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  1. 1
    Peer Reviewed

    WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture.

    Hofmeyr GJ; Say L; Gülmezoglu AM

    BJOG: An International Journal of Obstetrics and Gynaecology. 2005 Sep; 112:1221-1228.

    Objective To determine the prevalence of uterine rupture worldwide. Design Systematic review of all available data since 1990. Setting Community- based and facility-based reports from urban and rural studies worldwide. Sample Eighty-three reports of uterine rupture rates are included in the systematic review. Most are facility based using cross-sectional study designs. Methods Following a pre-defined protocol an extensive search was conducted of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Uterine rupture data were collected along with information on the quality of reporting including definitions and identification of cases. Data were entered into a database and tabulated using SAS software. Main outcome measures Prevalence of uterine rupture by country, period, study design, setting, participants, facility type and data source. Results Prevalence figures for uterine rupture were available for 86 groups of women. For unselected pregnant women, the prevalence of uterine rupture reported was considerably lower for community-based (median 0.053, range 0.016-0.30%) than for facility-based studies (0.31, 0.012-2.9%). The prevalence tended to be lower for countries defined by the United Nations as developed than the less or least developed countries. For women with previous caesarean section, the prevalence of uterine rupture reported was in the region of 1%. Only one report gave a prevalence for women without previous caesarean section, from a developed country, and this was extremely low (0.006%). Conclusion In less and least developed countries, uterine rupture is more prevalent than in developed countries. In developed countries most uterine ruptures follow caesarean section. Future research on the prevalence of uterine rupture should differentiate between uterine rupture with and without previous caesarean section. (author's)
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  2. 2

    Basic and clinical aspects of intra-uterine devices. Report of a WHO scientific group.


    Geneva, World Health Organization, 1966. (Technical Report Series NO. 332).

    The value and possible hazards of IUDs are discussed. Grafenberg developed a metal ring IUD in 1928. There was initial enthusiasm about the device, but it became discredited and interest was not revived in the method until 1959. Today, various shapes, sizes, and materials are employed in making IUD'S. No single cause or mechanism of action of an IUD has so far come to light. In sub-human primates the IUD causes accelerated passage of ova through the tube and the rest of the reproductive tract appears to be the major, but not necessarily the only, mechanism, of action. In ruminants, the contraceptive action of the IUD is exerted, at least in part, at the ovarian level. In rats, mice, rabbits, and ferrets, the main effect of the IUD is suppression of the implantation. It is concluded that the action of the IUDs in the human species is exerted before the stage of implantation. The most effective devices are associated with an incidence of 1.8 to 2.9 pregnancies per 100 insertions during the first year of use. The frequency of spontaneous expulsion ranges from about 5% to over 20% depending on the type of device. About one half of all expulsions occur in the first 3 months and comparatively few after the first year. The incidence of removal for medical reasons ranges from approximately 10% to 25% of first insertions during the first year. The method can be used successfully by almost 3 out of every 4 women who adopt it. Side effect and complications include bleeding and pain and less frequently pelvic inflammatory disease and perforation. The only absolute contraindications to the use of IUDs are: (1) active pelvic inflammatory disease, and (2) pregnancy, proven or suspected. Research needs are noted.
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  3. 3

    Safety of IUDs [letter]

    McCowan L

    NEW ZEALAND MEDICAL JOURNAL. 1987 Aug 12; 100(829):503.

    In 1987, the Minister of Health of New Zealand called for a committee to examine standards for IUDs, set guidelines for packaging information, consider reports of adverse reactions, and request information on IUD usage from users, physicians, and manufacturers. The media presented the committee's purpose and concerns in such a way, however, that coverage caused anxiety and uncertainty among women using IUDs. The family planning and medical communities needed to reassure those women with an IUD and who have had no problems of the IUD's safety. A 1987 WHO report could assist these communities because it attested to its effectiveness and safety for some women. For example, it referred to a Women's Health Study in the United States and WHO studies that showed that current IUD users are not at any higher risk of ectopic pregnancy than are those women who do not use any contraception. The report also stated that uterine perforation occurs <1/2000 insertions. In addition, it referred to evidence that fertility returns immediately after removing the IUD. The report concluded that the IUD is an important method of fertility regulation with high continuation rates and significant advantage in convenience of use. On the other hand, it also concluded that some women should never have an IUD, such as those who have invasive cancer of the cervix or uterus, a suspected pregnancy, or active pelvic infection. It further pointed out contraindications which included nulliparity, past ectopic pregnancy, anemia, heavy menstrual bleeding, previous pelvic inflammatory disease, an abnormally shaped uterus, etc. Women must always have the right to select from a range of contraceptives, including the IUD, and make an informed decision as to which method is best for her needs.
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  4. 4

    Statement on intrauterine devices.

    International Planned Parenthood Federation [IPPF]

    IPPF Medical Bulletin. 1981 Dec; 15(6):1-3.

    These policy statements and guidelines from the International Planned Parenthood Federation's (IPPF) International Medical Advisory Panel (IMAP) concern IUDs. The following contraindications to IUD use are recognized: 1) pelvic inflaminatory disease, 2) known or suspected pregnancy, 3) history of previous ectopic pregnancy, 4) gynecological bleeding disorders, 5) suspected malignancy of the genital tract, 6) congenital uterine abnormalities or fibroids distorting the cavity, and 7) anemia, blood coagulation, severe cervical stenosis, copper allergy, Wilson's disease, and others. Generalities regarding appropriate IUDs are: 1) non-medicated devices (e.g. Lippes Loop) are studied for women who may not return for regular check-ups, 2) smaller medicated devices usually cause less menstrual blood loss than the non-medicated devices, 3) smaller devices are better for a smaller uterus and larger devices for the larger uterus, and 4) when a smaller device is expelled it is advisable to try a larger one and vice versa. Dalkon Shields should not be used by the IPPF system and all women using them should have the device removed. Correct insertion of IUDs is important and should be done by properly trained personnel. The timing of insertion is best during the menstrual period. Withdrawal of the applicator while leaving the device in place is the recommended insertion technique. Sterilization of IUDs should follow instructions on bulk-packaged IUDs. Complications include perforation, bleeding and pain, infection, and ectopic pregnancy. IUD removal should be done during menstruation. Good clinical management and follow-up care are recommended.
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