U.S. patent number 3,771,520 [Application Number 05/087,663] was granted by the patent office on 1973-11-13 for intrauterine device inserter.
This patent grant is currently assigned to A. H. Robins Company, Incorporated. Invention is credited to Irwin S. Lerner.
United States Patent |
3,771,520 |
Lerner |
November 13, 1973 |
INTRAUTERINE DEVICE INSERTER
Abstract
An inserter for an intrauterine device is shaped with a slender,
elongated body and includes at one end thereof means whereby the
intrauterine device may be firmly retained upon the inserter.
Rotation of the inserter relative to the intrauterine device
effects release of the intrauterine device from the inserter
thereby permitting unobstructed withdrawal of the inserter with the
intrauterine device being left in place within the uterine cavity.
The inserter is particularly suitable for use with an intrauterine
device comprising a ring and an attached membrane extending
thereacross. With the intrauterine device in the mounted position,
notch means on one side of the inserter engage the ring with the
membrane extending about the opposite side of the inserter.
Inventors: |
Lerner; Irwin S. (Greenwich,
CT) |
Assignee: |
A. H. Robins Company,
Incorporated (Richmond, VA)
|
Family
ID: |
22206512 |
Appl.
No.: |
05/087,663 |
Filed: |
November 9, 1970 |
Current U.S.
Class: |
128/840 |
Current CPC
Class: |
A61F
6/18 (20130101) |
Current International
Class: |
A61F
6/00 (20060101); A61F 6/18 (20060101); A61f
005/46 () |
Field of
Search: |
;128/127,128,130,260,361,303,323 ;152/370 ;206/46SG |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Dunne; G. F.
Claims
What is claimed is:
1. An intrauterine device inserter comprising a slender elongated
body, and intrauterine device releasable retention means proximate
one end of said body for retaining an intrauterine device fixed
thereon during insertion into a uterus and incorporating means
enabling releasing of said intrauterine device in disposition
within a uterus from said intrauterine device releasable retention
means upon relative rotation of said body with respect to said
intrauterine device, said means enabling releasing of said
intrauterine device comprising a pair of notch means of opposite
sense located on one side of said body, said inserter being
gradually curved from approximately its midpoint to said pair of
notch means, said pair of notch means being on the outside of the
curve.
2. An inserter acording to claim 1 wherein said pair of notch means
comprise a pair of notches.
3. An inserter according to claim 2 wherein said pair of notches
are longitudinally spaced apart a predetermined distance.
4. An inserter according to claim 1 wherein said end of said
elongated body proximate said releasable retention means comprises
a rectangular cross sectional configuration.
5. An inserter according to claim 4 wherein said rectangular cross
sectional configuration includes a pair of shorter sides and a pair
of longer sides with said notch means formed on one of said shorter
sides.
6. An inserter according to claim 1 wherein said end of said
elongated body proximate said releasable retention means is formed
in a convex configuration at its extremity.
7. An inserter according to claim 1 wherein the end of said
elongated body opposite said releasable retention means comprises
non-cylindrical handle means configured to provide an indication of
the rotative orientation of said body about its long axis.
8. A inserter according to claim 1 wherein said elongated body
comprises means indicating on said body distances from said end
proximate said releasable retention means.
9. An inserter according to claim 8 wherein said indicating means
comprise variations increasing in cross-sectional diameter from
said end proximate said releasable retention means and formed in
said elongated body.
10. An inserter according to claim 1 wherein said elongated body
includes cervical os abutment means thereon limiting insertion
thereof of said inserter into a uterus.
11. An inserter according to claim 10 wherein said insertion
limiting means comprise a pair of tabs formed on and extending
laterally from said elongated body.
