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Gebremichael A, Teka H, Abadi KK, Siferih M, Moges M, Arusi M, Shiferaw A. Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report. Int Med Case Rep J 2024; 17:71-76. [PMID: 38293615 PMCID: PMC10826545 DOI: 10.2147/imcrj.s441386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Background The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources. Case Presentation We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications. Conclusion Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.
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Affiliation(s)
- Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidus Kebede Abadi
- Department of Obstetrics and Gynecology, Riwyet Maternal and Child Health Center, Tigray, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, Debre Markos University, Debre Markos, Ethiopia
| | - Menberu Moges
- Department of Obstetrics and Gynecology, Tayo Hospital, Baidoa, Somalia
| | - Muhudin Arusi
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Abel Shiferaw
- Department of Obstetrics and Gynecology, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
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das Neves J, Notario-Pérez F, Sarmento B. Women-specific routes of administration for drugs: A critical overview. Adv Drug Deliv Rev 2021; 176:113865. [PMID: 34280514 DOI: 10.1016/j.addr.2021.113865] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022]
Abstract
The woman's body presents a number of unique anatomical features that can constitute valuable routes for the administration of drugs, either for local or systemic action. These are associated with genitalia (vaginal, endocervical, intrauterine, intrafallopian and intraovarian routes), changes occurring during pregnancy (extra-amniotic, intra-amniotic and intraplacental routes) and the female breast (breast intraductal route). While the vaginal administration of drug products is common, other routes have limited clinical application and are fairly unknown even for scientists involved in drug delivery science. Understanding the possibilities and limitations of women-specific routes is of key importance for the development of new preventative, diagnostic and therapeutic strategies that will ultimately contribute to the advancement of women's health. This article provides an overview on women-specific routes for the administration of drugs, focusing on aspects such as biological features pertaining to drug delivery, relevance in current clinical practice, available drug dosage forms/delivery systems and administration techniques, as well as recent trends in the field.
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Han L, Ma S, Zhao L, Liu Y, Wang Y, Feng X, Zhang K, Wang L, Wang L, Yin P, Liang D, Hou H, Shi G, Li Q. Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices. Front Med (Lausanne) 2020; 7:598689. [PMID: 33330563 PMCID: PMC7734192 DOI: 10.3389/fmed.2020.598689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: For women with intrauterine devices (IUDs), it is difficult to sample the endometrium when abnormal uterine bleeding occurs or when regular screening of endometrial cancer is proposed. The purpose of this study is to evaluate the validity of endometrial sampling using Li Brush in IUD users. Methods: This study was a prospective cohort study and conducted in two parts. Part I was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part II was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. IUD users with irregular uterine bleeding were recruited in the IUD group and IUD non-users who arranged for dilatation and curettage (D&C) were recruited in the control group. The endometrium was sampled by Li Brush for cells and by D&C for tissues in both groups. The satisfactoriness of sampling and validity of Li Brush were evaluated. Results: Seventeen cases in part I confirmed no significant difference in the position of IUDs before and after sampling (p = 0.20). 112 IUD users and 139 IUD non-users were recruited in part II. Li Brush achieved 94.64 and 92.09% satisfactory sampling rates in the IUD group and control group, respectively, without statistically significant difference between the two groups (p = 0.42). The Sensitivity and specificity of Li Brush for detection of endometrial lesions in IUD group were 95.35 and 87.76% respectively. Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high yield of satisfactory samples and good validity for endometrial diagnoses. It was feasible to screen endometrial lesions by Li Brush for women with IUDs.
