Intrauterine devices have been used successfully for many years both for voluntary family planning and for control of the rapidly increasing population of the world. Also there have been a number of reports of the insertion of intrauterine devices in the immediate postabortal periods, however, the potential benefit of this procedure has not been fully utilized. Obstetricians have generally been concerned about the possible danger of postabortal sepsis and perforation.
But, such early insertion is safe and potentially most effective. In 1960, with the development of the inert polyethylene plastics. Margolis and Lippes conceived the idea of a device which could be introduced into the uterine canal without the necessity of cervical dilatation. And Robert meyer, who examined uterine tissues from several Grafenberg ring patients, considered the glandular patterns to be reasonable normal and in phase. He did observe localized edema, distended vessels, and some enlargement of the superficial stromal cells(Meyer, 1928).
As yet, the true mechanism of the antifertility action of these devices is unknown (Ishihama, 1959).
Present investigation demonstrates the presence of many millions of macrophages in the endometrial cavity. This is a constant finding in all women using Lippes loops. It is concluded that Lippes loop attracts the macrophages, stimulating them to accumulate in the uterine cavity. It is not, therefore, the intrauterine device itself, but the macrophages which acts as the contraceptive(Sagiroglu and Sagiroglu, 1970).
Materials and Methods
A total of 326 cases were selected among the patients registered in the Family Planning Clinic of Yonsei University and Ewha Woman's University. Of the total intrauterine contraceptive device acceptors, 91 cases, selected randomly bya simple random sampling, had insertion carried out in the immediate postabortal period at the time of D & C for incomplete abortion of D & E.
Insertions were done with Lippes loop size 27.5mm or 30 mm which were sterilized in 1% hygiene solution for 10 minutes or over.
The materials were divided into following groups.
Control group-Active IUD users
a) clinical observation 235 cases.
b) Intrauterine contraceptive device smear 73 cases.
c) endometrial biopsy 73cases.
Experimental group-First trimester induced abortion with IUD insertion.
a) clinical observation 91 cases.
b) Intrauterine contraceptive device smear 52 cases.
c) endometrial biopsy 52cases.
Each individual was interviewed and examined as to their subjective and objective symptoms before and after insertion. Loopal smears and endometrial biopsies were performed at 1wk, 2wks, one month, and monthly up to 1 year with control group 73
cases and experimental group 52 cases.
Specimens for light microscopic studies were fixed in 10% neutral formalin and embedded in paraffin. Sections, 6 micron thick, were made and stained with hematoxylin and eosin routinely. Loopal smears were fixed in ether-alcohol.
After Papanicolaou staining, microscopic examination of smears was done.
Result and Summary
Polyethylene Lippes ioops were inserted in 235 cases of non-pregnant state women (Control group) and 91 cases of postabortal state women (Experimental group). Clinical observations were performed mainly in the aspect of side effects. Loopal smears and endometrial biopsies were done in 73 cases of control and 52 cases of experimental group.
The results may be summerized as follows:
1) Clinical side effects observed were hemorrhage(6.9%), lumbago and lower abdominal pain (each 1.9%), hypermenorrhea(0.2%) in experimental group. The incidence of hemorrhage was similar to control group, but the incidence of pain in experimental group was rather low than the one of control The side effects of the experimental group disappeared spontaneously 2 months after the insertion.
2) The histopathologic findings were minimal in the experimental group: endometrium with proliferation of small blood vessels, congestion and hemorrhage, and stromal changes.
3) Inflammatory reactions were also mild and showed no significant difference between control and experimental group.
4) There were no atypicalities, dysplasias or malignant changes of endometrium, itself.
On the basis of the above results immediate loop insertion after early abortion produces no significant change from insertion in nonpregnant state. Therefore, immediate loop insertion in the postabortal state should be a recommended method of contraception.