BACKGROUND & AIMS: :Because of inconsistent findings among case-control studies on the relationship between IUD use and the risk of ectopic pregnancy, a meta-analysis of published literature was conducted. From 1977 through 1994, 19 publications regarding 16 studies of ectopic pregnancy and IUD use were found by MEDLINE and manual search. The odds ratio (ORs) of ectopic pregnancy with current and past IUD use in each study were pooled. A quality score system was developed to assess each study. Funnel plot was used to assess potential publication biases. For current IUD use, when cases were compared to pregnant controls, there was an increased risk of ectopic pregnancy (pooled OR: 10.63, 95% confidence interval (CI): 7.66-14.74); when cases were compared to non-pregnant controls, there was no risk of ectopic pregnancy (pooled OR: 1.06, 95% CI: 0.91-1.24). Past IUD use could mildly increase the risk of ectopic pregnancy (pooled OR: 1.40, 95% CI: 1.23-1.59). Selecting pregnant or non-pregnant women as controls, however, did not affect the OR estimates of past IUD use. Current IUD use does not increase the risk of the ectopic pregnancy. However, a pregnancy with an IUD in situ is more often an ectopic one than a pregnancy with no IUD. Past IUD use could mildly elevate the risk of ectopic pregnancy.

背景与目标： ：由于病例对照研究中宫内节育器使用与异位妊娠风险之间关系的研究结果不一致，因此对已发表文献进行了荟萃分析。从1977年到1994年，通过MEDLINE和手动搜索发现了19篇关于16例异位妊娠和宫内节育器使用研究的出版物。汇总了每项研究中异位妊娠与当前和过去使用宫内节育器的比值比（OR）。开发了质量评分系统来评估每项研究。漏斗图用于评估潜在的出版偏倚。对于目前使用的宫内节育器，将病例与怀孕的对照组进行比较，异位妊娠的风险增加（合并OR：10.63，95％置信区间（CI）：7.66-14.74）；当将病例与非妊娠对照进行比较时，没有异位妊娠的风险（合并OR：1.06，95％CI：0.91-1.24）。过去使用宫内节育器可能会轻度增加异位妊娠的风险（合并OR：1.40，95％CI：1.23-1.59）。然而，选择孕妇或非孕妇作为对照并不会影响过去宫内节育器使用的OR估计值。当前使用宫内节育器不会增加异位妊娠的风险。但是，原位宫内节育器的妊娠比没有宫内节育器的妊娠更常是异位妊娠。过去使用宫内节育器可能会轻度增加异位妊娠的风险。

BACKGROUND & AIMS: A letter to the editor of the journal, Contraception, concerns an article previously published in that journal entitled "WHO study of the Progesterone IUD," and indicts that article as having ignored standards for scientific reporting of prospective trials of contraceptives. The authors of the complaining letter have attempted to reach the authors of the progsterone IUD paper, but have received no response to their questions; in this article, only a corrigendum from WHO disavowing any knowledge or authorization of the disputed paper constitutes the reply. Objections to the IUD study, which had been published in volume 19, number 6, June 1979, p. 575-589, include discrepancies with study dates, incompleteness of data, improper statistical conclusions of significance, errors in menstruation data, problems with computation of medians, and improper conclusions from existing data. The complainants conclude, "it appears that the contradictions and inaccuracies in the report, as well as the substantial incompleteness of the data being reported, prevent this report from being a scientific document of the material under study."

背景与目标： 给《避孕》杂志编辑的一封信涉及先前在该杂志上发表的一篇题​​为“世界卫生组织对孕激素宫内节育器的研究”的文章，并指出该文章忽略了对避孕药的前瞻性试验进行科学报告的标准。投诉信的作者曾试图联系Progsterone IUD论文的作者，但未收到任何答复。在本文中，只有来自WHO的更正，而不是对有争议的文件有任何了解或授权，才构成答复。对宫内节育器研究的异议，已于1979年6月在第19卷第6期上发表。 575-589，包括研究日期的差异，数据的不完整，显着性的统计结论不正确，月经数据有误，中位数的计算问题以及现有数据的不正确结论。投诉人总结说：“报告中的矛盾和不正确之处，以及所报告数据的严重不完整，使该报告无法成为所研究材料的科学文件。”

BACKGROUND & AIMS: :To examine the factors associated with copper T IUD removal due to bleeding/pain, a nested case-control analysis using data from an international multicenter randomized clinical trial of the copper T-380A IUD was performed. One-hundred-forty-three cases with removal due to bleeding/pain within one year postinsertion and 2,023 controls with the IUD in place at last follow-up visit are included. Proportional hazards regression analysis indicated that uterine length greater than 70 mm and better IUD provider's skill were associated with a decreased risk of removal due to bleeding/pain. Amenorrhea and breastfeeding at insertion have short-term beneficial effects but less long-term effects. These findings may help family planning providers in counseling and practice.