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Affiliation(s)
- Lu Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sijia Ma
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lanbo Zhao
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yu Liu
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiran Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xue Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kailu Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Panyue Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dongxin Liang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huilian Hou
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guizhi Shi
- Aviation General Hospital of Beijing, Medical University & Beijing Institute of Translational Medicine, University of Chinese Academy of Sciences, Beijing, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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An Y, Liu C, Mao F, Yang G, Mao G. Intrauterine device found in an ovarian tumor: A case report. Medicine (Baltimore) 2020; 99:e22825. [PMID: 33080762 PMCID: PMC7571936 DOI: 10.1097/md.0000000000022825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Intrauterine devices (IUDs) are one of the most common and effective methods of contraception worldwide. Migration of an IUD to an extrauterine site is a rare complication. The aim of this study was to report an extremely rare case in which an IUD was found in an ovarian tumor. PATIENT CONCERNS A 63-year-old Chinese woman presented with vaginal bleeding and lower abdominal pain during hospitalization due to pneumonia. Preoperative imaging showed bilateral cystic masses in the adnexal region, and ring hyperdensity was found in the right ovarian mass. Endometrial thickening and multiple uterine leiomyomas were found on ultrasonography. Hysteroscopy showed partial septate uterus and a small endometrial polyp. DIAGNOSIS Bilateral ovarian cystadenomas with perforation of the IUD into the right ovarian tumor were considered based on preoperative imaging and the patient's medical history. Furthermore, early endometrial carcinoma was suspected. INTERVENTIONS The patient underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A stainless steel ring IUD was confirmed within the right ovarian tumor during the operation. OUTCOMES The pathology results demonstrated bilateral ovarian serous cystadenofibromas with focal epithelial proliferation and endometrial atypical hyperplasia with malignant transformation. The patient has been followed up for 7 months, and there has been no recurrence at present. LESSONS The presence of an IUD within an ovarian tumor is extremely rare. This is the second reported case in the English literature describing an extrauterine IUD within an ovarian tumor. The correlation between ovarian cancer tumorigenesis and IUD translocation is unclear and requires further investigation.
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Wang Z, Lou C, Jin L, Miao M, Tu X, Liang H, Cheng Y, Yuan W. Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers. Reprod Health 2019; 16:10. [PMID: 30704499 PMCID: PMC6357508 DOI: 10.1186/s12978-019-0678-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Unintended pregnancy and induced abortion among young (unmarried or nulliparous) women have become serious social and health issues in China, which are thought to partly result from low use of long-acting reversible contraception, such as intrauterine devices (IUDs). Considering that providers may play an especially important role in increasing use of this particular method, we investigated Chinese health care providers' attitudes and practices regarding IUDs use for nulliparous women, and further examine the potential factors and reasons contributing to their attitudes and practices. METHODS We recruited health care providers at two Chinese national academic conferences and surveyed them about knowledge of IUDs, willingness to recommend IUDs to nulliparous women, and their related practices. Modified Poisson regression was used to examine the potential factors related to their attitudes and practices. RESULTS Approximately a half of respondents reported unwillingness to recommend IUDs to nulliparous women. Providers with more misperceptions about the safety and contraindications were more likely to be unwilling to recommend IUDs to nulliparous women. Moreover, 71.0% of respondents rarely or never recommended or provided IUDs to nulliparous women. Providers' unwillingness to recommend IUDs to nulliparous women was associated with their infrequent practices (aPR=1.43; 95% CI: 1.04, 1.96). In addition to concerns about the side effects or complications, traditional sexual concept against premarital sex was often cited as a reason by Chinese health providers for their negative attitudes towards IUDs use for nulliparous women, a large proportion of whom are unmarried. CONCLUSIONS Our findings suggest that negative attitudes and infrequent practices regarding IUDs use for nulliparous women are common in Chinese health care providers. Moreover, misperceptions about IUDs, as well as traditional sexual concept, contribute to Chinese health care providers' negative attitudes towards IUDs use for nulliparous women, and may further reduce their provision. Educational interventions are needed to improve providers' accurate knowledge of IUDs and fill the gap between traditional sexual concept and young women's needs of contraceptive services.
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Affiliation(s)
- Ziliang Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Chaohua Lou
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Longmei Jin
- Minhang Maternal and Child Health Care Hospital, Shanghai, 201102 China
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Xiaowen Tu
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Yan Cheng
- Family Planning NSW, Sydney, 2131 Australia
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
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Sun X, Xue M, Deng X, Lin Y, Tan Y, Wei X. Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs). ACTA ACUST UNITED AC 2018; 15:3. [PMID: 29386988 PMCID: PMC5770510 DOI: 10.1186/s10397-017-1032-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
Background Intrauterine devices (IUDs) are the most popular form of contraception used worldwide; however, IUD is not risk-free. IUD migrations, especially uterine perforations, were frequently occurred in patients. The aim of this study was to investigate the clinical characteristics and intraoperative findings in patients with migrated IUDs. Results 29 cases of uterine perforation associated with migrated IUDs and 69 control patients were followed between January 2008 to March 2015. Patients who used IUDs within first 6 months from the last delivery experienced a characteristically high rate of the perforation of the uterine wall. A significantly larger number of IUD insertion associated with uterine perforation were performed in rural hospitals or operated at a lower level health care system. There was no clear difference in the age and presented symptoms in patients between two groups. Majority of contraceptive intrauterine devices was the copper-releasing IUDs. Furthermore, patients who used V-shaped IUD showed significantly higher incidence of pelvic adhesions when compared with the users of O-shaped IUDs. Conclusions Unique clinical characteristics of IUD migration were identified in patients with uterine perforation. Hysteroscopy and/or laparoscopy were the effective approaches to remove the migrated IUDs. Improving operating skills is required at the lower level of health care system.
