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Elsayed M, Amer MI, Gamal R, Haggag A, Mashaly AR, Absi TE, Elsayed W. Measuring uterine cavity volume with sonohysterography: A new objective method. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:94-101. [PMID: 38694830 PMCID: PMC11060122 DOI: 10.1177/1742271x231215502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/08/2023] [Indexed: 05/04/2024]
Abstract
Introduction The uterine cavity is a potential space with limited methods for evaluating its volume, limiting the evaluation of interventions' effectiveness in various uterine conditions. This study aims to objectively measure the uterine cavity volume using sonohysterography coupled with a Foley catheter to provide a normative model of age and parity-related uterine cavity volume. Methods The research included 35 women (group 1) with a total abdominal hysterectomy and 150 women (group 2) who underwent sonohysterography for various gynecologic indications. Saline infusion sonography was administered to all patients. The most common shape obtained after the saline infusion was taken to measure the uterine cavity's dimensions and volume. The uterine cavity volumes, as measured by sonohysterography, and the volumes of saline injected after the hysterectomy were compared. Results A significant association exists between uterine cavity volumes measured by sonohysterography and true volumes measured immediately after hysterectomy (p = 0.001). The association between uterine cavity volume measured by sonohysterography and using only a Foley catheter balloon was statistically insignificant (p = 0.13). A statistically significant positive association was observed between the uterine cavity volume and the patient's age and parity (p ⩽ 0.05). Conclusion Measuring the uterine cavity volume using a paediatric Foley catheter balloon coupled with sonohysterography offers an objective approach to measuring a normal (without gross pathologies) uterus volume. This technique would improve the diagnostic accuracy and the management of women with distinct uterine cavity morphologies.
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Affiliation(s)
- Mortada Elsayed
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Mohamed I Amer
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Rania Gamal
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Aly Haggag
- Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Ahmed R Mashaly
- National Medical Institute in Damanhur, Ain Shams University, Cairo, Egypt
| | - Tamer El Absi
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Walaa Elsayed
- Department of Obstetrics and Gynecology, Helwan University Hospital, Cairo, Egypt
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Boehnke T, Bauerfeind A, Eggebrecht L, Cellier C, Lange JA, Heinemann K, Madden T. TEMPORARILY WITHDRAWN: Does the shape of the copper intrauterine device play a role in expulsion? Results from the ongoing European Active Surveillance Study on LCS12. Contraception 2023:110111. [PMID: 37414331 DOI: 10.1016/j.contraception.2023.110111] [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: 03/07/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
This article has been temporarily withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal
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Affiliation(s)
- Tanja Boehnke
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany.
| | - Anja Bauerfeind
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Lisa Eggebrecht
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Camille Cellier
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Jens A Lange
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Klaas Heinemann
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Tessa Madden
- Division of Family Planning, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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Connolly CT, Fox NS. Incidence and Risk Factors for a Malpositioned Intrauterine Device Detected on Three-Dimensional Ultrasound Within Eight Weeks of Placement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1525-1536. [PMID: 34580900 DOI: 10.1002/jum.15836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To estimate the incidence of intrauterine device (IUD) malpositioning detected on three-dimensional (3D) transvaginal ultrasound within 8 weeks of placement and identify risk factors for malpositioning. METHODS Retrospective study of women who had an IUD placed at a large obstetrics and gynecology practice from January 1, 2015, to December 31, 2020. All patients underwent two-dimensional ultrasound at the time of insertion and routine three-dimensional ultrasound within 8 weeks. Baseline characteristics and potential risk factors were compared between women with correctly positioned and malpositioned IUDs. Odds ratios were calculated by logistic regression to identify risk factors independently associated with malpositioning. RESULTS A total of 763 IUD placements were included, and 127 malpositioned IUDs were identified representing an overall rate of malpositioning of 16.6% (95% confidence interval [CI] 14.0-19.3) with 8.8% (95% CI 6.8-10.8) requiring removal. Patients with malpositioned IUD had higher rates of morbid obesity (13.4% versus 3.8%, adjusted odds ratio [aOR] 2.46, 95% CI 1.10-5.50), prior uterine window or rupture (9.0% versus 2.2%, aOR 2.78, 95% CI 1.06-7.30), copper IUD placement (64.2% versus 47.4%, aOR 1.99, 95% CI 1.31-3.03), and symptoms such as bleeding or pain at follow-up (35.8% versus 20.1%, aOR 2.58, 95% CI 1.67-3.98). Parity, breastfeeding, difficult insertion, and uterine size and positioning were not significant. CONCLUSIONS The incidence of malpositioned IUD within 8 weeks of placement on 3D ultrasound is 16.6%, with 8.8% requiring removal. Significant risk factors for malpositioning include morbid obesity, prior uterine window or rupture, and copper IUD placement. These findings support the importance of routine follow-up 3D ultrasound after seemingly successful IUD placement.