12. An arrangement for placement of an intrauterine device in a
uterus comprising in combination an intrauterine device, an
inserter having a slender elongated body, and intrauterine device
releasable retention means on one end of said body, said
intrauterine device comprising a ring and a membrane attached to
said ring upon opposite sides thereof and extending therebetween,
said intrauterine device releasable retention means comprising a
pair of notches formed on one side of said inserter, said ring
engaged across said pair of notches on said one side of said
inserter, said membrane extending about the opposite side of said
inserter, whereby said intrauterine device is retained in
interlocked disposition on said inserter during insertion into a
uterus and is released from said inserter in disposition within a
uterus upon relative rotation of said body with respect to said
intrauterine device.
13. An arrangement according to claim 12 wherein said pair of
notches are longitudinally spaced a distance sufficient for
enabling engagement of said ring within said notches whereby said
intrauterine device may be releasably held upon said inserter.
14. An arrangement according to claim 13 wherein said ring is
resilient and wherein said longitudinal spacing of said notches is
sufficient to cause flexure of said ring when engaged
thereacross.
15. An arrangement according to claim 12 wherein said inserter
comprises a generally rectangular cross-sectional configuration at
least along the length thereof proximate said pair of notches, said
rectangular configuration defining a pair of shorter sides and a
pair of longer sides with said pair of notches being formed upon
one of said shorter sides and with said membrane extending about
the other of said shorter sides.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention pertains generally to contraceptive devices,
and more particularly to an instrument for insertion of an
intrauterine device.
2. Discussion of the Prior Art
Among the several female contraceptive devices presently in use
most extensively, the intrauterine device ranks as of significant
importance. Recent improvements in their performance resulting from
contemporary, more sophisticated intrauterine devices, has enhanced
acceptance of this form of contraception and further extended its
utilization.
With use of intrauterine devices, there have been recently reported
pregnancy rates which are superior to sequential oral
contraceptives and only slightly inferior to the protection
afforded by combined oral contraception. Furthermore, many of the
problems and complications historically attendant the use of
intrauterine devices have been reportedly greatly reduced with
certain new types of the device. Reduction or elimination of these
problems, which have included bleeding, inadvertent expulsion
sometimes caused by contractions of the uterine wall, and
strangulation of portions of the intestines which become lodged
within the device, combined with improved performance could readily
operate to advance the intrauterine device to the forefront of
modern day contraceptive methods.
Its potential for primacy among contraceptive implements will
perhaps be better appreciated from consideration of the inherent
advantages of the intrauterine device. No requirement for periodic
reminders, such as to take a pill or for other action, exists with
the intrauterine device. There is no danger of side effects from
ingestion of any orally introduced substances. No manipulation by
the user is involved as with barrier types of contraceptive
devices. Once in place within the uterine cavity, the intrauterine
device could provide long term, effortless contraception requiring
little or no attention from the user other than for periodic checks
to insure that dislodgement has not occurred. Insertion and
placement of the device may be performed either by a physician or
by paramedical personnel with only slight potential for
inconvenience or discomfort to the user. Since the insertion aspect
of intrauterine device utilization could induce some hesitancy
regarding its acceptance, it will be appreciated that the means
utilized could be a crucial factor in the development of the
intrauterine device toward more widespread use.
Generally, intrauterine device insertion means should enable
accurate, secure placement without discomfort to the user. During
the insertion process, the insertion means should provide firm and
positive guidance of the intrauterine device until it has been
properly located within the uterine cavity, whereupon there must
occur appropriate disengagement and withdrawal of the insertion
means. This should occur without disturbing the position of the
intrauterine device and without distress to the user.
An additional advantage may be gained with an inserter which does
not require both hands in its operation. Insertion usually involves
gripping and straightening of the cervix in order to locate the
outer cervical os and to facilitate entry through the cervical
canal. This gripping is performed with a tenaculum, and if the
intrauterine device inserter may be operated with one hand only,
the other hand of the operator may be free and available to
manipulate the tenaculum.
Accordingly, it will be seen that much of the potential for success
of the intrauterine device may depend upon development of
appropriate means for insertion. Provision of a insertion
instrument which enables achievement of all the necessary functions
for intrauterine device placement without introduction of
detriments will, therefore, be an important contribution to the
state and development of the art of contraception.
