca do dispositivo intrauterino: uma revisão / Controversies about the intrauterine device: a review

O dispositivo intrauterino (DIU) é atualmente o método contraceptivoreversível mais usado no mundo, sobretudo nos países em desenvolvimento, com maior número de usuáriasna Ásia oriental. Entretanto, ainda há controvérsias envolvendo o seu uso. Por esse motivo, consultamos sitescom bancos de dados eletrônicos como Medline, Lilacs, Wholis e Biblioteca Cochrane, sem restrição linguística,à procura de artigos que abordassem controvérsias sobre o DIU e selecionamos 32, os quais foram incluídos napresente revisão. O mecanismo de ação se deve à reação inflamatória, citotóxica, comprometendo a qualidade,viabilidade e a migração do esperma pela ação do DIU com cobre sobre o muco cervical. A inserção imediatamenteapós uma gestação apresenta várias vantagens, como prevenção de gravidez indesejada, porém não há consensose é tão segura e eficaz quando comparada à inserção fora desse período. O uso profilático de antibióticos nãodiminui o risco de infecções do trato genital, podendo ser indicada para mulheres que vivem em regiões comalta prevalência de doenças sexualmente transmissíveis (DST). Menorragia e dismenorreia são os efeitos colateraismais frequentes referidos pelas usuárias de DIU e as principais causas de sua remoção. O uso de anti-inflamatóriosnão hormonais para tratá-los é motivo de controvérsias na literatura. Sobre o uso de DIU em nulíparas, existemrelativamente poucos estudos na literatura e as conclusões não são seguras. Apesar dos dados sobre adolescentesquanto à segurança, eficácia e aceitação, serem escassos, há pressa no que diz respeito ao uso nesse grupo,tendo em vista a prevenção de gravidez indesejada, tão comum entre elas. As contraindicações são limitadas àgravidez, neoplasias malignas uterinas e efeitos adversos aos componentes do DIU. Apesar de o DIU ser usadohá muitos anos, existe ainda questionamentos de como a fertilidade subsequente é afetada...

The intrauterine device (IUD) is nowadays the most widely used reversiblecontraceptive method in the world, particularly in developing countries, with the highest use in Eastern Asia.Nevertheless, there are still controversies involving its use. For this reason, we searched Medline, Lilacs, Wholisand Cochrane Collaboration databases for articles in any language, addressing controversies about the IUD, selecting 32 for inclusion in this review. The mechanism of action is due to cytotoxic and inflammatory reaction,compromising the quality, viability and sperm migration, by the action of the IUD with cupper on the cervicalmucus. Insertion immediately after a pregnancy ends has several potential advantages, like preventing an unwantedpregnancy. However, there is no consensus if the insertion in this period is as safe and effective as the intervalinsertion. The prophylactic use of antibiotics has not decreased the risk of upper genital tract infection, but itmay be justified for women living in regions with high prevalence for sexually transmitted diseases (STD). Themost frequent side effects reported by users of IUD are menorrhagia and dysmenorrhea, considered the mostcommon reasons for its removal. Non-steroidal anti-inflammatory drugs used for these associated symptoms arecause for controversy in the literature. Concerning the utilization of IUDs in nuliparous women, there are relativelyfew studies in the medical literature and the conclusions are no definitive. There are little data regarding safety,efficacy, and acceptability of IUDs in teenagers. However, this should be countered with the pressing need toprevent unintended pregnancy in this group of women. Contraindications are restricted to pregnancy, malignantuterine neoplasms and adverse effects of the IUD components in the user...

Dispositivo anticonceptivo intraovárico. Presentación de caso / Intraovaric anticonceptive device. Case presentation

Fundamento: los dispositivos intrauterinos no están exentos de complicaciones y al igual que cualquier otro cuerpo extraño implantado en el organismo puede migrar a otra región. Presentación de caso: paciente femenina con antecedentes de implantación de un dispositivo intrauterino (T de cobre) en su área de salud hace seis meses, acude al servicio de cirugía refiriendo dolor intermitente en fosa iliaca izquierda y bajo vientre de varios meses de evolución, además de proctodinia. En el ultrasonido abdominal y ginecológico no se observó la presencia del dispositivo intrautero pero sí hacia la proyección anexial izquierda, en el rayos x de pelvis antero posterior se comprobó la imagen radiopaca del dispositivo intrauterino hacia fosa ilíaca izquierda. Conclusiones: se intervino quirúrgicamente encontrándose dispositivo intrauterino de localización intraovárica y trompa de Falopio de ese lado inflamada y adherida al ovario, realizándosele salpingectomía y ooforectomía izquierda. La paciente evolucionó favorablemente sin complicaciones postoperatorias, se egresó a los cinco días después de terminado el tratamiento antibiótico de la sala de cirugía.

