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Algeri P, Spazzini MD, Pinna N, Biancotti L, Mariuzzo F, Tomaselli T, Mantegazza P, Von Wunster S, Villa A. Levonorgestrel intrauterine device with absence of threads: don't take expulsion for granted! A case series of possible errors in ultrasound evaluation, in case of "lost IUDs". J Ultrasound 2023:10.1007/s40477-023-00807-2. [PMID: 37516719 DOI: 10.1007/s40477-023-00807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 07/31/2023] Open
Abstract
Levonorgestel intrauterine devices are safe contraceptive methods, with even medical indications. However, they may present rare, but severe complications such as perforation and abdominal dislocation. Ultrasound assessment may be limited if a medicate intrauterine device is lost, due to its particular echogenicity. We report cases complicated by loss of intrauterine devices. Based on this experience we believe that ultrasound should always be associated to an X-ray examination to prevent misdiagnosis, especially in case of loss of a levonorgestrel device. Although our conclusions are not innovative and the cases are limited, we believe they can be a reminder in clinical practice to avoid not so infrequent complications and clinical errors. We would also like to recall the limitations of ultrasound in locating levonorgestrel intra uterine devices and stress that one should never take for granted the expulsion of the device in case of lost its threads.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo-est, Seriate, Bergamo, Italy.
| | - Maria Donata Spazzini
- Department of Obstetrics and Gynaecology, ASST Bergamo ovest, Treviglio, Bergamo, Italy
| | - Nina Pinna
- Department of Oncology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Luciana Biancotti
- Department of Obstetrics and Gynaecology, Moriggia Pelascini Hospital, Gravedona, Italy
| | - Federica Mariuzzo
- Department of Obstetrics and Gynaecology, ASST Bergamo ovest, Treviglio, Bergamo, Italy
| | - Tiziana Tomaselli
- Department of Obstetrics and Gynaecology, ASST Bergamo ovest, Treviglio, Bergamo, Italy
| | - Priscilla Mantegazza
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo-est, Seriate, Bergamo, Italy
| | - Silvia Von Wunster
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo-est, Seriate, Bergamo, Italy
| | - Antonella Villa
- Department of Obstetrics and Gynaecology, ASST Bergamo ovest, Treviglio, Bergamo, Italy
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Lee J, Oh JH, Kim J, Lim CH, Jung SH. Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:48-52. [PMID: 34312357 DOI: 10.4166/kjg.2021.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
Intrauterine devices (IUDs) are widely used for contraception in South Korea. However, several complications of IUDs have been reported, including inflammation, obstruction, perforation, and fistula. IUD perforation is the rarest of these complications but is also severe. Migrated IUDs can be retrieved through endoscopy, laparoscopy, or laparotomy. Presented below is an atypical case of an IUD perforating the sigmoid colon, which could not be removed endoscopically, and was subsequently incompletely removed through laparoscopic surgery. The present case underlines the importance of appropriate diagnosis and treatment approach in the management of IUD perforation.
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Affiliation(s)
- Junseak Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinsu Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoon Jung
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yamamoto A, Hiro J, Omura Y, Ichikawa T, Ide S, Imaoka H, Yasuda H, Fujikawa H, Okita Y, Yokoe T, Ohi M, Toiyama Y. Laparoscopic removal of an aberrant acupuncture needle in the gluteus that reached the pelvic cavity: a case report. Surg Case Rep 2021; 7:51. [PMID: 33595766 PMCID: PMC7889768 DOI: 10.1186/s40792-020-01065-8] [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: 06/29/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Intrapelvic aberrant needles are rare in clinical practice. Long-term foreign bodies in the abdominal cavity may form granulation tissue or an abscess, and may cause organ injury. Therefore, such foreign bodies need prompt removal. Case presentation A 26-year-old male athlete was referred to our hospital for investigation of an aberrant acupuncture needle in the gluteus. The needle was unable to be removed during acupuncture treatment, and the end broke off and remained in the gluteus. Abdominal X-ray examination showed a thin, 40-mm-long, metallic foreign body resembling an acupuncture needle. Abdominal computed tomography showed an abnormal shadow in the gluteus. However, it was unclear whether the tip of the needle reached the pelvic cavity. Thus, it was decided to surgically extract the needle via laparoscopic surgery under X-ray guidance as a safe and minimally invasive method. Although X-ray fluoroscopy confirmed that the aberrant needle was located in the gluteus, the needle could not be felt with the forceps, as the peritoneum surrounding the needle had granulomatous changes due to inflammation. Therefore, the retroperitoneum was further dissected to search for the needle. Once the needle was identified, its flexibility enabled it to be easily removed by grasping it directly with a needle holder. The length of the aberrant needle was 40 mm. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 2. Conclusions When a foreign body remains in the gluteus and its tip touches intrapelvic organs, such as the rectum, it is critical to determine the best approach for its safe removal. Given the anatomical location of the foreign body and the patient background, laparoscopic removal was considered the best approach in the present case.
