Effect Of Pregnancy With Copper Intrauterine Device On Pregnancy Outcome

Backgroud:IUD(Intrauterine device)is a long-acting,highly effective,low cost and reversible contraception.It is the most commonly used contraceptive measure in China.Among the 230 million married women of childbearing age who use various contraceptive measures,about 53.6%of women use IUD.In China,mostly modern intrauterine contraceptives are copper intrauterine device(Copper IUD).Despite the overall excellent safety profile,side effects and complications can occur at or after the time of insertion.The common side effects include IUD failure,ectopic,a change in bleeding pattern,expulsion and so on.Pregnancy with IUD is uncommon,the problem of embryo retention often puzzles pregnant women and clinicians.Previous studies on copper content in decidua and chorionic tissues of pregnant women with IUD showed that the concentration of copper in the uterus is increasing.However,the cellular and reproductive genotoxic effects of increased copper ions and their effects on maternal and child health are still unclear.Ectopic IUD is one of the three risk factors for pregnancy,and the other two risk factors include age and history of natural IUD shedding.In addition,ectopic IUD may cause serious complications such as uterine perforation,intestinal obstruction,pelvic mass,and even death,affecting female reproductive health.So,it is important to find a diagnostic method for ectopic IUD which is simple,safe,accuracy and valuable for the selection of operation methods.We focus on the side effects of IUD about pregnancy with IUD and ectopic IUD.It is well known that embryonic development is a complicated process.It is related with inherit,mutrition,environment,placenta and some other factors.Spontaneous abortion,premature birth,fetal intrauterine growth restriction might be associated with the level of genes and cytokine expression.Human leukocyte antigen G(HLA-G)is a nonclassical Class ? major histocompatiblitiy complex(MHC)gene.During pregnancy,selective expression of HLA-G in fetal extravillous trophoblasts,and the expression of HLA-G gradually increases with the trophoblast invades the uterus.HLA-G affects embryo development and growth,vascular remodeling,success of assisted reproduction techniques.A lower expression of HLA-G is associated with poor pregnancy outcome,such as miscarriage,preterm birth,pre-eclampsia,and premature rupture of menbrane.Insulin-like growth factors ?(IGF-?)is found to be the major growth factor before birth.IGF-? might participate in the regulation of early pregnancy by autocrine,paracrine and endocrine fashion.IGF-? is an important regulator for early embryonic development.A lower expression of IGF-II is associated with poor pregnancy outcome,such as intrauterine growth retardation,preeclampsia,embryonal developmentdeficiency and embryo damage.So,we are concerned about the problem whether Cu2+affects the expression levels of HLA-G and IGF-? in decidua and villi.The risk of IUD failure resulting in pregnancy is about 0.1 per 100 woman-years.Clinically,the vast majority of IUD in the pregnancy women were removed in the first and second trimester of pregnancy,and only a small part of the IUD were removed during childbirth.Pregnancy with IUD may increase the incidence of infection,septic abortion,miscarriage,preterm birth,chorioamnionitis and so on.Based on the increased risk of poor maternal and fetal outcomes associated with a retained IUD and the reduction of risk associated with IUD removal early in pregnancy,mostly IUD was removed as early as possible,which is consistent with other practice recommendations.If the IUD cannot be removed,it should be leaving in situ.The effect of copper IUD on the late pregnancy woman and fetus is still unclear.Ectopic IUD is one of the risk factors for pregnancy failure.IUD ectopic is a lessserious side effect and occurs in up to 10 percent of women.IUD ectopic can lead to severe health complications,including uterine perforation,intestinal obstruction,pelvic mass,even death.50 percent of the ectopic IUDs are asymptomatic.The IUD string being invisible or unusually short is also not a distinctive sign of IUD ectopic.Therefore,the World Health Organization recommends that once it was diagnosed as ectopic IUD,it should be removed immediately.Two dimensional ultrasound,three dimensional ultrasound and computer tomography are applied to diagnose ectopic IUD.However which examination was safer,more accurate,simpler and less cost worths further investigation.Aiming at these problems,we use research in laboratory and clinical data analysis to illustrate the following three aspects.To observe the expression levels of HLA-G and IGF-? in decidua and villi in women pregnancy with IUD.Firstly,we compared the expression level of embryonic development important factor HLA-G and IGF-? in normal early pregnancy group and pregnancy with IUD group to explore the influence of copper IUD on the growth and development of the embryo.Second,we study the effects of copper IUD on maternal and neonatal diseases to explore the safety of the pregnancy with copper IUD.Third,we compared the value of ultrasound and CT in the diagnosis of ectopic copper IUD,and selected a suitable auxiliary examination method to diagnose the ectopic IUD.Part ? Effects of copper IUD on the expression level of HLA-G andIGF-? of decidua and villiObjective:Comparing the expression level of HLA-G and IGF-? in villi and decidua of the early pregnancy women with copper IUD in situ.Methods:Unplanned early pregnancy women with copper IUD in situ was assigned as pregnancy with IUD group.And unplanned early pregnancy women without IUD was recruited as normal pregnancy