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  • Title: Current status of intrauterine devices. II. Intrauterine devices and pelvic inflammatory disease and ectopic pregnancy.
    Author: Malhotra N, Chaudhury RR.
    Journal: Obstet Gynecol Surv; 1982 Jan; 37(1):1-8. PubMed ID: 7054735.
    Abstract:
    The suspected causal relationship between use of different types of IUDs and pelvic inflammatory disease and ectopic pregnancy are reviewed. The information available at this time regarding the IUD and pelvic inflammatory disease (PID) in the early IUDs, the Lippes loop and other polyethylene devices, the copper-containing devices, and the progesterone-containing devices. Grafenberg, in 1929, reported 17 cases of inflammation following insertion of silk IUDs which had been placed entirely within the uterine cavity. He found no such evidence following insertion of 150 silver rings. Oppenheimer inserted 1500 rings and did not find any complication such as inflammation, fever, or infection as a result of the ring insertion. In regard to the Lippes loop and other polyethylene devices, investigators in 1 study accumulated 15,419 woman-months experience with 1531 first insertions. The incidence of PID was 1.6%. Another group of investigators reported a 7.7% incidence of PID in a group of 623 clinic patients who were using IUDs. Lippes reported a rate of 0.6/100 woman-years for 1673 patients during 16,077 woman-months of exposure. It has been suggested that the IUD tails may be responsible for the passage of vaginal bacteria into the uterus. A lower incidence of bacterial contamination of the uterine cavity with copper devices as compared with others has been demonstrated. It has been observed that the PID rate in 750 women using the Copper T-200 for 1 year after insertion was 2.1%. A group of investigators reviewed the incidence of PID in 516 never pregnant women using Copper 7 IUD for 9080 woman-months at 4 centers. The incidence of PID varied between 0.9-1.4% per year in different centers. It was found that the rate of PID in women using Progestaserts was between 2 and 3.1% per year, and it was strongly correlated with the history of PID. Comparative trials are reported along with studies relating to the use of IUDs and an increased risk of ectopic pregnancy. A positive relationship between the duration of IUD use the risk of ectopic pregnancy has been observed. An investigator reviewed his experiences of 711 ectopic pregnancies; 70 of these were associated with the use of an IUD, which comprised 10% of all the ectopics in a 9-year period. A prevalence of about 21% extrauterine pregnancies among the Progestasert IUD users, as against 2.5% among other IUD users. Little information is available regarding whether, after removal of the IUD, the woman is still at a higher risk of tubal pregnancy at a subsequent pregnancy.
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