Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder:A case report

BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.

Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

Objective: The aim of this study was to describe the use of the postpartum intrauterine device in the maternity ward of the Ratoma communal medical center in Conakry. Methods: This was a descriptive cross-sectional study carried out between July 1st 2015 and June 30 2016, i.e. a duration of one year. Results: A total of 551 patients received advice on various contraceptive methods. Most of this advice was given in the post-partum period (40.2%) and during antenatal care (39.1%). Of the patients advised, 87 (15.8%) used the intrauterine device. The majority of users (93%) were married and uneducated (63.2%), and 39.1% were poor. The majority (56.3%) of intra-uterine devices were inserted in the immediate post-partum period. The majority of women had no adverse events either during the first six weeks (n = 57;65.5%) or at 3rd months (n = 75;86.2%) or 6th months (n = 76;87.4%) after IUD insertion. Most users remained complication-free throughout the follow-up period (n = 76;87.4% at 6th weeks and 3rd months, and n = 77;88.5% at 6th months). The continuation rate was 89.7% at 6 weeks and 3rd months, and 87.4% at 6th months after insertion. The majority of users (87.0%) were satisfied with the care they received. Conclusion: This study showed very few complications among intrauterine device users, and high continuation and satisfaction rates. The intrauterine device is a long-acting, effective, reversible and safe contraceptive that can be used by most women for birth spacing in Guinea, where women do not regularly visit health facilities.

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

BACKGROUND A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of adenomyosis.CASE SUMMARY Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device(LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Releasing of Cupric Ion of Three types of Copper-bearing Intrauterine Contraceptive Device in Simulated UterineFluid

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

Pre-Clinical Experimental Studies of Indomethacin-Releasing Copper Intrauterine Device

Effects of two types of intrauterine device (IUD) on the prostaglandins and endothelin (ET) in uterus and on the endometrial morphology in rats and rabbits, and Cu 2+ releasing amounts of both IUDs in vitro were observed. The results showed that the inhibiting action of the indomethacin releasing copper IUD (FICu IUD) on the PGI 2 was stronger than that on the TXA 2, the ratio of 6 keto PGF 1α /TXB 2 was reduced with the increase of the doses. There were significant differences between the groups. The FICu IUD could inhibit the rising of the ET level and lighten the endometrial impairment caused by the FCu IUD, and promote copper ion release. It was suggested that indomethacin released by FICu IUD could effectively reduce abnormal uterine bleeding.

Ectopic intrauterine device in the bladder causing cystolithiasis:A case report

BACKGROUND An intrauterine device(IUD)is a commonly used contraceptive among women in China.It is widely used because it is safe,effective,simple,economic,and reversible.Among the possible complications,an ectopic IUD in the bladder is rare.It occurs insidiously,has a long course,is associated with a high risk for injury,and is difficult to treat.CASE SUMMARY A 44-year-old woman was admitted for repeated episodes of urinary frequency,urgency,and dysuria over three months.Laboratory tests revealed significantly elevated urine leukocytes and bacteria.Urine culture suggested colonization with Enterococcus faecalis.Abdominal computed tomography images suggested an abnormally positioned IUD that was protruding into the bladder.Cystoscopy revealed a metallic foreign body with multiple stones on its surface in the left posterior bladder wall.The foreign body measured approximately 1 cm.Hysteroscopy revealed the arm of a V-type metal IUD embedded in the middle and upper sections of the anterior wall of the cervical canal.The majority of the IUD was located in the uterine cavity.Cystoscopy was performed,and a holmium laser was utilized to break the stones attached to the portion of the IUD in the bladder.The IUD was then removed through hysteroscopy.CONCLUSION Ectopic IUDs in the bladder can be diagnosed with thorough imaging and safely removed through cystoscopy or hysteroscopy.

Effect of Domestically-made Levonorgestrel-releasing Intrauterine Device on the Endocrine System and Mensentruation in Monkeys

Effect of domestically-made levonorgestrel-releasing intrauterine device (LNG, release rate: 6 μg/day) on the endocrine system and menstruation in mondeys was investigated. The results showed that the Estradiol (E2) and progesterone (P) levels were significantly decreased 2 ovulatory cycles after iusertion of the devices as compared with those before insertion in 3 monkeys (P>0. 001) ,suggesting an evident ovulation-suppressing effect. In 1 monkey, the E2 and P levels were the same before and after insertion,and expulsion of device was found in the monkey later. The plasma LNG concentration in 3 animals was 493. 69-454. 60 pg/ml and plasma LNG was not detected in 1 monkey. The hormone level returned to normal level after removal of the devices.

Vaginitis in Intrauterine Contraceptive Device Users

Objectives: This study aimed to assess clinical, microbial changes in IUD users and other contraceptive methods in referent to urban health centers in Hamadan city, Iran. Methods: Detailed history and gynecological examination were conducted on women (IUD users, n = 100) or other contraceptive methods (controls, n = 160) in the health centers. Results: Frequencies of the different vaginal pathogens, high indices of infection by bacterial vaginosis (12.0%) candida albicance (7.0%) and low indices of trichomoniasis (5.0%) were found in present study, but none of them in both groups was significant. Menorrhagia was more frequent among women with IUD than that among women without IUD (P < 0.05). A trend of erosion cervix and dysmenorrhea being more frequent among women with IUD was also found (P < 0.05). Conclusions: IUD is the safety in general;however, an increase occurred in the frequency of vaginitis.

