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
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
Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicit...Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 IUD inserted previously.This is a rare complication and only fourteen previous cases were recorded in the literature.展开更多
AIM: To review the safety(infection, perforation) andefficacy(expulsion, continuation rates, pregnancy) of intrauterine device(IUD) insertion in the postpartum period. METHODS: MEDLINE, Pub Med and Google Scholar were...AIM: To review the safety(infection, perforation) andefficacy(expulsion, continuation rates, pregnancy) of intrauterine device(IUD) insertion in the postpartum period. METHODS: MEDLINE, Pub Med 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 specifically, immediate post placenta period(within 10 min), early post placenta period(10 min to 72 h), and delayed/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 efficacious. 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 significant 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 nonhormonal(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 hormonesecreting 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 benefit 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
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
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
Objective To evaluate the cytotoxicity of six commonly used copper-bearing intrauterine devices (Cu-IUDs) on Chinese hamster ovary (CHO-K1) cells and to investigate the influence of frame, shape and copper surface...Objective To evaluate the cytotoxicity of six commonly used copper-bearing intrauterine devices (Cu-IUDs) on Chinese hamster ovary (CHO-K1) cells and to investigate the influence of frame, shape and copper surface area of Cu-IUDs on cell toxicity.Methods Cu-IUDs were incubated in 10% FBS-DMEM/F12 culture medium at 37 ℃ for 24 h. The extracts were analyzed by flame atomic absorption spectrometer and were then diluted into different concentrations with culture medium. Finally, cytotoxicity of these original and diluted extracts on CHO-K1 cells was detected by cell counting kit-8 (CCK-8) assay.Results The viabilities of cells treated with the original extracts of six Cu-IUDs (TCu220C bulb, TCu220C, GCu220, GCu300, Yuangong Cu270 and Yuangong Ⅱ- 300) were all below 10% and the cupric ion concentrations in these extracts were 28.22 mg/L, 31.80 mg/L, 92.80 mg/L, 99.74 mg/L, 114.90 mg/L and 119.20 mg/L, respectively. After these original extracts were diluted, significant differences in cytotoxicity were exhibited. IUDs with larger copper surface areas (GCu300 and Yuangong Ⅱ-300) showed more cytotoxicity than those with smaller areas (GCu220 and Yuangong Cu270) respectively; When different shapes of Cu-IUDs were compared, TCu220C bulb showed lower cytotoxicity than TCu220C, and GCu300 exhibited higher toxicity than Yuangong Ⅱ-300; TCu220C displayed significantly lower cytotoxicity than GCu220 due to their differences in frames.Conclusion We presented evidence on the cytotoxic effects of copper ions released from Cu-IUDs on CHO-K1 cells and found that shape, frame together with copper surface area of Cu-IUDs had obvious influence on the cytotoxicity.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
The use of copper-containing intrauterine devices(Cu-IUDs)is a safe,effective,and long-term contraceptive method.Here,we review the effects of Cu-IUDs on subsequent pregnancy and the morphology,local coagulation funct...The use of copper-containing intrauterine devices(Cu-IUDs)is a safe,effective,and long-term contraceptive method.Here,we review the effects of Cu-IUDs on subsequent pregnancy and the morphology,local coagulation function,sensitivity to estrogen and progesterone,cell proliferation,and immune response of the endometrium.Studies on the morphology of endometrium indicate that the use of Cu-IUDs can affect the number and binding capacity of estrogen and progesterone receptors in the endometrium and reduce the response of the endometrium to estrogen and progesterone.The use of Cu-IUDs can also affect the proliferation of endometrial cells,suggesting that the aseptic inflammation caused by Cu-IUDs may differ from chronic infectious or noninfectious inflammation;this highlights that the use of Cu-IUDs provides protection against endometrial proliferative diseases.The use of Cu-IUDs increases local endometrial angiogenesis,bleeding tendency,and fibrinolytic activity,which can result in prolonged menstruation or abnormal uterine bleeding.Additionally,the use of Cu-IUDs can cause the infiltration of numerous lymphocytes,monocytes,macrophages,and other inflammatory cells around the endometrial gland and changes in endometrial immune function,immune cell function,and the number and type of immune molecules.Cu-IUD-induced decidual injury significantly increases the invasiveness of trophoblasts,further affecting the aberrant expression of their growth-,angiogenesis-,and invasion-related factors and improving the formation of the placenta.Moreover,the endometrial damage caused by Cu-IUD placement before embryo transfer can improve both clinical pregnancy and live birth rates;however,specific changes in the immune system after Cu-IUD use as well as its effects on future pregnancies require further investigation.展开更多
Objective To determine the pattern of biosocial characteristics of the new IUD acceptors and describe their concerns. Methods This was a retrospective review of records of new IUD acceptors at the University Colleg...Objective To determine the pattern of biosocial characteristics of the new IUD acceptors and describe their concerns. Methods This was a retrospective review of records of new IUD acceptors at the University College Hospital, Ibadan, Nigeria from January to December 2007. Results The age range of subjects was 19 to 49 years with a mean of 33.5 ±% 2.4 years. The commonest source (46.0%) of clientele referral was through the health care providers -doctors and nurse/midwife. Other referral patterns were from friends/ relative (23.5%), media -TV and radio (17.0%), outreach programmes (7.3%), self referral (5.2%) and others -the source was not indicated (1.2%). Of the total participants, only 239 (56.1%) reported for follow-up visits. Majority had at least one visit; about a third had two, while others had three or four and above visits. About 43.2% of those at follow-up visits had complaints. The commonest (37.5%) complaint was menstrual irregularity. Other complaints were cramping abdominal pain (22.2%), vaginal discharge (19.6%), amenorrhoea (10.3%), penile discomfort during sexual intercourse (4.3%), expulsion of IUD (3.8%) and 2.2% of missing IUD. Conclusion This audit shows that new IUD acceptors are largely referred by health care providers and are mainly offered the TCu380A version. Community outreach programmes as alternative strategy is likely to boost the uptake of this particular method in Nigeria.展开更多
In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic sta...In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.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Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 IUD inserted previously.This is a rare complication and only fourteen previous cases were recorded in the literature.