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Affiliation(s)
- Akira Yamamoto
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Junichiro Hiro
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yusuke Omura
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takashi Ichikawa
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shozo Ide
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Imaoka
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiromi Yasuda
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroyuki Fujikawa
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yoshiki Okita
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takeshi Yokoe
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ohi
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yuji Toiyama
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
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Huh JM, Kim KS, Cho YS, Suh DK, Lee JU, Baek SD, Moon SK. Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon. Ann Coloproctol 2018; 34:106-108. [PMID: 29742863 PMCID: PMC5951096 DOI: 10.3393/ac.2017.10.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/30/2017] [Indexed: 11/01/2022] Open
Abstract
The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.
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Affiliation(s)
- Jin Myeong Huh
- Department of General Surgery, SM Christianity Hospital, Pohang, Korea
| | - Ki Seok Kim
- Department of General Surgery, SM Christianity Hospital, Pohang, Korea
| | - Yong Seok Cho
- Department of General Surgery, SM Christianity Hospital, Pohang, Korea
| | - Dong Kwon Suh
- Department of General Surgery, SM Christianity Hospital, Pohang, Korea
| | - Jae Uk Lee
- Department of Internal Medicine, SM Christianity Hospital, Pohang, Korea
| | - Seong Deuk Baek
- Department of Internal Medicine, SM Christianity Hospital, Pohang, Korea
| | - Sin Kil Moon
- Department of Internal Medicine, SM Christianity Hospital, Pohang, Korea
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A rare site of intrauterine contraceptive device migration. Eur J Obstet Gynecol Reprod Biol 2016; 198:172-173. [DOI: 10.1016/j.ejogrb.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/21/2015] [Accepted: 12/10/2015] [Indexed: 11/23/2022]
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Şengül Ö, Dilbaz B, Kavak D, Dede S, Yerebasmaz N, Altinbaş Ş. Surgical management of extrauterine mislocated intrauterine contraceptive devices and related risks. J OBSTET GYNAECOL 2013; 34:70-3. [DOI: 10.3109/01443615.2013.831047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Balci O, Capar M, Mahmoud AS, Colakoglu MC. Removal of intra-abdominal mislocated intrauterine devices by laparoscopy. J OBSTET GYNAECOL 2012; 31:650-2. [PMID: 21973139 DOI: 10.3109/01443615.2011.593646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena(®) (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.
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Affiliation(s)
- O Balci
- Department of Obstetrics and Gynecology, Meram Medicine Faculty, Selcuk University, Konya, Turkey.
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Weng SF, Chen HS, Chen YH, Lee JN, Tsai EM. Rectum penetration that was caused by the displacement of an intrauterine device and mimicked rectal endometriosis. Taiwan J Obstet Gynecol 2011; 50:375-6. [PMID: 22030057 DOI: 10.1016/j.tjog.2011.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2010] [Indexed: 10/15/2022] Open
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Cetinkaya K, Kumtepe Y, Ingec M. Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience. Eur J Obstet Gynecol Reprod Biol 2011; 159:119-21. [PMID: 21821341 DOI: 10.1016/j.ejogrb.2011.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 04/17/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of hysteroscopy and laparoscopy for diagnosis and treatment in women with lost intra-uterine devices (IUDs), and to elucidate the most common extra-uterine locations of lost IUDs. STUDY DESIGN Retrospective clinical study at Atatürk University Hospital, Erzurum, Turkey. Women with lost IUDs presenting in the last 7 years were referred to the obstetrics and gynaecology clinics. Women whose lost IUDs were removed using a Novak curette were excluded from the study. RESULTS Of the 55 cases studied, 29 (52.7%) lost IUDs were located inside the uterine cavity, 23 (41.8%) were located outside the uterine cavity, and three (5.5%) were embedded in the myometrium. The most common extra-uterine location of lost IUDs was around the uterosacral ligaments (n=8, 34.7%). Considerable association was found between the position of the uterus and the extra-uterine location of lost IUDs. In all eight cases where the lost IUD was located around the uterosacral ligaments, the uterine position was anteverted and perforation was found on the posterior side of the uterus. IUD removal was performed successfully in 46 women (83.6%) by either hysteroscopy or laparoscopy. CONCLUSIONS Lost IUDs inside or outside the uterine cavity can be managed by minimally invasive approaches. If an anteverted uterus is seen on laparoscopy, the initial exploration for the lost IUD should be made around the uterosacral ligaments.
