الفهرس 
ContraceptionOnly 14 pages are availabe for public view
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Abstract
The intrauterine contraceptive device is one of the most frequently used method of contraception allover the world. The most important adverse effects related to copper intrauterine contraceptive device use are excessive uterine bleeding and menstrual pain which are responsible for 5-15% removal rate of IUD during the first year of its insertion.
Abnormal uterine bleeding may be excessive to the extent of causing iron deficiency anemia.
There are several possible mechanism that explain the cause of menorrhagia in patient using IUCD. Several studies reported that IUD insertion increase the production of prostaglandins in the endometrium which cause an increase in vascularity, vascular permeability and inhibit platelet activity and therefore increase menstrual bleeding.
With recent advances in ultrasound. Three-dimensional power Doppler ultrasound can be used to evaluate endometrial and subendometrial perfusion in cases of menorrhagia.
The aim of the present study is to evaluate subendomtrial blood flow in cases of menorrhagia after copper IUCD insertion in comparison to cases using IUCD and not complaining of abnormal uterine bleeding and cases not using IUCD.
This study includes 315 women divided into three groups. Group I; included 105 women using copper intrauterine device (Tcu 380A) and complaining of menorrhagia, Group II; included 105 women using copper IUD and not complaining of abnormal uterine bleeding and group III; not using any contraceptive method and not complaining of abnormal uterine bleeding.
The uterus and ovaries were first visualized using conventional B-mode ultrasound to check uterine size and presence of uterine masses and the accurate placement of the device inside the uterus in first and second groups.
The color pulsed Doppler was activated in the 2D mode, the right and left uterine arteries pulsatility index (PI) and resistance index (RI) were calculated. Then the ultrasound machine was switched to the 3D mode with power Doppler, subendometrial blood flow pulsatility index (PI) and resistance index were calculated then three-dimensional power Doppler vascular indices; vascularization index (VI), flow index (FI) and vacular flow index (VFI) were calculated automatically using VOCAL (virtual-organ computer aided analysis) software.
As regard to Doppler findings, it was noted that PI, RI of uterine arteries and subendometrial PI and RI were significantly lower in group I in comparison to group II and group III (p-value <0.001) while subendometrial power Doppler indices VI,
FI, VFI were significantly higher in group I in comparison to group II and group III.
The results of our study revealed that uterine artery and subendometrial blood flow were increased in women with IUCD induced menorrhagia in comparison to women with copper IUD and not complaining of abnormal bleeding and women without copper IUD. By using ROC curves, the optimum cutoff value of VI was >4.1 and FI was >34 and VFI >0.98 with sensitivity 87.6%, 89.5% and 85.7% and specificity 96%, 95.2% and 87.6% respectively.