Uterine Cavity-shaped Device Used in China

Objective To assess the effectiveness, side effects, and acceptability of copper uterine cavity - shaped intrauterine devices （UCD） with and without indomethacin. Methods We used electronic search and hand search to identify relevant literatures. Included papers were systematically reviewed according to previous established guidelines. Results A total of 39 related papers were identified. Of them, 9papers were included in this review： 4 associated with medicated or non-medicated UCD200 （containing copper 200 mm^2） and 5 associated with medicated or non-medicated UCD300 （containing copper 300 mm^2）. The contraceptive effectiveness, cumulative one-year and two-year continuation rates＇ were similar between medicated UCD200, non-medicated UCD200 and TCu220C. The effectiveness of non-medicated UCD300 was similar to that of TCu220C and TCu200. The effectiveness of medicated UCD300 was similar to that of MLCu375 and TCu220C but lower than that of TCu38OA. The cumulative one-year, three-year and five-year continuation rates were similar between medicated, non-medicated UCD300 and TCu380A or MLCu375. The problem of bleeding was less common among medicated UCD users than among non-medicated devices. Conclusions Uterine cavity-shaped devices should continue to be used in the National Family Planning Proramme. However, priority should be given to the 300 mm^2 copper containing device. A large multicenter randomized comparative trial of UCD300 and TCu380A is needed.

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

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.

An Investigation on the Utilization of Intra Uterine Contraceptive Device among Women in Kabwe, Central Province

Introduction: Intrauterine contraceptive device (IUCD) is an effective long acting reversible contraceptive but its use is low. This study examined factors contributing to the utilization of intrauterine contraceptive devices (IUCDs) among women in Kabwe Central Province. Methodology: This was an analytical cross sectional study. Primary data was collected from 150 respondents in using simple random sampling method. Data was analysed using the statistical package of social sciences (SPSS) version 22. Chi-square test was used to test associations among the dependent and independent variables. Logistic regression analysis was conducted. The confidence interval was set at 95% and significant level was at 0.05%. Findings: The study found that 44% of the respondents had high level of knowledge about IUCD. About 28% of the respondents, said that they used IUCD because it maintains menstrual bleeding, 26% said that they used because IUCD it does not cause infections, and 19% said that they used IUCD because it does not migrate to other body parts. Majority (81%) of the respondents agreed with a statement that age contributes to underutilization of IUCD. About 77% of the respondents agreed with a statement that marital status contributes to underutilization of IUCD and 75% agreed with a statement that, education level contributes to underutilization of IUCD and was significant. Furthermore, 91% of the respondents agreed with a statement that lack of knowledge about IUCD contributes to underutilization of IUCD and 74% agreed with a statement that religion contributes to underutilization of IUCD. Age (p = 0.003), marital status (p = 0.002), education level (p = 0.003), and employment status (p = 0.02), were found to have a significant relationship with the utilization of IUCD. About 36% of the respondents said that knowledge or education affects the utilization of IUCD at a large extent. The study showed a positive relationship between the utilization of IUCD and all explanatory variables such as age, education/knowledge, marital status, religion, family size and income and acceptability which had a positive correlation ranging from 0.543 to 0.815. Older women with higher education levels were more inclined to use IUCDs compared to younger individuals and those with only a primary education. Religious affiliation influenced IUCD use with Muslim women being less likely to opt for IUCDs. Moreover, being married was associated with lower IUCD utilization. Conclusion: Based on these findings, the study identified age, education/knowledge, marital status, religion, family size and income, and acceptability as the primary drivers of IUCD usage. The study recommends that, there should be a conduct of educational workshops, there should be community awareness programs and there should be comprehensive family Planning Services.

Intra Uterine Device (IUD) Migration into the Bladder. Diagnosis Issues and Management

Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the difficulty of diagnosis. Case Presentation: A 40-year-old woman had a history of IUD implantation after her last delivery. Six years later, she visited a doctor for a pelvic pain going on for a long period. The diagnosis of mislocated intra uterine device (IUD) was made using imaging techniques. Conclusion: A pelvic pain in a woman, going on for a long period, should evoke a migrated IUD. Thorough exploration and management are required.

