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IUDs: an appropriate contraceptive for many women. DIU: un anticonceptivo apropiado para muchas mujeres.
Population Reports. Series B: Intrauterine Devices. 1982 Jul; (4):B101-B135.This discussion of IUDs covers the following: usage shifts to copper IUDs; issues for the 1980s; comparing the Lippes Loop and copper IUDs; life span of copper devices; steroid releasing IUDs; donor agency supplies; types of devices used; insertion and removal (timing of interval insertion, postpartum insertion, postabortion insertion, postcoital insertion, measuring the uterus, removal, and insertion by nurse midwives and paramedicals); bleeding (risk of anemia, limited bleeding); infection (mechanisms of infection, prevention, treatment, actinomyces); pregnancy (uterine pregnancies, ectopic pregnancies, differences among devices, and subsequent fertility); product and packaging issues (manufacture in developing countries, prices, bulk and individual packaging, methods of sterilizing IUDs, and storage). At this time about 60 million women worldwide are using IUDs, including over 40 million in China. In recent years the total number of users has remained relatively stable. The life table event rates per 100 women, by which IUDs are usually evaluated, are approximately as follows after 1 year of use in large, multicenter studies: pregnancy, 0.5-5; expulsion, 5-15; removal for bleeding/pain (5-15); removal for other medical reasons, 3-9; and removel for personal reasons, 1-6. Continuation rates 1 year after insertion tend to range from 50-85%, high rates for a reversible mothed. Some shift in usage occurred in the late 1970s from unmedicated Lippes Loop to copper releasing IUDs and to a lesser extent to IUDs that release progestins into the uterine cavity. Copper devices now have captured much of the market in the US and Western europe and amount to about 2/3 of the supplies provided by donor agencies to many developing countries. During the 1980s attention should probably focus less on the search for an ideal device and more on the need for family planning programs to identify suitable candidates for IUDs, encourage better health service support for IUD insertion and follow-up, and the newer IUDs more widely available to individuals and national programs. In most developing countries the great majority of IUDs are supplied by various national and international donor agencies that purchase large quantities at the lowest possible price and ship them to government and private programs. No data are available on the number of each type of IUD currently in use. Proper insertion of an IUD is important. Insertion can affect all major events that determine success. While there are several different techniques for inserting IUDs, with each the skill of the operator is critical. Recent studies fo about 10,000 women show that there is no one preferable time for insertion.
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.
Family Planning Perspectives. May-June 1977; 9(3):138-140.There have been no IUD-related spontaneous abortion deaths since the occurrence of mass media publicity about the Dalkon Shield and the risks associated with leaving an IUD in place following conception. Scientific publications, drug company labeling changes, drug package inserts, and other professional warnings do not seem to have been as effective as mass media publicity in causing a change in a dangerous clinical practice. It seems that publicity directed against a preventable health problem will affect both clinical practice and public health. Such publicity could be useful in getting doctors to prescribe lower estrogen dosage pills and in getting women to obtain abortions as early in the pregnancy as possible.
Report of safety and efficacy of the Dalkon Shield and other IUDs: prepared by ad-hoc Obstetric-Gynecology Advisory Committee.
October. 1974 Oct 29-30; 19.Following the evidence of an increase in incidence of complicated pregnancies related to the use of the Dalkon Shield IUD, the ad-hoc Obstetric-Gynecology Advisory Committee reported on the safety issues related to the Dalkon Shield and other types of IUDs. Since 1967 there were 39 reported deaths in the U.S. attributed to IUDs, 14 of which were related to the use of the Dalkon Shield and to complicated pregnancies. The Dalkon Shield is set apart from other types of IUDs especially for its design, since it has spicules of a different shape, and a multiple filament tail. It is true that the Dalkon Shield has a lower expulsion rate than other types of IUDs, but it also has an excess of pregnancy related complications and of instances of midtrimester spontaneous septic abortions, both factors leading to a number of cases of fatal sepsis. Moreover, it has a higher rate of extrauterine placements and of complications such as pelvic inflammatory disease. The Committee reviewed the current status of IUDs, concluding that they are relatively safe and a reliable means of contraception, but that they should be marketed with labeling providing adequate information about possible danger. It was the opinion of the Committee that the Dalkon Shield may have potential hazardous characteristics, and that the moratorium on its commercial distribution should remain in effect pending accumulation of definitive data.