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Notes: Forty-seven women were studied before and for one year after insertion of an intrauterine contraceptive device (IUCD). The menstrual blood loss increased in 44 subjects (94 per cent), and this was related to the surface area of the IUCD. Plasma ferritin levels in the iron deficient range (below 16 ug/l) were present in 9 subjects (19 per cent) before insertion of the IUCD, whereas by the end of one year, 21 subjects (45 per cent) had reached these levels. The incidence of depressed ferritin levels was highest in subjects with a monthly blood loss exceeding 80 ml. The haemoglobin, mean corpuscular haemoglobin and mean corpuscular volume measurements declined progressively, but were less sensitive predictors of iron deficiency. These findings indicate the need to monitor iron status and administer oral iron replacement therapy in subjects with an IUCD.

Notes: A randomized serial study of uterine blood loss was made of 281 women fitted with one of three intrauterine contraceptive devices (IUCDs): a Lippes loop D, a Dalkon shield or a Copper 7. The increase in the amount of blood loss was greatest with Lippes loop D users and least with Copper 7 users. However, the duration of menstrual and intermenstrual bleeding and of spotting was significantly greater among Copper 7 users than with the two inert devices. Thus the mechanisms whereby IUCDs increase the duration as opposed to the volume of uterine bleeding may be different. Previous users of oral contraceptives were found to have significantly less bleeding before IUCD insertion, but showed a similar pattern of increase of uterine bleeding after IUCD insertion to those who had not used oral contraceptives. For all three IUCDs, the increment in amount and duration of uterine bleeding after insertion decreased between the first and the sixth period, on average by about 15 ml and one to two days. No subsequent improvement was found and after 12 cycles the Copper 7 users had longer but less heavy uterine blood loss than users of the Lippes loop D.

Notes: Twenty-five healthy parous women using intrauterine contraceptive devices (IUCD's) received mefenamic acid, 500 mg 8-hourly, during two menstrual periods. Two pre- and two post-treatment menses were similarly studied, by the collection of used sanitary pads and/or tampons and measurement of daily blood loss. A highly significant reduction in mean total blood loss during the treatment periods was observed, unaffected by whether therapy began on the first day of bleeding or in the late luteal phase. The reduction was observed among both inert and copper-containing IUCD-users. Expressed as a percentage of the mean pre-treatment volume, the reduction in loss was not significantly different for those IUCD-users who were light losers (less than 80 ml) compared with heavy losers (80 ml or more), but it was greater in volume terms among the latter. The amounts lost during the post-treatment periods, whether or not placebo tablets were given, were not significantly different from pre-treatment. Reports of side effects were infrequent. By contrast with the reduction in volume lost, no effect of mefenamic acid on the total duration of bleeding and non-collectable 'spotting’could be demonstrated.

Notes: Objective To assess the relative efficacy of three disposable plastic instruments in the retrieval of ‘missing’ IUCD threads.Design A prospective randomised comparative single centre study.Setting Family Planning Clinic in London, UK.Subjects 217 of 350 IUCD users referred to the research team with ‘missing’ IUCD threads entered the study.Intervention All women initially underwent exploration of the endocervical canal with Spencer Wells forceps. When this procedure did not retrieve the threads, the patients were entered into the study. A maximum of two randomly chosen plastic IUCD thread retrievers were then used in any one patient to explore the uterine cavity and capture the ‘missing’ threads. The order in which the two retrievers were employed was also determined at random. Four separate entries into the uterine cavity were permitted with each instrument, the endocervical canal being explored with Spencer Wells forceps after each retraction of the instrument to identify the possible descent of the threads.Main outcome measures Threads brought down beyond the external cervical os, or threads brought to within the endocervical canal and then grasped by Spencer Wells forceps.Results In approximately 40% of all patients, the threads were retrieved with Spencer Wells forceps alone and a further 40% with the disposable plastic retrievers. About 5% had no retrievable threads, and only 2.5% of the referred patients required general anaesthesia for removal of their IUCD. The analysis of the comparative trial was confined to the 197 patients with retrievable threads which could not be brought below the external os with Spencer Wells forceps. The first plastic retriever used was successful in 50% of patients. The Retrievette (59%) and the Emmett (53%) performed better than the Mi-Mark Helix (37%) in this study. The difference was statistically significant (P=0.03) and the 95% confidence interval for the difference of the Mi-Mark Helix from the other two retrievers was 4% to 33%. This retrieval rate for the Mi-Mark Helix was much worse than in previously reported studies, though one doctor did have a better success rate with this retriever. The success rates, using a second plastic retriever randomly chosen from the two not used in the first attempt, were almost identical to those observed with the first retrievers: 63%, 56% and 36%. The success rate did not appear to be influenced by the length of thread, day of cycle, device type or parity. The success of the second retriever tried did not seem to be influenced by the retriever that had failed previously.Conclusions Based on our experience, the initial exploration of the endocervical canal with Spencer Wells forceps is invaluable. If this simple manoeuvre fails to retrieve the ‘missing’ threads, either the Retrievette or the Emmett thread retrievers are useful tools in general practice or in the family planning clinic setting.

Notes: Objective–To investigate the efficacy of ethacridine lactate by the extraamniotic route for second trimester pregnancy termination and its associated complications. Design–Retrospective study of women undergoing second trimester termination, over 3½ years, with extra-amniotic ethacridine alone, or extra-amniotic ethacridine supplemented later by extra-amniotic 15-methyl prostaglandin F,α. Setting–Teaching hospital in Bombay. Patients–315 consecutive women undergoing late abortions with extraamniotic ethacridine. Demographic features were similar in the two groups. Interventions–In group 1, 207 women had 150ml of 0.1% ethacridine lactate injected slowly into the extra-amniotic space. In group 2, 108 women had the initial injection supplemented 6 h later by an extra-amniotic injection of 250 μ.g (1 ml) of 15-methyl prostaglandin F2α. Main outcome measures–The occurrence of abortion following the induction procedure. The development of complications such as haemorrhage, infection, or injury to the uterus or cervix. Results–The method was successful in 191 women (92%) in group 1 and in 106 (98%) in group 2. The median induction-abortion intervals were 35 and 19 h, respectively (Mann-Whitney U test, P〈0.001). The corrected complication rate was 〈10% (30 women), with unplanned uterine evacuation in 6% (20), haemorrhage in 1% (4), and pelvic infection in 4% (14). Conclusion–The use of extra-amniotic ethacridine lactate provides an effective and safe treatment method for second trimester legal abortion. The inductionabortion interval can be appreciably reduced by supplementary prostaglandin.

Notes: Female sterilization using clips applied laparoscopically under local anaesthesia was used in 200 women. Apart from two patients in whom there were technical difficulties, the operation was completed without complication and without immediate or delayed morbidity. The technique, which avoids the risks of general anaesthesia, is commended as a safe, simple method of sterilization suitable for, and acceptable to, the majority of women.

Notes: Objective To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 μg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age.Design A systematic review and meta-analysis of randomised controlled trials.Identification Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field.Main outcome measures Unplanned pregnancy and continuation of contraceptive method.Results Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those 〉 250 mm3 (Copper T 380 Ag and Copper T 380 A intrauterine devices) and those ≤ 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices ≤ 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices 〉 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting.Conclusions The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.