Evaluation of Insertion with the New Inserter of the Intra-Uterine Device of the Postpartum at the Referral Health Center of Commune II of Bamako, Mali

Background: In Mali, contraceptive prevalence is low, while the unmet need for family planning is very high. Postpartum contraception can help to significantly reduce these unsatisfied needs. The introduction of the intrauterine device (IUD) in the postpartum quickly encountered problems with the type of forceps used to make the insertions (Kelly or Heart forceps), and also their availability at the various health centers. Thus, in 2016, the Population Services International Mali (PSI-Mali) introduced the insertion of the IUD in the postpartum with the new inserter in order to counter this forceps problem and to contribute to guaranteeing the quality of postpartum IUD insertions. Objectives: They were to determine the frequency, the socio-demographic and clinical characteristics and to report the side effects and the complications. Methods: This was a descriptive and analytical cross-sectional study from September 1st 2016 to August 31st, 2018. All deliveries that met the eligibility criteria, having chosen and benefited the postpartum intra-uterine device with the new inserter were included. Results: During the 2 years, we recorded 73 cases of insertion of the postpartum intra-uterine device with the new inserter over 7797 clients meeting of the world health organization’s criteria of medical admissibility for the use of an intra-uterine device with a frequency of 0.93%. They were married in 97% of cases, large multiparous in 48% of cases, aged between 30 and 39 years in 62% of cases. We didn’t notice any complications in 96% of cases. Expulsion with 4% was the only complication. The clients didn’t have any side effects in 98% of cases. Conclusion: The insertion of a postpartum intra-uterine device with the new inserter has supplanted the insertion techniques using forceps in our center because of its ease and speed. Its use is worth being popularized to help reduce the unmet need for family planning.

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.

Foley球囊与宫内节育器在中重度宫腔粘连HEOS冷刀微剪分离术后患者中的应用效果比较

目的:比较Foley球囊与宫内节育器在中重度宫腔粘连HEOS冷刀微剪分离术后患者中的应用效果。方法:选取2020年1月至2023年1月该院收治的80例中重度宫腔粘连患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各40例。两组均行HEOS冷刀微剪分离术治疗,对照组术后给予宫内节育器治疗,观察组术后给予Foley球囊治疗,比较两组临床疗效,治疗前后子宫内膜厚度、子宫容积、子宫动脉血流指标[阻力指数(RI)、子宫动脉搏动指数(PI)]水平,以及再粘连发生率。结果:观察组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),差异有统计学意义(P<0.05);治疗后,两组子宫内膜厚度、子宫内膜容积均大于治疗前,且观察组大于对照组,差异有统计学意义(P<0.05);两组PI、RI水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组再粘连发生率低于对照组,差异有统计学意义(P<0.05)。结论:Foley球囊应用于中重度宫腔粘连HEOS冷刀微剪分离术后患者中可提高治疗总有效率,增加子宫内膜厚度和子宫容积,改善子宫动脉血流指标水平,降低再粘连发生率的效果优于宫内节育器。

Uterine Artery Rupture After Induced Abortion and Extraction of an Intrauterine Device

An intrauterine device （IUD） is a safe, effective, simple, and reversible method tbr birth control, but some women with IUD may still become pregnant. Induced abortion is the main method for termination of pregnancy. If induced abortion is not well-managed in these patients, it may result in serious vaginal bleeding and uterine rupture. We report a case of uterine artery rupture after induced abortion combined with extraction of an IUD. This case highlights the necessity of a standard operation for complicated induced abortion, and the value of interventional therapy, such as uterine artery embolization （UAE）, for controlling serious vaginal bleedit3g.

Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma

Intrauterine contraceptive device （IUCD） is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma.