背景与目标： ：为了检查与出血/疼痛引起的铜T宫内节育器去除相关的因素，使用来自国际多中心铜T-380A宫内节育器的随机临床试验数据进行了嵌套病例对照分析。其中包括143例在插入后一年内因出血/疼痛而去除的病例，以及上次随访时就诊的IUD的2,023例对照。比例风险回归分析表明，子宫长度大于70 mm以及宫内节育器提供者的技能更好，与出血/疼痛引起的切除风险降低有关。闭经和母乳喂养在短期内具有有益效果，但长期影响较小。这些发现可能有助于计划生育提供者的咨询和实践。

BACKGROUND & AIMS: :The risk of spontaneous abortion and intra-uterine infections in pregnancies associated with an intra-uterine conceptive device (IUD) is well documented. There is a general agreement regarding the desirability of removing the IUD as soon as the pregnancy is diagnosed. When the string is not visible, the proper management is controversial. This study reports the successful retrieval of occult IUD in early pregnancy under ultrasonic guidance in 8 out of 9 women. In the one case where we failed to remove the IUD, the women chose to terminate the pregnancy by legal abortion. Seven women completed their pregnancy, while one experienced a spontaneous abortion. We consider the removal of the occult IUD in pregnancy under ultrasonic guidance to be a useful procedure. :The IUDs were removed with ultrasonic guidance from 8 out of 9 women who desired to continue their unplanned pregnancy, among 120 IUD contraception failures ascertained at the University Hospital of Trondheim, Norway, from January 1981-June 1990. The IUDs were removed without analgesia or anesthesia, by grasping the anterior lip of the cervix with a uterine tenaculum, and inserting forceps without cervical dilatation. The IUD was visualized with a convex electronic 3.5 MHz probe (Hitachi EUB-450). The women ranged in parity from 0-3, and gestational ages from 6-13 weeks. 8 procedures were successful. 1 failed after 2 attempts, as the IUD was located between the gestational sac and the fundus: the women chose legal abortion. 6 women delivered spontaneously at term. 1 had a cesarean section at 35 weeks because of fetal growth retardation. 1 woman aborted 1 week later at 7 weeks gestation. Usually implantation with an IUD in place occurs away from the device, and it is easily removed with the thread. Ultrasonically guided removal was judged a useful way to manage the situation of an occult IUD.

背景与目标： ：有充分的证据证明与子宫内受孕器（IUD）相关的妊娠中自然流产和子宫内感染的风险。人们普遍希望在诊断出怀孕后立即取下宫内节育器。当字符串不可见时，正确的管理将引起争议。这项研究报告了9名女性中有8名在超声引导下成功恢复了隐匿性宫内节育器。在我们未能移除宫内节育器的情况下，妇女选择通过合法堕胎终止妊娠。七名妇女完成了怀孕，而一名妇女自然流产。我们认为在超声引导下去除妊娠期隐匿性宫内节育器是一种有用的方法。
：从1981年1月至1990年6月在挪威特隆赫姆大学医院确定的120例宫内节育器避孕失败病例中，有9名希望继续计划外怀孕的妇女中有8例在超声引导下摘除宫内节育器。用子宫触角抓住子宫颈的前唇，并插入无宫颈扩张的镊子，以进行麻醉或麻醉。用凸形3.5 MHz电子探头（Hitachi EUB-450）可视化宫内节育器。这些妇女的平均年龄为0-3岁，胎龄为6-13周。成功完成了8个程序。由于宫内节育器位于胎囊和眼底之间，因此2次尝试中有1例失败：妇女选择了合法堕胎。足月自发分娩的有6名妇女。 1例因胎儿发育迟缓而在35周时进行了剖宫产。 1名妇女在妊娠7周后1周流产。通常，在适当位置放置宫内节育器的植入是在远离设备的地方进行的，并且很容易用螺纹将其移除。超声引导切除被认为是管理隐匿性宫内节育器情况的一种有用方法。

BACKGROUND & AIMS: The TCu 380A and FlexiGard IUDs were compared in a randomized multicenter trial including 28 institutes in 13 countries. There were 53 insertion failures with the FlexiGard and one with the TCu 380A. There were 2184 successful insertions of the TCu380A and 2102 of the FlexiGard device. The three-year pregnancy rates for the TCu 380A and FlexiGard were similar (1.6 and 1.9 per 100 women, respectively) but the FlexiGard three-year expulsion rate (7.4 per 100 women) was significantly higher than that of the TCu 380A (4.4 per 100 women). The insertion technique for the FlexiGard needs to be improved in order to lower the expulsion rate.