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Affiliation(s)
- Xin Sun
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Min Xue
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Xinliang Deng
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Yun Lin
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Ying Tan
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Xueli Wei
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
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Turok DK, Gawron LM, Lawson S. New developments in long-acting reversible contraception: the promise of intrauterine devices and implants to improve family planning services. Fertil Steril 2016; 106:1273-1281. [PMID: 27717553 PMCID: PMC6861013 DOI: 10.1016/j.fertnstert.2016.09.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/10/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
After decades of having the developed world's highest rates of unintended pregnancy, the United States finally shows signs of improvement. This progress is likely due in large part to increased use of highly effective long-acting reversible methods of contraception. These methods can be placed and do not require any maintenance to provide years of contraception as effective as sterilization. Upon removal, fertility returns to baseline rates. This article addresses advances in both software-improved use and elimination of barriers to provide these methods; and hardware-novel delivery systems and devices.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Samantha Lawson
- College of Nursing, University of Utah, Salt Lake City, Utah
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Nelson AL, Massoudi N. New developments in intrauterine device use: focus on the US. Open Access J Contracept 2016; 7:127-141. [PMID: 29386944 PMCID: PMC5683151 DOI: 10.2147/oajc.s85755] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Many more women in the US today rely upon intrauterine devices (IUDs) than in the past. This increased utilization may have substantially contributed to the decline in the percentage of unintended pregnancies in the US. Evidence-based practices have increased the number of women who are medically eligible for IUDs and have enabled more rapid access to the methods. Many women enjoy freedom to use IUDs without cost, but for many the impact of the Affordable Care Act has yet to be realized. Currently, there are three hormonal IUDs and one copper IUD available in the US. Each IUD is extremely effective, convenient, and safe. The newer IUDs have been tested in populations not usually included in clinical trials and provide reassuring answers to older concerns about IUD use in these women, including information about expulsion, infection, and discontinuation. On the other hand, larger surveillance studies have provided new estimates about the risks of complications such as perforation, especially in postpartum and breastfeeding women. This article summarizes significant features of each IUD and provides a summary of the differences to aid clinicians in the US and other countries in advising women about IUD choices.
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Affiliation(s)
- Anita L Nelson
- Department of Obstetrics and Gynecology, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, CA, USA
| | - Natasha Massoudi
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
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Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH. Ultrasonography of intrauterine devices. Ultrasonography 2015; 34:183-94. [PMID: 25985959 PMCID: PMC4484292 DOI: 10.14366/usg.15010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/29/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Abstract
The intrauterine device (IUD) is gaining popularity as a reversible form of contraception. Ultrasonography serves as first-line imaging for the evaluation of IUD position in patients with pelvic pain, abnormal bleeding, or absent retrieval strings. This review highlights the imaging of both properly positioned and malpositioned IUDs. The problems associated with malpositioned IUDs include expulsion, displacement, embedment, and perforation. Management considerations depend on the severity of the malposition and the presence or absence of symptoms. Three-dimensional ultrasonography has proven to be more sensitive in the evaluation of more subtle findings of malposition, particularly side-arm embedment. Familiarity with the ultrasonographic features of properly positioned and malpositioned IUDs is essential.