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Affiliation(s)
- Courtney T Connolly
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Maternal Fetal Medicine Associates, PLLC, New York, NY, USA
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Feng Y, Zhang S, Zhou Y, He G, Hong L, Shi L, Wang J, Zhang P, Zhai L. Three-dimensional measurement and analysis of morphological parameters of the uterus in infertile women. Quant Imaging Med Surg 2022; 12:2224-2237. [PMID: 35371941 PMCID: PMC8923859 DOI: 10.21037/qims-21-812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2023]
Abstract
BACKGROUND To determine differences in endometrial cavity anteroposterior diameter, thickness, volume, and diameter lines of uterine body and thickness, and volume of upper, middle, and lower regions of the endometrium in infertile women using a new method for three-dimensional (3D) reconstruction based on two-dimensional (2D) ultrasound images. METHODS This retrospective cross-sectional study included a total of 81 infertile women, who underwent 2D ultrasound standard examination. We created 3D models of the uterine body, endometrial cavity, and endometrium based on 2D ultrasound images. The parameters that were measured and analyzed in a 3D plane included volume and diameter lines of endometrial cavity, surface area, thickness, volume, and diameter lines of uterine body, and surface area, thickness, and volume of upper, middle, and lower region of the endometrium. These parameters were used for comparisons between normal and arcuate uterus, between non-pregnant and pregnant infertile women, and between nulliparous and multiparous infertile women. The differences between the different regions of the endometrium and the correlations between age and the parameters were also determined in this study. RESULTS Endometrial cavity length, and middle and lower regions of the endometrial volume in the normal uterus were 39.63±7.61 mm, 1,307.92±1,034.40 mm3, and 653.98±460.41 mm3, respectively. For arcuate uterus, these parameters were 32.96±4.69 mm, 539.89±298.94 mm3, and 347.90±129.61 mm3, respectively. The parameters were significantly higher in normal uterus compared with arcuate uterus (P=0.000, 0.001, and 0.006, respectively). Upper, middle, and lower regions of endometrial thickness in normal uterus were 7.79±3.26, 8.18±3.33, and 6.41±2.60 mm, respectively. Both upper and middle regions of endometrial thickness were significantly greater than the lower regions of endometrial thickness with P=0.009 and P=0.001, respectively. Correlation analysis revealed that age positively correlated with volume of upper endometrial regions (r=0.274, P=0.028). CONCLUSIONS This study provides references for the volume and thickness of the endometrium in the different anatomical regions of normal and arcuate uterus. Age mainly affects the upper region of the endometrium. The 3D measurement provides a precise way to quantify the morphological parameters of gynecological diseases.
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Affiliation(s)
- Yankun Feng
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Shaojing Zhang
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ying Zhou
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guibing He
- Department of Urology, Jinhua People’s Hospital, Jinhua, China
| | - Liting Hong
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Li Shi
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Jianmei Wang
- Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ping Zhang
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Lidong Zhai
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
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Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens? Arch Gynecol Obstet 2020; 302:1181-1187. [PMID: 32748051 DOI: 10.1007/s00404-020-05713-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography. MATERIALS AND METHODS Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1 month, 3 months, and 6 months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement. RESULTS Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5 mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5 mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60-0.75). CONCLUSION IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.
