Laparoscopic removal of intrauterine devices with retracted threads.

Sixteen women had intrauterine devices (IUDs) with retracted threads. If an IUD with retracted thread is located within the uterus or intramurally, hysteroscopic removal is advisable. If it is located intraabdominally, laparoscopic removal is recommended.

PIP: From 1980-1985, 16 women between the ages of 24 and 47 years old were referred to the gynecology department of Saint Maria Hospital in Vejle, Denmark, because their IUDs could not be seen on cervical inspection; the threads had become retracted, and attempts by their physicians to remove the IUDs had failed. 7 of the devices were Multiloads, 7 were Nova Ts, and 2 were Gravigards. Ultrasonic scanning resulted in correct identification of the IUD in 12 patients. In the 4 cases in which the IUD was not visible on scanning, roentgenograms of the whole abdomen in 2 planes were obtained, and the IUD was easily identified. In 2 patients, the IUD was removed when dilation and curettage was carried out. In 9 cases the IUD could be removed with hysteroscopy, in 4 with laparoscopy, and in 1 with laparotomy. 2 of the IUDs were found intramurally, and 7 were in the uterine cavity. If an IUD with retracter thread is located within the uterus of intramurally, hysteroscopic removal is advisable; if it is located intraabdominally, laparoscopic removal in recommended.

[Laparoscopic sterilization]. / Laparoskopisk sterilisation

PIP: 44 women, 24-43 years of age, underwent laparoscopic sterilization. 16 has only sterilization, 24 had sterilization in conjunction with abortion performed by vacuum aspiration, and 4 were performed in the puerperium. Biopsies of the coagulated Fallopian tubes were discontined because definite histological determination of coagulation was impossible; thereafter, each tube was coagulated in 2 places. Care had to be taken with the patients in the puerperium because of the enlarged uterus. The women had had an average of 4.2 pregnancies. The entire operation lasted approximately 20 minutes and the average hospitalization length was 5.2 days. 82% of the patients later underwent hysterosalpingography (HSG). The sterilization was not complete with 1 patient. There were no complications of the laparoscopy, but 2 complications of the abortions. 4 patients who showed open Fallopian tubes 10 weeks after the operation showed clased tubes 14-32 weeks later; the HSG should be taken at least 12 weeks after the laparoscopy.^ieng

[Induced abortion after the 12th week of pregnancy employing prostaglandin F2alpha administered extra-amnially]. / Abortfremkaldelse efter 12. gravidittetsuge med prostaglandin F2alpha indgivet ekstra-amnialt

PIP: (PGF2alpha) Prostaglandin F2alpha was administered to 34 patients in clinical trials to produce abortion later than the 12th week of pregnancy. The preparation was instilled extraamnially via a Foley catheter with balloon. The concentration of the fluid instilled was 250 mcg/ml. In group 1 (10 patients), the maximum was a single dose of 750 mcg; 50% of these aborted within 36 hours. The catheters were then removed and the remaining 5 patients were treated with oxytocin. After 52 hours, all of the patients had completed abortions. In group 2 (24 patients), the maximal single dose was increased to 1500 mcg. 15 of the patients aborted within 24 hours (63%) and 1 patient aborted immediately after the 24 hours had elapsed. In the remaining patients, treatment was continued after 24 hours with a combination of PGF2alpha and oxytocin. All of these patients had aborted within 36 hours. The average time for abortion for patients in group 2 was 21.6 hours and the average dose of PGF2alpha was 13.3 mg. The side effects were mild and it did not prove necessary to interrupt treatment on account of side effects in any of the cases. 4 patients (12%) developed febrile reactions without accompanying symptoms and reevacuation of the uterus proved necessary in 1 case. The therapeutic regime for patients in group 2 may be recommended for provocation of late abortion. It is discussed whether PGs should be administered intraamnially after the 16th week of pregnancy. Similarly, it is discussed whether the combined treatment with PG-oxytocin should be initiated early to further reduce the duration of abortion. (author's)^ieng

[Laparoscopic sterilization with the Falope ring]. / Laparoskopisk sterilisation med Falope-ring.

PIP: 53 women, 27-45 years of age, underwent laparoscopic sterilization by the Falope ring. 2 pregnancies were reported, and an HSG (hysterosalpingography) examination revealed an open Fallopian tube in 1 patient. One pregnancy was caused by an incorrectly placed ring, while an ectopic pregnancy occurred in spite of a correctly placed one. The average length of the oepration was 8.3 minutes, with a maximum length of 35 minutes. 12 patients had minor immediate peroperative complications, e.g. bleeding, laceration of the Fallopian tube. 9% complained of bleeding irregularities and 6% of pelvic pain.^ieng