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Affiliation(s)
- Kadir Cetinkaya
- Department of Obstetrics and Gynaecology, Ankara Oncology Hospital, Ankara 06160, Turkey
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Prabhu JK, Rani R, Nayak NK, Natarajan P. Migration of intrauterine contraceptive device into sigmoid colon. J OBSTET GYNAECOL 2010; 30:526-7. [PMID: 20604666 DOI: 10.3109/01443615.2010.486087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J K Prabhu
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Pudhucherry, India.
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Nceboz Ü, Özçakir HT, Uyar Y, Çağlar H. Migration of an intrauterine contraceptive device to the sigmoid colon: a case report. EUR J CONTRACEP REPR 2009. [DOI: 10.1080/ejc.8.4.229.232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ingec M, Kumtepe Y, Kadanali S, Ozdiller O. A rare case of ileal embedding by an intrauterine device. EUR J CONTRACEP REPR 2009; 10:29-31. [PMID: 16036296 DOI: 10.1080/13625180500035082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ileal penetration by a copper-bearing intrauterine device (IUD) is a rare but serious potential complication. This paper reports the case of a 30-year-old gravida 4 para 3 woman with ileal embedding by an IUD. Laparoscopy was performed on the patient 4 months after the insertion of the IUD. When the tail of the IUD was seen during laparoscopy protruding outside the small bowel, the device was removed through a 1-cm incision in the ileum by laparotomy. This report demonstrates a rare case of ileal embedding of an IUD.
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Affiliation(s)
- M Ingec
- Sara Hatun Dogumevi, Elazig, Turkey
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Dane C, Dane B, Cetin A, Yayla M. The Management of Translocated Intrauterine Contraceptive Devices. J Gynecol Surg 2009. [DOI: 10.1089/gyn.2008.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cem Dane
- Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey
| | - Banu Dane
- Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey
| | - Ahmet Cetin
- Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey
| | - Murat Yayla
- Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey
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Brunner SM, Comman A, Gaetzschmann P, Kipf B, Behrend M. Laparoscopic removal of a perforating intrauterine device mimicking chronic appendicitis. J Laparoendosc Adv Surg Tech A 2008; 18:609-10. [PMID: 18721015 DOI: 10.1089/lap.2007.0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.
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Affiliation(s)
- Stefan M Brunner
- Klinikum Deggendorf, Klinik für Visceral-, Thorax-, und Gefässchirurgie, Deggendorf, Germany
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Mülayim B, Mülayim S, Celik NY. A lost intrauterine device. Guess where we found it and how it happened? EUR J CONTRACEP REPR 2006; 11:47-9. [PMID: 16546816 DOI: 10.1080/13625180500456791] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Perforation of the uterus by an intrauterine device (IUD) is a serious complication occurring at or following 1/350 to 1/2,500 insertions. It is more common among women with 'lost' IUDs. If a woman presents with pelvic pain and a history of a 'lost' IUD, X-rays of the abdomen and of the pelvis should be ordered. We report on a 'lost' IUD that had been inserted 12 years previously. It was found in the lower anterior abdominal wall. Most probably uterine perforation had happened during a dilatation and curettage (D & C) attempted for removal of the device. Thereafter the IUD must have migrated to the abdominal wall. This case illustrates that unless it can be recovered by simple traction on the threads, a trained medical professional should be called upon for removal of the IUD.
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Affiliation(s)
- Bariş Mülayim
- Department of Obstetrics and Gynecology, Alanya Hospital, Başkent University, Alanya/Antalya, Turkey.
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Bibliography Current World Literature. Curr Opin Obstet Gynecol 2003. [DOI: 10.1097/01.gco.0000084240.09900.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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