Thinking minds must , go on churning their Brain. , and they are supposed to use there Grey matter and implement the right policy.? May I ask the policy makers that why they are paying more incentive to the mother’s , for deliveries and a very less amount is being paid as a incentive for the persons opting for permanent methods of contraception?? Everyone knows , m
ost population is leaving in rural area, where illliteracy and poverty are dominating factor . Contraception is not given much emphasis. Why...??The incidence of intrauterine device perforation is 0.87 per 1000 insertions. An intrauterine device (IUD) may perforate through the uterine wall into the pelvic or abdominal cavity or into adjacent organs. The accepted treatment for displaced IUDs is surgical removal because of the putative risk of adhesion formation or of damage to the intestine or urinary bladder. Whilst surgical procedures to remove a misplaced IUD must be performed on symptomatic patients, asymptomatic patients, under certain circumstances, may benefit from conservative management.To evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs). The diagnosis and management of Twenty one (21) patients with intra-abdominal, mislocated IUDs were analyzed in this study. Trained midwives inserted Fifteen (15) of the IUDs, while four ( 4 )were inserted by general practitioners and two (2) by specialist gynecologists. Fifteen (15) of the patients were diagnosed by gynecological examination and ultrasonography (USG), Abdominal X-ray( AP View ) , in addition, was required in the other Four (4) patients were managed by laparoscopy, whereas laparotomy was required in Two (2) patients . For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients. Our humble submission is that , Persons who insert IUCDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUCD strings are not visible during gynecologic examination , USG should be tried to locate the IUCD and pelvic X-ray used only when USG fails to locate the IUCD. , then Hystero salpingography should also be tried . Laparoscopy can be the first choice for removal. IUCD’s located in the intra-abdominal cavity have been shown to cause adhesions.!! Therefore, there is concern about the potential for extensive adhesion formation as well as medico legal implications if a device is not removed. The symptoms, age and medical history of the patient must be taken into account, as the benefits of surgery should be balanced against the risks. If the woman is asymptomatic the intra-abdominal IUCD can be removed by laparoscopy, in keeping with current guidelines. However if a Laparotomy is required, serious consideration should be given to the morbidity and mortality this would cause. In the meantime , the woman should be offered contraception emergency contraception if required. Previous perforation is not a contraindication to IUCD after an interval of 6 weeks from the initial insertion before reinsertion of an intrauterine method. The women must be discussed for temporary or permanent method of contraception. She and her husband must be counseled for permanent method as Vasectomy or Abdominal Tubectomy or if at all fails in counseling ., Motivation to be given for laparoscopic sterilization and Non Scalpal technique of vasectomy.Then and then we can think of checking the population explosion in our country. !!!
ost population is leaving in rural area, where illliteracy and poverty are dominating factor . Contraception is not given much emphasis. Why...??The incidence of intrauterine device perforation is 0.87 per 1000 insertions. An intrauterine device (IUD) may perforate through the uterine wall into the pelvic or abdominal cavity or into adjacent organs. The accepted treatment for displaced IUDs is surgical removal because of the putative risk of adhesion formation or of damage to the intestine or urinary bladder. Whilst surgical procedures to remove a misplaced IUD must be performed on symptomatic patients, asymptomatic patients, under certain circumstances, may benefit from conservative management.To evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs). The diagnosis and management of Twenty one (21) patients with intra-abdominal, mislocated IUDs were analyzed in this study. Trained midwives inserted Fifteen (15) of the IUDs, while four ( 4 )were inserted by general practitioners and two (2) by specialist gynecologists. Fifteen (15) of the patients were diagnosed by gynecological examination and ultrasonography (USG), Abdominal X-ray( AP View ) , in addition, was required in the other Four (4) patients were managed by laparoscopy, whereas laparotomy was required in Two (2) patients . For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients. Our humble submission is that , Persons who insert IUCDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUCD strings are not visible during gynecologic examination , USG should be tried to locate the IUCD and pelvic X-ray used only when USG fails to locate the IUCD. , then Hystero salpingography should also be tried . Laparoscopy can be the first choice for removal. IUCD’s located in the intra-abdominal cavity have been shown to cause adhesions.!! Therefore, there is concern about the potential for extensive adhesion formation as well as medico legal implications if a device is not removed. The symptoms, age and medical history of the patient must be taken into account, as the benefits of surgery should be balanced against the risks. If the woman is asymptomatic the intra-abdominal IUCD can be removed by laparoscopy, in keeping with current guidelines. However if a Laparotomy is required, serious consideration should be given to the morbidity and mortality this would cause. In the meantime , the woman should be offered contraception emergency contraception if required. Previous perforation is not a contraindication to IUCD after an interval of 6 weeks from the initial insertion before reinsertion of an intrauterine method. The women must be discussed for temporary or permanent method of contraception. She and her husband must be counseled for permanent method as Vasectomy or Abdominal Tubectomy or if at all fails in counseling ., Motivation to be given for laparoscopic sterilization and Non Scalpal technique of vasectomy.Then and then we can think of checking the population explosion in our country. !!!
5 comments:
Dr. Raghav, I personally appreciate your efforts for the faculty. The content of PERMORATION OF UTERUS WITH IUCD are quite commendable. For the UG/PG students these are more than saficient.
You are a flag on the part of faculty. I proud of it!
Thnaks.
Dr. Mukesh Raghav, I am proud on you for a nice blog , along with relevant pictures and more than sufficient contents for the faculty.
Regards.
Respected Sir, I feel proud, that I am your student. PERFORATION OF UTERUS BY IUCD has not been covered in any Text book, and you are the only one , who recived photos too along with contents.
Regards.
Dear Dr. Mukesh , I think ,you have no work at all , writting beautiful blog for UG/PG students is mere wastage of time. No student is going to pay/recognise you after passing the exams.Any how it is up to you.
Do not mind???????
Dr. Raghav,M., I was delighted to see the content and natural photographs of perforated IUCD, One photo it has been written " raghav" means hand made. oh!! my dear God bless you.
No words to say , except to bow down.
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