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Gesendet: Montag, 14. Januar 2008 22:41
An: novamed@greenmail.ch
Betreff: AW: AW: Ring IUD Dr.John Provatopoulos/Jennifer Small,MSN,WHNP
Dear Jennifer Small on this way I want to recognise your hellp, and I want to make public
your kindness to hellp me.
Sincerely
Dr.G.Györffy Oberarzt/Switzerland
________________________________
Von: novamed@greenmail.ch
________________________________
Gesendet: Mi 09.01.2008 07:57
An: ob-gyn-l@obgyn.net
Betreff: 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
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Felad=F3: ob-gyn-l@obgyn.net meghatalmaz=F3: 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.
________________________________
Felad=F3: ob-gyn-l@obgyn.net meghatalmaz=F3: 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
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