圆形宫内节育器异位子宫外1例

患者,49岁,放置圆形宫内节育器(IUD)20余年,绝经半年,先后2次取环失败,行宫腔镜检查见:宫腔内可见部分节育器(IUD),考虑节育器嵌入子宫肌层,改行腹式取器术取出节育器。     

绝经后妇女宫内节育器两种取出方法的效果观察

目的探讨能绝经后妇女宫内节育器(IUD)取出的安全有效方法。方法对在本院门诊要求取出IUD的绝经后妇女随机分为两组:观察组80例,提前1周后给予尼尔雌醇2 mg顿服,取环术前2 h阴道后穹隆放置米索前列醇400μg;对照组102例,仅口头安慰后施术。结果观察组用药后宫口变松,宫颈软化,取环操作顺利,且术中疼痛明显减轻,手术时间和术中出血明显减少。结论术前应用联合应用尼尔雌醇、米索前列醇,可改善取环操作条件,提高IUD取出成功率,并降低患者的痛苦,减少手术时间和术中出血。     

米非司酮在绝经后取出宫内节育器中的应用

宫内节育器一次性放置于宫腔即可长期避孕,是一种安全、有效、简便、经济的可逆性节育方法,目前已成为我国育龄妇女的主要避孕措施.放置宫内节育器一定期限或绝经期后须及时取出,但由于各种原因亦有极少数妇女绝经多年后才取出宫内节育器(简称取环),此时宫颈已萎缩、变硬,导致宫内节育器取出困难.我院于2012年对3例绝经多年后取宫内节育器者,采用术前口服米非司酮软化宫颈后,均成功取出节育器,现报告如下.     

86例绝经后妇女取宫内节育器分析

目的探讨提高绝经后妇女取宫内节育器（IUD）的成功率,减少绝经后取器并发症发生的有效方法。方法对86例绝经后妇女取器者术前给予米非司酮25mg,每12h 1次,连续口服3天,服药前后2h禁食,第4天空腹口服米索前列醇600μg后2h取器。结果顺利取出IUD者59例,用宫颈扩张器扩张宫口为6号后顺利取出者23例;IUD嵌顿者4例,1例最终通过宫腔镜取器,余3例由宫颈扩宫器扩至6号后剪断不锈钢丝后取出。所有取器者术中腹痛和出血量正常,术后阴道出血2～5天。结论米非司酮联合米索前列醇在绝经后妇女取宫内节育器应用中,可有效扩张、软化宫颈,具有安全、有效的特点,值得基层推广。     

置IUD与宫腔厌氧菌感染的探讨

观察47 例健康妇女放置宫内节育器(IUD)后与宫腔厌氧菌感染的关系。结果表明,置IUD 厌氧菌总感染率为17.02% ,其中IUD 带尾丝组厌氧菌感染率为13.33% ,不带尾丝组感染率为18.75% ,两者无显著性差异;置IUD< 6 个月厌氧菌感染率虽高于> 6 个月组,但无统计学意义;有异常出血组与无异常出血组厌氧菌感染率差异无显著性     

农牧民地区开展避孕方法知情选择,降低放置IUD副反应的临床观察

目的:通过开展避孕方法知情选择,降低放置IUD副反应。方法:采取分组抽样的方法,对自愿放置IUD避孕妇女(426例)随访,并进行相应的健康检查,对术前接受知情选择和未接受现在的妇女进行对照。结果:与对照组比较,术前接受知情选择的妇女出现小腹坠胀、隐痛,月经周期不规则及生殖道感染发生率低于对照组。结论:农村妇女对IUD的征知识了解不够,对放置IUD产生恐惧心理,通过术前开展知情选择,让前来放置IUD的妇女全面、正确、客观地了解所需的信息和知识,帮助她们正确理解自己的身体状况,自主选择避孕方法。     

55例宫内节育器放置术患者心理分析及护理干预

目的:对宫内节育器放置术患者的心理进行分析,并给予有效的心理护理干预。方法:随机抽取我站2014年1月—2015年1月行宫内节育器放置术的110例妇女,按照随机数字排列法将其划分为干预组和对照组(各55例),分别给予心理护理干预和常规护理。结果:两组患者入院前SAS焦虑心理评分差异较小(P0.05);治疗后干预组患者SAS焦虑心理评分低于对照组,两组数据对比差异显著,具有统计学意义(P0.05);同时术后6个月干预组患者不良反应率为6.0%,对照组不良反应率为(18.0%)干预组患者不良反应发生率相比对照组显著降低(P0.05)。结论:在接受宫内节育器放置术妇女心理焦虑,通过有效的心理护理干预后能够切实缓解焦虑情绪,积极配合治疗,降低了对手术效果的影响。     

宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连中的临床效果

摘要 目的：探讨宫内节育器与宫腔支撑球囊联合应用治疗中重度宫腔粘连的临床效果。方法：选择2016年12月至2019年8月于西安交通大学第一附属医院宫腔镜诊疗中心接受宫腔镜下中重度宫腔粘连分解术的患者共96例,采用随机对照表法将其分为两组。对照组48例,术后宫腔内放置宫内节育器(intrauterine contraceptive device,IUD);研究组48例,术后放置宫腔支撑球囊(intrauterine support balloon,ISB),3~5 d后更换为宫内节育器。两组术后均给予为期3月的人工周期治疗。术后1月,复查宫腔镜了解宫腔有无再粘连并取出宫内节育器,以此评估手术效果是否有效,术后3月时随访其月经来潮情况。统计比较两组术后5 d内阴道出血量、C反应蛋白水平、发热、下腹痛以及节育器或支持球囊有无脱落等情况,术后1月手术效果及术后3月月经恢复情况。结果：研究组的手术有效率及月经改善比例均显著高于对照组(P<0.05),术后5 d内阴道出血量显著少于对照组(P<0.05);下腹痛及球囊脱落事件发生率显著低于对照组(P<0.05)。两组在C反应蛋白水平、发热发生率对比无统计学差异(P>0.05)。结论：与单独使用宫内节育器相比,联合使用宫腔支撑球囊能提高中重度宫腔粘连分解手术有效率,改善月经,减少术后出血,不增加感染风险,但球囊易于脱落且会增加患者下腹疼痛。     

宫内节育器与细菌及其L型相关性的研究

自１９９５年６月－１９９８年底于山东医科大学第一附属医院计划生育门诊选择１４８例患者,放置有活性的宫内节育器（ＩＵＤ）３２例（均为有尾丝者）为Ａ组,放置惰性ＩＵＤ者５６例Ｂ组;未放置ＩＵＤ的育龄妇女,其中无生殖器炎症者３０例为Ｃ组,有盆腔炎症者３０例为Ｄ组。各组均采用无菌操作取出宫腔内分泌物,同步进行了需氧菌、厌氧菌及其Ｌ型菌的他离培养;Ａ、Ｂ两组同时取出ＩＵＤ做需氧菌培养,其培养阳性结果是：Ａ、     

IUD合并异位妊娠10例报告

宫内节育器(IUD),是一种安全、可靠、方便、经济的避孕方法,全世界约有6千多万人应用,其中我国使用者已超过70％。随着IUD的推广。宫外孕的发生率明显上升。目前,宫外孕已成为危及妇女健康的一种特殊类型的疾病,即使在发达国家也是孕妇的死亡原因之一,因此,宫外孕的发生与使用IUD之间有一定的关系,所以,引起我们的高度重视。1 临床资料: 我站自1996年～2001年共收治异位妊娠28例,其中带器妊娠10例,发病率占35.7％。年龄最     

IUD appendicitis during pregnancy.

This case shows that abdominal and pelvic x-ray examinations may not adequately show a misplaced IUD in a gravid woman, and further workup is necessary after delivery if the IUD is not clearly visible on the initial x-ray films. It also shows that chronic inflammation may develop in the area of a misplaced IUD, producing chronic abdominal pain and complications, even after several years have transpired. Finally, patients may still be at risk for complications after an IUD has been removed because of the dense adhesions that develop due to the chronic inflammatory response elicited by the IUD.     

Incidence of actinomycetes infection in women using intrauterine contraceptive devices

Pancervicovaginal smears taken from 350 women using an intrauterine contraceptive device (IUD) were screened for the presence of actinomycetes organisms. Of the 12 cases in which actinomycetes-like organisms were seen in Papanicolaou-stained smears, the presence of actinomycetes organisms was confirmed by immunofluorescence in 10 cases. The prevalence of actinomycetes infection was thus 2.8% (10 of 350 cases) in the IUD users. Eight (4.3%) of 173 symptomatic subjects had actinomycetes infections. Two of the positive cases were asymptomatic. Eight of the ten patients with confirmed actinomycetes infection were using the Cu T device while two were wearing the Lippes Loop IUD. Seven of the ten patients had been using an IUD for more than two years. The time of insertion of the IUD (postpuerperal, postmenstrual or after medical termination of pregnancy) did not show any correlation with the presence of actinomycetes infection. Actinomyces israelii was responsible for the infection in eight cases while Arachnia propionica was seen in two cases. The organisms could not be grown in culture.     