SUMMARY OF THE INVENTION
Briefly, the present invention may be described as an inserter for
an intruterine device comprising a slender elongated body, and
means proximate one end of said body for retaining an intrauterine
device fixed thereupon, said retaining means being configured to
effect release of said intrauterine device upon relative rotation
between said body and said intrauterine device. In the preferred
embodiment of the invention, the specific structure for said
retaining means comprises notch means on one side of said elongated
body and means preventing relative lateral movement of the
intrauterine device relative to the inserter, but permitting
relative rotational and longitudinal motion therebetween.
The inserter of the present invention is particularly suitable for
use with an intrauterine device comprising a ring and an attached
membrane extending thereacross which is maintained fixed upon the
inserter by engagement of the ring within said notch means with
said membrane extending about the opposite side of said inserter.
For release of the intrauterine device, the inserter is rotated to
disengage the ring from the notch means and then longitudinally
withdrawn.
BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will be better understood by reference to the
following detailed description of the preferred embodiment thereof
taken in connection with the accompanying drawings wherein:
FIGS. 1, 2, 3 and 4 are side elevations each taken from one of four
different sides of the instrument embodying the present
invention;
FIGS. 5, 5A, 5B and 5C are sectional views taken, respectively,
along the lines 5--5, 5A--5A, 5B--5B, and 5C--5C of FIG. 2;
FIG. 6 is a side elevation showing the inserter of the present
invention with an intrauterine device mounted thereon and being
positioned within the uterine cavity;
FIG. 7 is a sectional view taken along the line 7--7 of FIG. 6;
and
FIG. 8 is a side elevation depicting disengagement of the inserter
from the intrauterine device by relative rotation therebetween from
the position depicted in FIGS. 6 and 7.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now in detail to the drawings, the present invention is
embodied in an inserter 10 which is formed with a slender elongated
body having a forward end 12 and a handle end 14. In the
utilization of the inserter 10 of the invention, an intrauterine
device may be mounted upon the forward end 12 with the inserter
being gripped for manipulation by an operator at or proximate the
handle end 14. The inserter 10 is shaped at its forward extremity
with a curved tip 16 configured to provide purchase when a very
tightly closed cervical os is encountered during insertion. As best
seen in FIGS. 2 and 4, the entire forward end 12 of the inserter
10, extending from the curved tip 16 to approximately the mid point
thereof, is shaped in one plane with a gently sloping curved
configuration. The degree of curvature of the forward end 12
facilitates the insertion of the intrauterine device by permitting
adaption of the inserter 10 to the normal curvature of the cervical
canal.
The body of the inserter 10 extending from the curved tip 16 to
approximately a point 17 comprises a generally rectangular cross
sectional configuration which, as best seen in FIG. 5, includes a
pair of side walls 18 and 20 and a pair of end walls 22 and 24.
From the point 17 to approximately a point labeled 25 the body of
the inserter 10 comprises a generally circular cross sectional
configuration best shown in FIG. 5A. Throughout the body portion
generally identified by the numeral 25, the shape of the inserter
10 gradually changes form from the circular configuration depicted
in FIG. 5A to a generally square cross sectional configuration best
shown in FIG. 5B and comprising walls 26, 28, 30 and 32 each having
smooth rounded corners therebetween. At a point 33, the body of the
inserter 10 gradually slopes from a generally square cross
sectional configuration to a generally flat rectangular cross
sectional configuration which as best shown in the sectional view
of FIG. 5C comprises the handle end 14.
A pair of notches 34 and 36 are formed proximate the curved tip 16
on the side 22 of the upper forward end of the inserter 10. The
notches 34 and 36 are spaced apart a predetermined longitudinal
distance, and they comprise oppositely directed surfaces, with the
notch 34 having a surface 38 sloped in the direction of the curved
tip 16 while the notch 36 comprises a surface 40 sloped in the
opposite direction toward the handle end 14. The opposite side 24
is formed with an indentation 42 which extends for a longitudinal
distance intermediate the distance between the notches 34 and
36.
