Objective To compare the cupric ion releasing in vitro o.f the three IUDs. Methods The stability o.f cupric ion releasing o.f IUDs including TCu 380.4 IUD (TCu 380A), Multiload Cu375 IUD (MCu 375) and Yuangong 365...Objective To compare the cupric ion releasing in vitro o.f the three IUDs. Methods The stability o.f cupric ion releasing o.f IUDs including TCu 380.4 IUD (TCu 380A), Multiload Cu375 IUD (MCu 375) and Yuangong 365 copper-bearing indomethacin-releasing IUD (Yuangong 365) by the determination of cupric ion releasing in simulated uterine fluid. The simulated uterine fluid was used for releasing media. Copper ion was determined by flame atomic absorption spectrometer. Results The cupric ion releasing of three IUDs were instable at the beginning and tend to be stable gradually. In the stable phase, the average level of cupric ion releasing of TCu380A, MCu375 and Yuangong 365 were 4.25±2.71-7.62±6.42 μg, 4.92±1.23 -8.62±3.08 μg and 2.19±0.40-4.68±1.66 μg, respectively. TCu380A had higher instable releasing level than those of Yuangong 365 (P〈0. 05). Conclusion TCu 380.4 and MCu 375 showed a "burst release" during the first few days and the.former was of great significance(P〈0.05). The initial cupric ion releasing of Yuangong 365 appeared to be the lowest, followed by MCu375 and TCu380A in a releasing order展开更多
Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforaUon by IUD can involve several neighboring organs. A case of acute appendici...Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforaUon by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 TUD inserted previously. This is a rare complication and only fourteen previous cases were recorded in the literature.展开更多
Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive de...Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive devices. Methods: Three hundred and fifteen women attending gynecology and family planning outpatient clinics in the maternity hospital, Ain Shams University were included in the study. They were classified into three groups, 105 women using IUCD with menorrhagia (group I), 105 women using IUCD without menorrhagia (group II), and 105 normal controls not using IUCD (group III). After excluding local causes for bleeding, blood disease or any medical disorders, transvaginal ultrasound including three dimensional power Doppler (3DPD) ultrasound was done for all women. Right and left uterine artery pulsatility index (PI) and resistance index (RI) were calculated, subednometrial blood flow RI and PI were obtained then 3DPD Vascular indices (VI, FI and VFI) of subendometrial blood flow were obtained for all cases. Statistical analysis was done to compare between the three groups. Results: A significant statistical difference was found as regards subendometrial vascularity indices, while there was no difference as regards bilateral uterine arteries Doppler indices in the three groups. Conclusion: Subendometrial vascularity in cases of menorrhagia with IUCD was markedly higher than in cases without menorrhagia and cases with no IUCD. 3DPD may be used for selection of cases prior to insertion of IUCD.展开更多
AIM: To review the safety (infection, perforation) and efficacy (expulsion, continuation rates, pregnancy) of intrauterine device (IUD) insertion in the postpartum period. METHODS: MEDLINE, PubMed and Google S...AIM: To review the safety (infection, perforation) and efficacy (expulsion, continuation rates, pregnancy) of intrauterine device (IUD) insertion in the postpartum period. METHODS: MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period (within 10 min), early post placenta period (10 min to 72 h), and de-layed/interval period (greater than 6 wk). Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS: IUD insertion in the immediate postpartum (within 10 min of placental delivery), early postpartum (10 min up to 72 h) and Interval/Delayed (6 wk onward) were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal (copper) IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION: IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.展开更多
Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a convenience sample of sub...Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a convenience sample of subjects receiving obstetrical care at a University-Based Women’s Clinic. Eligible women who consented to participate self-administered a 16-question survey during a routine prenatal visit. Descriptive statistics were used to report participants’ demographics and history of contraception use. Additionally, subjects were asked if they would consider IUD use in the future. Results: A total of 160 women participated in this study. The average age of this sample was 24.9 (SD = 6.3). The majority were in low income and low education categories. Only 5% of women reported previous IUD use. 27% of women surveyed desired more information regarding IUD contraception. 19% of participants would consider using an IUD in the future and 25% would consider?IUD in the future if they knew more about them. Insurance and financial constraints were cited as barriers to IUD use. 4% of the sample reported that they had used an IUD previously and were unhappy with it due to pain and discomfort. 18% would not consider an IUD because they had heard about side effects. 68%?of the surveyed sample reported unintended pregnancies. Conclusion: The two most common barriers to IUD use in this patient population was lack of knowledge?and concern about side effects. Increasing patients’ knowledge of IUDs has the potential to increase IUD utilization in this clinic population which reported a 68% rate of unintended pregnancy.展开更多
Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a p...Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.展开更多
Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate pos...Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD insreted by ring forceps. Using Life Table Method and χ 2 test, expulsion and other discontinuation rates were compared at 6, 12, 24, and 36 months post insertion between these two different groups. No uterine perforation, infection or prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events (expulsion, pregnancy, removal for bleeding/pain, etc.) were not statistically significantly different (P>0.05). The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380 A, which appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breast feeding and IUD position in uterine cavity, are also analyzed and discussed in this paper.展开更多
Intraunterine device (IUD) is a safe, effective and feasible method used for reversible contraception worldwide. Transvesical migration of an Intrauterine device (IUD) is a rare complication. We describe a case in who...Intraunterine device (IUD) is a safe, effective and feasible method used for reversible contraception worldwide. Transvesical migration of an Intrauterine device (IUD) is a rare complication. We describe a case in whom initially a plain abdominopelvic radiography demonstrated calcified string of an IUD in a 42-year-old woman with recurrent lower urinary symptoms (LUTS) and urinary tract infection since 2 years earlier. The IUD had been inserted 12 years earlier and 3 years after placement of the IUD, the patient experienced an uneventful pregnancy and a successful delivery. Sonographic images and later on the cystoscopic procedure confirmed the diagnosis of transvesical migration of the IUD. The IUD was removed using cystoscopic procedure, leaving no complication.展开更多
<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions...<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. </span><b><span style="font-family:Verdana;">Results and comments: </span></b><span style="font-family:Verdana;">We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even </span><span style="font-family:Verdana;">though it </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.</span></span></span></span>展开更多
A comparative study was made on the contraception efficacy and safety of the vaginal ring releasing 10mg/day Of progesterone in 160 cases and an intrauterine device,the cOPPer T 380A in 100 cases during lactation.It w...A comparative study was made on the contraception efficacy and safety of the vaginal ring releasing 10mg/day Of progesterone in 160 cases and an intrauterine device,the cOPPer T 380A in 100 cases during lactation.It was found that the contraceptive method is acceptable from 42 to 60 days postpartum.No pregnancy occurred in the copper T 380A IUD users during lactation.Those methods are worth to be recommended because of their contraceptive efficacy and no adverse effects on breastfeeding children.Prenatal care and Family Planning Programe are administered together to raise lactation performance rate,and to decrease induced abortion rate,the health of mothers and children were protected.展开更多
Objective To investigate IUD-related vaginitis in IUD users at the University College Hospital Ibadan, South-western Nigeria.Methods A prospective cohort study in IUD users present with abnormal vaginal discharge at t...Objective To investigate IUD-related vaginitis in IUD users at the University College Hospital Ibadan, South-western Nigeria.Methods A prospective cohort study in IUD users present with abnormal vaginal discharge at the family planning clinic of the University College Hospital, Ibadan was conducted between lOth of October, 2008 and 31st of May 2009. High Vaginal Swabs were taken from the clients for microbiology, culture and drug sensitivity test. Diagnosis of bacterial vaginosis was made based on gram stained vaginal smear using the standard Nugents criteria. Other aetiological agents were identified either on wet preparation or culture using standard techniques. Treatment given was by the family planning nurse, as was the protocol at the family planning clinic.Results Twenty-four IUD users present at the Jamtty ptannmg ctmtc with vaginal discharge were studied. Their ages ranged 28-51 years(38.14 ± 5.9 years), Mean parity was 4.4 ± 1.4, All the women were married and all used CuT 380A. The mean duration of lUCD use was 2.5 years only. Majority (46%) had used it for more than 3 years and most (75%) of the visits were unscheduled. All the clients complained of abnormal vaginal discharge which was copious, watery and foul smelling, or clumpy. Nine users (37.5%) complained of pruritus vulvae, 3 users (12.5%) lower abdominal pain, 1 user (4,2%) dyspareunia and vaginosis was made in 16 (66. 