文摘AIM: To review the safety(infection, perforation) andefficacy(expulsion, continuation rates, pregnancy) of intrauterine device(IUD) insertion in the postpartum period. METHODS: MEDLINE, Pub Med 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 specifically, immediate post placenta period(within 10 min), early post placenta period(10 min to 72 h), and delayed/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 efficacious. 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 significant 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 nonhormonal(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 hormonesecreting 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 benefit 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.
基金supported by Public Service Platform of Science and Technology Projects in Data mining of contraceptives monitoring and research of risk assessment model(BM2012062)the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Objective To evaluate the cytotoxicity of six commonly used copper-bearing intrauterine devices (Cu-IUDs) on Chinese hamster ovary (CHO-K1) cells and to investigate the influence of frame, shape and copper surface area of Cu-IUDs on cell toxicity.Methods Cu-IUDs were incubated in 10% FBS-DMEM/F12 culture medium at 37 ℃ for 24 h. The extracts were analyzed by flame atomic absorption spectrometer and were then diluted into different concentrations with culture medium. Finally, cytotoxicity of these original and diluted extracts on CHO-K1 cells was detected by cell counting kit-8 (CCK-8) assay.Results The viabilities of cells treated with the original extracts of six Cu-IUDs (TCu220C bulb, TCu220C, GCu220, GCu300, Yuangong Cu270 and Yuangong Ⅱ- 300) were all below 10% and the cupric ion concentrations in these extracts were 28.22 mg/L, 31.80 mg/L, 92.80 mg/L, 99.74 mg/L, 114.90 mg/L and 119.20 mg/L, respectively. After these original extracts were diluted, significant differences in cytotoxicity were exhibited. IUDs with larger copper surface areas (GCu300 and Yuangong Ⅱ-300) showed more cytotoxicity than those with smaller areas (GCu220 and Yuangong Cu270) respectively; When different shapes of Cu-IUDs were compared, TCu220C bulb showed lower cytotoxicity than TCu220C, and GCu300 exhibited higher toxicity than Yuangong Ⅱ-300; TCu220C displayed significantly lower cytotoxicity than GCu220 due to their differences in frames.Conclusion We presented evidence on the cytotoxic effects of copper ions released from Cu-IUDs on CHO-K1 cells and found that shape, frame together with copper surface area of Cu-IUDs had obvious influence on the cytotoxicity.
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.
文摘The use of copper-containing intrauterine devices(Cu-IUDs)is a safe,effective,and long-term contraceptive method.Here,we review the effects of Cu-IUDs on subsequent pregnancy and the morphology,local coagulation function,sensitivity to estrogen and progesterone,cell proliferation,and immune response of the endometrium.Studies on the morphology of endometrium indicate that the use of Cu-IUDs can affect the number and binding capacity of estrogen and progesterone receptors in the endometrium and reduce the response of the endometrium to estrogen and progesterone.The use of Cu-IUDs can also affect the proliferation of endometrial cells,suggesting that the aseptic inflammation caused by Cu-IUDs may differ from chronic infectious or noninfectious inflammation;this highlights that the use of Cu-IUDs provides protection against endometrial proliferative diseases.The use of Cu-IUDs increases local endometrial angiogenesis,bleeding tendency,and fibrinolytic activity,which can result in prolonged menstruation or abnormal uterine bleeding.Additionally,the use of Cu-IUDs can cause the infiltration of numerous lymphocytes,monocytes,macrophages,and other inflammatory cells around the endometrial gland and changes in endometrial immune function,immune cell function,and the number and type of immune molecules.Cu-IUD-induced decidual injury significantly increases the invasiveness of trophoblasts,further affecting the aberrant expression of their growth-,angiogenesis-,and invasion-related factors and improving the formation of the placenta.Moreover,the endometrial damage caused by Cu-IUD placement before embryo transfer can improve both clinical pregnancy and live birth rates;however,specific changes in the immune system after Cu-IUD use as well as its effects on future pregnancies require further investigation.
文摘Objective To determine the pattern of biosocial characteristics of the new IUD acceptors and describe their concerns. Methods This was a retrospective review of records of new IUD acceptors at the University College Hospital, Ibadan, Nigeria from January to December 2007. Results The age range of subjects was 19 to 49 years with a mean of 33.5 ±% 2.4 years. The commonest source (46.0%) of clientele referral was through the health care providers -doctors and nurse/midwife. Other referral patterns were from friends/ relative (23.5%), media -TV and radio (17.0%), outreach programmes (7.3%), self referral (5.2%) and others -the source was not indicated (1.2%). Of the total participants, only 239 (56.1%) reported for follow-up visits. Majority had at least one visit; about a third had two, while others had three or four and above visits. About 43.2% of those at follow-up visits had complaints. The commonest (37.5%) complaint was menstrual irregularity. Other complaints were cramping abdominal pain (22.2%), vaginal discharge (19.6%), amenorrhoea (10.3%), penile discomfort during sexual intercourse (4.3%), expulsion of IUD (3.8%) and 2.2% of missing IUD. Conclusion This audit shows that new IUD acceptors are largely referred by health care providers and are mainly offered the TCu380A version. Community outreach programmes as alternative strategy is likely to boost the uptake of this particular method in Nigeria.
文摘In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.