The body of the inserter 10 in the vicinity of the point 25 has
affixed thereon markings 44 in the form of numerical designations
indicating distance between the curved tip 16 and the point at
which a marking 44 is located. The markings 44 are similar to and
conform with markings which are usually contained upon uteral
sounds in common use especially suited for gynecological
examination. The markings shown in FIGS. 2 and 4 designate length
in centimeters with the thickness of the body of the inserter 10
being varied at each level where a different marking 44 is
indicated. For example, the circular body portion extending
forwardly of the point 25 is structured to comprise length sections
of differing diameters. A forward circular section 46 of smaller
diameter adjoins a lower circular section 48 having a slightly
larger diameter. The lower circular section 48 comprises a marking
44 consisting of the numeral "6" which indicates that the distance
between the curved tip 16 and a ridge 50 located at the point where
the sections 46 and 48 adjoin is 6 centimeters in length.
Similarly, differently sized square sections 52 and 54 are provided
each having thereon, respectively the numerical designations "7"
and "8" with ridges 58 and 60 resulting from the differing section
thicknesses indicating, respectively, points at which the distance
from the curved tip 16 is 7 centimeters and 8 centimeters. The
square section 54 has integrally formed at the forward end thereof
a pair of laterally extending tabs 62 and 64 to indicate a point on
the inserter 10 which is 9 centimeters from the curved tip 16, with
the designation "9" being located immediately below the tabs 62 and
64 on both sides 28 and 32 of the square section 54. The tabs 62
and 64, although they serve an additional purpose to be described
hereinafter, will tend to prevent or minimize uteral perforation by
limiting insertion of the device beyond a point at which they
engage the cervical os. Although, if necessary, the tabs 62 and 64
may be brought to within the cervical canal, it will be found that
in most cases the distance between the fundal wall of the uterus
and the external cervical os does not exceed nine centimeters, and
that the operator should, therefore, be made aware of a deeper
insertion to prevent perforation. A second pair of laterally
extending tabs 66 and 68 are likewise integrally formed at the
handle end of the square section 54.
In FIGS. 6, 7 and 8, the inserter 10 of the present invention is
shown in conjunction with an intrauterine device 70 which is of a
special configuration and which is described and claimed in
copending application Ser. No. 775,729 filed Nov. 14, 1968 and
assigned to the same assignee as the present invention. The
intrauterine device 70 is essentially comprised of an outer ring 72
and a membrane 74 extending across the central portion of the ring
72. A plurality of spurs 76 extend from opposite sides of the ring
72 there being five spurs 76 shown on each side of the ring 72. The
spurs 76 operate to prevent expulsion of the device from the
uterus. The membrane 74 is provided with an opening 78 at the
forward or head end thereof and with an opening 80 at its tail end.
A telltale string 82 is affixed about the ring 72 for the purposes
of indicating the presence of the device and also for potential use
as an aid in removing the device.
The intrauterine device 70 is affixed upon the forward end 12 of
the inserter 10 by engagement of the head end and tail end of the
ring 72, respectively, within the notches 34 and 36 with the
membrane 74 extending about the opposite side 24 in contact with
the indentation 42. As best seen in FIGS. 6 and 7, the outer ring
72 comprises a head end 72A and a tail end 72B. The head end 72A
when engaged within the notch 34 is prevented from movement in a
direction toward the tail end of the intrauterine device 70 by
engagement upon the forwardly sloped surface 38. In a similar but
reverse fashion, the tail end 72B is prevented from movement toward
the head end by engagement against the rearwardly sloped surface 40
of the notch 36. The device 70 may be generally comprised of a
single integral piece of molded plastic material, and consequently
it will be generally resilient in nature and easily deformable for
the purposes involved in its manipulation and utilization. The
notches 34 and 36 are spaced apart a distance slightly greater than
the head-to-tail distance between the ends 72A and 72B of the outer
ring 72. Accordingly, in order to engage the device 70 upon the
notches 34 and 36, the outer ring 72 must be expanded slightly
thereby creating a spring force tending to contract the outer ring
72 which operates to retain the ends 72A and 72B under a slight
contracting pressure in abutment with the sloped surfaces 38 and
40. This slight spring pressure prevents the ends 72A and 72B from
slipping out of the notches 34 and 36 and contributes toward
retention of the device 70 upon the inserter 10.