Background: the intrauterine devices are not exempt of complications and as any other foreign body implanted in the organism can migrate to another area. Case presentation: a female patient with a history of an implant of an intrauterine device (copper T) in her health area six months ago comes to the surgery service with an intermittent pain in the left iliac fossa and low abdomen with several months of evolution, besides proctodinia. In the abdominal and gynecological ultrasounds there was no presence of the intrauterine device but towards the left iliac fossa. Conclusions: She had a surgery, finding the intrauterine device of intraovaric and pallopian's tube of that swollen and adhered side to the ovary, carrying out left salpingectomy and oophorectomy. The patient evolved favorably without post-operatory complications. She was released five days after finished the antibiotic treatment of the surgery ward.

Histological study of hysteroscopy guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

The intrauterine device [IUD] is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups: the control group [10 patients], with no past history of IUD insertion, and the IUD group [20 patients], with a history of copper IUD insertion for 6 months to 3 years [subgroup B1] or for more than 3 years [subgroup B2]. Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal

Magnetic Field Interactions of Copper-Containing Intrauterine Devices in 3.0-Tesla Magnetic Resonance Imaging: In Vivo Study

OBJECTIVE: An ex vivo study found a copper-containing intrauterine device (IUD) to be safe for women undergoing an MRI examination at a 3.0-T field. No significant artifacts caused by the metallic implant were detected. However, there are still no in vivo data about these concerns. The aim of this study was to evaluate 3.0-T magnetic field interactions of copper-containing IUDs in vivo. MATERIALS AND METHODS: Magnetic field interactions and potential adverse events were evaluated in 33 women using a questionnaire-based telephone survey. Two experienced radiologists performed artifact evaluation on MR images of the pelvis. RESULTS: Eighteen patients were eligible for the survey. One patient reported a dislocation of the IUD after the MR examination. All other patients had no signs of field interactions. No IUD-related artifacts were found. CONCLUSION: MRI at 3.0-T is possible for women with copper-containing IUDs. However, consulting a gynecologist to check the correct position of the IUD and exclude complications after an MR examination is highly recommended. High-quality clinical imaging of the female pelvis can be performed without a loss in image quality.

Post-placental intrauterine device insertion - A five year experience at a tertiary care centre in north India.

Background & objectives: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective, long-term contraception such as intrauterine device (IUD) in post-partum women. The present study was planned to evaluate the safety and efficacy of immediate post-partum IUD insertion in women delivering vaginally or by caesarian section in a tertiary care centre facility in north India during a period of five years. Methods: The women recruited had CuT 200B insertion immediately after delivery of placenta in vaginal or caesarean delivery. Women having post-partum haemorrhage (PPH), anaemia, pre-labour rupture of membranes >18 h, obstructed labour and distorted uterine cavity by fibroid or by congenital malformation were excluded from the study. The women were followed up at 6 wk and 6 months after delivery. Results: A total of 1317 women were included in the study. Of these, 1037 (78.7%) came for first follow up. The cumulative expulsion rate at the end of 6 months was 10.68 per cent. There was no case of misplaced IUD. Interpretation & conclusions: Although the expulsion rate for immediate post-partum insertion was higher than for interval insertion, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country where women have limited access to medical care.

Levonorgestrel-releasing IUD versus coper IUD in control of dysmenorrhea, satisfaction and quality of life in women using IUD

The levonorgestrel-releasing IUD can help the treatment of dysmenorrheal by reducing the synthesis of endometrial prostaglandins as a conventional treatment. This study was performed to assess the frequency of dysmenorrheal, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper [380-A] IUD. Demographic data, assessment of dysmenorrheal, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Dysmenorrheal significantly was decreased in both groups six months after IUD insertion as compared to the first month [p<0.001]. However, statistically, Mirena reduced dysmenorrheal faster and earlier compared to cupper IUD [<0.003]. There isn't any significant difference between these two groups in satisfaction and quality of life outcomes. There is no difference between these two groups in terms of the satisfaction and quality of life, therefore the usage of Mirena IUD is not a preferred contraception method

Effect of lidocaine gel on pain from copper IUD insertion: A randomized double-blind controlled trial.

