频繁脱器妇女使用吉妮IUD的临床观察

放置宫内节育器（IUD）因具有安全、有效、简便、经济、长效、可逆等优点而被广泛使用，是目前我国育龄妇女的主要节育措施之一。但是，由于宫颈条件、子宫排异性不同，以及IUD支架的硬度、大小、形状与官腔内形状不符等因素，造成IUD脱落、意外妊娠、带器妊娠、出血、腹痛等副反应和不良后果，影响了宫内节育器的避孕效果。如何提高IUD的使用有效率和置器成功率、减少副反应的发生，一直是临床关注的问题。近年来，我所对有频繁脱器史的妇女放置吉妮IUD（GyneFix IN IUD）80例，并跟踪随访，发现其使用效果较为理想，现报告如下。     

宫内节育器与生殖道感染研究进展

正宫内节育器(intrauterine device,IUD)是我国育龄妇女的主要避孕措施。国家卫计委调查发现,在2.3亿采用各种避孕措施的已婚育龄妇女中,有1.14亿妇女正在使用IUD,占49.79%。尽管已有文献资料显示,特别是对于性传播疾病(sexu-ally transmitted disease,STD)低危人群而言,放置IUD发生盆腔炎性疾病(pelvic inflammatory dis-ease,PID)的风险很低,IUD操作前后对生殖道感     

宫内节育器异位临床分析

目的探讨宫内节育器(IUD)异位的病因、临床特点、诊治方法及预后。方法回顾性分析2015年4月至2020年8月于广东省妇幼保健院诊治的3例IUD异位患者的临床资料, 包括患者的一般情况、发生时间、临床症状、辅助检查及诊治手段, 并结合相关文献报道进行分析总结。结果 3例患者因避孕需求放置IUD, 均在超声检查时发现IUD异位而就诊, 1例IUD异位于膀胱, 1例IUD异位于右侧输尿管, 另1例IUD异位于肠管。3例患者分别进行宫腔镜、腹腔镜微创手术, 顺利取出异位的IUD, 术后恢复良好, 无并发症发生。结论 IUD异位到重要器官如膀胱、输尿管、肠管等, 很可能会影响其功能, 甚至发生进一步的严重并发症。IUD放置术后应定期B超检查, 一旦发现IUD异位或存在其他并发症时, 应尽早取出IUD, 避免更严重并发症的发生。     

人工流产术后即时放置三种宫内节育器的多中心随机对照研究

目的 了解3种常用宫内节育器(IUD)在人工流产术后即时放置的临床效果和安全性.方法 通过前瞻性随机对照临床研究,对来自全国7个省市的12个协作中心的1800例研究对象于人工流产术后即时放置IUD,放置的IUD类型分为宫形含铜IUD宫铜200、T形含铜IUDTCu380A和活性γ型IUD 3种,每种分别观察600例,并随访12个月.结果 1798例完成了使用12个月的随访,2例失访(失访率为0.11%,2/1800);17例不符合纳入标准的未产妇资料在进行数据统计分析时被剔除.3种IUD使用者均未发生妊娠(或带器妊娠),且均无子宫穿孔、IUD异位等并发症发生.活性γ型IUD的医疗原因终止率为1.02/百妇女年,低于宫铜200、TCu380A(分别为3.60/百妇女年、2.25/百妇女年),3者比较,差异有统计学意义(P=0.015).宫铜200、TCu380A和活性.y型IUD中,与IUD使用相关的终止率分别为7.58/百妇女年、7.30/百妇女年和3.72/百妇女年,3者比较,差异有统计学意义(P=0.008).结论 人工流产术后即时放置宫铜200、TCu380A和活性γ型IUD的避孕效果均良好,均安全可行,尤其是国产活性γ型IUD,值得推广.     

