Incidence of infections associated with the intrauterine contraceptive device in an isolated community.

In an attempt to estimate more precisely the frequency of infections associated with the intrauterine contraceptive device (IUD), all gynecologic morbidity resulting from infection and occurring during a two-year period in an isolated community was reviewed. Ten septic abortions occurred, and all but one were associated with IUD use. In 26 gynecologic inpatients (41 per cent of all admissions for acute pelvic inflammatory disease), pelvic infection was associated with IUD use. In contradistinction to the septic abortion data, implicating only the Dalkon Shield, the gynecologic infections were associated with various types of devices.

PIP: Evaluation of the extent of the problems of infections associated with IUDs was attempted by collecting all gynecologic morbidity data relating to infections in women of childbearing age which occurred during a 2-year period in an isolated community. Chittenden County, Vermont, had a total population of 105,700 with 24,795 women in the 15-44 year age range. All seriously ill patients from the county are admitted to the Medical Care Center Hospital of Vermont. Venereal disease is relatively uncommon as only 168 cases of gonorrhea in women were reported during the 2-year period. Legal abortion services are highly developed so that illegal or self-induced abortions are few. During the 2-year period, 10 patients were admitted to the obstetric service with a diagnosis of septic abortion, with a ratio of 1 to every 400 deliveries. Of these, 9 had a Dalkon Shield in place at the time. 8 of the abortions occurred in the second trimester. Only 1 was a primigravida. The insertion-infection interval was from 4 months to 3 years. Prompt uterine evacuations were done in all cases and antibiotic therapy given. All patients recovered. Of the 2352 admissions to the gynecologic service in the 2-year period, 63 had acute inflammatory disease and 26 of them (41%) were wearing an IUD. These gynecologic infections were associated with several types of IUD devices of which 10 (38%) involved a Dalkon shield. The insertion-infection interval ranged from 1 to 42 months with half occurring 2 years or more after insertion. Responsible pathogens were equally divided between aerobic and anaerobic bacteria. N. gonorrhoeae was isolated in only 2 cases. Of the 26 patients wearing IUDs, 7 required major operations. This may be an issue in the choice of contraception, particularly for nullipara.