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Affiliation(s)
- Kristina M Nowitzki
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew L Hoimes
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA ; Newton Wellesley Radiology Associates, Newton Wellesley Hospital, Newton, MA, USA
| | - Byron Chen
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Larry Z Zheng
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
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10
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Huang Z, Gao Y, Wen W, Li H, Zheng W, Shu XO, Beeghly-Fadiel A. Contraceptive methods and ovarian cancer risk among Chinese women: A report from the Shanghai Women's Health Study. Int J Cancer 2015; 137:607-14. [PMID: 25556333 DOI: 10.1002/ijc.29412] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 12/10/2014] [Indexed: 11/06/2022]
Abstract
Oral contraceptive use is associated with reduced ovarian cancer risk; however, associations with other contraceptive methods, such as intrauterine device (IUD) and tubal ligation, are less clear. Women in China differ from western women in regard to mechanisms and duration of use of contraception. This study was undertaken to evaluate associations between contraceptive methods and ovarian cancer risk using data from the prospective Shanghai Women's Health Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. A total of 174 epithelial ovarian cancer cases were found to occur among 70,259 women who were followed-up for a total of 888,258 person-years. The majority of women had ever used any contraception (77.0%), including IUD (55.6%), oral contraceptive (20.4%), tubal ligation (14.7%) or contraceptive shots (2.6%). Ever use of any contraception was associated with a nonsignificant reduction in ovarian cancer risk (HR: 0.86, 95% CI: 0.60-1.24). Longer duration of IUD use was associated with lower ovarian cancer risk (p-value for trend = 0.04). Compared with never users, women with durations of IUD use longer than the median (20 years) were 38% less likely to develop ovarian cancer (HR: 0.62, 95% CI: 0.40-0.97). Based on the high prevalence and long duration of IUD use among Chinese women, we estimate a preventive fraction of 9.3%, corresponding to approximately 16 ovarian cancer cases. High prevalence of long-term IUD use may, therefore, contribute to the low incidence of ovarian cancer observed in China.
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Affiliation(s)
- Zhezhou Huang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China.,Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Yutang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Honglan Li
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Snow RC, Laski L, Mutumba M. Sexual and reproductive health: progress and outstanding needs. Glob Public Health 2015; 10:149-73. [PMID: 25555027 PMCID: PMC4318113 DOI: 10.1080/17441692.2014.986178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/06/2014] [Indexed: 10/25/2022]
Abstract
We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.
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Affiliation(s)
- Rachel C. Snow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Laura Laski
- Sexual and Reproductive Health Branch, UNFPA, New York, NY, USA
| | - Massy Mutumba
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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12
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Chen XY, Guo QY, Wang W, Huang LL. Three-dimensional ultrasonography versus two-dimensional ultrasonography for the diagnosis of intrauterine device malposition. Int J Gynaecol Obstet 2014; 128:157-9. [PMID: 25467914 DOI: 10.1016/j.ijgo.2014.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/19/2014] [Accepted: 10/20/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of two-dimensional (2D) versus three-dimensional (3D) ultrasonography for the diagnosis of intrauterine device (IUD) malposition. METHODS In a prospective study, women with a history of failed IUD removal and/or ultrasonography results indicating malposition were recruited at a center in Hangzhou, China, between March 1, 2009, and September 30, 2011. All patients underwent 2D and 3D ultrasonography. Hysteroscopy, laparoscopy, or laparotomy was carried out to remove the IUDs and was considered the gold standard for diagnosing malposition. RESULTS Among 130 participants, 128 (98.5%) were diagnosed with IUD malposition by hysteroscopy, laparoscopy, or laparotomy. Malposition had been correctly identified with 2D ultrasonography in 83 (64.8%) cases, and with 3D ultrasonography in 107 (83.6%) cases. The diagnostic accuracy of 3D ultrasonography was significantly better than was that of 2D ultrasonography (P<0.001). CONCLUSION The use of 2D ultrasonography is recommended for the follow-up of women who use IUDs as a contraceptive method. However, 3D ultrasonography should be used when malposition is suspected.