In mounting the device 70 upon the inserter 10, the curved tip 16
is first introduced into the opening 80 in a direction, as seen in
FIG. 6, over the tail end 70B and under the membrane 74. The curved
tip 16 is subsequently moved through the opening 78 and over the
head end 72A until the outer ring 72 is positioned adjacent the
notches 34 and 36. The ends 72A and 72B may then be snapped into
position within the notches 34 and 36 by slightly expanding the
outer ring 72 in the longitudinal direction. Lateral movement of
the device 70 is prevented by the engagement of the membrane 74
against the side of the inserter 10 which is opposite the side upon
which the outer ring 72 is engaged within the notches 34 and 36. It
will be apparent that with the device 70 mounted upon the inserter
10 in the manner described both longitudinal and lateral movement
of the device 70 will be prevented and the device 70 will then be
in a position for placement within the uterine cavity by
appropriate manipulation of the inserter 10.
With the intrauterine device 70 thus mounted upon the inserter 10
of the present invention, the combined structure may be packaged
and shipped in a condition ready for immediate placement by an
operator without there arising any need for manipulation or
adjustment prior to placement. Furthermore, due to the particular
mounting arrangement described, little or no liklihood will exist
that the device 70 will become dislodged or disoriented during
shipment. The tabs 62, 64 and 66, 68 are principally intended for
facilitating securement of the device to packaging means.
The inserter 10 is preferably formed of a somewhat stiff but
relatively flexible material such as molded plastic. In the
preferred embodiment described herein, the inserter 10 is formed as
a unitary molded plastic piece having sufficient flexiblity to
permit the device to follow the path of the cervical canal when the
device 70 is being inserted into the cervical cavity. The size and
shape of the curved tip 16 acts to predispose the cervical canal
for the intrauterine device 70 which follows thereby permitting
insertion without the need for previous dilation. With the device
70 firmly mounted upon the inserter 10 as previously described, the
operator may manipulate the inserter 10 by grasping the handle 14
to propel the device 70 to an appropriate location within the
uterus 84 against the uterine wall 86. With the device in place
within the uterine cavity as shown in FIGS. 6 and 7, the inserter
10 may be disengaged from the intrauterine device 17 by a
90.degree. rotation of the inserter 10 as indicated by the arrow
88. Rotation of the inserter 10 about its longitudinal axis in the
manner indicated by the arrow 88 will permit disengagement and easy
withdrawal of the inserter 10 from within the uterine cavity while
allowing the device 70 to remain lodged therein in an appropriate
position.
In FIG. 8 there is depicted the relative positioning between the
inserter 10 and the device 70 subsequent to rotation of the
inserter 10 through a 90.degree. angle and prior to movement of the
inserter 10 in a direction for withdrawal from the uterine cavity.
It will be noted that due to the rectangular configuration of the
inserter 10 across the portion thereof in engagement with the
intrauterine device 70, the distance between the walls 22 and 24
will be greater than the distance between the walls 18 and 20.
Accordingly, when the inserter 10 is engaged upon the device 70 in
the configuration shown in FIGS. 6 and 7, the wider dimension
extending between the walls 22 and 24 will be placed across the
device 70 between the ring 72 and the membrane 74. As a result,
this wider lateral dimension will operate to stretch somewhat the
device 70 thereby enhancing retention of the device 70 upon the
inserter 10 during shipping and during insertion to within the
uterine cavity. Upon rotation of the inserter 10 through the
90.degree. arc indicated by the arrow 88, the narrower dimension
extending between the walls 18 and 20 will be placed between the
ring 72 and the membrane 74, thereby eliminating this stretching
action and expediting withdrawal of the inserter 10 from within the
device 70.
