[IUD insertion during cesarean section and its most frequent complications]. / DIU transcesárea y sus complicaciones más frecuentes.

A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction.

PIP: 78 women were fitted with copper T 220 IUDs during cesarean deliveries at a Mexican Institute of Social Security hospital in Cardenas, Tabasco, between August 1991 and December 1992 in a study of the suitability of IUD insertion during cesareans. A control group consisted of 74 women undergoing cesarean deliveries who did not have IUDs inserted. The average age was 20.6 years for IUD acceptors and 24.9 years for controls. The average number of pregnancies including the current one was 1.3 for the IUD group and 3.2 for the control group. Average gestational age at the time of delivery was 38.5 weeks for the IUD group and 40.1 weeks for the control group. The indication for cesarean was fetopelvic disproportion for 51.2% of the IUD group and 40.5% of controls. The volume of bleeding was normal for 98.7% of IUD acceptors and all in the control group. The IUD was vaginally removed two hours postpartum in the one IUD acceptor with postpartum hemorrhage. The average duration of bleeding was 23.8 days for the IUD group and 22.0 days for the control group. Pain during the postpartum period was described as light for 91.0% and moderate for 9.0% in the IUD group and as light for 93.2% and moderate for 6.8% in the control group. Four cases of endometritis (5.1%) were observed in the IUD group. Three cases of endometritis and one of abscess of the abdominal incision were observed in the control group, for an overall infection rate of 5.4%. One IUD expulsion occurred on the fifteenth postpartum day, for a rate of 1.28%. The strings could be seen in only 21.7% of cases at the six-week check-up. The IUD was visualized by X-ray for 71.7% at the control visit. IUD insertion did not significantly increase postoperative pain, hospital stay, the volume or duration of bleeding, or frequency of infection. The results suggest that IUD insertion during cesarean is a safe and effective method of fertility control for patients at high reproductive risk.

[Transformation of hepatic adenoma into hepatocellular carcinoma in patients with prolonged use of oral contraceptives]. / Transformação de adenoma hepático em carcinoma hepatocelular em pacientes com uso prolongado de contraceptivo oral.

Liver cell adenomas were relatively rare until the use of oral contraceptives. Most of these tumors have occurred in otherwise healthy young women who have been exposed to oral contraceptives. The treatment of this condition remained controversial for a long time. However, bleeding is still a frequent complication and can lead to a significant mortality rate. The better surgical results in hepatic resection, due to technological advances, has contributed to the indication of surgical management as therapeutic option in hepatic cell adenoma. Some authors believe that liver cell adenomas were potentially premalignant and could degenerate into hepatocellular carcinoma but there is very few well documented reports of this transformation. We report our experience in the management of liver cell adenoma.

PIP: Two cases of hepatic cell adenoma associated with hepatocellular carcinoma in long-term oral contraceptive (OC) users are described. Hepatic cell adenomas are rare benign tumors whose incidence has increased with the use of OCs. They generally occur in women over age 30 who have used OCs for five years or longer. The preferred treatment is currently hepatic resection, which reduces the risk of intraperitoneal hemorrhage leading to death. A 30-year-old woman with a history of 15 years of OC use and a 37-year-old woman with a history of 20 years of OC use underwent diagnostic procedures followed by laparotomy and resection of hepatic cell adenomas. Histologic examination in both cases revealed hepatic cell adenoma with areas of hepatocellular carcinoma in a liver with otherwise normal parenchyma. Although the causal relationship between OC use and hepatic cell adenoma is well accepted, a similar etiologic relationship between OCs and hepatocellular carcinoma has not been definitively established despite anecdotal evidence and some suggestive epidemiological data. Relatively few well documented cases of malignant transformation of hepatic cell adenoma have been published. Many authors believe that hepatic cell adenomas induced by OC use are potentially premalignant, but the mechanism through which the transformation might occur has not been explained. It is likely that nonspecific pharmacological actions as well as actions mediated by hormonal receptors are involved.

A bright future for IUDS: new technology and research trigger expanded interest.

