A misplaced intrauterine device: a case report.

A 26-year-old woman consulted our Family Planning Unit because she could not locate the thread of her intrauterine device (IUD), which was placed 16 months earlier. Attempts to remove the IUD under fluoroscopy failed. A hysterography showed the IUD to be in the pelvis away from the uterus. At laparotomy, the IUD was found hidden in the omentum and its removal was done by resection of a piece of the omentum. The patient became pregnant three months later and gave birth to a healthy baby at term.

PIP: This article presents a case report involving a misplaced IUD in a 26-year old woman, para 2. The woman consulted a physician because she could not locate the thread of her IUD, a T-Cu-200 device, which had been inserted 16 months earlier. 3 attempts to remove the IUD under fluoroscopy failed. Hysterography revealed the IUD to be in the pelvis, away from the uterus. At laparotomy, the IUD was located hidden in the omentum and was removed by dissecting a piece of the omentum. Inspection of the uterus failed to reveal a macroscopic defect that could suggest the perforation through which the IUD passed into the pelvis. In addition, histologic examination of the omentum resected showed no reaction to any foreign body. The patient became pregnant 3 month later and gave birth to a healthy infant at term. 3 possible explanations are proposed for the IUD misplacement noted in this case: 1) the uterine perforation during insertion was incomplete, and completed several months later; 2) the perforation happened progressively by imbedding of the IUD in the uterine wall; and 3) the perforation occurred during the first 2 unsuccessful removal attempts (which seems improbable given the lack of recent scar tissue on the uterus). It is recommended that, in cases of misplaced IUDs, the device should be removed by laparoscopy or laparotomy.

[Epidemiologic study of visible congenital malformations in Zaire]. / Etude épidémiologique des malformations congénitales visibles en milieu zaïrois.

This retrospective study over an 11-year period revealed 79 cases of visible congenital malformations in a total of 64,777 deliveries (prevalence 1.2%). No aetiological feature was demonstrated. In contrast to data from the literature, the maternal age most involved was between 20 and 35 years and the pregnancy affected most often appeared to be the first. A past history of malformations and miscarriage was rare and difficult to assess because of the retrospective nature of the study. The commonest special features of the pregnancy were breech presentation (present in almost all cases of cranial abnormalities), foetal distress, dysgravidism and prematurity. The child with an external malformation is often born dead or dying and the organs most affected are the nervous and locomotor systems.

[Illicit abortion, a public health problem in Kinshasa (Zaire)]. / Avortement clandestin, problème de santé publique à Kinshasa (Zaïre).

Illegal (242), therapeutic (6), and spontaneous (836) abortions were treated in the years 1978 to 1979 in the University Clinics in Kinshasa (Zaire). Spontaneous abortions are more common after the age of 20, but their incidence diminishes as parity increases. As a whole, they did not have serious complications. In the illegal group, two categories of high risk women were discovered. The first, characterised in girls under the age of 20 with first or second pregnancies who were unmarried, at school or socially and economically poor. The second group were women of 20 years or more who were married, educated and professionally active. Illegal abortions were performed before the twelfth week of pregnancy, generally by unqualified people. Society seems to tolerate then more or less because only 5% are taken to court. Bleeding, infection, traumatic lesions and 13 maternal deaths show how common complications of illegal abortion were. Both at individual and national levels the cost is high. Sex education, improvement in contraception and revision of the abortion laws are suggested as prophylactic measures towards this public health problem.