剖宫产后42～90天放置IUD效果和副反应观察

自1989年12月20日～1990年6月27日,在剖宫产后和阴道分娩后42～90天,自愿放置IUD各310例,术后1、3、6、12、24个月各随访一次,随访率99.19％,IUD用硅VCu200。结果显示:剖宫产组与阴道分娩组置器后1、2年净累积续用率和各项停用率无差异,第二年剖宫产组脱落率显著较低。产后42～60天与61～90天置器各项停用率均无差异。置器后所有副反应两组亦无差异,剖宫产后42～90天放置IUD是安全可行的。

IUD Insertion at 42-90 Days after Cesarean Section a 2-Year Prospective Study of Safety and Efficacy

.Classical cesarean section had been replaced by lower segment cesarean section for decades. On the basis of anatomy,histology,and physiology the lower uterine segment bacomes the isthmus of uterine cervix after puerperium, that is after 42 days post-partum. Therefore, IUD is not in contact with the u-terine scar when it is inserted after puerperium. retrospective investigation of 200 cases in 1987, a prospective study of 620 consecutive cases of IUD insertion after cesarean section and vaginal birth, 310 for each group was conducted VCu 200 IUD was Inserted .Follow up rate was 99. 19%. Breast feeding rate 81. 3%. The mean time of breast feeding was 5. 9+0, 24 months. The net culmulative life table continuation rates were 92.5% at 1 year and 86.38% at 2 years, no significant difference was found in comparison with the vaginal birth group. Dilatation of cervix was not needed in 94. 7%. The length of uterine cavity was 11, 8 + 0. 07cm signifi-cantely longer than after vaginal birth (10. 89 = 0. 06). The mean, bleeding days were 5. 38 + 0. 39 no significant difference with the control. Adverse side effects;such as menorrhagia,irregular bleeding,prolonged menstrual period, shortening menstrual cycle , profuse leucorrhea, backache, lower abdominal-pain, showed no significant difference with the control. There were no complications such as injury, perforation, extrauterine migration, infection, bleeding etc. There was lectopic pregnancy (0. 32% ). Conclusions: IUD insertion at 42 ~ 90 days after lower segment cesarean is safe and effective, and is worth to advocate.