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Affiliation(s)
- Xiu-ying Chen
- The Fourth Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qing-yun Guo
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Wang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li-li Huang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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13
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Li Y, Guo S, Shi DL, Wang Z, Yu XZ. Contraceptive ring-induced intestinal obstruction. QJM 2014; 107:667-9. [PMID: 22198944 DOI: 10.1093/qjmed/hcr260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Li
- From the Emergency department, Peking Union Medical College Hospital, Dongchen district, Beijing and Department of Trauma & Orthopaedic Surgery, Wexham Park Hospital, Slough, SL2 4HL, UK
| | - S Guo
- From the Emergency department, Peking Union Medical College Hospital, Dongchen district, Beijing and Department of Trauma & Orthopaedic Surgery, Wexham Park Hospital, Slough, SL2 4HL, UK
| | - D L Shi
- From the Emergency department, Peking Union Medical College Hospital, Dongchen district, Beijing and Department of Trauma & Orthopaedic Surgery, Wexham Park Hospital, Slough, SL2 4HL, UK
| | - Z Wang
- From the Emergency department, Peking Union Medical College Hospital, Dongchen district, Beijing and Department of Trauma & Orthopaedic Surgery, Wexham Park Hospital, Slough, SL2 4HL, UK
| | - X Z Yu
- From the Emergency department, Peking Union Medical College Hospital, Dongchen district, Beijing and Department of Trauma & Orthopaedic Surgery, Wexham Park Hospital, Slough, SL2 4HL, UK
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Zhou J, Tan X, Song X, Zhang K, Fang J, Peng L, Qi W, Nie Z, Li M, Deng R, Yan C. Temporal Trends of Copper-Bearing Intrauterine Device Discontinuation. Asia Pac J Public Health 2014; 27:NP2433-42. [DOI: 10.1177/1010539513517259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.
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Affiliation(s)
- Jie Zhou
- Wuhan University, Wuhan, China
- Kunming Medical University, Kunming, China
| | | | - Xiangjing Song
- Yunnan Institute of Population and Family Planning Research, Kunming, China
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Lin Peng
- Yunnan Institute of Population and Family Planning Research, Kunming, China
| | - Wencai Qi
- Family Planning Centre of Yuanmou County in Yunnan Province, Yuanmou, China
| | - Zonghui Nie
- Health Bureau of Yuanmou County, Yuanmou, China
| | - Ming Li
- Maternal and Child Care Service Centre of Yuanmou County, Yuanmou, China
| | - Rui Deng
- Kunming Medical University, Kunming, China
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Buhling KJ, Zite NB, Lotke P, Black K. Worldwide use of intrauterine contraception: a review. Contraception 2013; 89:162-73. [PMID: 24369300 DOI: 10.1016/j.contraception.2013.11.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/28/2013] [Accepted: 11/15/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Globally, 14.3% of women of reproductive age use intrauterine contraception (IUC), but the distribution of IUC users is strikingly nonuniform. In some countries, the percentage of women using IUC is <2%, whereas in other countries, it is >40%. Reasons for this large variation are not well documented. The aims of this review are to describe the worldwide variation in IUC utilization and to explore factors that impact utilization rates among women of reproductive age in different continents and countries. STUDY DESIGN Published literature from 1982 to 2012 was reviewed, using Medline and Embase, to identify publications reporting diverse practices of IUC provision, including variation in the types of IUC available. Local experts who are active members of international advisory groups or congresses were also consulted to document variations in practice regulations, published guidelines and cost of IUC in different countries. RESULTS Multiple factors appear to contribute to global variability in IUC use, including government policy on family planning, the types of health care providers (HCPs) who are authorized to place and remove IUC, the medicolegal environment, the availability of practical training for HCPs, cost differences and the geographical spread of clinics providing IUC services. CONCLUSIONS Our review shows that the use of IUC is influenced more by factors such as geographic differences, government policy and the HCP's educational level than by medical eligibility criteria. These factors can be influenced through education of HCPs and greater understanding among policy makers of the effectiveness and cost-effectiveness of IUC methods. IMPLICATIONS Globally, 14.3% of women of reproductive age use IUC, but the percentage of women using IUC is in some countries <2%, whereas in other countries, it is >40%. This paper reviews the reasons for this diverse and highlights possible starting points to improve the inclusion of IUC in contraceptive counseling.