25岁以下未育女性负压吸宫术后即时放置两种宫内节育器的随机对照观察

目的:观察25岁以下未育女性负压吸宫术后即时分别放置吉妮致美或含药含铜宫型宫内节育器(IUD)的可行性和效果。方法:将自愿要求人工流产的≤25岁未育早孕女性作为观察对象,随机表法分组,分别放置吉妮致美IUD组(195例)和含药含铜宫型IUD组(简称宫药铜组)(196例)。于负压吸宫术后即时放置IUD,随访6个月,观察IUD的使用效果。结果:两组IUD的顺利放置率≥99%。采用生命表法对IUD的终止情况进行分析。两组均无妊娠发生,宫药铜组无脱落相关终止,吉妮致美组脱落相关终止率为2.09/100妇女年,高于宫药铜组(P<0.05)。吉妮致美组因症取出率为0.53/100妇女年,宫药铜组为1.60/100妇女年,但差异无统计学意义(P>0.05)。吉妮致美组和宫药铜组与IUD使用相关的终止率分别为1.60/100妇女年和2.60/100妇女年,两组间差异无统计学意义(P>0.05)。放置IUD后1、3、6个月随访时,吉妮致美组和宫药铜组IUD副作用的主诉率分别为17.3%、13.4%、6.7%和28.7%、29.5%、21.5%,吉妮致美组低于宫药铜组,差异有统计学意义(P<0.01、P<0.001、P<0.001)。结论:年轻未育女性负压吸宫术后即时放置吉妮致美或宫药铜IUD均安全、可行、避孕效果可靠,与宫药铜IUD相比吉妮致美IUD使用后不适主诉更少,需关注放置技术以减少脱落。

中药热奄包联合多功能艾灸仪对剖宫产产妇的影响

目的观察中药热奄包联合多功能艾灸仪对剖宫产产妇的影响。方法采用回顾性研究方法,根据护理方法不同将180例剖宫产产妇分为观察组和对照组,每组各90例。对照组给予快速康复护理,观察组在对照组的基础上使用中药热奄包联合多功能艾条仪,1日2次,持续3d。对比两组产妇术后24~72 h宫缩疼痛、生活自理能力评分、舒适度评分和术后肛门排气时间。结果干预后,观察组术后24-72 h宫缩痛评分均低于对照组(P<0.05);观察组术后24 h生活自理能力评分、舒适度评分虽高于对照组,但无统计学意义(P>0.05),观察组术后48 h、72 h生活自理能力评分和舒适度评分高于对照组(P<0.05);观察组术后肛门排气时间短于对照组(P<0.05)。结论中药热奄包联合多功能艾条仪能够减轻剖宫产产妇的宫缩痛,加速胃肠蠕动,促进肛门排气,提升生活自理能力,改善产妇舒适度。

人工流产术后放置宫内节育器1年停用影响因素分析

目的:调查非意愿妊娠人工流产者术后放置宫内节育器(IUD)停用情况及影响因素。方法:收集2022年1-12月本院收治的人工流产者1035例,均流产术后应用IUD避孕措施,随访1年,观察IUD使用情况并分为停用组(189例)、续用组(846例)。调查IUD停用原因,通过单因素分析及多因素logistic回归分析法分析人工流产者术后落实避孕措施1年内停用危险因素。结果:随访1年,人工流产术后IUD停用189例(18.4%),原因包括不良反应83例、社会心理因素100例、其他原因6例。多因素logistic分析显示,年龄低、无生育史、无重复流产、受教育程度高中及以下为人工流产者术后放置IUD停用的危险因素(OR=1.657、1.669、2.442、1.790,P<0.05)。结论:非意愿妊娠人工流产者术后放置IUD仍存在一定比例的停用情况,影响因素较多,临床需加强术前咨询、术后管理,针对性采取干预对策以提高流产后长效避孕措施的落实使用率。

产后康复治疗仪联合米索前列醇治疗子宫收缩乏力产后出血的临床效果

目的 探讨产后康复治疗仪联合米索前列醇对子宫收缩乏力产后出血的干预效果。方法 74例分娩且产后出现子宫收缩乏力产后出血患者,按照随机数字表法原则分成观察组和对照组,每组37例。对照组患者即刻给予缩宫素联合米索前列醇治疗,观察组则在对照组基础上增加产后康复治疗仪治疗。比较两组患者临床疗效、产后不同时间的阴道出血量、不良反应发生情况。结果 观察组临床总有效率94.59%高于对照组的78.38%,差异有统计学意义(P<0.05)。两组产后4 h阴道出血量比较,差异无统计学意义(P>0.05);两组产后8、12、24 h的阴道出血量均较产后4 h增加,且观察组阴道出血量分别为(322.25±45.56)、(428.56±50.12)、(552.15±56.25)ml,均少于对照组的(401.18±51.18)、(501.12±53.36)、(642.25±62.84)ml,差异具有统计学意义(P<0.05)。观察组不良反应发生率8.11%低于对照组的27.03%,差异有统计学意义(P<0.05)。结论 产后康复治疗仪联合米索前列醇对子宫收缩乏力产后出血的治疗效果明显,能够减少产后出血量,且不良反应发生率低。