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Pires MLL, Souza AI, Dantas MLBR, Soriano GD, Henriques CV, Ferreira ALCG. Indications and reasons for discontinuing the levonorgestrel-releasing intrauterine system (LNG-IUS). REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to identify the main indications and reasons for discontinuing the use of the Levonorgestrel-Releasing Intrauterine System (LNG-IUS). Methods: a cross-sectional study was carried out from medical records of 327 women who used the LNG-IUS 52mg between January 2011 and December 2016 at a public hospital in the Northeast of Brazil. Results: the main indications for the use of the LNG-IUS were: contraception (32.7%), myoma/metrorrhagia (28.7%) and endometriosis/pelvic pain (22.3%). Of the 327 women, 68 (20.8%) had discontinued using the device. The most frequent reasons for discontinuation were: expulsion (9.2%), LNG-IUS expiration (3.7%), bleeding (2.4%) and pain (1.5%). Most patients had no difficulty in the insertion and did not require anesthesia/sedation. Among the 30 women who expelled the device, 17 (56.7%) had used it for metrorrhagia and myoma, 8 (26.7%) for contraception, and 5 (16.6%) for endometriosis/pelvic pain. Conclusions: the LNG-IUS is a well-accepted contraceptive method, with therapeutic applications for some gynecological conditions and a low expulsion rate.
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Espinosa JA, Cuerva MJ, Nieto L, Garcia-Casarrubios P, Leal MÁ, Bartha JL. Length of uterine cavity after second phase of postpartum period in women requesting long-acting reversible contraception. J OBSTET GYNAECOL 2020; 41:162-163. [PMID: 32027192 DOI: 10.1080/01443615.2019.1702935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- José Angel Espinosa
- Affective Childbirth Department, Hospital San Francisco de Asis, Madrid, Spain
| | - Marcos Javier Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Nieto
- Department of Obstetrics and Gynecology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - María Ángeles Leal
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
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Tellum T, Qvigstad E, Skovholt EK, Lieng M. In Vivo Adenomyosis Tissue Sampling Using a Transvaginal Ultrasound–guided Core Biopsy Technique for Research Purposes: Safety, Feasibility, and Effectiveness. J Minim Invasive Gynecol 2019; 26:1357-1362. [DOI: 10.1016/j.jmig.2019.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
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Gerkowicz SA, Fiorentino DG, Kovacs AP, Arheart KL, Verma U. Uterine structural abnormality and intrauterine device malposition: analysis of ultrasonographic and demographic variables of 517 patients. Am J Obstet Gynecol 2019; 220:183.e1-183.e8. [PMID: 30419198 DOI: 10.1016/j.ajog.2018.11.122] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intrauterine devices are currently one of the leading forms of reversible contraception in the world. However, in approximately 10-25% of women, intrauterine devices can become malpositioned, leading to consequences including pain, bleeding, as well as possible decreased contraceptive efficacy. OBJECTIVE We sought to determine whether certain reproductive and uterine characteristics are associated with an increased risk of intrauterine device malposition. We hypothesized that anatomical characteristics such as the presence of any uterine anomalies, particularly congenital anomalies and fibroids that may lead to cavitary distortion, would be associated with a higher incidence of intrauterine device malposition. MATERIALS AND METHODS We conducted a retrospective case-control study in an academic medical center. All patients presenting for scheduled ultrasound appointments for gynecologic indication between June 2004 and February 2016 were included (1,253 ultrasound reports identified). Of these, 236 demonstrated malpositioned intrauterine devices. With a control group of 281 patients with normal intrauterine device location, a total of 517 patients were included in the study. Transabdominal and transvaginal ultrasounds were performed followed by 3-dimensional rendering (as per our institution's protocol for patients with intrauterine devices) using Voluson 730 and Voluson E8 ultrasound machines. Demographic and reproductive characteristics, indication for ultrasound, intrauterine device, and uterine characteristics were all extrapolated from the electronic medical record. χ2 Tests were performed for categorical variables. Generalized linear models for Poisson