Abdul Amir, Layla

Dabbagh, Abdul Ghany J.

Journal of University of Babylon for Pure and Applied Sciences

English

Journals of University of Babylon

Intra Uterine Contraceptive Device (LU.C.D) Advantages, Side Effects and Complications Layla Abdul Amir Medical College, Babylon University Abstract A retrograde study of 1000 women in Hilla from 1985-1995 in the private clinic, Gyn & Obst. Hos­pital and family planning clinic in the hospital, from different occupa­tions: doctors, engineer, phannacist, lawyer, teacher, worker, farmer and house-wife. The age group for the patients varied from 17 to 48 years with a parity of 1-12, with one women who was nUlliparous. Advantages, complication and side-effects were reported, serious complications, i.e perforation, were treated by a surgeon. Intra Uterine Contraceptive Device Introduction Since early in this century, at­tempts have been made, sporadic at the outset but very interse since 1960 to design a device that when insel1ed into the uterus would prevent preg­nancy without causing adverse ef­fects. One intriguing but unconfirmed story describes the first successful experience with an intrauterine de­vice to have been insertion of small Abdul Ghany J. Dabbagh Medical College, Babylon University stones into the uteri of camels to prevent pregnancy during long cara­vans. At the end-of1976; according to one estimate, more than 15 mil­lion women through out the world were using the I.U.C.D. Type of .U.C.D(lO). 1- Progesterone - releasing. 2- Copper T380 A. 3- Copper 7 Contraindications to Use of I.U.C.D.(9) 1- Known pelvic inflammatory dis­ease. 2- Pregnancy. 3- Abnormal uterine bleeding. 4- Large or moderatly large fibrom­yoma. 5 Recent or less than 6 weeks hyste­rotomy or cesarean section. 6- Congenital uterine abnoffi1alities. 7 - Severe cervicitis. 409 8- Severe cervical stenosis. 9- Blood dyscrasia and bleeding ten­dencies. 10- Gyn-malignancy. Possible Contraindications 1- History of ectopic pregnancy. 2- Menstrual disorder. Material and Methods Most of the LU.C.D. were in­serted by the researcher after thor­ough examination of the user and good couseling before insertion. Some women were referred to the researcher by other doctors. 10 patients were from Eygept, one from India, all devices were copper 7 and copper T. 1000 women were studied, who have had used LU.C.D. with differ­ent jobs as mentioned above. Insertion Insertion of the device is best preformed towards the end of the menstruation. I usually install on the last day of the cycle. So ensuring that an early pregnancy is not dis­trubed. Formarly it was adviced that six weeks should elapse after child birth or abortion, but the mertis of insertion after suction tremination or spontaneous abortion have been proven(3), Preliminary pelvic examination and passage of a sound are essential, the aim being to place the device in the fundal region, so that it confirm to the shape of the uterine cavity whlist avoiding risk of perforation. The methods varies slightly with the devices chosen, when inser­tion is difficult paracervical block may be most helpfuL In our study most of the LU.C.D. were easily in­serted except in few patients, pethi­dine LV. or valium used before in­sertion, 2 patients need general anaesthesia because they were doc­tors. Follow up One must be sure that the pa­tient can confirm the presence of the tail of the device on self examination after each period and at other times if she experiences discomfort and spotting. A second visit in 8-12 week after insertion is essentiaL The pa­tient should report earlier if they lose the thread. It is vital that patient should re­port at once if their menstruation is 14 days overdue. Should the preg­nancy be confirmed it may be safest to remove the device if the strinQ: is accesible and confirm it is prese~ce by Ultra-Sound. The high incidence of ectopic gestation must be remem­berecL Ultra Sound may help to con­firm intra uterine pregnancy. Side Effects and c0111plications of LU.C.D. (In OUf study) a- Immediate (at the time of inser­tion). B- Late, few months up to 2 years. C- Remote, more than 2 years. 410 A- IInmediate complications number precentage 1- Pricking sensation of the cervix 15 1.5% 2- Bleeding from site of tanaculum 6 0.6% A bdominal pain or cramps 20 2% 4- Backache and discomfort 20 2% 5- Nausea and Vomiting 5 0.5% 6- Syncope 6 0.6% 7 - Expulsion, Reinsertion ,. 8 . -.. --~'-.