Two modifications of the intrauterine membrane contraceptive device.

The intrauterine membrane (IUM) is an intrauterine contraceptive device designed to be compliant with a range of uterine shapes and sizes and with transient dimensional changes resulting from uterine motility. This compliance was expected to contribute to low rates for removal due to bleeding and pain, but the use of the IUM resulted in heavy bleeding among its early users. Consequently, two modifications of the device were made to decrease bleeding. One group of IUMs was modified by using ethylene vinyl acetate to provide a high level of lateral compliance and another was modified by using a tissue-compatible Hydron coating in order to decrease the inflammatory response of the endometrium. One hundred of each of these modified IUMs were tested along with 100 of the standard IUMs in a double-blind study conducted at the Noi Klinika in Debrecen, Hungary. The findings of this study suggested that these two modifications did not improve the over-all performance of the IUM.

A study on the contraceptive effectiveness of a newly designed IUD "FD-1" in Japan.

PIP: A newly designed IUD, FD-1, was inserted in 671 women for a total of 9624.5 months of use. The IUD is ready-loaded in its insertion so no folding or loading of the IUD before insertion is necessary. The net cumulative termination rates at the end of 23 months using the life-table techniques are as follows: pregnancy 4.0, expulsion 2.1, removal due to bleeding and pain 2.7, other medical reason 0.8, planning pregnancy 1.0, and other personal reason 0.4, per 100 women. This clinical experience has demonstrated that this IUD has a high contraceptive effectiveness with a low expulsion rate and high acceptability.^ieng

History of intrauterine devices.

PIP: The first published paper on actual IUD insertions was made by Dr. Richard Richter in 1909 in Germany. The device he inserted was a ring made of silkworm gut, with 2 ends which protruded from the cervical os enabling him both to check the device and remove it. In the mid 1920s, Ernest Graefenberg the silkworm gut with a coiled metal ring made of an alloy of copper, nickel, and zinc. Although the Graefenberg ring was widely used, it was considered a risky method in continental Europe and in the U.S. As late as 1959, Dr. Alan Guttmacher co-authored a paper in which the IUD was condemned for its ineffectiveness, potential source of infection, and its carcinogenic potential. Since 1960, various kinds of IUDs have been developed, and various organization such as the Population Council showed a renewed interest in IUDs as a contraceptive method. In 1 study of IUD side effects data from 6,450 individuals, there were 10 deaths and 15 instances of intestinal obstruction due to the preforation of the intestine by the device; ectopic pregnancies occurred at 10 times the normal rate; however, the vast majority of 56,000 insertions showed the device was well tolerated. Copper devices, such as the Copper-T, promise an even brighter future for the IUD. It is not yet known how the IUD works, but a promising hypothesis is that it promotes the local formation of prostaglandins.^ieng

The Dalkon Shield controversy. Structural and bacteriological studies of IUD tails.

The recent report of 209 cases of septic spontaneous abortion and 11 maternal deaths in the United States in women using the Dalkon Shield intrauterine device (IUD) raised the question about a possible causal relationship between the IUD and pelvic sepsis. It is essential to determine whether or not this sipsis is unique to the Dalkon Shield or generic to all types of IUDs. Our studies permit the conclusion that the tail of the Dalkon Shield is structurally and functionally different from the tails of the four other IUDs tested. The unique characteristics of the Dalkon tail theoretically could provide a mechanism whereby pathogenic bacteria from the vagina enter the uterine cavity and cause sepsis.

[Reaction of the uterine wall on IUD of abnormal positioning and size]. / Reakce delozní steny na IUD abnormálního ulození a velikosti.

PIP: The reliability of an IUD was examined in 9 women 1-7 days prior to hysterectomy or supracervical amputation of the uterus. An extra large Dana, Dana super, or Dana cor was inserted. All the women complained of hypogastric pains; in 2 cases, the IUD was removed after only a few hours. After the surgery, the uterus was prepared for histological verification of the effects of the IUD. Significant deformation of the uterine wall was found, especially in the region of the cervix and corpus uteri. This was particularly marked with the Dana super, which also caused a rotary deformation. There were changes seen in the IUD itself as well. The results show that an excessively large or incorrectly positioned IUD will cause pronounced deformation of the corpus, uterine cavity and of the cervix with subsequent pains, staining, and expulsion.^ieng

[Experiences with newer types of intrauterine contraceptive devices of Czechoslovak origin]. / Skusenosti s novsimi typmi intrauterinnych teliesok domãceho põvodu.

PIP: 922 women were studied, half using the Dana Super IUD and half using the Dana Super Fix IUD. Of the half using the Dana Super, 1.3% were expelled, 3.7% became pregnant, and 19.7% experienced complications. Of the half using the Dana Super Fix, 1.1% were expelled, none became pregnant, and 9.2% experienced complications. Manipulation of the device was must easier, more efficient, and comfortable for the patient with the Dana Super Fix.^ieng

[Nomenclature of intrauterine devices]. / Nomenclature des dispositifs intra-utérins.

PIP: This review lists 41 of the IUDs used worldwide in chronological order, accompanied by a few comments on development, composition or efficacy, without touching on drawbacks, of each model. Many are illustrated. The models included are: Richter silver rings (1909), Ota steel ring (1934), Hall-Stone ring (1962), Margulies sprial, Lippes loop, Birnberg bow, Zipper ring (Chile), Ahmed Ragab ring (Cairo), Antigon (Denmark), Schroeder (Sweden), Comet (U.S.), wing (Japan), Y (Japan), Majzlin steel spring (U.S.), Soonawala (India), Szontagh ring (Hungary), Yusei ring (Japan), Ahmed triangle (U.S.), Appleby (England, Holland), Marco butterfly (U.S.), Dana Super and Special bows (Czechoslovakia), Baudeloque, Spria ring (Japan), Beogradska spirala (Yugoslavia), Makhlouf (Egypt), Pathfinder ring (U.S.), heart (Boston), Saf-T-Coil (U.S.), M Pharmatex, in Rislan polyamide (France), Omega (Switzerland), Cohen Corolle (Paris), Dalkon shield, Steel ring, Zipper 7, Cooper T, Tatum T, Hall triangle, Davis icon, Marco Lem, Chaft M, and Burdick shamrock.^ieng