PIP: Refuting research findings on IUDs from the early 1980s, and controversy over the safety of the Dalkon Shield, research published over the past 10 years indicates that modern IUDs are safe and effective for most women. Better understanding of pelvic inflammatory disease (PID) reveals PID to present no more frequently among IUD user selection, insertion, and monitoring techniques are followed. Following such guidelines, and avoiding use in women at high risk for infection from sexually transmitted diseases (STD) will generally provide effective, acceptable, and inexpensive protection against pregnancy. The TCu 380 A IUD has in fact proved to be as effective as injectables or newly- developed hormonal implants. Accordingly, expanded use around the world is encouraged. The IUD has already become the most widely used from of reversible contraceptive with 85 million users in China, developed nations, Indonesia, Mexico, Egypt, and India. China claims 60/85 million users. Family Health International clinical trials involving 10,000 women in 23 developing countries during the period 1985-89, found declining removals due to complications, with increasing rates of method continuation. Women having a baby are ideal candidates for IUD acceptance and insertion. Such women may receive IUD insertion 10 minutes following expulsion of the placenta, while not posing risks to safe breastfeeding. Method drawbacks include the need for trained health professionals in insertion, removal, and follow-up exams over the 1st 3 months following insertion. IUDs also do not protect against STDs.^ieng

[Bilateral tubal pregnancy with intrauterine device -- a case report]. / Gravidez tubaria bilateral em portadora de DIU -- relato de um caso.

PIP: Ectopic pregnancy occurs in Brazil in 1/300 cases. 99% are in the ovarian tubes and are almost always unilateral. The incidence rate for bilateral ectopic pregnancy has been described in literature to be 1/1,580 ectopic pregnancies. The article reports a case history at the maternity hospital of the Federal University in the Minas Gerais region. A 31 year-old leukodermatous patient in December 1980 began using an IUD (Lippes loop), followed by episodes of menorrhagia accompanied by abdominal colics of medium intensity during the following months. After the 3rd cycle menstrual delay occurred with abdominal pains localized mostly in the hypogastrium, but also in the lumbar and anal regions. After the diagnosis of ectopic pregnancy, the IUD was removed, resulting in minor bleeding a few days later. Subsequent ultrasonographic tests exposed a posterior pelvic tumorous mass at the uterus, 5.0x6.5 cm in diameter, and absence of uterine abnormalities, suggesting an ectopic pregnancy on the left. Following a complete physical examination including specular examination of the inner genitals it was decided to perform a diagnostic peritoneoscopy. It revealed an abdominal cavity presenting a large quantity of blood spread diffusely, uterus of normal size, and a cystic mass to the left+-6 cm in diameter apparently with hemorrhagic content. Laparotomy with transversal suprapubic incision was then performed. Final examinations indicated a bilateral tubal pregnancy ruptured on the left. The patient had a normal postoperative period and was discharged from the hospital after 6 days. Diagnosis is generally difficult since the unsuspected opposite tube may be infected and edematized due to bilateral endosalpingitis. For IUD users 2 etiological aspects of tubal pregnancies may be involved: Greater incidence rate of pelvic infection, modified tubal motility altering contractibility and possibly reversal of peristaltic wave. The necessity for examining both tubes when suspecting tubal pregnancy is stressed.^ieng

[In situ IUD and pregnancy. Follow-up of 27 cases]. / Gravidez e DIU in situ. Evolucao de 27 casos.

PIP: 27 pregnant patients with IUDs in situ were diagnosed in health care centers in Belo Horizonte, MG, Brazil. The pregnancies were followed up and analyses of the complications were carried out in 2 groups. Group A consisted of 15 (55.6%) patients that did not have the IUD removed, and Group B consisted of 12 (44.5%) patients that had the IUD removed before the 12th week of pregnancy. 85.2% of the patients were using the Lippes Loop IUD, varying from 1 to 41 months. 48.1% of the patients were in age group 25-29, and 59.2% had between 2 and 3 children. In group A, 53.3% of the patients had spontaneous abortions, comparing with 8.3% in Group B, and 91.7% of the patients in that group had uncomplicated term deliveries. The results showed a significantly higher abortion rate in patients that did not have the IUD removed. The IUD should be removed as soon as possible when pregnancy is confirmed. If it is not possible, the patient should have careful follow-up.^ieng

[Oral contraceptives and cardiovascular diseases morbidity]. / Anticonceptivos orales y morbilidad de enfermedades cardiovasculares.