-'-'"'-0.8% 8- Epileptic fit 2 0.2% B- Late Complication number precentage % 1- Bleeding 62 6.2% Discharge 30 3% 3 Pelvic inflammatory disease P.LD. 1 0.1 4- Pregnancy > 30 3 ended in spontaneous abortion 15 1.5% - continuation of pregnancy until term Fig 4,5 15 1.5% 5- Ectopic gestation Fig 3 15 1.5% 6- Embeddino t::J > 8 0.8 - In the endometrium 5 0.5% - In the myometrium 3 0.3 7 - Upward displacement of the thread 20 2% 8- Perforation 1 2 , 5 0.5% 9- Dysparenia 6 0.6 10- Obesity, depression, insomnia 7 0.7 11 Pricking sensation of the husband 6 0.6% 411 C- Relllote Complications: Number Percentage 1­ Endometrial Polyps (all were benign) 5 0.5% 2­ Myomas (figure 7) 4 0.4% 3­ Overian cyst (all benign) 6 0.6% 4­ Post menapousal bleeding 2 0.2% 5 Secondary infertility (1 year after 10 1% removaol) .. ,..,. ... Result In our study of 1000 women who have had used LU.C.D .. the results shown in this table:­Percentage % Total Number 1000 Number - Women were happy, healthy and free 85% from symptoms 850 - Women seeked and asked for proper 30% time for replacements and requested 300 I re-insetion of new device after they have had another baby. - Women suffered from major 150 15% complications and these include -> Perforation 0.55* Embedding 0.8%8* Intrauterine pregnancy 3%30* Ectopic, gestation 1.5%15* Bleeding 62 6.2%* 3% -30~scharge \Vomen suffered from minor 135 1.35 complications 412 In c01l1parison with the result of other studies :­LU.C.D. Our study Other studies* 1­ PeIforation 0.5% 0.1-0.5% 2­ Pregnancy (intra uterine) 3 1.6-2.7% ,., j- Ectopic gestation 1.5 4-9 r­5­Expulsion Bleeding I 0.8% 6.2% . 8.5-14.8% M ____'''' ---­ -~ , 8.1 10.2% * Approval of NDA by US Food and drug administiration granted Nov. 4, 1976 (Current Obstetric and Gynecologic Diagnosis and Treatment middle east edition 1980). Discussion Most of the devices used were copper devices, they are smaller, produce no deformation of uterine cavity, have a lower expulsion rate and fewer side effects demanding re­moval. They are particularly helpful for those who have never been preg­nant(l). Uterine perforation is likely to oocur but if a T device is pushed down by the uterus, the stem can peIforate the cervix(2). There is no evidence that device predispose to carcinoma in women nor there is a significant alteration in vaginal or cervical cytology. No reported cases of death in our stucly from LU.C.D. except two patients, one died from electrical shock and the other from advanced cancer of the breast. Conclusion LU.C.D. is safe and effective method of family planning. One in­serted it continues to function until removed or expelled. It is independent from the act of coitus and its effects are limited to genital tract(7). Following removal of the device, fertility is unimpaired, 75% of the women conceiving with­in 6 months and 90% in 1 year(8). 413 References 1- Newton J. Ellas J. & Johanson A. (1974) J. Obst. & Bf. Common 81, 389. 2- Tatum H.J. (1974) Am. J. Obst. & Gyn. 119,884. 3- Newton J. Ellas J., Mac Ewan J. And Mann G. (1974) Br. Med J. Iii, 447. 4- Shaila N.A., Lane M. And sobre­fa A.J. (1974) Am. J. Obst & Gyn. 120,110. 5- Tietze C. (1966) Am. J. Obst. & Gyn. 96, 1043. 6- Steven J.D. Fraser LS. (1970) J. Obst. & Gyn. Br. Common 81, 181. 7 Tietze C., Lewit S. (966) Family planning 55, 1. 8- KleinMan R.I. (1966) in Royal commission Report on Popula­tion-London LP.P.F. Removal of Dalkon shield F.D. A.Drubull August 1983. 13,14. 9- Current Obstetric and Gynecolo­gin Diagnosis and Treatment. 10- DanfOlth,s Hand book of Obstet­rics and Gynecology. 414 ---. ../ Fi:.:,,,"c 2: PCltorallOIl (If IIlcrll.' 415 416 I i i , . 417 Fi~lIrl' 7: Ill' o!lla 418 - L.l11 -,;II...w:.t- ~ ­~~~~/~I~ ~;l6J1 ~ CO ~Fi::lo411 ~ ~ ~y6J1 ~ ~ ~ 4-=11 ~l ~I~I ..::.U~j . (S~I ~1...l;.j6....... jl ~~j11 IA _ ~.,L.u:J1 ....,...a- /Ao u- 1 IS"""" J-G 6::a...J1 __ J$L..t..l1 - 4..JL::.. b...l..l.=:a. ~ • - ­....,...a _ ..., __ _ ~ b.w ~~I ~~I ~ /1. U1j ~~I ~ jl dj~ .,~I ~ ~ljO .w .,L.u:J1 ~ /\ 0 lal . ..l~ Jli.bl J)l;. ~ ~L..t..ll ~ ..l~j k.,1 ,~jl ....j>J1 ~ ~~I ~~I u.b:J1 r-;l1 , b~1 ~I ~1)~;l1 u-u ~ 1 , r=--j 1 ~,) L::.. J.a.=.. 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Intra Uterine Contraceptive Device (I.U.C.D.) Advantages , Side Effects and Complications

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Intra Uterine Contraceptive Device (I.U.C.D.) Advantages , Side Effects and Complications

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