|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: 25 YEAR OLD LIPPES LOOPFrom: Mats Bergstrom (matsb@cor.sos.sll.se)Fri Apr 11 06:30:17 1997
On Thu, 10 Apr 1997 EboDoc@aol.com wrote:
>do we need to remove a plastic inert type iud just because it is there? Any kind of IUD increases the risk for (mostly unilateral) pyosalpinx of the endogenic type (no known STD, anaerobes dominating) with the typical patient being 35-50 years old. Whether this risk diminishes (or disappears) after menopause is probably unknown. Also, the rare kind of abscess where Actinomyces seems to have a causal role has been shown to coincide with IUD's which have been left in place for 10+ years. So I think any IUD should be removed when it's not needed any more, definitely if the extraction is easy. As Ed Ryan stated it's hard to find good evidence for this in the litterature. Most studies of IUD/PID have focused on risks for future infertility and not been looking at the middle aged group. After the salpingitis "epidemic" here in the 60's - early 80's the 16 - 25 yo patient laparoscoped with a typical chlamydia salpingitis has become a rare bird indeed, so rare that several proposed multicenter clinical treatment trials (f ex with azitromycine) have been dropped due to lack of patients (the reason for this is mostly unclear, there's still a lot of subclinical chlamydia around and we don't really know the incidence of subclinical salpingitis that might cause infertility in the future). But we have a distinct impression (no study yet) that the incidence of severe pyosalpinx/adnexitis in the "older" woman hasn't changed at all, and that 2/3 cases are current IUD users. Even if the absolute risk for a IUD user is low, this is typically a severe disease that needs parenteral antibiotic treatment for several days and in many cases salpingectomy (and has a minute but existing mortality rate). But in the case that started this thread, with a device stuck in the uterine cavity, one can speculate that the risk for severe adnexitis would be greater if one tried to remove it. This reference is partly discussing the endogenic type of PID and it's relation to IUD: Jossens MO. Schachter J. Sweet RL. Department of Obstetrics, Gynecology, University of California, San Francisco. Risk factors associated with pelvic inflammatory disease of differing microbial etiologies. Obstetrics & Gynecology. 83(6):989-97, 1994 Jun.
-- Mats Bergstrom, MD Ob Gyn South Hospital Stockholm
|
|
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 Dec 2 05:19:23 2009 |
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.