RESUMEN
PIP: This paper describes the use of a simple technique of hysterography to evaluate the side effects and mode of action of IUD. The technic utilizes 2 x-ray films per patient of the lower abdomen: a flat film to determine the presence or absence of the device, and a hysterogram; diluted water-soluble contrast medium was used, allowing visualization of the device and the endometrial cavity in a single x-ray exploration. The technic was performed on 100 women fitted with Lippes loop; 74 of these experienced side effects while 22 patients with no complaints were used as controls; 1 had an asymptomatic uterine peforation with the loop lying in the pelvis and 3 were pregnant (2 had a double uterus). In the control group, the hysterograms were performed 3-6 months after loop insertion while in the study group, the hysterogram were done 3-190 days after insertion, with the exception of true expulsion cases where a device similar to that ejected was reinserted just before taking x-ray. 44 patients were found to have bilateral cornual spasm. Incomplete fundal coverage of the device was associated with an increase in the incidence of side effects, mainly bleeding. Out of 23 cases of clinically suspected expulsion, the device was found in situ in 12 cases. In 10 cases, the IUD position was reversed with the thread withdrawn into the uterine cavity. In the remaining 2, the loop was found in the abdominal cavity. Congenital uterine abnormality was also found in 4 out of 10 cases with true expulsion. The incidence of side effects can be minimized by constructing IUDs which would fit properly into the endometrial cavity. Hysterography is a useful diagnostic tool for determining the incidence of side effects and possible mode of action of IUDs; it can also provide an index of the probable efficiency of the device after insertion.^ieng