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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.