7%) and 1 (4.2%) dysuria. The diagnosis of bacterial vaginal candidiasis in 8 (33.3%). Age less than 40 years, Christianity and IUD use more than 3 years were associated with a higher risk of bacterial vaginosis (OR=1.29, 1.67 and 6.6, respectively), while women above 40 years, Muslims and women with lower educational status had a higher risk of candida-related vaginitis (OR=1.67 and 4.2, respectively). Eight clients (33.3%) were treated for candidiasis with antifungals (3 empirically, and 5 after obtaining results of vaginal swab), 9 (37.5%) were given oral metronidazole, 3 patients were referred to the gynaecological emergency unit on account of abdominal pain and 4 did not return for follow up.Conclusion IUD associated vaginitis is a disturbing condition causing unscheduled visits among IUD users. Bacterial vaginosis and Candidia albicans are major aetiologies in south western Nigeria Ibadan. Persistent discharge is a documented reason for discontinuation of lUD use. Periodic empirical treatment for candidiasis and bacterial vaginosis with antifungals and oral metronidazole is advocated. This may reduce the discomfort caused by IUD-related vaginitis, the risk of PID and other risks exposed to the IUD users and ensure continued use of the IUD.展开更多
Objectives: Determination of influence of direct interview of postpartum women about their awareness and knowledge regarding contraception and modern contraceptive methods. Patients & Methods: 1437 women joined th...Objectives: Determination of influence of direct interview of postpartum women about their awareness and knowledge regarding contraception and modern contraceptive methods. Patients & Methods: 1437 women joined the intervention and underwent evaluation of their knowledge about the concept and methods of contraception. Then, an interview was conducted with each woman to clarify advantages and appropriateness of various contraceptives and the proper time for initiation of contraception. All women were asked to discuss these data with their families and return to give their decision. Study outcomes included evaluation of women’s knowledge about contraception and its modalities, frequency of non-users who accepted to use contraception and is considered as success of the intervention and frequency of requesting each modality of contraception. Results: TV programs and discussion with local health provider, relatives or friends are the main sources of knowledge of primiparas. 182 primiparas had good knowledge and chose the appropriate method of contraception during the 1st session of discussion, and 81 primiparas required >2 sessions to choose the method appropriate for them, while 21 primiparas insisted not to use contraception for an acceptance rate of 92.6% among primipara. Among multiparas, 222 multiparas were non-users, but after discussion 133 couples accepted to use contraception. Thus, 396 non-users had accepted to use contraception for an intervention success rate of 78.3%. Collectively 692 women (52.1%) received IUD and 635 women (47.9%) received hormonal contraception;432 orally (32.6%) and 203 parenterally (15.3%). Conclusion: Ignorance, low financial status and cultural beliefs deleteriously affect knowledge about contraception options and its methods, so direct interview is mandatory. The applied intervention succeeded to replenish women’s knowledge about benefits of using contraception. Primiparas had knowledge about contraception but their knowledge about methods is deficient or hazy. Contraception using IUD is the most acceptable method especially for primiparas.展开更多
Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing ...Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.展开更多
基金This study was supported by National Key Scientific and Technological Project(2004BA720A32)
文摘Objective To compare the cupric ion releasing in vitro o.f the three IUDs. Methods The stability o.f cupric ion releasing o.f IUDs including TCu 380.4 IUD (TCu 380A), Multiload Cu375 IUD (MCu 375) and Yuangong 365 copper-bearing indomethacin-releasing IUD (Yuangong 365) by the determination of cupric ion releasing in simulated uterine fluid. The simulated uterine fluid was used for releasing media. Copper ion was determined by flame atomic absorption spectrometer. Results The cupric ion releasing of three IUDs were instable at the beginning and tend to be stable gradually. In the stable phase, the average level of cupric ion releasing of TCu380A, MCu375 and Yuangong 365 were 4.25±2.71-7.62±6.42 μg, 4.92±1.23 -8.62±3.08 μg and 2.19±0.40-4.68±1.66 μg, respectively. TCu380A had higher instable releasing level than those of Yuangong 365 (P〈0. 05). Conclusion TCu 380.4 and MCu 375 showed a "burst release" during the first few days and the.former was of great significance(P〈0.05). The initial cupric ion releasing of Yuangong 365 appeared to be the lowest, followed by MCu375 and TCu380A in a releasing order
文摘Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforaUon by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 TUD inserted previously. This is a rare complication and only fourteen previous cases were recorded in the literature.
