Overview
Infection associated with intrauterine contraceptive devices (IUDs) can occur, particularly in the context of maternal TORCH infections, leading to inflammatory responses in neonates 1. Clinician knowledge and attitudes towards IUDs often improve during obstetrics and gynecology clerkships but still show significant gaps 2.Diagnosis
Clinical Presentation: Infants may exhibit signs of systemic inflammatory response, with elevated levels of cytokines (IL-1, IL-6, IL-8, IL-10), γ-IFN, TNF-α, procalcitonin, and neopterin 1.
Recommended Tests: Cytokine profiling, measurement of γ-IFN, TNF-α, procalcitonin, neopterin, and prostaglandin E2 levels in serum 1.
Diagnostic Challenges: Partial or complete uterine perforations may go undiagnosed initially, requiring long-term follow-up 3.Management
Antibiotic Therapy: Specific drug classes and doses are not detailed in the provided abstracts; however, targeted antibiotic therapy based on culture and sensitivity results is generally recommended for confirmed infections 1.
Surgical Intervention: Laparoscopic retrieval may be necessary for translocated or perforated IUDs 56.
Monitoring: Close monitoring for signs of infection and inflammatory markers in neonates born to mothers with TORCH infections 1.Special Populations
Pregnancy: Infants born to mothers with TORCH infections and IUDs may show heightened inflammatory responses 1.
Clinician Training: Medical students' knowledge and attitudes towards IUDs improve significantly through obstetrics and gynecology clerkships, though gaps persist 2.Key Recommendations
Monitor Inflammatory Markers in neonates born to mothers with TORCH infections and IUDs to detect early signs of intrauterine infection 1 (Evidence: Moderate).
Enhance Clinician Training on IUD insertion and management to improve knowledge and reduce barriers related to liability and skill 24 (Evidence: Moderate).
Consider Long-term Follow-up for potential uterine perforations following IUD insertion, especially in cases where initial diagnosis is unclear 3 (Evidence: Weak).References
1 Horlenko OM, Chuhran YY, Prylypko LB, Kossey GB, Debraetseni OV, Peresta MI et al.. INFLAMMATORY RESPONSE STATUS IN INFANTS WITH INTRAUTERINE INFECTION FROM MOTHERS WITH IDENTIFIED TORCH INFECTION. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2022. link
2 Bartz D, Tang J, Maurer R, Janiak E. Medical student intrauterine device knowledge and attitudes: an assessment of clerkship training. Contraception 2013. link
3 Harrison-Woolrych M, Ashton J, Coulter D. Uterine perforation on intrauterine device insertion: is the incidence higher than previously reported?. Contraception 2003. link00417-1)
4 Kooiker CH, Scutchfield FD. Barriers to prescribing the Copper T 380A intrauterine device by physicians. The Western journal of medicine 1990. link
5 Virkud AM, Shah SK. Laparoscopic retrieval of transmigrated IUDS (report of 3 cases). Journal of postgraduate medicine 1989. link
6 Guha-Ray DK. Translocation of the intrauterine contraceptive device: study of thirty-one cases. Fertility and sterility 1977. link42795-0)