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Affiliation(s)
- Kai J Buhling
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Pamela Lotke
- Department of Obstetrics and Gynecology, University of Arizona School of Medicine, Tucson, AZ, USA
| | - Kirsten Black
- Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, Australia
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Paraíso Torras B, Maldonado del Valle M, López Muñoz A, Cañete Palomo M. Anticoncepción en la mujer inmigrante: influencia de los aspectos socioculturales en la elección del método anticonceptivo. Semergen 2013; 39:440-4. [DOI: 10.1016/j.semerg.2013.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 01/09/2013] [Accepted: 01/31/2013] [Indexed: 11/29/2022]
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17
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Chitosan/alginate multilayer film for controlled release of IDM on Cu/LDPE composite intrauterine devices. Colloids Surf B Biointerfaces 2013; 109:82-9. [DOI: 10.1016/j.colsurfb.2013.03.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/22/2022]
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Qiu Y, Wang LG, Zhang MH, Zhang YP, Zhang AD, Yang DT. A new experimental three-dimensional, reticular intrauterine device (3-DRIUD) composed of nitinol and silicone rubber. Contraception 2012; 88:31-6. [PMID: 23218860 DOI: 10.1016/j.contraception.2012.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to explore a new three-dimensional, reticular intrauterine device (3-DRIUD) composed of nitinol and silicone rubber and to observe the contraceptive effect of the device in rats. STUDY DESIGN Two contraceptive experiments were performed. In the first, female rats underwent bilateral placement of a 20.0-35.0-mm 3-DRUID (experimental group, n=30) via an abdominal incision or a sham operation with no IUD (control group, n=30). Two weeks after the operation was performed, the rats from either group were caged together with male rats. The contraceptive effects of the 3-DRIUD were observed at 1 to 3 months postoperation, after which the 3-DRIUDs were removed. One month after this second operation, the rats from the two groups were again coupled with fertile male rats. In a second experiment, female rats underwent bilateral placement of a 10.0-mm 3-DRUID (n=5) via an abdominal incision or a two-dimensional IUD (2-DIUD, n=20) and mated 1 month after surgery. The single-pipeline IUD was placed in 10 rats, while the enfolded-pipeline IUD was placed in 10 different rats. RESULTS In the first experiment, none of the females in the experimental 3-DRIUD group became pregnant (0/30, 0%) after 3 months, compared to 28/30 (93.3%, p<.0001) rats in the control group. After the 3-DRIUDs were removed from the experimental group after 3 months, 27/30 (90%) became pregnant, compared with 29/30 (97%, p>.05). The litter size (mean±SD) did not differ between groups (10.9±1.5 3-DRUID, 11.2±1.1 control, p>.05). In the second experiment, five rats had a 10.0-mm 3-DRUID (which was one third the length of one uterine horn) inserted into the bilateral uterine horns, and three of the five rats became pregnant. All 20 rats were pregnant 1 month after the insertion of the 2-DIUD. Thus, the contraceptive rate for the 2-DIUD group was 0. CONCLUSIONS The primary contraceptive mechanism effect of the new 3-DRIUD in rodents appears to be a result of occupying physical space in the uterus.
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Affiliation(s)
- Yi Qiu
- Key Laboratory for Technique for Improving Birth Outcome, Shandong Provincial Institute of Science and Technology for Family Planning, 69 Yuhan Road Jinan, Shandong province, 250002, China.
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19
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Padmagirison R, Thomas N, Mitra S. Removal of a Retained Chinese Contraceptive Ring: A Clinical Challenge! J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Neil Thomas
- Department of Maternity and Gynaecology, Ipswich Hospital, Ipswich, England
| | - Surajit Mitra
- Department of Maternity and Gynaecology, Ipswich Hospital, Ipswich, England
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20
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Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: III. Intrauterine devices. EUR J CONTRACEP REPR 2012; 15:96-112. [PMID: 20230337 DOI: 10.3109/13625180903519885] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Since the 1959 revival of the IUD, non-hormonal devices have become the most widely used of all reversible contraceptives. Pregnancy rates of copper-releasing IUDs in current use range from approximately 0.5 to 1.5 per hundred continuing users in the first year, with somewhat lower annual pregnancy rates thereafter. Evidence-based research has been systematically conducted and translated into guidelines for eligibility criteria and problem management. Recent device research, beyond the T, Multiload and frameless devices has centred on improved designs such as U ,Y and Slimline shapes, or enhanced copper release, the latter through electrochemical effects or nanotechnology applications. Other IUD research foci concern devices that decrease bleeding and pain by releasing non-steroidal anti-inflammatory drugs. Yet other research lines indicate noncontraceptive benefits of copper intrauterine devices in protecting against endometrial cancer, and favourable risk-benefit analyses of IUD use by women at risk of or post HIV infection. IUD mechanisms of action and the relation of IUDs to pelvic infection and ectopic pregnancy are briefly reviewed. For our literature search we used Medline, Popline and Cochrane Library data bases, Google search, our personal files, and the references contained in articles in our files.