文摘Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive devices. Methods: Three hundred and fifteen women attending gynecology and family planning outpatient clinics in the maternity hospital, Ain Shams University were included in the study. They were classified into three groups, 105 women using IUCD with menorrhagia (group I), 105 women using IUCD without menorrhagia (group II), and 105 normal controls not using IUCD (group III). After excluding local causes for bleeding, blood disease or any medical disorders, transvaginal ultrasound including three dimensional power Doppler (3DPD) ultrasound was done for all women. Right and left uterine artery pulsatility index (PI) and resistance index (RI) were calculated, subednometrial blood flow RI and PI were obtained then 3DPD Vascular indices (VI, FI and VFI) of subendometrial blood flow were obtained for all cases. Statistical analysis was done to compare between the three groups. Results: A significant statistical difference was found as regards subendometrial vascularity indices, while there was no difference as regards bilateral uterine arteries Doppler indices in the three groups. Conclusion: Subendometrial vascularity in cases of menorrhagia with IUCD was markedly higher than in cases without menorrhagia and cases with no IUCD. 3DPD may be used for selection of cases prior to insertion of IUCD.
文摘AIM: To review the safety (infection, perforation) and efficacy (expulsion, continuation rates, pregnancy) of intrauterine device (IUD) insertion in the postpartum period. METHODS: MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period (within 10 min), early post placenta period (10 min to 72 h), and de-layed/interval period (greater than 6 wk). Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS: IUD insertion in the immediate postpartum (within 10 min of placental delivery), early postpartum (10 min up to 72 h) and Interval/Delayed (6 wk onward) were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal (copper) IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION: IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.
文摘Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a convenience sample of subjects receiving obstetrical care at a University-Based Women’s Clinic. Eligible women who consented to participate self-administered a 16-question survey during a routine prenatal visit. Descriptive statistics were used to report participants’ demographics and history of contraception use. Additionally, subjects were asked if they would consider IUD use in the future. Results: A total of 160 women participated in this study. The average age of this sample was 24.9 (SD = 6.3). The majority were in low income and low education categories. Only 5% of women reported previous IUD use. 27% of women surveyed desired more information regarding IUD contraception. 19% of participants would consider using an IUD in the future and 25% would consider?IUD in the future if they knew more about them. Insurance and financial constraints were cited as barriers to IUD use. 4% of the sample reported that they had used an IUD previously and were unhappy with it due to pain and discomfort. 18% would not consider an IUD because they had heard about side effects. 68%?of the surveyed sample reported unintended pregnancies. Conclusion: The two most common barriers to IUD use in this patient population was lack of knowledge?and concern about side effects. Increasing patients’ knowledge of IUDs has the potential to increase IUD utilization in this clinic population which reported a 68% rate of unintended pregnancy.
文摘Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.
文摘Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD insreted by ring forceps. Using Life Table Method and χ 2 test, expulsion and other discontinuation rates were compared at 6, 12, 24, and 36 months post insertion between these two different groups. No uterine perforation, infection or prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events (expulsion, pregnancy, removal for bleeding/pain, etc.) were not statistically significantly different (P>0.05). The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380 A, which appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breast feeding and IUD position in uterine cavity, are also analyzed and discussed in this paper.
文摘Intraunterine device (IUD) is a safe, effective and feasible method used for reversible contraception worldwide. Transvesical migration of an Intrauterine device (IUD) is a rare complication. We describe a case in whom initially a plain abdominopelvic radiography demonstrated calcified string of an IUD in a 42-year-old woman with recurrent lower urinary symptoms (LUTS) and urinary tract infection since 2 years earlier. The IUD had been inserted 12 years earlier and 3 years after placement of the IUD, the patient experienced an uneventful pregnancy and a successful delivery. Sonographic images and later on the cystoscopic procedure confirmed the diagnosis of transvesical migration of the IUD. The IUD was removed using cystoscopic procedure, leaving no complication.
文摘<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. </span><b><span style="font-family:Verdana;">Results and comments: </span></b><span style="font-family:Verdana;">We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even </span><span style="font-family:Verdana;">though it </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.</span></span></span></span>
文摘A comparative study was made on the contraception efficacy and safety of the vaginal ring releasing 10mg/day Of progesterone in 160 cases and an intrauterine device,the cOPPer T 380A in 100 cases during lactation.It was found that the contraceptive method is acceptable from 42 to 60 days postpartum.No pregnancy occurred in the copper T 380A IUD users during lactation.Those methods are worth to be recommended because of their contraceptive efficacy and no adverse effects on breastfeeding children.Prenatal care and Family Planning Programe are administered together to raise lactation performance rate,and to decrease induced abortion rate,the health of mothers and children were protected.
