ASSESSMENT OF THE EFFECT OF COPPER COATED IUCD ON THE UTERINE BLOOD FLOW USING THE TRANSVAGINAL COLOUR AND PULSED DOPPLER SONOGRAPHY  

----------------------------------------------------------------------------- 

Dr Huda Ali Al-Araji (FIBMS.Rad), Dr Suhaila Fadhil Al-Shaikh (FIBMS.OG, FABM.OG), Dr Asmaa Kadhum Al-Sarraji (FIBMS.OG, CABM.OG) 
 

Background: Uterine blood flow  can be assessed by transvaginal colour and pulsed Doppler ultrasound by measuring the Resistance index (RI) and the Pulsatility index (PI) of the uterine artery in women with and without IUCD to detect blood flow changes at different times during the menstrual cycle. It also provides an opportunity  to visualize and quantify pelvic blood flow in uterine and adnexial  pathologies.   The intrauterine contraceptive device (IUCD) is a widely used measure of contraception that is not devoid of complications, and the most important one is the occurrence of menorrhagia in women using the copper coated IUCD.    Aims of the study: The aim of this study was to evaluate the effect of copper- IUCD on uterine artery blood flow by using pulsed  and colour Doppler ultrasonography.    Patients material and method: Sixty women were submitted to this study and after exclusion of two of them then 58 women ( age range 16-45 ) were divided into two groups: the control group 30 women (51.72%) without IUCD and the 2nd group 28 women (48.28%) with copper coated IUCD. The RI and PI of the uterine artery were measured by colour and pulsed Doppler TVUS, 44 women (75.86%) of them were in the proliferative and the other 14 (24.14%) were in the secretory phase of the menstrual cycle.     Results:  the RI and the PI values of the uterine artery are changed by the phase of the menstrual cycle in both groups, the mean RI in the early proliferative phase 0.88  , and in the secretory phase 0.87 of the control group  , and in the IUCD group it was in the proliferative 0.85 while in the secretory was  0.86.

 
The PI also showed differences between the two halves of the cycle in both groups :   In the 1st  group were 2.37 , 2.13 in the early 1st and the 2nd halves of the cycle respectively, and in the 2nd  was  2.15 and 2.53 in the early 1st and the 2nd halves respectively.It was evident that in women with IUCD and  menorhagia both the RI (0.81)and PI (1.78) were lower than the women with IUCD and normal menstrual flow    Conclusions and comment: The IUCD does not alter the blood flow indices of the uterine arteries significantly as measured by Doppler TVUS except in susceptible women who are prone to develop menorrhagia after IUCD insertion. So it can be used to predict which women will develop menorrhagia after IUCD insertion.