Endometrial reaction to intrauterine device in pregnancy
| Autor: | Yossef Ezra, Itzhak S. Levij, Arie Birkenfeld |
|---|---|
| Rok vydání: | 1989 |
| Předmět: |
Gynecology
Adult medicine.medical_specialty Pregnancy business.industry Obstetrics Uterus Obstetrics and Gynecology Endometrium medicine.disease Intrauterine device medicine.anatomical_structure Reproductive Medicine In utero medicine Gestation Humans Female Endometritis business Chronic Endometritis Intrauterine Devices |
| Zdroj: | Gynecologic and obstetric investigation. 28(1) |
| ISSN: | 0378-7346 |
| Popis: | It is generally assumed that the intrauterine device (IUD) exerts its action by altering endometrial receptivity for the implanting embryo. The most frequently encountered endometrial reaction reported in the presence of an IUD is a chronic inflammatory reaction which may be responsible for the alterations in the normal physiology of the human endometrium. In order to evaluate the endometrial response to the IUD when pregnancy occurs with the device in situ, we have examined the morphology of decidual tissue obtained during interruptions of pregnancy of 32 patients who had conceived in the presence of IUDs. Twenty-three decidual specimens, obtained during interruption of pregnancies without an IUD, served as controls. The incidence of chronic inflammatory reaction was 6.25% in the presence of an IUD and 4.34% in the control group. The incidence of chronic endometritis reported in nonpregnant IUD users is higher (14-100%) than the incidence of chronic endometritis observed in both groups. This observation may be the result of the generally observed alterations in the immune system during a normal pregnancy, but may also be interpreted as a primary reduced endometrial reaction to the IUD, consequently leading to the contraceptive failure in this group.To learn more about the endometrial response to the IUD when pregnancy occurs with a device in situ, morphologic analysis of decidual tissue obtained from 32 such patients during induced abortion was conducted and the results were compared to decidual specimens from 23 controls who conceived without an IUD. Acute inflammatory reactions were noted in 9 (28%) of cases and 6 (26%) of controls; this finding is assumed to be a normal feature of the decidual reaction at the site of the placental bed. Chronic inflammatory reactions were observed in the decidua of 2 cases (6.3%) and in 1 non-IUD user (4.3%). Notable was lymphocyte and plasma cell infiltration in the decidual stroma underneath the endometrial epithelium and glands. Studies in nonpregnant IUD users have found a 14-100% incidence of chronic endometritis. The significantly lower rate recorded among pregnant IUD users in this study may reflect both the generally observed alterations in the immune system during pregnancy and a primary reduced endometrial reaction to the IUD. In fact, this preconception-reduced endometrial reaction may have been the cause of the contraceptive failure among IUD users in this study. |
| Databáze: | OpenAIRE |
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