PIP: A case control study was conducted in Mexican Institute of Social Security hospitals in the Valley of Mexico to determine the relationship between oral contraceptive (OC) use and nonrheumatic cardiovascular disease in Mexican women. The study involved Mexican women between 20-44 years of age residing in the metropolitan Mexico City area and married or in stable union. 28 women hospitalized with confirmed diagnoses of ischemic heart disease, 22 with cerebrovascular accidents, 70 with pulmonary embolism or venous thrombosis, 33 with hypertensive cardiopathy, and 55 with other nonrheumatic heart diseases comprised the 201 cases. The 606 controls were women hospitalized with noncardiovascular acute illnesses who met the same requirements for inclusion or exclusion as the cases. Over 98% of the women in the study had been pregnant at some time. OC users were younger and better educated than nonusers. 30% of OC users and 26% of nonusers were smokers. The relative risk of nonrheumatic cardiovascular disease was 1.22 for past users of OCs, who included women using OCs until 1 month prior to the interview. The relative risk for women using OCs within 30 days of the interview (current users) was 1.24. The relative risk according to the estrogen dose was 1.79 for users receiving 40 mcg or less, but paradoxically doses of over 40 mcg decreased the risk to .75. The risk was 1.35 after 1 year of use of OCs, .96 from 12-18 months of use, and 1.34 after 48 months of use. The relative risk was .95 for ever users of OCs aged 20-29 years, 1.38 for those aged 30-39, and 1.48 for those 40-44. Among current users the relative risks were 1.19 for those aged 20-29, .84 for those aged 30-39, and 3.83 for those aged 40-44. The relative risks for ever users and current users respectively were 1.65 and 2.01 for ischemic heart disease and cerebral vascular accidents; 1.40 and 1.43 for pulmonary embolism and venous thrombosis; .85 and .71 for hypertensive cardiopathy; and 1.09 and 1.91 for other cardiovascular diseases. Users and nonusers of OCs had the same access to medical services. Observed differences in the ages and educational levels of users and nonusers were not a source of bias because cases and controls were paired by age and education. The results demonstrated that Mexican women in the Valley of Mexico who use OCs have a statistically significant elevated risk of developing nonrheumatic cardiovascular disease. In declining order of risk are cerebral vascular accident, ischemic heart disease, and pulmonary embolism and venous thrombosis. The risk is present from the 1st days of OC use and in use of OCs containing less than 40 mcg of estrogen. The risk increases with the age of users but not with smoking.^ieng

[Ectopic pregnancy in the presence of an intrauterine device. Communication of a case and review of the literature]. / Embarazo ectópico en presencia de un dispositivo intrauterino. Comunicación de un caso y revisión de la literatura.

PIP: A rare case of cervical pregnancy in the presence of an IUD is described. A 25-year-old woman with 2 children was treated with injectable hormones for intermittent vaginal bleeding after insertion of an IUD. She was later seen in a health center where removal of the IUD was recommended because of a suspected strangulating endocervical polyp. Uncontrollable hemorrhage during the removal resulted in emergency admittance to the General Hospital of Acapulco and a total hysterectomy and bilateral salpingo-oophorectomy. The postoperative course was uneventful. The case met some of Rubin's criteria for a true cervical pregnancy established in 1911: the uterine cavity was empty, and the site of implantation of the blastocyst was below the internal orifice of the cervix and 1 cm above the external cervical opening. Schneider applied the term cervical pregnancy to all cases in which the pregnancy is "obviously and predominantly" situated in the cervix, whether the placenta extended to the isthmus or the endometrium. No pregnancy of greater than 12 weeks is available for histologic proof because of the growth of the placenta in areas contiguous to the cervix and the effacing effect of the growing ovisac. Numerous etiologic factors for cervical pregnancy have been proposed, of which the 3 finding greatest acceptance have been lack of an adequate endometrium for nidation of the trophoblast, a rapid passage of the egg through the uterine cavity, and a premature closing of the internal opening of the cervix. The frequency of cervical pregnancy has been estimated at 1 in 1000 to 1 in 16,000 pregnancies, but its true frequency is unknown. The case described is of great interest because it occurred with an IUD in place.^ieng

[Pelvic inflammations]. / Inflamaciones pelvianas.