group.The decidua and villi in the pregnancy with IUD group and normal pregnancy group were collected.HE staining was used to compare the morphological differences in the decidua and villi of the two groups.Western blot method was used to investigate the protein expression of HLA-G and IGF-? in decidua and villi.RT-PCR was used to investigate the mRNA expression of HLA-G and IGF-?in decidua and villi.Results:1.There were no significantly differences in the morphology of villi and decidua between the pregnancy with IUD group and normal pregnancy group.2.The decidua expression of HLA-G protein in the pregnancy with IUD group was significantly lower than that in the normal pregnancy group,P<0.05.The villi expression level of HLA-G protein and decidua or villi expression level of IGF-?protein had no significantly difference between the pregnancy with IUD group and normal pregnancy group.3.The villi expression level of HLA-G mRNA in the pregnancy with IUD group was significantly lower than the normal group,P<0.05.The decidua expression level of HLA-G mRNA and decidua or villi expression level of IGF-? mRNA had no significantly difference beltween the pregnancy with IUD group and normal pregnancy group.Conclusions:1.There were no significantly difference in the morphology of villi and decidua between the pregnancy with IUD group and normal pregnancy group.2.The decidua expression of HLA-G protein in the pregnancy with IUD group is significantly lower than that in the normal pregnancy group.3.The decidua or villi expression level of IGF-? protein had no significantly difference between the pregnancy with IUD group and normal pregnancy group.Part ? Effects of copper IUD on complication of mother andneonateObjectives:To evaluate the effect of copper IUD in situ on the incidence of complications during pregnancy,childbirth,puerperium period and the incidence of neonates abnormal.Study Design:This study included 76 cases of pregnancy with copper IUD and 76 cases of pregnancy without IUD.All women delivered at more than 28 weeks of gestation.The information collected included the general condition of the patient,history of birth,previous surgical complications.And the pregnancy coexisted diseases of pregnancy hypertension disease,gestational diabetes mellitus,premature rupture of membranes,placental abruption,and puerperal infection were both collected.We also collected the gestational weeks,the location of IUD at birth,the birth weight of the newborn,neonatal intrauterine infection,neonatal malformation,etc.Results:1.There was no significant difference in the age and the average gestational week in the normal pregnancy group and the pregnancy with copper IUD group(P>0.05).2.There was no significant differences in the gestational diabetes mellitus and pregnancy-induced hypertension between the normal pregnancy group and the pregnancy with copper IUD group(P>0.05).3.The incidence of PROM and PPROM in the pregnancy with copper IUD group was significantly higher than that in the normal pregnancy group(P<0.05).PROM and PPROM in the pregnancy with copper IUD group was not associated with the location of the IUD and the length of IUD used.4.There was no significant difference of the neonate birth weight in the normal pregnancy group and the pregnancy with copper IUD group(P>0.05).The incidence of neonatal asphyxia,intrauterine infection,low birth weight and neonatal congenital malformation in the pregnancy with copper IUD group was not significantly higher than the normal pregnancy group.Conclusion:1.Study on the women who delivered at more than 28 weeks of gestation found that copper IUD had no obvious influence on gestational diabetes mellitus and pregnancy-induced hypertension.2.Pregnancy with copper IUD had a high rate of PROM and PPROM.3.Pregnancy with copper IUD had no obvious influence on neonatal asphyxia,intrauterine infection,low birth weight and neonatal congenital malformation.Part ? The value of ultrasound and Computer Tomography in diagnosis of copper IUD malpositionObjective:To evaluate the diagnostic value of ultrasound and CT in malpositioned copper IUD.To find an accurate,simple,and effective auxiliary examination method that can provide effective reference for the selection of surgical methods.Methods:Cases of suspecting copper IUD transmigration due to ultrasound examination or failure of removal of IUD were collected from June,2009 to September,2011.All patients underwent 2D ultrasound,3D ultrasound and/or CT examinations.Hysteroscopy,laparoscopy,and/or laparotomy was the gold standard for diagnosing copper IUD malposition.The diagnostic value of ultrasound and CT in copper IUD malposition was confirmed.Results were analyzed with chi-squared tests.P-value less than 0.05 was considered significantly different.Results:1.The sensitivities of 2D and 3D ultrasound for diagnosing copper IUD malposition were 64.8%and 82.6%,respectively.The accuracy of three-dimensional ultrasound in the diagnosis of copper IUD malposition was significantly higher than that of two-dimensional ultrasound,the difference was statistically significant(P<0.05).2.The sensitivities of 3D ultrasound and CT in diagnosing copper IUD partial malposition were 82.91%and 83.76%respectively,in total malposition was 85.71%and 100%respectively,and malposition out the uterus was 66.67%and 100%respectively.Difference of the diagnostic accuracy between 3D ultrasound and CT was not significantly different(P<0.05).Conclusion:1.The accuracy of 3D ultrasound in the diagnosis of copper IUD malposition was significantly higher than that of 2D ultrasound.2.No significant difference was found in the diagnostic accuracy of 3D ultrasound and CT in copper IUD malposition.