distributed variables, and multiple logistic regression were used to ascertain significant independent predictors of IUD malposition. Ninety-five percent confidence intervals and effect sizes were calculated, and P < .05 was considered statistically significant. RESULTS In this study, we found a cumulative IUD malposition rate of 19%. In patients with malpositioned intrauterine devices, there was increased incidence of retroflexed uterine positions (7.6% vs 1.8%, P = .001), and all uterine anomalies (this includes septate and bicornuate uteri and fibroids, 31.9% vs 23.5%, P = .02) compared with controls. The anterior midline uterine position was more commonly noted in controls (28.5% vs 11%, P < .001). A higher total number of fibroids was noted in the malpositioned group (3.7 vs 1.8, P = .01); however, fibroid size was not statistically significant. In particular, there was an increased incidence of submucosal fibroids in women with malpositioned intrauterine devices (P = .01). Multivariable logistic regression revealed that anterior midline position (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.20-0.57) and absence of uterine anomalies (OR, 0.59; 95% CI, 0.38-0.93) were factors associated with a lower risk of IUD malposition; whereas vaginal bleeding (OR, 2.25; 95% CI, 1.38-3.67), pain (OR, 2.85; 95% CI, 1.84-4.44), or missing IUD strings at time of presentation (OR, 3.58; 95% CI, 1.88-6.82) were associated with an increased risk of malposition. CONCLUSION Retroflexed uterine positions and all uterine malformations are associated with higher incidence of malpositioned intrauterine devices. Presence of increased number of fibroids and specifically submucosal fibroids showed a positive association with intrauterine device malposition, as did symptoms of bleeding, pain, and missing IUD strings at time of presentation. These findings pertain to women presenting for gynecologic ultrasound evaluation and may not be generalizable to all women with IUDs.
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Affiliation(s)
- Sabrina A Gerkowicz
- Department of Obstetrics and Gynecology, Jackson Memorial Hospital/University of Miami, Miami, FL.
| | - Desiree G Fiorentino
- Department of Obstetrics and Gynecology, Jackson Memorial Hospital/University of Miami, Miami, FL
| | | | - Kristopher L Arheart
- University of Miami Department of Public Health Sciences, Division of Biostatistics, Miami, FL
| | - Usha Verma
- Department of Obstetrics and Gynecology, Jackson Memorial Hospital/University of Miami, Miami, FL
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Pain Perception during Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Women: A Systematic Review. J Pediatr Adolesc Gynecol 2018; 31:549-556.e4. [PMID: 29890206 DOI: 10.1016/j.jpag.2018.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/20/2018] [Accepted: 05/30/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Intrauterine devices (IUDs) still remain underused in adolescents. Pain during insertion might prevent adolescents to opt for a levonorgestrel-releasing IUD. This study aimed to conduct a systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and critically appraise published data with respect to the efficacy of various substances (analgesics or not) in preventing pain during levonorgestrel-releasing IUD insertion in nulliparous women as a proxy for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A comprehensive computerized systematic literature search of all English language studies between 2006 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were manually searched. RESULTS The computerized database search revealed 31 citations of relevance, 9 of which with a total of 355 treated women and 345 controls fulfilled the inclusion/exclusion criteria. In women treated with misoprostol (n = 150) vs placebo (n = 145), the median visual analogue scale (VAS) score ± SD were 5.7 ± 2.1 vs 5.1 ± 2.2, respectively. In the previously mentioned population, there was a nonsignificant change in VAS score (odds ratio, 1.44; 95% confidence interval, 0.86-2.40). In women treated with lidocaine (n = 140) vs placebo (n = 136), the median VAS score ± SD were 4.6 ± 2.1 vs 5.8 ± 2, respectively. In the aforementioned population, there was a significant decrease in VAS score (odds ratio, 0.12; 95% confidence interval, 0.02-0.91). CONCLUSION In nulliparous women, lidocaine treatment seems to be a reasonable choice. However, further studies are required to examine the different routes and modes of administration as well as optimal quantities.