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Nelson AL. Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2011. [DOI: 10.4137/cmwh.s5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.
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Affiliation(s)
- Anita L. Nelson
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
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22
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Tran N, Stapleton J, Zhang Y, Harlow S, Yang H, Moyer CA. Contraceptive practices of women visiting a gynecology clinic in Beijing, China. Int J Gynaecol Obstet 2010; 112:64-5. [PMID: 20961543 DOI: 10.1016/j.ijgo.2010.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 09/21/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Nguyen Tran
- Global REACH, University of Michigan Medical School, Ann Arbor, USA
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Tang Y, Xia X, Wang Y, Xie C. Study on the mechanical properties of Cu/LDPE composite IUDs. Contraception 2010; 83:255-62. [PMID: 21310288 DOI: 10.1016/j.contraception.2010.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 07/01/2010] [Accepted: 07/16/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The copper/low-density polyethylene composite (Cu/LDPE composite) intrauterine devices (IUDs), which can eliminate or lessen the side effects of existing IUDs, have been developed in our laboratory. As a novel type of copper-containing IUDs, it is not clear whether the mechanical properties of the Cu/LDPE composite IUDs can meet the need of clinical use or not. Therefore, the mechanical properties of the Cu/LDPE composite IUDs have been studied in the present article. STUDY DESIGN The influence of copper particle content and size on the mechanical properties of the Cu/LDPE composite IUDs was analyzed firstly to provide guidance for the material composition design of the Cu/LDPE composite IUDs, and then the BaSO(4)/LDPE composite, which has been applied as a framework of the existing copper-containing IUDs in clinical use for decades, has been used as reference to judge whether the mechanical properties of the Cu/LDPE composite IUDs can meet the need of clinical use or not. However, the mechanical properties of IUDs cannot be characterized directly. Therefore, the mechanical properties of both the Cu/LDPE composite IUDs and the framework of the existing copper-containing IUDs were investigated by means of tensile test using standard tensile samples, and the fracture surface morphology of the tensile samples was characterized by scanning electron microscopy (SEM). RESULTS Both the elongation at break and the tensile strength decrease with increasing of copper particle content and increase with increasing of the copper particle size, while the elastic modulus shows an opposite tendency. The tensile strength and elastic modulus of both the Cu/LDPE microcomposite IUDs and the Cu/LDPE nanocomposite IUDs with 25 wt.% of copper particles are higher than those of existing copper-containing IUDs (TCu220C; its framework is made of the BaSO(4)/LDPE composite with 20 wt.% of BaSO(4)). CONCLUSIONS The content and size of the copper particles have significant effect on the mechanical properties of Cu/LDPE composite IUDs. The mechanical properties of both the Cu/LDPE microcomposite IUDs and the Cu/LDPE nanocomposite IUDs with 25 wt.% of copper particles were superior to that of existing copper-containing IUDs, indicating that the novel Cu/LDPE composite IUDs can satisfy the requirement of mechanical properties in clinical application.
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Affiliation(s)
- Ying Tang
- State Key Laboratory of Material Processing and Die and Mould Technology, Department of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, PR China
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Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health 2010; 2:211-20. [PMID: 21072313 PMCID: PMC2971735 DOI: 10.2147/ijwh.s6914] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Indexed: 11/23/2022] Open
Abstract
The intrauterine device (IUD), primarily in the form of the copper IUD, is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. With a remarkably low failure rate of less than 1 per 100 women in the first year of use, the Copper T-380A is in the top tier of contraceptives in terms of efficacy. Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion. Overall, the number of adverse events is low, making the Copper T-380A a very safe contraceptive method. The most common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. However, cumulative discontinuation rates of Copper T-380A are lower than that have been reported for other methods, indicating that the Copper T-380A is highly acceptable to women. After 5 years, approximately 50% of all women, who have a Copper T-380A inserted, will continue to use this highly effective contraceptive method.