背景与目标： 在包括13个国家的28个研究所的随机多中心试验中，对TCu 380A和FlexiGard宫内节育器进行了比较。 FlexiGard发生53次插入故障，而TCu 380A发生1次插入故障。 TCu380A成功插入2184次，FlexiGard设备成功插入2102次。 TCu 380A和FlexiGard的三年妊娠率相似（分别为每100名女性1.6和1.9），但FlexiGard三年驱逐率（每100名妇女7.4）显着高于TCu 380A（4.4名妇女）。 100名女性）。需要改进FlexiGard的插入技术，以降低驱逐率。

BACKGROUND & AIMS: :Contraindications to IUD or IUS use can be found on product labeling, in the guidelines of various specialty groups and in recommendations from peer-reviewed articles. Overly restrictive contraindications block access to this top-tier method for many women who would be candidates based on current scientific evidence. Assuming that a condition should be listed as a contraindication only if the risk of IUD/IUS use by a woman with that condition exceeds her risk with pregnancy, the list of contraindications is reduced to pregnancy, active uterine infection, malignancy in the uterus or cervix, an inability to place or retain the device, unexplained abnormal bleeding and adverse reaction to product ingredients.

背景与目标： ：在产品标签上，各种专业团体的指南中以及在经过同行评审的文章中的建议中，都可以找到宫内节育器或宫内节育器的禁忌症。过于严格的禁忌症阻碍了许多将根据当前科学证据成为候选人的妇女使用这种顶级方法。假设仅当患有该疾病的妇女使用IUD / IUS的风险超过其怀孕风险时，才应将该疾病列为禁忌证，禁忌证的清单将减少为怀孕，活动性子宫感染，子宫或子宫颈恶性肿瘤。 ，无法放置或保留设备，无法解释的异常出血以及对产品成分的不良反应。

BACKGROUND & AIMS: :Some investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while others have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). To study the effect of length of IUD use, IUD type and the modifying influences of age and PID history on time required to conceive, we followed women trying to become pregnant after removal of their IUD. Five hundred forty women in Ljubljana, Yugoslavia who were first fitted with an IUD between 1964 and 1972 and had their IUD removed in order to become pregnant were followed through 1980. We found no relationship between the duration of IUD use or type of IUD used, but increasing age and a history of PID each decreased the monthly probability of conception. These findings, along with other recent work, indicate that IUDs are a safe and efficacious contraceptive for women at low risk for sexually transmitted diseases. :Previous investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while other studies have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). This investigation uses regression analysis to assess the influence of various factors individually on time to conceive. 540 women in Ljubljana, Yugoslavia, who were 1st fitted with an IUD between 1964 and 1972 and had their IUD removed to become pregnant, were followed through 1980. The COX regression model is used to assess simultaneously the influences of length of IUD use, device type (Lippes Loop), age at removal, parity, previous PID history, and duration of marriage on time to conception, thus controlling for the interrelationships between variables. This technique estimates the probability of conceiving at different times. Results indicate that duration of IUD use did not affect the time to conception. In addition, IUD type, duration of marriage or parity did not affect the time required to conceive. These findings demonstrate that the use of IUDs does not, in and of itself, lead to problems with subsequent fertility. However, these results underscore the importance of limiting IUDs to women who are not at high risk of sexually transmitted diseases.

背景与目标： ：一些对宫内节育器使用的调查显示，取出宫内避孕器后怀孕的能力受损，而其他人则没有。然而，这些研究都没有充分考虑诸如年龄和盆腔炎史（PID）之类的潜在影响因素。为了研究宫内节育器使用时间，宫内节育器类型以及年龄和PID史对怀孕时间的影响，我们追踪了那些试图在取出宫内节育器后怀孕的妇女。在南斯拉夫的卢布尔雅那有540名妇女在1964年至1972年之间首次装有宫内节育器，并为了怀孕而拔掉宫内节育器，直到1980年。我们发现宫内节育器的使用时间或宫内节育器的类型之间没有关系，但是年龄的增长和PID的病史都降低了每月受孕的可能性。这些发现以及最近的其他工作表明，宫内节育器对于性传播疾病风险低的妇女是一种安全有效的避孕药具。
：以前的宫内节育器使用研究表明，取出后怀孕的能力受损，而其他研究则没有。然而，这些研究都没有充分考虑诸如年龄和盆腔炎史（PID）之类的潜在影响因素。这项研究使用回归分析来评估各个因素对受孕时间的影响。在1964年至1972年之间，对南斯拉夫卢布尔雅那的540名妇女进行了第一次子宫内节育器的配戴，并在1980年之前将其取出。妇女使用COX回归模型同时评估了宫内节育器使用时间，装置的影响。类型（“ Lippes循环”），移除时的年龄，奇偶校验，以前的PID历史记录以及准时结婚的持续时间，从而控制变量之间的相互关系。该技术估计在不同时间受孕的可能性。结果表明，宫内节育器的使用时间不影响受孕时间。此外，宫内节育器的类型，婚姻的持续时间或同等的年龄并没有影响怀孕的时间。这些发现表明，宫内节育器的使用本身并不会导致随后的生育问题。但是，这些结果强调了将宫内节育器仅限于没有性传播疾病高风险的妇女的重要性。

