الفهرس 
CHAPTER 1: intrauterine contraceptive Devices.Only 14 pages are availabe for public view
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Abstract
Bleeding with IUCDs is considered iatrogenic dysfunctional
uterine bleeding. The bleeding associated with IUCD use may either
occur during menstruation (heavy and/or prolonged) or in the form of
intermenstrual bleeding and spotting. The IUCD increases menstrual
bleeding by its impact on several aspects of endometrial haemostasis.
Some prostaglandins may cause increase vascularity and vascular
permeability and some prostaglandins inhibit platelet activity, the
increased production of prostaglandins may contribute to endometrial
bleeding synthesis and release could be stimulated in.
IUCD exposed endometrium. IUCD induced menorrhagia might be
correlated with poor contractility of spiral arterioles in spontaneous layer
of the endometrium. Also the increased fibrinolysis with IUCD is likely
to arise as a result of damage to the capillary plexus causing increase and
prolonged menstrual bleeding.
Several diagnostic techniques have been used to reveal
complication after insertion of IUCDs, including X-ray, hysteroscope and
echosongraphy. The X-ray procedure has significant doses of ionizing
radiation, while hysteroscopy may require general anesthesia. On the
other hand echosonography is free of these drawbacks and has high
accuracy in localizing of IUCD. It is therefore the method of choice for
diagnosing IUCD complications. Transvaginal color Doppler sonography
can evaluate the hemodynamic changes in the uterine vascular bed after
the insertion of an intrauterine contraceptive device and to investigate
whether those findings could predict potential side effects, such as
dysmenorrheal and abnormal bleeding.
This study was carried out on 70 women that attend the family
planning out- patient clinic in the obstetrics and gynecology department,
El Menshawy General Hospital, during the period from February 2015 to
February 2016.
Patients divided in 2 groups according to the patient response
to IUD insertion:
group (I): Non-complicated IUDs users.
Group(II): Complicated IUDs users by bleeding or newly
developed dysmenorrhea.
All women attended to family planning clinic at El Menshawy
General Hospital subjected to the following steps:
1. Full medical history.
2. General clinical examination.
3. Local pelvic examination.
4. Pre-insertion Transvaginal Doppler ultrasound of the main uterine
artery and subendometrial vasculature.
5. Application of Cu T380A intrauterine contraceptive device.
6. Transvaginal Doppler ultrasound 3 months post-insertion IUD.
Interpretation of the results of this work showed that uterine artery
mean value of the PI of the women complicated with abnormal bleeding
(group II) (1.36 ± 0.1) were significantly lower than those of the noncomplicated
IUCDs users (group I) (2.29 ± 0.15).,also showed that
uterine artery mean value of the RI of the women complicated with
abnormal bleeding (group II) (0.68 ± 0.02) were significantly lower than
those of the non-complicated IUCDs users (group I) (0.88 ± 0.07).
The results showed also that subendometrial vasculature mean
values of the PI of the women complicated with abnormal bleeding
(group II) (1.75 ± 0.28) were significantly lower than those of the noncomplicated
IUCDs users (group I) (2.11 ± 0.2)., also showed that uterine
artery mean value of the RI of the women complicated with abnormal
bleeding (group II) (0.62 ± 0.02) were significantly lower than those of
the non-complicated IUCDs users (group I) (0.75 ± 0.04).
The color Doppler indices (PI & RI) showed sensitivity (92% &
80%) and specificity (84.4% & 82.2%) with a PPV = (76.7 % &71.4%)