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Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:806-822. [PMID: 30429071 DOI: 10.1016/j.gofs.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide national clinical guidelines focusing on intrauterine contraception. METHODS A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
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Affiliation(s)
- F Vidal
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
| | - L Paret
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France
| | - Y Tanguy le Gac
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Guerby
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
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Unal C, Eser A, Tozkir E, Wildemeersch D. Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS®) versus the TCu380A: A randomized trial. Contraception 2018; 98:S0010-7824(18)30135-5. [PMID: 29678365 DOI: 10.1016/j.contraception.2018.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The intent of this study (primary outcome measure) is to assess the expulsion rate of a newly developed copper releasing frameless intrauterine IUD GyneFix® Cesarean Section (Gyn-CS®) at 3 months' follow-up, compared to the TCu-380A IUD, inserted immediately postplacental expulsion following cesarean section delivery. STUDY DESIGN This is a randomized trial from one hospital research center in Istanbul, Turkey. Eligible pregnant women, the majority undergoing elective cesarean delivery (n=106), and the remaining emergency cesarean section cases (n=34), received intracesarean insertion of Gyn-CS or TCu380A insertion. Follow-up ended with a 3 month-visit. The Zeynep Kamil University Hospital Ethics Committee approved this study. RESULTS The study explores the retention of 140 insertions, 70 Gyn-CS and 70 TCu380A. There were two follow-up visits after discharge from hospital at 6 weeks and 3 months. A single Gyn-CS expulsion occurred after approximately 6 weeks likely a consequence of improper anchoring. Expulsion was more common in the TCu380 A IUD group (11.4% vs 1.4%, p=.039). There were 4 removals for medical reasons in the Gyn-CS patients and 4 in the TCu380A patients, respectively, with 4 non-medical removals occurred, 2 in each group. No serious adverse events (e.g., PID, perforation) were reported. At the study conclusion of 3 months, 61 Gyn-CS (88%) and 54 TCu380A (79%) IUDs remain in place. CONCLUSION This immediate postplacental study in cesarean section patients suggests that the anchoring technique employed resulted in the excellent retention of Gyn-CS. Insertion was easy, safe and quick requiring minimal physician training. The possibility of direct visualization of the anchor by ultrasound at insertion and follow-up allows the surgeon to verify the position of the IUD serving to enhance provider and patient confidence and assurance. IMPLICATIONS The frameless anchored intrauterine IUD is effective in minimizing displacement and expulsion. The results of this study suggest that the Gyn-CS IUD is appropriate for wider intracesarean use.
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Affiliation(s)
- Ceren Unal
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital
| | - Ahmet Eser
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital
| | - Elif Tozkir
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital
| | - D Wildemeersch
- Reproductive Health Consultant Intrauterine Devices and Systems, F. Rooseveltlaan 43/44, Ghent, Belgium.
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Moshesh M, Saldana T, Deans E, Cooper T, Baird D. Factors associated with low-lying intrauterine devices: a cross-sectional ultrasound study in a cohort of African-American women. Contraception 2018; 98:25-29. [PMID: 29550456 DOI: 10.1016/j.contraception.2018.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The object of this study is to examine factors and symptoms associated with low-lying IUDs as defined by ultrasound. STUDY DESIGN This is a cross-sectional sub-study of participants in the Study of Environment, Life-style, and Fibroids (SELF). SELF participants had screening ultrasounds for fibroids at study enrollment; those with an IUD in place are included in this sub-study. Low-lying IUDs were identified and localized. Logistic regression was used to identify factors and symptoms associated with low-lying IUDs. RESULTS Among 168 women with IUDs at ultrasound, 28 (17%) had a low-lying IUD. Having a low-lying IUD was associated with low education level (≤high school: aOR 3.1 95% CI 1.14-8.55) and with increased BMI (p=.002). Women with a low-lying IUD were more likely to report a "big problem" with dysmenorrhea (the highest option of the Likert scale) as compared to women with a normally-positioned IUD (OR 3.2 95% CI 1.07-9.54). CONCLUSION Our study found that women with a low-lying IUD are more likely to be of lower education and higher BMI, and to report more dysmenorrhea. IMPLICATIONS Women who are obese may benefit from additional counseling and closer follow-up after IUD placement. Future research is warranted to investigate IUD placement and possible IUD migration among women who are obese.