Contraceptive choice in an urban clinic in Nigeria

Contraceptive choice in the 1st 1075 acceptors at an urban clinic in Lagos, Nigeria is studied using clinical notes of all patients who attended the clinic between September 1, 1980 and August 31, 1983. Details of previous and current contraception, age, parity and level of education are analyzed. The IUD was the most popular choice followed by the injectable contraceptive and the pill. Interval tubal ligation was chosen by some patients. Acceptors of injectables were older women of high parity and lower educational standard while pill acceptors were of lower parity and higher educational level. The IUD was acceptable to all ages and parities except those with only 1 child or none. Loss to follow-up and the wish to plan another pregnancy were the commonest reasons for discontinuing contraception. Medical reasons for discontinuing the IUD were pain, menstrual disorder, accidental pregnancy and expulsion/perforation; for discontinuing injectables the reasons were menstrual disorder, accidental pregnancy and raised blood pressure. Of acceptors of the 3 main methods, former pill and IUD users were more likely to choose the same method again. A strategy should be devised to encourage patients of lower parities and age to use contraceptives, while sterilization in patients of parity 3 and above should be even more actively advocated. Greater effort should be made to support patients through the 1st 6 months after starting any method as this is the time when a large number of discontinuations occur.     

一种宫内节育器的染色体畸变试验研究

目的检测一种宫内节育器的体外细胞的染色体畸变作为遗传毒性评价的一部分。方法在加和不加S9活化系统条件下,试验组用三种不同浓度的节育器浸提液处理CHL细胞20h,对照组分别加入阴性、阳性进行交换,各组置37℃培养箱中培养。24h后采集细胞并分析中期细胞染色体畸变情况,计算染色体畸变率。结果在4g/20mL的浓度下受试物对细胞有明显的细胞毒性,其稀释浸提液的畸变率与阴性对照相比,在统计学上无显著性差异(P>0.05)。结论在该试验条件下,受试物稀释浸提液未诱发CHL细胞染色体畸变。     

Inhibition of an IUD-induced precocious luteolysis by prostaglandin E1 (PGE1) in sheep

Fifteen ewes were assigned as they came into estrus to one of three randomized treatment groups: 1. Sham IUD + Vehicle, 2. IUD + Vehicle or 3. IUD + PGE1 in vehicle. An IUD was inserted adjacent to the luteal-bearing ovary on day 3 postestrus. Prostaglandin E1 (500 micrograms) in vehicle (Na2CO3) or vehicle was given intrauterine through an indwelling uterine cannula every four hours from day 3 postestrus until ewes returned to estrus. Precocious estrus was induced in both the sham IUD and IUD groups receiving vehicle. Prostaglandin E1 prevented an IUD-induced premature luteolysis based on daily concentrations of progesterone in peripheral blood and the interestrous interval. It is concluded that an IUD-induced premature luteolysis is not necessarily via physical distention by the IUD. It is also concluded that chronic intrauterine infusions of PGE1 can prevent an IUD-induced premature luteolysis.     

Retention function of all segments of IUD usage: a compound distribution.

The distribution of the all segments of IUD use consists of two components: the distribution of the length of each segment and the distribution of the number of segments. In this article, a compound distribution of all segments of IUD, developed by the authors is described. The distribution assumes that each segment of IUD use is a mixed exponential distribution and the number of segments experienced by women is a truncated Poisson distribution. This distribution is useful in estimating the demographic impact of an IUD and IUD program.     

Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion. METHODS: Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes. DISCUSSION: The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion.Trial registrationClinicalTrials.gov Identifier NCT01174225.     

Association of amoebae and actinomyces in an intrauterine contraceptive device user

A patient wearing an intrauterine contraceptive device (IUD) was diagnosed as being colonized by Actinomyces and amoebae by examination of a routine Papanicolaou smear. The patient received vaginal treatment with metronidazole, which temporarily eliminated the protozoa; however, it was necessary to remove the IUD to definitively eradicate the microorganisms. Follow-up Papanicolaou smears taken after removal of the IUD have been normal and free of both microorganisms.     

Abdominal and endometrial actinomycosis associated with an intrauterine device.

Actinomycotic endometrial infection associated with an intrauterine device (IUD) complicated chronic abdominal inflammatory disease in a 28-year-old woman. Colonies of organisms with morphologic resemblance to and staining reactions of Actinomyces israelii were observed in tissue adherent to the IUD and in inflamed omental and pericolic tissues. However, the organism could not be cultured. Because intact tissues are resistant to actinomyces it is likely that the IUD created an environment favouring the establishment and growth of the organism.