PIP: Pelvic inflammations account for approximately 1/4 of the economic resources expended for maternity care in Chile. The use of IUDs has replaced abortion as the primary cause of pelvic inflammation. Sexually transmitted diseases are increasing but have not yet become a major cause of pelvic inflammations. A retrospective study was conducted of women hospitalized for pelvic inflammations in the septic unit of a hospital in Santiago, Chile, in 1980-83. Among the 313 women admitted with a diagnosis of pelvic inflammation, ages ranged from 17 to 57 and averaged 30.4 years. 11.1% were nulligestes, 25.2% were primiparas, 55.5% were multiparas, and 7.9% were grand multiparas. 45 of the 313 reported an induced abortion prior to the pelvic complication. 126 women (40.2%) reported use of an IUD. 36 women had postpartum infections, and no risk factor was identified for the remainder. The major clinical symptoms were abdominal pain in 67.7%, fever in 48.5%, metrorrhagia in 14.0%, and palpable mass on gynecological examination in 52.3%. Sonography was performed in 92 cases and laparoscopy in 20. Use of laparoscopy increased greatly after the study period and has proven to be extremely valuable in diagnosis. 121 of the 313 patients were treated medically and 192 were treated medically and surgically. The average hospital stay was 8.8 days, with a maximum of 80 days and a minimum of 1 day. The admission diagnosis was incorrect in 138 cases and correct in 175. A purulent acute appendicitis was discovered in 1 patient with a presumed tubo-ovarian abscess. The mortality rate was 1.2%.^ieng

[Analysis of the association between previous contraceptive use and the incidence of cervico-uterine cancer in women from the northern and eastern area of Santiago]. / Análisis de la asociación entre uso previo de anticonceptivos e incidencia de cáncer cervicouterino en mujeres del area norte y oriente de Santiago.

PIP: The case-control method was used to analyze records of 85 women with cervical cancer detected by screening in the northern area of Santiago, Chile, to assess a possible relationship of oral contraceptive (OC) use and cervical cancer. Epidemiologic methods used to assess the association between OCs and cervical cancer were 1st described. Several of the cohort studies failed to provide adequate controls or to take into account the factor of sexual promiscuity. Most of the case control studies found no risk or a slight increase in risk; the study finding the greatest relative risk had inadequate controls. In the present study, 4 controls were sought for each case matched by age, parity, year of examination, and number of previous cytological examinations. The average age was 45.18 for the 85 cases and 44.28 for the 268 controls. The average parity was 3.73 for cases and 3.72 for controls. The average number of previous examinations was 3.46 for cases and 5.79 for controls. At the time of the examinations, 6 cases and 14 controls used OCs, no cases and 1 control used injectables, 24 cases and 118 controls used IUDs, 5 cases and 13 controls used other methods, and 51 cases and 117 controls used no method. No increase in the relative risk of developing cervical cancer was detected among OC users.^ieng

[Endometrial cytology of IUD smears: endometrial reaction study]. / Citologia endometrial de esfregacos de DIU: estudo da reacao endometrial.

PIP: The objective of this research was to ascertain possible abnormal endometrial reactions to the IUD. The Family Planning Clinic of the Gynecology and Obstetrics Department of the Federal University of Minas Gerais, Brazil, used 110 cases from patients with IUDs who used the clinics from July 1981 to December 1982. Pap smears from 102 of these cases were made from material contained on the IUD. Several parameters were used, represented by endometrial cells and associated elements, including the IUD model, the user's age, and the day of the menstrual cycle on which the IUD was removed. The breakdown of endometrial cells was greater in Lippes Loop users than in TCu 200 and Copper 7 users. There was no significant difference in the amount of endometrial cells in the various stages of the menstrual cycle. The large number of cells in 90% of the smears leads to the suggestion that these smears be used for determining exclusion or diagnosis of cancer in the perimenopausal age group when the IUD is removed. A special histiocyte reaction was evident only in Lippes Loop users. A greater frequency of plasmocytes and leukocytes in the pre- and postmenstrual stages should be considered as physiological. A greater frequency of plasmocytes was found in Lippes Loop users, and a smaller frequency of lymphocytes observed from the 8th to 14th days of the menstrual cycle should be considered physiological. The lymphocytes were more frequent in users of the TCu 200 and Copper 7, but not significant enough to suggest the use of medicated IUDs.^ieng

