Intrauterine device practice guidelines: patient types

IUDs and adolescents--an under-utilized opportunity for pregnancy prevention

Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infertility, nor rate of ectopic pregnancy. Adolesecnts need more education about and increased access to IUDs. Practical points regarding IUD selection and insertion in adolescents are reviewed, including pain prophylaxis, anticipatory guidance, side effects and complications. In summary, IUDs are safe for contraception in most adolescents. IUDs are effective and eliminate the need for ongoing adherence and thus have the potential to decrease unplanned pregnancies.

The intrauterine device in modern contraception: Still an actuality?

The intrauterine devices (IUD) is a contraceptive method largely used as an effective, safe and economic method of contraception; IUD efficacy is demonstrated to be about 97%, and copper IUD contraceptive failure frequency is about 0.8% for the first year of use, and this is about 0.1-0.2% for the progestin IUD. IUD benefits are different; it produces a well-defined contraceptive efficacy for long time, is useful for sexual activity and is rather free from common problems. However, IUD utilization is associated with an increasing risk of pelvic infection (0.5%) in the 8 years from initial use, and the common risk of pelvic inflammatory infection (PID) is about one to two cases per year; this risk, for copper IUD users, is 0.2-0.5% per year. The possible side effects of IUD use are: pelvic pain, irregular meshes, infections, bleeding and uterine perforation; we report a uterine perforation due to IUD migration in the Retzius space, diagnosed on transvaginal ultrasonography, confirmed on CT and removed by laparoscopy. In any case, the IUD remains the mainstay of family planning measures in developing countries but, unfortunately, its association with possible serious complications, change the cost-benefit link and restrict its utilization by a large part of the general population.

Sonographic Evaluation of an Abnormal Location of an Intrauterine Device

Ultrasound has been used to locate intrauterine devices for many years and continues to be considered one of the best ways to visualize the presence and location of an intrauterine device. Using a transvaginal approach ultrasound can be used to identify intauterine device expulsion and translocation, organ perforation, and incorectly placed devices. Although no longer a popular method of birth control in the United States, the intrauterine device remains the most common reversible form of contraception used worldwide. The intrauterine device is the most cost effective method of birth control if used more than 2 years. One rare complication of intrauterine device use is translocation of the device. An intrauterine device that has moved from the fundus of the uterus can become imbedded in the myometrium and can even perforate the uterus and move into the abdomen or pelvis. Intrauterine devices have been reported to perforate the intestine and the bladder. This case illustrates the ultrasound appearance of a perforation caused by an intrauterine device.