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Affiliation(s)
- Bliss Kaneshiro
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Tod Aeby
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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Cheung VYT. Sonographic appearances of Chinese intrauterine devices. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1093-1101. [PMID: 20587433 DOI: 10.7863/jum.2010.29.7.1093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this presentation is to familiarize physicians about the different types of intrauterine devices (IUDs) used in China. METHODS The characteristic features and the sonographic appearances of the different types of IUDs commonly used in China are described. RESULTS The stainless steel ring is the most commonly used IUD in China. However, various different types of copper-bearing IUDs are gaining popularity. Most Chinese IUDs do not have an attached thread and are more difficult to remove than the IUDs commonly used in North America. Also, most Chinese IUDs have a distinct sonographic appearance; therefore, sonography can play an important role when assessing a woman who has a retained Chinese IUD or has a complication associated with the IUD. CONCLUSIONS Knowledge about the different types of Chinese IUDs will enable physicians to provide optimal care to their patients.
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Affiliation(s)
- Vincent Y T Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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26
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Cheung VY. A 10-year experience in removing Chinese intrauterine devices. Int J Gynaecol Obstet 2010; 109:219-22. [DOI: 10.1016/j.ijgo.2009.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 12/21/2009] [Accepted: 01/25/2010] [Indexed: 11/15/2022]
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27
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Dorjgochoo T, Shu XO, Li HL, Qian HZ, Yang G, Cai H, Gao YT, Zheng W. Use of oral contraceptives, intrauterine devices and tubal sterilization and cancer risk in a large prospective study, from 1996 to 2006. Int J Cancer 2009; 124:2442-9. [PMID: 19170208 DOI: 10.1002/ijc.24232] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The association of contraceptive methods, including oral contraceptives (OC), intrauterine devices (IUD) and tubal sterilization (TS), with overall and site-specific cancer were prospectively investigated in a cohort of 66,661 Chinese women in Shanghai, 76.7% of whom used contraception. During a median follow-up time of 7.5 years, 2,250 women were diagnosed with cancer. Ever-use of any contraceptive method was not associated with overall cancer risk [adjusted hazard ratio (HR(adj)) = 1.02, 95% CI, 0.92-1.12]. Use of any contraceptive method was associated with increased risk of rectal cancer (HR(adj) = 1.68, 95% CI, 1.08-2.62) and reduced risk of thyroid cancer (HR(adj) = 0.63, 95% CI, 0.38-1.04). Risk of gallbladder cancer increased with ever use of OC (HR(adj) = 2.38, 95% CI, 1.26-4.49). IUD use was associated with a possible reduced risk of thyroid cancer (HR(adj) = 0.64, 95% CI, 0.38-1.07). Longer duration of IUD use decreased risk for breast, thyroid and lung cancers. Ever having a TS was associated with increased uterine body cancer (HR(adj) = 2.50, 95% CI, 1.47-4.25) and decreased risk of stomach cancer (HR(adj) = 0.59, 95% CI, 0.39-0.91). We did not find any contraceptive method to be related to the risk of ovarian cancer but the analyses were based on few events. Although chance findings are a likely explanation for some of the associations found in our study, these findings suggest that various contraceptive methods or reproductive patterns may play a role in the etiology of cancer.
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Affiliation(s)
- Tsogzolmaa Dorjgochoo
- Vanderbilt Epidemiology Center, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN 37203-1738, USA
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Yang Z, Xie C, Xiang H, Feng J, Xia X, Cai S. IDM release behavior and surface characteristics of the novel Cu/IDM/LDPE nanocomposite for intrauterine device. Colloids Surf B Biointerfaces 2009; 69:276-80. [DOI: 10.1016/j.colsurfb.2008.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 11/24/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
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Committee on Publication Ethics. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008. [DOI: 10.1783/147118908784734936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Edouard L. Contraptions for intrauterine contraception. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008; 34:199-201. [DOI: 10.1783/147118908784734972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thonneau PF, Almont T. Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008; 198:248-53. [PMID: 18221924 DOI: 10.1016/j.ajog.2007.10.787] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Revised: 10/01/2007] [Accepted: 10/01/2007] [Indexed: 11/17/2022]
Abstract
To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.
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