[Response to stress of the MLCu 250 intrauterine device]. / Comportamento a fatica del dispositivo intrauterino MLCu 250.

The study examined the response to stress of a particular type of intrauterine device (MLCu 250) which had already been evaluated due to a supposed tendency to intracavity fragmentation. The study, which was carried out using original equipment specially designed for this experiment, highlights a reduced resistance to mechanical stress in both new IUDs and in those already subjected to several months' use.

[Mechanical resistance of intrauterine devices. Experimental evaluation]. / La resistenza meccanica dei dispositivi intrauterini. Una valutazione sperimentale.

In view of the possible intracavitary breakage of an IUD, an experimental model was created to evaluate resistance to mechanical stress in new IUDs and IUDs which had been used for varying periods (6-12-24 months). The results of the study showed that, in addition to a slight inhomogeneity of the product which is probably due to incorrect industrial manufacturing procedures, there is also a correlation between the risk of breakage and intrauterine ageing which is particularly evident in some IUDS.

The assessment of IUD mechanical resistance: an experimental model.

An experimental model to assess IUD resistance to mechanical fatigue is presented by which the performance of several IUD models has been tested both new and after variable intrauterine use, up to 33 months. According to the results of this study, IUD resistance decreases exponentially with time, and IUD shape apparently affects resistance. Therefore, prolonged intrauterine use apparently increases rupture liability. Moreover, it is suggested that some IUD features can minimize chances of intrauterine rupture and/or fragmentation.

[Vaginitis and vaginosis]. / Vaginiti e vaginosi.

Recently, within the wide subject on vaginal phlogosis a new pathology has been included. Owing to its peculiar characteristics, as it is not to be regarded as a vaginitis in the strict sense of the word, it has been identified as anaerobic bacterial vaginosis. The latter proves to be different from most common vaginitis related pathologies as a result of a series of microbiological and clinical patterns that are widely dealt with in this research. Moreover, the author place special emphasis on the diagnostic and therapeutic aspects of vaginosis.

The adjusted contraceptive score (ACS) improves the overall performance of behavioural and barrier contraceptive methods.

PIP: The Adjusted Contraceptive Score (ACS), a new scoring method that was designed to help health providers and acceptors to select the most appropriate behavioral or barrier contraceptive method, was found to positively affect contraceptive performance. In this study, 100 women who applied to an Italian clinic for contraceptive counseling were administered the ACS and 100 controls also attending the clinic were given conventional contraception counseling. The following methods were available to cases and controls: diaphragm, condom, basal temperature, Billings method, Ogino method, and coitus interruptus. At a follow-up interview 12-15 months after the initial clinic visit, study participants were questioned about the number and type of contraceptive methods they had been using. Cases who were administered the ACS reported a significantly lower number of contraceptive choices at follow-up (150 choices total) compared with at the initial visit (224 choices) or the number reported by controls at follow-up (181 choices). Also recorded among those administered the ACS were reduced use of coitus interruptus and the Ogino method and increased reliance on the diaphragm and basal body temperature. Moreover, the occurrence of pregnancy in the follow-up period was markedly less among women administered the ACS (4.2%) than among controls (10.8%). Use of the ACS thus appears to represent a means of achieving effective fertility control among women who cannot use oral contraceptives or the IUD.^ieng

Intrauterine rupture of the intrauterine device "ML Cu 250": an uncommon complication: presentation of a case.

We have reported on fragmentation on removal of an ML Cu 250. The patient's management is discussed and the possible causes of fragmentation presented, with special reference to the IUD materials and/or design.

PIP: This paper presents a case of fragmentation on removal of an ML Cu 250 IUD. This device, which was introduced in 1974, has been widely and successfully used in multiparous and nulliparous women. The device is built as a small idented crown over a vertical copper-coiled stem. The patient in this case, a 36-year old woman with 3 previous vaginal deliveries, was seen for removal of the device 26 months after insertion. When vaginal extraction was attempted, the nylon string of the IUD broke. Ecotomography and x-rays revealed the IUD to be in a transversal position on the uterine fundus. A hysterectomy was deemed necessary for removal. At 1st effort, only the stem was removed. Further attempts yielded a fragment of the crown. Other fragments were not found after repeated trials. Although shedding of the IUD's copper coil is not uncommon in longterm IUD users, intrauterine fragmentation of the IUD frame is a rare complication. The literature includes 3 other reports of this complication in ML Cu 250 acceptors. This device is thought to be vulnerable to intrauterine fragmentation because of the combined effect of deep adhesions to the endometrium and low resistance points of the device frame. It is hypothesized that the adhesion is dependent on the crown teeth, which become embedded in the endometrial mucosa and determine both stiffness and high resistance to extraction. Comparative resistance trials are currently being conducted on several IUDs. Until the results of these trials become available, selective use and very cautious removal of the ML Cu 250 are advised.