[Intra-uterine contraceptive devices in nulliparous women: a retrospective study]. / Dispositivo intra-uterino na contracepcao de mulheres nuligestas: um estudo retrospectivo.

PIP: The insertion of intrauterine devices (IUDs) in nulliparous women is a controversial subject, with no unanimous opinion on whether or not to use this method. A study was undertaken to analyze retrospectively the complications of the TCu-200 IUD in nulliparous women compared to complications encountered in multiparous women using the same device. In 1982 and 1983, the Family Planning and Human Reproduction Clinic of the UFMG Medical School in Belo Horizonte, Brazil, inserted 114 IUDs in nulliparas. The principle characteristics of the study group were a low socioeconomic condition, regularity of menstrual flow, and absence of vaginal infection at the time of examination. The choice of method was the spontaneous decision of the women. It was noted that nulliparas requested IUD insertion after previous unsatisfactory experience with other contraceptive methods. 56% of the group were single and 38% married. For comparison, 300 records of multiparous TCU-200 IUD users were studied retrospectively. All insertions were made by the same clinic. The racial, social, and economical characteristics were typical of the users of any free family planning service. Among early complications, pain and lipothymia were encountered at an elevated incidence in nulliparous women when compared to multiparas (p0.01). Among late complications, the appearance of vaginal discharge and metrorrhagia were significant when compared to multiparas (p0.05). Pelvic infection and dysmenorrhea, although more frequent in nulliparas, were not statistically significant. The authors concluded that the IUD should not be used as the contraceptive method of 1st choice in nulliparous women, using it only in exceptional situations.^ieng

Prospective experience with a levonorgestrel implant--Norplant.

PIP: The clinical trial of a longacting levonorgestrel implant, Norplant, as a reversible method of contraception in 2 outpatient clinics of 2 hospitals in Colombia, has had very promising results. In almost 400 acceptors, with thus far more than 2600 woman-months, the pregnancy rate has been nil. Results of the 1st 300 cases are summarized, illustrating 2 sites of insertion--the inner region of the left arm and the left scapular region, both of which present some advantages. Secondary effects and other parameters are analyzed, including irregular bleeding and amenorrheas. Finally, some comments are made in relation to site, extraction, acceptability, and future use of the method. (author's) modified^ieng

[Cardiovascular diseases and oral contraception. Study of cases and controls]. / Enfermedades cardiovasculares y anticoncepción oral. Estudio de casos y controles.

PIP: Data on 146 Mexican women aged 20-44 years who were residents of the Mexico City metropolitan area, married or in stable union, and who suffered from nonrheumatic cardiovascular disease, and on 387 controls matched for age, parity, and education were used to study the possible association of nonrheumatic cardiovascular diseases and the use of oral contraceptives (OCs). The women were hospitalized at Mexican Institute of Social Security hospitals between 1979 and 1982. 20 cases had ischemic heart disease, 15 had cerebrovascular accidents, 50 had pulmonary embolism or venous thrombosis, 27 had hypertensive cardiopathy, and 41 had other conditions, primarily arrhythmia, cardiomyopathies, and pericarditis. Among OC users and controls respectively, 1.3% and 2.3% had never been pregnant. 35.0% and 18.6% were aged 20-29 years, 50.0% and 49.0% were 30-39, and 15.0% and 32.4% were 40-44. 25.0% of users and 22.8% of nonusers currently smoked. 60.0% of users and 76.5% of nonusers had primary education or less. The relative risk for nonrheumatic cardiovascular disease was 1.00 for 58 women who had never used OCs, 1.49 for 88 ever-users of OCs, and 1.40 for 26 current users. The relative risk for 10 women using pills with an estrogen dose of 40 mcg or less was 1.60, compared to 1.06 for 11 women with an estrogen dose over 40 mcg. The relative risk was 1.60 for 52 patients using OCs for 12 months or less, 1.13 for 22 patients using them for 13-48 months, and 1.87 for 14 patients using them for over 48 months. Relative risk increased by age and was over 3 times as high for women aged 40-44. The relative risk was 1.55 for 13 OC users who had never smoked, .44 for 2 users who had previously smoked, and 1.51 for 11 users who currently smoked. Considering smoking only, relative risk was 1.00 for 80 women who never smoked, 1.61 for 66 who previously smoked, and 1.45 for 47 who currently smoked. The risk was significantly increased in OC users for ischemic heart disease, cerebrovascular accidents, venous thrombosis, and pulmonary thromboembolism.^ieng

