The risk of inadvertent intrauterine device insertion in women carriers of endocervical Chlamydia trachomatis.

The most important complication attributed to the use of intrauterine device (IUD) is pelvic inflammatory disease (PID), often associated with Neisseria or Chlamydia infection. Consequently, the IUD should not be inserted in women at risk of infection or with symptoms of endocervicitis. To evaluate the effectiveness of such a policy, a systematic investigation of Chlamydia and Neisseria was carried out among 407 contraceptive acceptors. Twenty-seven cases were positive for Chlamydia and none were positive for Neisseria. There were no statistical differences in the proportion of women with and without Chlamydia who had vulvovaginal or cervical signs or symptoms, although twice as many women had pain at pelvic exam in the Chlamydia-infected group. In 29 women in whom infection was clinically suspected, two were found to be infected with Chlamydia. IUD were not inserted in women suspected of having infection, but 19 of 327 IUD acceptors were subsequently found to have a positive Chlamydia test result. Two women returned with symptoms of PID and 17 were asymptomatic, but all were treated. PID was not suspected in any other subject. These results reinforce the need for careful selection of IUD acceptors and for thorough counseling for symptoms of PID and the need for immediate consultation.

Performance of copper intrauterine devices when inserted after an expulsion.

A total of 124 women who re-inserted a TCu-200B intrauterine device (IUD) following an expulsion were followed up for 1 year after the IUD re-insertion. The cumulative expulsion rate at 6 months was 21.7 and 31.4 per 100 women at the end of the first year. Women who expelled the first IUD within the first 3 months of use had a significantly higher expulsion rate with the second IUD. Our conclusion is that women who expelled a copper IUD are at a significantly higher risk of expelling the re-inserted IUD than the first IUD. Health workers must also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.

PIP: Researchers analyzed retrospective data on 124 women aged 16-35 who had experienced spontaneous expulsion of the copper T-200 B IUD and then re-insertion of the same type of IUD at the family planning clinic of the State University of Campinas in Brazil during August 1986-December 1992. They were followed for 12 months after IUD re-insertion. Two senior nurses/midwives and two senior physicians performed 86 and 38 of the IUD re-insertions, respectively. Even though the re-expulsion rate was higher when performed by physicians than nurses (34.2% vs. 26.7%), the difference was not statistically significant. The net cumulative re-expulsion rates at 6 and 12 months were high (21.7% and 31.4%, respectively). There were few removals for medical and personal reasons. The 12-month continuation rate stood at 64.3%. Women who had experienced the first expulsion within 3 months after insertion had a significantly higher re-expulsion rate than those whose first expulsion occurred 3 months after insertion (41% vs. 18%; p 0.001). Both these re-expulsion rates were higher than the expulsion rate during the first period of IUD use in the same family planning clinic (3.1-3.9%). These findings suggest that women who have already experienced expulsion of a copper IUD face a much higher risk of expelling the re-inserted IUD than the first IUD. They also indicate that an expulsion after IUD re-insertion due to an earlier expulsion is more likely to happen than after a re-insertion due to life-span expiration. Providers should perform careful follow-up and adequate counseling to all IUD women who have had an IUD re-inserted after expulsion during the first year. The providers should also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.

The influence of human chorionic gonadotrophin administration upon the next ovarian cycle.

We examined the influence of human chorionic gonadotrophin (HCG), used as an ovulation inducer and/or for supporting the luteal phase, on the next ovarian cycle. Four women received 10,000 IU of HCG at mid-cycle and another four received the same dose plus 1500 IU on the 17th, 19th and 21st days of the cycle. In the menstrual cycle prior to our experiments, venous blood samples were collected and vaginal ultrasound of the ovaries was performed every other day from day 21-28; the same data were also collected on days 1-10 of the experiment cycle. In such a way, control values were obtained. After the administration of HCG, venous blood samples were collected and ultrasound was performed in the same way and on the same days as in the controls. Follicle stimulating hormone (FSH) and luteinizing hormone were determined by radioimmunoassay in all blood samples, and HCG only in samples collected after the experiment. The results showed that only FSH was lower in the late luteal phase after the administration of 10,000 IU of HCG. Follicular diameters were higher during the follicular phase than during the previous cycle only in women who received the low dose of HCG. In addition, one woman presented with detectable HCG in the following ovarian cycle. The use of HCG in the preceding cycle may reduce FSH and develop persistent follicles in the subsequent cycle. We suggest that an ultrasound of the ovaries should be performed before starting a new ovulation induction cycle in a woman who has received HCG in the previous cycle.(ABSTRACT TRUNCATED AT 250 WORDS)