Abstract:BackgroundThe purpose of this study was to examine factors that could help reduce primary perforation during insertion of a framed intrauterine device (IUD) and to determine factors that contribute in generating enough uterine muscle force to cause embedment and secondary perforation of an IUD. The objective was also to evaluate the main underlying mechanism of IUD expulsion.MethodsWe compared known IUD insertion forces for “framed” devices with known perforation forces in vitro (hysterectomy specimens) and kn… Show more
“…In this case the likelihood of problems (e.g, expulsion, embedment) in any group, nulliparous or multiparous is drastically reduced [26]. If the transverse arm of the IUD is too long as in Figure 4A-C, then the IUD will either be expelled due to symmetrical expulsive forces or the anchor becomes pathological, causing embedment and bleeding due to asymmetrical uterine forces acting on the IUD [27]. In the latter case, the uterus may not be capable of expelling the IUD.…”
Objective: The intrauterine device (IUD) is an important long-acting reversible contraceptive method (LARC) which plays a major role in contraception. Expulsion and intolerance because of pain and/or bleeding are two factors which limit more widespread use. IUDs have to form some type of 'anchor', which must be well tolerated in order not to be expelled and not cause problems as might any other intrauterine object. We considered how an IUD might behave in comparison to a physiological or pathological intra-uterine body.
Methods:We reviewed historical and present day IUDs on a three point rating scale of i) flexibility ii) horizontal to vertical ratio and iii) percentage increase in size of the IUD over mean cavity measurements to determine an Anchor Index(AI) to separate the types of anchor methods the various devices employ.
Results:The AI generally varied from 3-7 in multiparous women signifying a marginally 'physiological' fit. The AI was mainly above 5 for most IUDs in nulliparous women indicating a largely non-physiological ('pathological' type) fit.
Conclusions:The structure, composition and design of most IUDs are still not optimal for the nulliparous and occasionally the multiparous endometrial cavity. IUD design should be such that they appear to the endometrial cavity to be a physiological rather than a pathological incumbent.
“…In this case the likelihood of problems (e.g, expulsion, embedment) in any group, nulliparous or multiparous is drastically reduced [26]. If the transverse arm of the IUD is too long as in Figure 4A-C, then the IUD will either be expelled due to symmetrical expulsive forces or the anchor becomes pathological, causing embedment and bleeding due to asymmetrical uterine forces acting on the IUD [27]. In the latter case, the uterus may not be capable of expelling the IUD.…”
Objective: The intrauterine device (IUD) is an important long-acting reversible contraceptive method (LARC) which plays a major role in contraception. Expulsion and intolerance because of pain and/or bleeding are two factors which limit more widespread use. IUDs have to form some type of 'anchor', which must be well tolerated in order not to be expelled and not cause problems as might any other intrauterine object. We considered how an IUD might behave in comparison to a physiological or pathological intra-uterine body.
Methods:We reviewed historical and present day IUDs on a three point rating scale of i) flexibility ii) horizontal to vertical ratio and iii) percentage increase in size of the IUD over mean cavity measurements to determine an Anchor Index(AI) to separate the types of anchor methods the various devices employ.
Results:The AI generally varied from 3-7 in multiparous women signifying a marginally 'physiological' fit. The AI was mainly above 5 for most IUDs in nulliparous women indicating a largely non-physiological ('pathological' type) fit.
Conclusions:The structure, composition and design of most IUDs are still not optimal for the nulliparous and occasionally the multiparous endometrial cavity. IUD design should be such that they appear to the endometrial cavity to be a physiological rather than a pathological incumbent.
“…If the IUD is not fully expelled, embedment and/or secondary perforation of the IUD may occur. The imbalance between the size of the IUD and that of the uterine cavity can result in the production of asymmetrical uterine forces, which can increase patient discomfort especially while menstruating [16]. Hubacher's review of copper IUDs revealed that nulliparous women experience higher rates of total expulsion and removals for bleeding and/or pain compared with parous women [17].…”
Section: Is There An Association Of Malposition and Subsequent Expulsmentioning
confidence: 99%
“…Incompatibility between the IUD and the endometrial cavity will provoke uterine contraction in an attempt to expel the IUD. The impact of uterine forces can be significant if the transverse arm of the IUD/IUD is significantly greater than the fundal transverse diameter [16]. These forces can compress, distort, displace, and expel the IUD, particularly if the IUD is not capable of adaptive changes [30].…”
Section: How To Avoid Iud Malposition and Displacementmentioning
Introduction: Malposition and displacement of IUDs is an important drawback of all conventional intrauterine devices which rely sole on size for uterine retention.
“…The attachment to the fundus of the uterus minimizes the risk of expulsion [22,23]. Long term comfort, especially for those women (e.g., nulliparous and adolescent women) with a small or distorted uterine cavity, and for women who have experienced problems with framed IUDs can be achieved with a frameless IUD ( Figure 9) [19,24].…”
Section: The Frameless Copper Iud (Gynefix)mentioning
Figure 1: 3D ultrasound illustration of the measurement of the transverse width of the uterine cavity (arrows show the transverse distance which is 20.73 mm in this case).
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