神经肌肉刺激治疗仪结合肌筋膜手法+运动康复指导治疗子宫脱垂的临床研究

目的:探讨子宫脱垂患者应用神经肌肉刺激治疗仪结合肌筋膜手法+运动康复指导的效果。方法:选取2021年8月—2023年8月贵州医科大学第二附属医院收治的70例子宫脱垂患者作为研究对象,通过随机数表法将患者分为常规组和观察组,各35例。常规组采取神经肌肉刺激治疗仪行盆底电刺激+电子生物反馈治疗,观察组采取神经肌肉刺激治疗仪结合肌筋膜手法+运动康复指导治疗,比较两组生活质量、炎症因子水平、盆底超声结果、治疗效果、盆底肌功能及尿失禁改善情况。结果:观察组治疗后心理功能、躯体功能、物质生活、社会功能评分、总有效率、盆底肌最大收缩力、持续收缩力高于常规组,转化生长因子β3(TGF-β3)、层粘连蛋白(LN)和松弛素(RLX)水平低于常规组,肛提肌裂孔前后径、横径、面积、膀胱颈角度、旋转角度优于常规组,尿失禁情况优于常规组,差异有统计学意义(P<0.05)。结论:子宫脱垂患者实施神经肌肉刺激治疗仪结合肌筋膜手法+运动康复指导治疗效果显著。

雌二醇凝胶联合米索前列醇在绝经后妇女取环术中的临床效果分析

目的 探讨雌二醇凝胶联合米索前列醇在绝经后妇女取环术中的临床效果。方法 随机选取2022年6月—2023年6月南平市建阳区妇幼保健院行取环术的100例绝经后妇女为研究对象,按照治疗方案分为两组,每组50例。对照组行取环术前予以米索前列醇处理,观察组给予雌二醇凝胶+米索前列醇方案预处理,对比两组宫颈软化效果、手术成功率、手术相关指标以及不良反应发生状况。结果 观察组宫颈软化率、手术成功率均高于对照组,差异有统计学意义(P均<0.05)。观察组取环时间及取环时疼痛评分均优于对照组,差异有统计学意义(P均<0.05)。两组术中出血量比较,差异无统计学意义(P>0.05)。两组患者的不良反应发生率比较(2.00%vs 6.00%),差异无统计学意义(χ^(2)=0.260,P=0.609)。结论 雌二醇凝胶与米索前列醇联合用于绝经后妇女取环术的预处理,能够明显提升宫颈软化效果,减少取环手术时间,提高手术成功率,减轻取环时患者的疼痛状况,且安全性较高。

宫腔镜下子宫中隔切除术后防宫腔粘连方法的探讨

目的探讨子宫中隔患者行宫腔镜子宫中隔切除术(TCRS)后防止宫腔粘连的方法及效果。方法回顾性分析2004年1月～2010年1月在该院门诊宫腔镜中心确诊为子宫中隔并排除其他不孕不育因素的患者共212例实施了TCRS手术,按术后预防宫腔粘连的处理方式分成4组:宫腔内仅放置节育环组(A组),单用雌孕激素序贯治疗组(B组),宫内放置节育器和雌孕激素序贯治疗组(C组),未用任何处理组(D组)。结果在后续随访中,发现14.22%的患者有残余子宫中隔,4.74%有宫腔粘连,经统计学分析组间比较差异均无显著性。在A,B,C,D组患者术后的宫腔粘连发生率分别为7.55%,6.00%,1.92%和3.51%,术后妊娠率分别为35.85%,40.00%,42.31%和45.61%,流产率分别为5.66%,6.00%,5.77%和8.77%,经统计学分析各组间术后宫腔粘连率、妊娠率及流产率发生率差异均无显著性。结论对子宫中隔患者行TCRS时宫内放置节育环和(或)加用雌激素治疗在预防宫腔粘连或提高术后妊娠率没有明显作用。