Intrauterine contraceptive device appendicitis: A case report

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.

Barriers to Intrauterine Device Use at an University-Based Women’s Clinic

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.

Can We Predict Menorrhagia with Intrauterine Contraceptive Device (IUCD) Insertion?

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.

Postpartum intrauterine device contraception: A review

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.

Intravesical Migration of Intrauterine Device and Calculi Formation 12 Years Post Missing: A Case Report

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.

Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

Objective: 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. Patients and methods: 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. Results and comments: 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 though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: 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.

Com parison betw een Two Techniques Used in Im m ediatePostplacentalInsertion of TCu 380AIntrauterine Device:36-Month follow-up

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.

Role of IL-6 in the contraceptive mechanism of intrauterine device

目的 :探讨血清中白细胞介素 - 6(IL- 6)水平与宫内节育器 (IUD)存在的关系。方法 :采用酶联免疫吸附试验测定 64例置器妇女 (试验组 ,试验组又分为置器出血组和无出血组 ) ,以及60例健康妇女 (对照组 )血清中 IL- 6水平 ,同时测定两组血清中 C-反应蛋白 (CRP)水平。结果 :试验组 64例中有 31例血中 IL- 6水平升高 ,与对照组相比差异显著 (P<0 .0 1 )。但其中置器出血组与不出血组中 IL- 6水平无统计学差异 (P>0 .0 5)。试验组及对照组血清中 CRP检验结果均为阴性。结论 :宫内节育器引起子宫内膜无菌性炎症反应 ,导致部分妇女血清中 IL- 6水平升高。IL-

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system:A case report

BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.

25岁以下未育女性人工流产后即时落实宫内节育器和短效口服避孕药的临床对照观察

目的:观察25岁以下未育女性人工流产后即时放置宫内节育器(IUD)和使用短效复方口服避孕药(COC)的可行性和使用情况。方法:将≤25岁未育早孕自愿要求人工流产的女性作为观察对象,根据其意愿术后放置IUD或使用COC避孕。IUD组148例,COC组204例,随访6个月观察两组的避孕情况。结果:两组均无妊娠发生。IUD组1例因完全脱落而终止使用,终止率为0.7%。COC组术后3月的累积停用率69.1%,6月达92.1%,停用的主要原因是嫌麻烦/不能坚持服药,占31.4%。术后1,3个月的不适主诉率IUD组高于COC组(P<0.010,P<0.001)。结论:≤25岁未育女性人工流产后即时放置IUD或使用COC避孕均可行高效。IUD组6个月续用率高;COC副作用轻,但需加强咨询,提高续用率。

非意愿妊娠女性人工流产后放置吉妮致美IUD效果

目的:探讨非意愿妊娠女性人工流产后放置吉妮致美宫内节育器(IUD)效果.方法:以2021年7月-2022年7月在本院自愿要求人工流产术的未育女性213例,对实行流产后关爱干预,其中选择IUD避孕103例为观察组,未选择IUD避孕方法110例为对照组,问卷调查比较两组干预前后对人工流产危害的知信行,比较流产后性生活恢复时间,随访1年非意愿妊娠及其妊娠原因、人工流产情况.结果:干预前后两组对人工流产危害性知识理论认知、态度信念、行为能力评分均提升(P<0.05),但两组间无差异;干预后观察组性生活恢复时间(3.7±0.1月)晚于对照组(3.2±0.9月),非意愿妊娠发生(8例,7.8%)低于对照组(24例,21.8%)(P<0.05),两组人工流产(0.9%、1.9%)发生无差异,观察组非意愿妊娠原因均为IUD脱落,对照组为避孕措施失败(11例,45.8%)和未避孕或避孕措施使用不正确(13例,54.2%).结论:吉妮致美IUD对降低人工流产后妇女非意愿妊娠有效,但需要重视IUD脱落率问题.

不同非手术治疗方案在子宫腺肌病中的临床效果分析

目的探讨不同非手术治疗方案在子宫腺肌病中的临床效果。方法回顾性分析非手术治疗子宫腺肌病患者临床资料130例,根据主治医师及患者选择治疗方案分为A组(曼月乐组,50例)、B组[促性腺激素释放激素激动剂(GnRHa)+曼月乐组,50例]和C组(地诺孕素组,30例)。观察各组治疗前与治疗后不同时间的子宫体积变化、月经量、痛经症状缓解情况、不良反应发生率及复发率等,评估临床治疗效果。结果治疗后各时间点子宫体积B组均小于A组,A组均小于C组,差异有统计学意义(P<0.05)。治疗后各时间点VAS评分C组均小于A组,差异有统计学意义(P<0.05);治疗后3个月、6个月痛经VAS评分、PBAC评分B组小于A组,差异具有统计学意义(P<0.05);治疗后6个月月经量评分C组小于B组,差异有统计学意义(P<0.05);治疗后12个月、24个月PBAC评分C组小于A组,差异有统计学意义(P<0.05)。不规则流血发生情况C组与A组差异无统计学意义(P>0.05)。结论3组治疗均可以缓解临床症状,但以GnRHa+曼月乐效果最佳。