It should be noted that the membrane 74 may be formed in a slightly
bowed configuration to insure elimination of any stretching when
the narrower dimension between walls 18 and 20 is placed across the
device 70.
Rotation through the 90.degree. arc of arrow 88, will cause the
ends 72A and 72B of the ring 72 to become disengaged from within
the notches 34 and 36, respectively. It will be appreciated that
this will occur as a result of abutment of the device 70 against
the walls of the uterus. For example, as seen in FIG. 7 the device
70 will be in abutment against the wall 86 of the uterus 84. This
abutment will prevent rotation of the device 70 during the time
that the inserter 10 is rotated as indicated by the arrow 88. The
amount of force needed to disengage the ring 72 from within the
notches 34 and 36 is very slight and is such as to exert very
little pressure against the walls of the uterus. When the inserter
10 is rotated in the manner described, the ends 72A and 72B will be
snapped out of engagement from within the notches 34 and 36 as a
result of the relative rotational motion between the inserter 10
and the device 70. The relative positioning of the members
immediately following this rotation and snapping out of engagement
is depicted in FIG. 8, and with the parts in this position the
inserter 10 can be easily withdrawn from within the device 70 and
from the uterine cavity, with the device 70 being retained in the
desired position within the uterus. As a result of the lessened
thickness between the walls 18 and 20 which will now extend across
the device 70, withdrawal of the inserter 10 without dislodgement
or disturbance of the device 70 is enhanced. Of course, it will be
clear that the inserter 10 may be rotated in either direction for
disengagement and withdrawal.
During the insertion process, the markings 44 will provide an
indication of the extent to which the device has penetrated the
cervical canal. The physical dimensioning of the inserter 10
whereby the lateral dimensions thereof are gradually altered by the
increasing thickness of the sections 46, 48, 52 and 54 will enhance
the ability of the operator to detect the degree of insertion of
the device. Furthermore, the shape and configuration of the handle
14 will operate to enable determination of the relative rotational
positioning of the device thereby permitting the operator to
discern with greater accuracy the point at which 90 degrees of
relative rotation has occurred between the device 70 and the
inserter 10 with the device 70 in place within the uterine cavity.
Additionally, the shape of the handle 14 will enable easy
manipulation of the inserter 10 to effect the required rotation
thereof for withdrawal from within the intrauterine device 70.
An additional advantage of the inserter 10 in determining
orientation during placement relates to the fact that the point of
intersection between the handle 14 and the forward body position is
smooth on one side but is formed with a sloped shoulder 69 on the
opposite side. This enables determination of the direction of
orientation of the sloped forward end. Thus, during insertion, it
can be determined from the shoulder 69 whether the inserter 10 is
following the curvature of the cervical canal or is oppositely
directed.
Although the present invention has been described in connection
with a specific intrauterine device 70 with which it is especially
suitable for use, it is to be understood that the shape and
configuration of the intrauterine device which is placed by
utilization of the inserter of the invention is not intended to
constitute a limiting factor with regard to the scope of the
invention, of which the intrauterine device forms no part. Any one
of a variety of intrauterine devices which are appropriately shaped
and configured to cooperate with the present invention may be
utilized therewith. It will be clear, of course, that the
intrauterine device must be appropriately sized and shaped for
adequate mounting upon the inserter 10 but it should be understood
that many modifications of the specific device 70 described herein
may be effected without affecting the performance of the present
invention in the placement of such a device.
It should be further understood that many modifications and
variations of the device of the present invention may be
accomplished by those skilled in the art within the context of the
present invention, and that such variations and modifications are
to be considered within the scope and purview thereof.
* * * * *