子宫中隔电切术后宫腔放置医用生物蛋白胶和水囊的临床疗效

目的:探讨腹腔镜监视下子宫中隔电切术后宫腔放置医用生物蛋白胶和水囊代替宫内节育器(IUD)的临床疗效。方法:将子宫中隔患者69例,随机分成3组,实施腹腔镜监视下子宫中隔电切术治疗,术后治疗组1宫腔内放置弗莱氏尿管,注入4 ml生理盐水形成水囊并经尿管注入生物蛋白胶封管,留置1 d后取出并使用雌孕激素人工周期序贯疗法;治疗组2方法同治疗组1,但水囊留置3 d;对照组放置IUD并使用雌孕激素人工周期序贯疗法。比较3组患者术后阴道流血时间、腰腹部疼痛和3月后宫腔镜检查宫腔情况。结果:宫腔放置医用生物蛋白胶和水囊的治疗组1有1例宫腔膜状粘连,治疗组2与放置IUD的对照组宫腔均无粘连,三者两两比较无显著性差异(P>0.05);患者阴道流血时间治疗组2较对照组明显缩短,治疗组1和2腰腹部疼痛时间较对照组明显延长,比较均有显著性差异(均为P<0.05);而治疗组1和治疗组2之间比较无显著性差异(P>0.05)。结论:腹腔镜监视下子宫中隔电切术后放置医用生物蛋白胶和水囊与宫内放置IUD疗效相同,而阴道流血时间和腰腹部疼痛时间短,是宫腔放置IUD的有效替代治疗方式。

子宫内膜采集器在绝经后子宫异常出血的子宫内膜细胞学检查中的应用

目的绝经后子宫异常出血进行子宫内膜病理诊断时,比较子宫内膜细胞采集器和诊断性刮宫获取子宫内膜活检组织的准确性及其临床意义。方法收集2012年5月—2014年5月就诊的188例绝经后子宫异常出血的需进行子宫内膜筛查的患者,所有患者先利用子宫内膜细胞采集器获取子宫内膜组织,再进行诊断性刮宫。比较两种检查方法的取材满意率、诊断结果、宫颈扩张及疼痛感觉等方面的差异。结果两种方法采集标本合格率、病理诊断均无显著差异(P>0.05),宫颈扩张情况、疼痛情况比较有显著性差异(P<0.05,P<0.01)。结论应用子宫内膜细胞采集器采集子宫内膜组织方法简单、便于操作、无须扩张宫颈、几乎无痛,适用于绝经后异常子宫出血时子宫内膜的筛查。

铜/低密度聚乙烯复合材料宫内节育器引起子宫异常出血与铜离子浓度和血管生成的相关性

背景:含铜宫内节育器表面的铜丝在宫腔内持续释放铜离子,避孕效果明显,但容易发生节育器异位、子宫异常出血、经期延长、腰腹酸痛等不良反应。目的:探讨铜/低密度聚乙烯复合材料宫内节育器致子宫异常出血与子宫内膜组织中铜离子浓度及血管内皮生长因子表达的关系。方法:纳入取铜/低密度聚乙烯复合材料宫内节育器女性患者60例,年龄25-40岁,分为子宫异常出血组(n=32)和无出血组(n=28);另选择未放置宫内节育器且月经周期正常的女性为对照组(n=20)。子宫异常出血组与无出血组在月经干净后4-7 d内取宫内节育器的同时,刮取子宫内膜组织;对照组月经干净后4-7 d内刮取子宫内膜组织。采用原子吸收法测定子宫内膜组织铜离子含量,免疫组织化学染色检测子宫内膜血管内皮生长因子表达,计数微血管密度;火焰原子吸收法测定模拟宫腔液中宫内节育器铜离子溶蚀量。结果与结论:(1)铜离子含量:子宫异常出血组高于无出血组(P<0.05),无出血组高于对照组(P<0.05);(2)铜离子溶蚀量:子宫异常出血组高于无出血组(P<0.05);(3)组织学观察:与无出血组和对照组相比,子宫异常出血组血管内皮生长因子蛋白表达和微血管密度明显增加(P<0.05);无出血组与对照组内皮生长因子蛋白表达与微血管密度比较差异无显著性意义;(4)子宫内膜血管内皮生长因子表达与微血管密度、铜离子含量呈正相关(P<0.05)。(5)结果表明:铜/低密度聚乙烯复合材料宫内节育器置入后,子宫内膜组织中铜离子浓度过高可能引起血管内皮生长因子高表达,血管内皮生长因子通过多种途径增加子宫内膜微血管密度,促进微血管扩张、充血,导致子宫异常出血。