[Injectable contraception using depot progestagens]. / Anticoncepción inyectable con progestágenos de depósito.

PIP: After 20 years of clinical experience, injectable hormonal contraceptives such as norethisterone enanthate (NET) and medroxyprogesterone acetate (MPA) remain one of the most controversial methods currently used for temporary control of fertility in women. Since December 1980 this controversy has been accentuated in Mexico with issuing of regulations by the Secretary of Health and Welfare which initially did not permit promotion of long-acting injectable hormones for contraception purposes, and later, in June 1981, a reconsideration which exclusively authorized use of NET as an injectable contraceptive. Undeniably these official measures and the scientific information, occasionally contradictory, have created confusion about the indications and risks of using these formulations in clinical work. This paper presents an anlysis of the basic pharmacological aspects of long-acting contraceptive progestagens, potential risks for side effects, and some clinical rules for safe use. The authors conclude that injectable contraceptives will continue holding a definite place among hormonal methods of temporary fertility control, particularly with the advent of new administration schemes for NET which have elevated its contraceptive efficacy without appreciably increasing complications. The more rapid metabolism of NET, manifested in the absence of significant effects on body weight, less alteration of the menstrual cycle, and more rapid return of fertility after discontinuation, has considerably increased its popularity, and the possibility exists that with time and an increase in clinical experience, it may replace MPA as the injectable contraceptive of choice. Nevertheless, while investigative studies have not clearly defined the possibilities of potential risk of using these contraceptives, its clinical use must be governed by appropriate selection and careful follow-up of patients.^ieng

Preliminary report on a postpartum CuT 200 study, Santiago, Chile.

An analysis is presented of a study of the Copper-T 200 (CuT 200) intrauterine device at the Barros Luco Hospital in Santiago, Chile. The devices were inserted in 1142 postpartum patients. The expulsion rate was high, 32.1% at 3 months. Of the 372 women who expelled devices, 349 received a replacement CuT 200. The expulsion rate for these reinsertions was 7.7% at 12 months with a continuation rate of 86.4%.