BACKGROUND & AIMS: OBJECTIVE:Although the intrauterine device (IUD) is one of the most widely used forms of contraception throughout the world, its potential long-term effects on the uterus have not been thoroughly evaluated. This paper reports the long-term results of IUD use on the incidence of endometrial cancer. STUDY DESIGN:The data is part of a nationwide case-control, pilot study that was undertaken in order to evaluate the possible influence of ovulation induction drugs on the risk of endometrial cancer. The study included 128 living women 35-64 years old, with a histologically confirmed diagnosis of endometrial carcinoma. The controls were 255 women from the same dialing areas selected by random digit dialing. A multivariate logistic model, controlling for age, was used to assess the independent effects of factors found to be significantly associated with endometrial cancer on univariate analysis. RESULTS:The following parameters were found to be independently associated with endometrial cancer controlling for age: nulliparity OR=2.7 (95% CI 1.1-6.5, P=0.03); history of infertility OR=1.8 (95% CI 1.0-3.3, P=0.05); BMI>/=27 OR=2.3 (95% CI 1.4-3.8, P=0.001). The use of oral contraceptives and IUD were found to be protective; OR=0.29 and 0.37, respectively, (95% CI 0.14-0.61, P=0.001, 0.19-0.70, and 0.003, respectively). CONCLUSIONS:IUD use may have a protective effect on endometrial cancer risk. The protective effect of IUD may be either, through the intense inflammatory response that leads to other lisosomal and inflammatory actions, which may include cells responsible for early elimination of hyperplastic endometrial epithelial cells or, the more complete shedding of the endometrium associated with IUD use may decrease hyperplasia of the endometrium, a known risk factor for endometrial carcinoma.

背景与目标： 目的：尽管宫内节育器（IUD）是世界范围内使用最广泛的避孕方法之一，但尚未全面评估其对子宫的潜在长期影响。本文报道了宫内节育器使用对子宫内膜癌发生率的长期结果。
研究设计：数据是一项全国病例对照研究的一部分，该研究旨在评估排卵诱导药物对子宫内膜癌风险的可能影响。该研究包括128名35-64岁的活着的妇女，这些妇女在组织学上被确诊为子宫内膜癌。对照是来自通过随机数字拨号选择的相同拨号区域的255名女性。使用控制年龄的多元逻辑模型评估单因素分析中与子宫内膜癌显着相关的因素的独立影响。
结果：发现以下参数与控制年龄的子宫内膜癌独立相关：无效性OR = 2.7（95％CI 1.1-6.5，P = 0.03）；不孕史OR = 1.8（95％CI 1.0-3.3，P = 0.05）; BMI> / = 27 OR = 2.3（95％CI 1.4-3.8，P = 0.001）。口服避孕药和宫内节育器被发现具有保护作用。 OR分别为0.29和0.37（95％CI为0.14-0.61，P = 0.001、0.19-0.70和0.003）。
结论：IUD的使用可能对子宫内膜癌的风险具有保护作用。宫内节育器的保护作用可能是通过导致其他溶酶体和炎性作用的强烈炎症反应而引起，其中可能包括负责尽早消除增生性子宫内膜上皮细胞的细胞，或者与宫内节育器使用相关的子宫内膜脱落更为彻底。减少子宫内膜增生，子宫内膜癌是子宫内膜癌的已知危险因素。

BACKGROUND & AIMS: OBJECTIVE:To describe an uncommon case of bladder calculus arising from an intrauterine device (IUD).

METHODS/RESULTS:A female patient with an IUD for the past 10 years consulted for frequent episodes of cystitis. Patient evaluation demonstrated a bladder calculus that warranted surgery. Treatment was by cystolithotomy, which disclosed a 6 cm calculus attached to the IUD.

CONCLUSION:Bladder calculus arising from an IUD is rare. The case described herein was successfully managed by cystolithotomy.

背景与目标： 目的：描述子宫内节育器（IUD）引起的膀胱结石的罕见病例。

方法/结果：一名患有宫内节育器的女性患者在过去的十年中，膀胱炎频繁发作。患者评估显示，需要进行手术的膀胱结石。膀胱切开术治疗了结石，发现结石附着在IUD上有一个6厘米的结石。

结论：IUD引起的膀胱结石很少见。本文描述的病例已通过膀胱切开术成功治疗。