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Affiliation(s)
- Malana Moshesh
- Duke University Department of Obstetrics & Gynecology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710.
| | - Tina Saldana
- Social & Scientific Systems, Inc., 4505 Emperor Blvd. Suite 400, Durham, NC 27703
| | - Elizabeth Deans
- Duke University Department of Obstetrics & Gynecology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710
| | - Tracy Cooper
- Henry Ford Health Systems, 2799 West Grand Blvd., Detroit, MI 48202
| | - Donna Baird
- National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709
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Relationship between copper IUD complications and ultrasonographic findings. Arch Gynecol Obstet 2018; 297:989-996. [DOI: 10.1007/s00404-018-4711-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Dakhly DMR, Bassiouny YA. Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial. EUR J CONTRACEP REPR 2017; 22:349-353. [PMID: 28978240 DOI: 10.1080/13625187.2017.1381234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM OF STUDY To reduce the pain and duration of the intrauterine device (IUD) insertion procedure through minimizing instrumentation and using trans-abdominal sonography (TAS). METHODS This randomized control trial was conducted in a university hospital and included 102 eligible females, fulfilling the inclusion criteria. They were randomly assigned into two groups via 1:1 computer-based randomization program; the trans-abdominal guided IUD insertion group (n = 51), and the traditional IUD insertion group (n = 51). The main outcomes were the pain experienced during the procedure as scored by the visual analogue score and the duration of the procedure. RESULTS The trans-abdominal guided IUD insertion was found to be statistically superior to the traditional technique for IUD insertion regarding the pain scores (according to the Visual Analogue Scale, from 0 to 10) recorded by the candidates (2.4 ± 2.1 vs. 5.0 ± 1.7, p < .001) as well as the time (in seconds) taken for IUD insertion procedure (32.2 ± 14.8 vs. 77.7 ± 30.6, p < .001). CONCLUSIONS Due to the decrease in pain and time taken for IUD insertion, the trans-abdominal guided technique can be used as a modified technique for IUD insertion. ClinicalTrials.gov Identifier: NCT02582268.
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A multicenter study assessing uterine cavity width in over 400 nulliparous women seeking IUD insertion using 2D and 3D sonography. Eur J Obstet Gynecol Reprod Biol 2016; 206:232-238. [DOI: 10.1016/j.ejogrb.2016.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
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Wildemeersch D, Andrade A, Goldstuck N. Femilis(®) 60 Levonorgestrel-Releasing Intrauterine System-A Review of 10 Years of Clinical Experience. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2016; 10:19-27. [PMID: 27547046 PMCID: PMC4979586 DOI: 10.4137/cmrh.s40087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to update the clinical experience with the Femilis® 60 levonorgestrel-releasing intrauterine system (LNG-IUS), now up to 10 years in parous and nulliparous women, particularly with regard to ease and safety of insertion, contraceptive performance, retention, acceptability, continuation of use, impact on menstrual blood loss (MBL), and duration of action. STUDY DESIGN Using the Femilis® 60 LNG-IUS releasing 20 µg of levonorgestrel/day, the following studies were conducted: an open, prospective noncomparative contraceptive study, an MBL study, a perimenopausal study, a study for the treatment of endometrial hyperplasia, and early cancer of the uterus, a residue study. RESULTS A total of 599 Femilis LNG-IUS were inserted in various clinical trials, the majority for contraceptive purposes. The total exposure in the first and second contraceptive studies, covering 558 parous and nulliparous women, was 32,717 woman-months. Femilis has high contraceptive effectiveness as only one pregnancy occurred. Expulsion of the LNG-IUS was rare with only two total and no partial expulsions (stem protruding through the cervical canal) occurred. Femilis was well tolerated, with continuation rates remaining high. Several MBL studies were conducted, totaling 80 heavy and normal menstrual bleeders, using the pictorial bleeding assessment chart method or the quantitative alkaline hematin technique. Virtually all women responded well with strongly reduced menstrual bleeding. Amenorrhea rates were high, up to 80% after three months, and ferritin levels simultaneously increased significantly. The Femilis LNG-IUS was tested in 104 symptomatic perimenopausal women for seamless transition to and through menopause, adding estrogen therapy when required. Patient tolerability appeared high as >80% requested a second and a third LNG-IUS. Twenty women presenting with nonatypical and atypical hyperplasia and one woman presenting with early endometrial carcinoma