-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: AW: Ring IUD Dr.John Provatopoulos/Jennifer Small,MSN,WHNP From: Small, Jennifer (JSmall@planned.org) Wed Jan 9 10:17:30 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: GIN11153@aol.com: "Highmark Inc. to pay $9.9 million class action settlement for shortchanging docs" Previous message: robert berg: "Re: HYMENOTOMY and Hillary" In reply to: novamed@greenmail.ch: "Re: AW: Ring IUD Dr.John Provatopoulos/Jennifer Small,MSN,WHNP" Thank you Jennifer is very kind from you, your procedure sounds very good, and I think I understood. Please correct me if I am wrong At first you make a contraholding with tenaculum to achieve a better rectify of the Uterus. Yes; Depending on where you place the tenaculum, anterior or posterior portio, you will help "straighten" the uterus for easier insertion. At second time you make a sound control before inserting Yes, I like the metal sounds because I can "feel" the give of the internal os better. Probably just my preference! and you "mold" the insert tube with your hands extracorporaly before you introduce, before you insert. Yes; using sterile technique of course! Did I understand well ? You did! What kind of factory typ(hormone IUD's) are you using in your country ? We currently only have Mirena available to use via the Federal Drug Administration license. What about nulipara and IUD as you wrote "the os is just to small" what does it really mean? We do insert into nullipara women and teens if the uterus is greater than 6cm and the endocervical canal (internal and external os)can be penetrated. I have had a couple of patients, one a nullip and one a grand multip, who had such tight external os's that I just could not get the insertion tube through. For the rest though, no problem. You have of course much more experience as I have could you tell me something about expulsionrate and subclinical infection related IUD from your experience ? Our expulsion rate is very low. I see it more in our very young patients (16-20). Often I see a pattern if a patient is going to have a problem; either the uterus is on the small side (6-7cm) and/or the patient will really complain of discomfort during and after the procedure; much more than is usually expected. This is just an anecdotal pattern I've seen. As far as infection, we test for chlamydia/gonorrhea prior to insertion. If it is suspected, we treat before insertion. We treat any vaginitis (yeast, bacterial vaginitis) we suspect or diagnose prior to, or at the time of insertion. If the copper IUD is being used for emergency contraceptive or we decide to do a same-day insertion we prophylactically treat with antibiotics (Doxycycline 100 mg) for 10 days. We also highly encourage the use of condoms for the first month (and forever after if they are not monogamous ^__^) because that is when we see the most infection. I am glad to have been of help! Best of wishes to you! Jennifer Gyõrffy Gábor Oberarzt Jennifer Small, MSN,WHNP -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of novamed@greenmail.ch Sent: Tuesday, January 08, 2008 11:00 PM To: Multiple recipients of list OB-GYN-L Subject: Re: AW: Ring IUD Dr.John Provatopoulos/Jennifer Small,MSN,WHNP Thank you Jennifer is very kind from you, your procedure sounds very good, and I think I understood. Please correct me if I am wrong At first you make a contraholding with tenaculum to achieve a better rectify of the Uterus. At second time you make a sound controll before inserting and you "mold" the insert tube with your hands extracorporaly before you introduce, before you insert. Did I understand well ? What kind of factory typ(hormone IUD's) are you using in your country ? What about nulipara and IUD as you wrote "the os is just to small" what does it really mean? You have of course much more experience as I have could you tell me something about expulsionrate and subclinical infection related IUD from your experience ? Gyõrffy Gábor Oberarzt ________________________________ =20 -- ________________________________ Feladó: ob-gyn-l@obgyn.net meghatalmazó: Small, Jennifer Küldve: 2008. 01. 08., K 17:30 Címzett: Multiple recipients of list OB-GYN-L Tárgy: RE: AW: Ring IUD Dr.John Provatopoulos I think I can help you! Where I work we insert several IUD's per week, both the levonorgestrel and copper. My failure is zero unless the os is just too small (2 in 10 years). Here are the steps I take: bimanual to ascertain the uterine position. If the uterus is ante-flexed, then I place the tenaculum on the posterior portion of the portio at 8 and 4 O'clock and apply gentle traction. If the uterus is retroflexed, then I place the tenaculum at 11 and 2 O'clock. When the uterus is stable (no longer responding the gentle traction) I am able to "easily" insert the sound and IUD. One other pearl I have learned: gently "mold" the plastic insertion tube into a slight curve. As you insert, allow the insertion tube to "find" its own way. I find this works best with slow, persistent, GENTLE pressure. You will actually feel the insertion tube rolling to match the curves of the uterus. I have had no known perforations. Most of my patients are free from discomfort by the time ! they leave the clinic (so they report). I hope this helps! Jennifer Small, MSN,WHNP -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of novamed@greenmail.ch Sent: Tuesday, January 08, 2008 4:47 AM To: Multiple recipients of list OB-GYN-L Subject: Re: AW: Ring IUD Dr.John Provatopoulos Yes my intention is the option of Ring IUD to contain a progestional component. In Switzerland approximately from 10 women wish 9 women hormone IUD and only one who desire a cooper IUD. I suppose this trend is characteristic for west European countries. I know I am not the most technical talented gynaecologist, may be I have not yet enough experience, but sometimes I have difficulties to insert the hormone IUD by extremely ante or retroversioflexio. My estimated failure rate to insert is very high approximately 10-11%. Estimated rate of difficulties is approximately 20%. That because I think it would be better a Ring IUD bearing hormone Components, witch could be inserted linear and in a second step closed in a completely ring where the fringe is leading not the picked part of the IUD, and then is no chance to perforate. Do you have some Idea except pull down the Portio under inserting procedure ? Have you also sometimes difficulties ? If I don't bother you what is your estimated inserting failure rate ?- To know in witch percentage have I two left hands ? Also from other colleges the answer is welcome. ________________________________ =20 -- ________________________________ Feladó: ob-gyn-l@obgyn.net meghatalmazó: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. Küldve: 2008. 01. 06., V 13:42 Címzett: Multiple recipients of list OB-GYN-L Tárgy: Re: AW: Ring IUD Do these rings come with an option to contain a progestional component? The biggest advancement in the IUD in the last decade was the addition of levonorgesteral to the IUD. The main reason women have their IUD's removed is persistent heavy bleeding and dysmenorrhea. -- Take care, John ------ This e-mail is for the sole use of the intended recipient(s) and contains information belonging to Planned Parenthood of San Diego and Riverside Counties, which is confidential and/or legally privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or taking of any action in reliance on the contents of this e-mail information is strictly prohibited. If you have received this e-mail in error, please immediately notify the sender by reply e-mail and destroy all copies of the original message. ------ This e-mail is for the sole use of the intended recipient(s) and contains information belonging to Planned Parenthood of San Diego and Riverside Counties, which is confidential and/or legally privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or taking of any action in reliance on the contents of this e-mail information is strictly prohibited. If you have received this e-mail in error, please immediately notify the sender by reply e-mail and destroy all copies of the original message. Next message: GIN11153@aol.com: "Highmark Inc. to pay $9.9 million class action settlement for shortchanging docs" Previous message: robert berg: "Re: HYMENOTOMY and Hillary" In reply to: novamed@greenmail.ch: "Re: AW: Ring IUD Dr.John Provatopoulos/Jennifer Small,MSN,WHNP"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:48:37 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.