文摘Objective To investigate IUD-related vaginitis in IUD users at the University College Hospital Ibadan, South-western Nigeria.Methods A prospective cohort study in IUD users present with abnormal vaginal discharge at the family planning clinic of the University College Hospital, Ibadan was conducted between lOth of October, 2008 and 31st of May 2009. High Vaginal Swabs were taken from the clients for microbiology, culture and drug sensitivity test. Diagnosis of bacterial vaginosis was made based on gram stained vaginal smear using the standard Nugents criteria. Other aetiological agents were identified either on wet preparation or culture using standard techniques. Treatment given was by the family planning nurse, as was the protocol at the family planning clinic.Results Twenty-four IUD users present at the Jamtty ptannmg ctmtc with vaginal discharge were studied. Their ages ranged 28-51 years(38.14 ± 5.9 years), Mean parity was 4.4 ± 1.4, All the women were married and all used CuT 380A. The mean duration of lUCD use was 2.5 years only. Majority (46%) had used it for more than 3 years and most (75%) of the visits were unscheduled. All the clients complained of abnormal vaginal discharge which was copious, watery and foul smelling, or clumpy. Nine users (37.5%) complained of pruritus vulvae, 3 users (12.5%) lower abdominal pain, 1 user (4,2%) dyspareunia and vaginosis was made in 16 (66. 7%) and 1 (4.2%) dysuria. The diagnosis of bacterial vaginal candidiasis in 8 (33.3%). Age less than 40 years, Christianity and IUD use more than 3 years were associated with a higher risk of bacterial vaginosis (OR=1.29, 1.67 and 6.6, respectively), while women above 40 years, Muslims and women with lower educational status had a higher risk of candida-related vaginitis (OR=1.67 and 4.2, respectively). Eight clients (33.3%) were treated for candidiasis with antifungals (3 empirically, and 5 after obtaining results of vaginal swab), 9 (37.5%) were given oral metronidazole, 3 patients were referred to the gynaecological emergency unit on account of abdominal pain and 4 did not return for follow up.Conclusion IUD associated vaginitis is a disturbing condition causing unscheduled visits among IUD users. Bacterial vaginosis and Candidia albicans are major aetiologies in south western Nigeria Ibadan. Persistent discharge is a documented reason for discontinuation of lUD use. Periodic empirical treatment for candidiasis and bacterial vaginosis with antifungals and oral metronidazole is advocated. This may reduce the discomfort caused by IUD-related vaginitis, the risk of PID and other risks exposed to the IUD users and ensure continued use of the IUD.
文摘Objectives: Determination of influence of direct interview of postpartum women about their awareness and knowledge regarding contraception and modern contraceptive methods. Patients & Methods: 1437 women joined the intervention and underwent evaluation of their knowledge about the concept and methods of contraception. Then, an interview was conducted with each woman to clarify advantages and appropriateness of various contraceptives and the proper time for initiation of contraception. All women were asked to discuss these data with their families and return to give their decision. Study outcomes included evaluation of women’s knowledge about contraception and its modalities, frequency of non-users who accepted to use contraception and is considered as success of the intervention and frequency of requesting each modality of contraception. Results: TV programs and discussion with local health provider, relatives or friends are the main sources of knowledge of primiparas. 182 primiparas had good knowledge and chose the appropriate method of contraception during the 1st session of discussion, and 81 primiparas required >2 sessions to choose the method appropriate for them, while 21 primiparas insisted not to use contraception for an acceptance rate of 92.6% among primipara. Among multiparas, 222 multiparas were non-users, but after discussion 133 couples accepted to use contraception. Thus, 396 non-users had accepted to use contraception for an intervention success rate of 78.3%. Collectively 692 women (52.1%) received IUD and 635 women (47.9%) received hormonal contraception;432 orally (32.6%) and 203 parenterally (15.3%). Conclusion: Ignorance, low financial status and cultural beliefs deleteriously affect knowledge about contraception options and its methods, so direct interview is mandatory. The applied intervention succeeded to replenish women’s knowledge about benefits of using contraception. Primiparas had knowledge about contraception but their knowledge about methods is deficient or hazy. Contraception using IUD is the most acceptable method especially for primiparas.
文摘Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.