Intrauterine devices.

IUDs were 1st used in Poland in 1909 when Richter introduced a silkworm gut device. Grafenberg's ring, made 1st of silkworm gut and later of gold or silver, was used in Berlin in the 1920s, but dangerous infections were associated with these IUDs. In the early 1960s new biologically inert materials (stainless steel and plastic) were used for the Lippes Loop, the Saf-T-Coil, and the Spiral (associated with a higher expulsion rate). The stainless tell Majzlin Spring was recalled by the FDA because of embedding in the uterine wall. The Dalkon Shield, introduced in the early 1970s, was implicated in midtrimester septic abortions and deaths, and was later withdrawn. Progestasert containing progesterone was 1st used in the mid-1970s, however, side effects included dysmenorrhea, vaso-vagal reaction, and higher ectopic pregnancy rates. Stimulation of the vagus nerve occurring during tenaculum placement can induce symptoms known as the vaso-vagal reaction: bradycardia, hypotension, nausea, pallor, syncope, and cardiac arrest. Moderate symptoms may be relieved by atropine sulfate (.6 mg iv). Baseline pulse and blood pressure must be routinely read before IUD fitting. Sounding the uterus during menstruation and a follow-up visit within 3 months with x-ray if necessary is recommended to rule out perforation. Reported expulsion rates vary from 1 to 24%, mostly among nulliparas. Copper-bearing devices usually require laparotomy for removal. Pregnancy occurs in 1-5% of IUD users. Removal may trigger spontaneous abortion, but the in situ IUD poses more danger. The theoretical efficacy of IUDs is 97-99% (of 100 women correctly using IUDs for 1 year, 1-3 become pregnant). Their disadvantages include increased dysmenorrhea, menstrual cramps, and bleeding. An estimated 5-10% of pregnancies occurring with an IUD in situ are ectopic. Women who use IUDs are several times more likely to develop pelvic inflammatory disease (PID) than nonusers. Recent research substantiates a 4.4 to 9-fold increase in PID risk in IUD users. About 80% of women continue to use their IUDs after 1 year.