PIP: An analysis is presented of a study of the Copper-T 200 (CuT 200) IUD at the Barros Luco Hospital in Santiago, Chile over the August 16, 1976 June 30, 1978 period. 1142 IUDs were inserted in postpartum women, the majority of whom (96.1%) received their IUDs within 72 hours of giving birth. Data were recorded on standard forms designed to obtain demographic and medical information and were processed by the International Fertility Research Program (IFRP). The CuT 200 used in this study consisted of a plastic T-shaped device with 200 sq mm of copper wire wound around the vertical arm. The mean age of women in this study was 24.0 years; the mean number of live births was 2.4 57 (5.0%) of the women reported having had 1 or more induced abortions. There was no previous incidence of pelvic inflammatory disease (PID) reported by the patients, and none of them showed evidence of inflammation/infection of the genital organs at the time of insertion. There were no complications or complaints reported for women at insertion. There were no complications or complaints reported for women at insertion. 945 (82.7%) patients returned for 1 or more follow-up visits. Cervical perforation was found at follow-up in 2 (0.2%) women, and 9 (0.7%) women were hospitalized during the study period. From this latter group, women were hospitalized because of retained placentas and 2 women because of a perineotomy infection. 4 women were hospitalized for endometritis and 1 for the spontaneous abortion of a pregnancy conceived with the IUD in situ. 158 (13.8%) women were diagnosed as having 1 or more incidents of inflammation/infection. Included among these were 19 (1.7%) cases of adnexitis and 20 (1.8%) cases of endometritis. Dysmenorrhea was reported by 23.7% of the women. Intermenstrual bleeding/pain was reported by 297 (20.0%) of the women and 113 (9.9%) reported intermenstrual spotting. The continuation rate after 1 year was 55.5. The 3 month termination rates were 0.3 for accidental pregnancy, 32.1 for expulsion/displacement, 0.2 for bleeding/pain, and 1.3 for other medical reasons. Most expulsions occurred within 1 month postinsertion. 372 (32.6%) women who received CuT 200s in this study expelled them; 370 of them received a replacement IUD. 349 received a 2nd CuT 200 and 21 received Lippes Loop IUDs. 92.8% of the women who received replacement CuT 200s returned for follow-up and were diagnosed as having 1 or more infections. 19 of the women who expelled their 1st CuT and received a replacement also expelled their 2nd device and had a 3rd CuT 200 inserted. No complications or complaints were reported at insertion for this group. At follow-up 4 women were diagnosed with trichmonas and 1 with an unspecified inflammation/infection. 7 women expelled their IUDs and 1 woman had her IUD removed for other personal reasons.

[Evaluation of a type of biomedicated IUD (model Copper 7 200) in a family planning clinic]. / Avaliacao de um tipo de dispositivo intra-uterino biomedicado (modelo "7 de cobre 200") em uma clinica de planejamento familiar.

PIP: In October 1978, 95 patients were inserted with a model 7 Cu 200 IUD at the Family Planning and Human Reproduction Clinic of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Patients varied in age between 16 and over 40, the great majority being in the age group 21-30, and in parity between 1 and over 4, the majority with parity over 4. Most patients, or 76.19%, had previously used OC (oral contraception); 84 of the original 95 patients were followed up at 1, 6, 12, and 18 months after insertion of the device. Continuation rate was 86.7%; there were 36 cases, or 42.85%, of menstrual disorders, mostly hypermenorrhea; 8.23% of patients complained of pain, and 16.47% of discomfort. There was 1 ectopic pregnancy, or a Pearl index of 0.82%, 12 expulsions, or 9.88% of cases, and 1 case of pelvic inflammatory infection. There was 1 removal for hemorrhage, and 2 removals on request from the patients. Hemoglobin levels were measured in 7 patients before insertion and after 14 months, and changes were not significant. These results show that the device was well tolerated and side effects and complications were minimal.^ieng

[Translocation and inversion of the intrauterine contraceptive device (Author's transl)]. / Translocacao e inversao de dispositivos intra-uterinos.

PIP: This article presents 3 cases in which an IUD had to be removed from the uterine cavity after X-rays and hysterography had shown translocation and inversion of the device. In 2 cases the device was withdrawn after dilatation of the cervix and 1 case laparotomy was necessary. The article also reviews the literature on the subject, and gives some suggestions about IUD insertions.^ieng

[Actinomycosis of the female genital tract]. / Actinomicosis del tracto genital femenino.

PIP: Actinomycosis is a rare infection caused by 2 different types of bacteria. Actinomycosis develops in the mouth, on the face, in the lungs, or in the digestive tract. Abdominal, pelvic, or genital actinomycosis is very rate; up to now there are only 300 cases reported in the published literature. This article presents the 3rd case that ever occurred in Chile. A 27 year-old patient, wearer of a Lippes Loop, was hospitalized for recurrent abdominal pains and for purulent discharges from the vagina. A diagnosis of endometritis and bilateral tubo-ovarian abcess was followed by laparotomy, which revealed an abdominal cavity filled with pus and with necrotic tissues. After extensive laboratory examination actinomycosis was diagnosed and the patient successfully treated with antibiotics. Since 1973 the association between actinomycosis and IUD use has been made several times, although the mechanism of association is not well known. Several types of IUDs have been involved in actinomycosis cases. The disease, which was once fatal in 80% of cases, is today treated with penicillin and tetracycline, and by surgery.^ieng