Context: Insertion pain or fear of it may make women hesitate to use the intrauterine device (IUD); a long-term, reversible, highly-effective contraception method. Further study has been recommended on the effects of lidocaine (xylocaine) gel on IUD insertion pain in the recent Cochran review. Aims: To determine the effect of lidocaine gel on pain from TCu-380AIUD insertion. Materials and Methods: At a health center in Tabriz, Iran, 96 women were allocated into 3 groups using block randomization with 6 and 9 block sizes considering allocation concealment. In 1 st group, lidocaine 2% gel and in the 2 nd , lubricant gel was placed in the cervical canal 1 minute before an IUD insertion, and the 3 rd group got no intervention. Immediately after IUD insertion, pain during the insertion was measured using 0-10 cm visual analogue scale. Statistical Analysis Used: Kruskal-Wallis and linear regression in SPSS-13 were used to identify effect of lidocaine gel on the pain. Results: Overall, the mean pain score was 3.5 ± 1.8. In univariate analysis, there was no significant difference in pain scores between the 3 groups. Also, results of linear regression model by controlling effect of the possible confounding showed no significant effect of lidocaine gel on the insertion pain. The mean pain score in the lidocaine group was 0.39 less than the no intervention group, but it was not significant (CI 95% of the difference: -1.3, 0.57). Conclusions: Use of 2% lidocaine gel into the cervical canal has no effect on reducing overall pain during IUD insertion.

Preparation and characterization of polyurethane/polyethylene glycol/copper nanocomposite / 生物医学工程学杂志

A novel Cu-IUDs material, PU/PEG/Cu nanocomposite, was prepared by melt blending method with thermoplastic polyurethane (PU) as the matrix, with polyethylene glycol (PEG) as a hydrophilic modifier, and with nanometer particles of copper as active matter instead of copper wire or copper tube. The structure, morphology, mechanical properties, thermal stability and water absorption were investigated by using FT-IR, XRD, SEM and so on. The results indicated that the nanometer particles of copper were uniformly dispersed in the matrix in PU/PEG/ Cu nanocomposites. It can be seen that the water absorption ability of this nanocomposite was obviously improved while mechanical properties and thermal stability were at high levels. These results provided a good basis for the studies on the cupric ions release of the nanocomposites in future.

Laparoscopic removal of a round ligament translocated intrauterine contraceptive device

We report a 24-year-old woman presented to university hospital Amir-Semnan on 10-Jan -2007 with history of lower abdominal pain and spotting after insertion of intrauterine device [copper-T 380A], 1 2 days earlier. On pelvic examination, abdominal ultrasonography, and hysteroscopy the IUCD was not inside the endometrial cavity. A laparoscopy was performed and a small [3-4 mm] perforation was seen in posterior left lateral portion of uterus and another perforation of the left round ligament and the end of one of horizontal arms of the IUCD was visible in the perforated round ligament. IUCD was removed by laparoscopic forceps from perforated left round ligament without any complication

[Comparison of two commonly used IUDs in pain and menstrual bleeding]

The intrauterine device [IUD] is the most widely used reversible method of contraception in the world. One of the most common side effects of intrauterine device is increasing of menstrual blood loss, which may cause discontinuation and iron - deficiency anemia. BY considering the effects of IUD type on menstrual bleeding this study was conducted to compare the side effects of T Cu 380A and Cu safe300 IUDs including bleeding, pain on during 3-month period in clients referring to family planning center of Shahrekord Hajar hospital. This study was a randomized single-blind clinical trial, during which 70 candidates applied for IUD were randomly placed in two groups of IUD T Cu 380A and Cu safe300. The major side effects were recorded in the following 1, 2, 3 months. The comparisons were made using t-test, Mann-Whitney, Chi-Square and Wilcoxon tests by SPSS soft ware. Menstrual bleeding and dysmenorrheal was more commonly occurred during the 3 month of implantation in both groups but bleeding and pain was significantly lower in Cu safe300 group than the other group. With regard in this study showed menstrual blood loss and dysmenorrheal in the 3 months after IUD insertion a in Cu safe300 users were less than T Cu380A users therefore recommending to be possible this kind IUD to distribute in the health centers