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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.
Instructions for immediate postpartum insertion of either the Delta-Loop or Delta-T IUDs with either uterine, ovum or ring forceps.
[Unpublished] 1981 Jul. 2 p.Detailed instructions for immediate postpartum insertion of the Delta Loop or Delta T IUDs with either uterine, ovum, or ring forceps are presented. The steps are as follows: 1) put on a clean and sterile glove; 2) expose the postpartum cervix by using a posterior vaginal retractor and a right-angled or vaginal wall retractor; 3) grasp the anterior lip of the postpartum cervix at the 12 o'clock position with a ring forceps; 4) thoroughly clense the vagina and the cervix with an antiseptic; 5) open the sterile IUD pack and with a 2nd sterile ovum or ring forcep grasp the IUD as is shown in figures accompanying these instructions, and as the IUD is clamped in the forceps for insertion, slip the distal portion of the string between the ring finger and small fingers to keep the strings straight; 6) with the left hand, apply gentle downward traction on the anterior lip of the cervix via the ring forceps and simultaneously begin to insert the Delta IUD through the cervical canal; 7) resistance is felt as the IUD reaches the fundus, and at this point the left hand should be placed on the abdomen and the fundus palpated; 8) release the ring forceps holding the IUD once the IUD has reached the fundus, separating the blades and gently withdrawing the forceps from the uterine cavity; 9) release the ring forceps that have been grasping the cervix following removal of the ring forceps that held the IUD; and 10) trim the strings 1.5 cm from the cervical os. The patient should be educated not to pull on the IUD strings if they begin to protrude within the next 7-10 days. She should be instructed to return to have them shortened. The patient should also be advised to examine sanitary napkins for the IUD in case it is expelled up to the time of her 1st follow-up visit. At follow-up, if the strings of the IUD are visible, the physician should straighten them to remove any excess thread from the uterus. Cut the strings 1.5 cm from the cervical os. On each successive visit, the length of the strings should be determined. If the strings are not visible, it can be determined that the IUD is in place simply by sounding the uterus and sensing the presence of the IUD.
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.
FDA Drug Bulletin. 1974 Dec;Continued FDA study of the Dalkon shield and IUDs in general has res ulted in new conditions for IUD distribution. The FDA has recommended 1) controlled and regulated distribution of the Dalkon shield; 2) development of definitive data concerning the Dalkon shield including expulsion rates and adverse reactions; 3) the replacement of the multifilament string on the shield with a monofilament string; 4) the inclusion of a leaflet warning all wearers of IUDs of the dangers of pregnancy with the device in situ; and 5) the distribution of 2 new package inserts for physicians and patients with all IUDs. A Registry System provided by A.H. Robins Company will involve the inclusion of prenumbered and preregistered Patient Report Forms, a Patient Brochure and Physician Brochure, the maintenance of inventory control of packages, a computer file on insertion and follow-up data and status report of infections and adverser reactions. The system will provide "denominator data" to determine incidence rates for classifying experiences andt o provide a base for further epidemiological investigat ions. Additional research, better labeling and availability of additional information on IUDs to patients and doctors is the only respo nsible course of action for the safety of women using these devices.