were treated with Femilis LNG-IUS. All histology specimens showed full regression, and patients remained in remission without signs of hyperplasia or cancer at yearly and ongoing follow-up examinations up to 10 years. Residual content of LNG was measured in 37 women having the Femilis LNG-IUS for up to 10 years. In 10 of the 102 women who had the Femilis 60 in situ for 10 years between 20% and 30% of the original 60 mg was recovered confirming the long duration of action of the Femilis 60 LNG-IUS. CONCLUSION These studies suggest that the Femilis 60 LNG-IUS releasing 20 µg of LNG/day is an effective, well-tolerated, and well-retained contraceptive both in parous and in nulliparous women. The design of the LNG-IUS, with flexible transverse arm(s) length of 28 mm, allows for a simplification of the insertion technique and training requirements facilitating the use by nonspecialist providers in either developed or developing countries. For nulliparous women, additional evaluation of devices with a 24 mm transverse arm(s), as it relates to tolerability, retention, and continuation of use, still needs to be undertaken.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Amaury Andrade
- Center for Reproductive Biology, Federal University Juiz de Fora, Juiz de Fora, Brazil
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
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Zhang X, Xiao L, Zhu H, Cheng L. The risk of using intrauterine devices to benign reproductive system conditions in postmenopausal women: A case control study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:17. [PMID: 27904563 PMCID: PMC5122215 DOI: 10.4103/1735-1995.178756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/28/2014] [Accepted: 01/27/2016] [Indexed: 11/24/2022]
Abstract
Background: To investigate the effect of using intrauterine devices (IUDs) during the fertile window on women's reproductive system health. Materials and Methods: 2,744 postmenopausal women in the Minhang District, Shanghai, China were enrolled. In the IUDs group there were 2,253 women; in the tubal ligation group there were 202 women and there were 289 women in the control group. We selected subjects according to the cases number in different hospital by using step sampling, and, in addition, collected the sociological data and information of the previously used contraceptives by the subjects, which included whether the contraceptives were used appropriately and the effect they had. Kolmogorov-Smirnov test, Levene's test, and logistic regression analysis were used to analyze the data. Results: The prevalence rate of benign reproductive system conditions was significantly different among them (P < 0.05). Further comparison revealed, the rate in Group 1 was significantly lower than that in Group 2 and Group 3 (P < 0.05, respectively). Results of logistic regression analysis show that the risk factors for development of such conditions lie in the women's pregnancy history [odds ratio (OR) = 3.85], reproductive history (OR = 0.5), the use of IUD in fertile window (OR = 0.4), tubal ligation (OR = 1.74), birth control time (OR = 0.9), contraceptive failure history (OR = 1.7), and history of family planning procedures (OR = 1.73). Conclusion: IUDs, maybe, can effectively reduce the risk of getting benign reproductive conditions in postmenopausal females.
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Affiliation(s)
- Xiaohua Zhang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital, Minhang, China
| | - Liping Xiao
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital, Minhang, China
| | - Haoping Zhu
- Department of the Basic Medical Research Center, Shanghai Institute of Planned Parenthood, Shanghai, China
| | - Linan Cheng
- Department of the Basic Medical Research Center, Shanghai Institute of Planned Parenthood, Shanghai, China
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Abstract
INTRODUCTION Intrauterine devices (IUD) are viewed as important contraceptive methodologies to prevent unintended pregnancy. AREAS COVERED This expert opinion examines the place of frameless devices for use in young women in order to minimize side effect, improve patient comfort and maximize continuation of use to help reduce unintended pregnancies. EXPERT OPINION Frameless designed IUDs have the ability to be used in both small and large uterine cavities of varied shapes and can significantly reduce abnormal bleeding, pain, embedment and expulsion and likely account for higher continuation rates than that seen with framed IUDs.
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Affiliation(s)
- Dirk Wildemeersch
- a Gynecological Outpatient Clinic and IUD Training Center , Ghent , Belgium
| | - Norman D Goldstuck
- b Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Western Cape , South Africa
| | - Thomas Hasskamp
- c Klinik für Operativen Gynäkologie, GynMünster , Münster , Germany
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