宫腔镜下处理迷路IUD32例分析

<正>宫内节育器（IUD）是一种高效、安全、简便、经济的避孕方法,但会发生并发症,如月经过多、经期延长、痛经、带器妊娠、IUD迷路等,影响妇女身心健康而需取出IUD。迷路IUD,如尾丝迷失,IUD粘连、断裂、残留、嵌顿以及穿入或穿出子宫外,致使取出IUD困难。我们利用宫腔镜配合活检钳     

避孕方法知情选择对人工流产发生的影响

目的:从个体角度解析知情选择避孕方法对人工流产发生的影响,并进一步探究两者间的相互关系。方法:采取病例对照研究方法(case-control),根据已婚育龄妇女管理信息系统登记名单,从浙江省德清县、山东省即墨市、安徽省居巢区、宁夏回族自治区中卫市四县(市、区)中,每县(市、区)随机抽取在2002￣2004年间有过人工流产经历的已婚妇女200名,以及截止2004年底从未有过人工流产经历的已婚妇女200名进行1∶1配对。结果:IUD使用者对IUD禁忌证、副作用知情,以及避孕套使用者对正确使用知识知情,可降低人工流产的发生;此外,促进群众能够主动地选择避孕节育方法,而不是由计划生育干部代替选择,则人工流产的发生会降低。从提供个性化咨询服务、规范化筛查服务以及常规化随访服务等方面提高服务能力和质量,促进知情和自主选择避孕方法,可以降低人工流产的发生。结论:对使用IUD和避孕套者,知情可降低人工流产的发生;自主选择对减少避孕失败的发生有重要的影响;技术服务贯穿整个知情选择的全过程,服务到位是降低人工流产的重要手段。     

2054例围绝经期及绝经后妇女宫内节育器使用年限及取出情况调查

目的:了解围绝经期及绝经后妇女宫内节育器(IUD)的取出情况及实际使用年限。方法:以在黄浦区居住且末次使用避孕方法为IUD的45~60岁妇女为研究对象,于2011.08~12期间开展横断面调查,共调查2 167人,其中2 054人纳入分析。结果:研究对象平均年龄52.4±4.0岁。1 160例已绝经的妇女中,63例(5.4%)使用的IUD仍未取出,其中15例IUD已放置至绝经后5年以上;IUD的平均宫内放置时间为18.9±5.7年,50.2%的IUD使用者宫内放置时间20年。732例未绝经的妇女中,IUD的平均使用年限为17.3±5.7年,有51.1%的女性使用IUD已超出建议使用期限。结论:绝经后IUD过期使用情况严重,相当一部分正在使用的IUD已超过了使用期限。     

B超在检查IUD中的应用

宫内节育器(IUD)是目前国内外应用的一种安全、简便、可逆的长效避孕措施，我国育龄妇女使用者占全世界的80％以上，是应用最广泛的避孕工具。而B超能准确可靠地判断IUD在宫腔内正常和异常的位置，提高IUD的避孕效果。现将我站对6800例使用IUD的育龄妇女B超健康查体，发现34例IUD异常情况并总结分析如下。     

宫内节育器与异位妊娠394例分析

目前,国内约有40%的育龄妇女使用宫内节育器(IUD)避孕,随着 IUD 的广泛应用,人们愈加关注其并发症的发生,对其严重并发症一带器异位妊娠尤为重视.但有关 IUD 与异位妊娠的关系,迄今尚无定论.本文综合南京鼓楼医院等8个单位394例带器异位妊娠的临床资料,以探讨其间的关系.     

宫内节育器个体脱落概率的计算及其临床应用方法

本方法是通过对当地近二千例使用IUD 的农村妇女的多因素分析而得出的,有一定价值。本法简便易行、有独立见解,故介绍给读者,欢迎对其实用价值及科学性进行探讨,也欢迎大家对如何利用大量计划生育临床数据来选择使用IUD 的对象和预测效果进行讨论。     

Riesgo de cáncer de mama en portadoras de DIU de levonorgestrel. Revisión sistemática

IntroductionBreast cancer is the leading cause of cancer death in European women. The question arises whether the use of levonorgestrel IUD (LNG-IUD) could be associated with an increased risk of breast cancer.Material and methodsWe conducted a systematic review to identify the risk of breast cancer among LNG-IUD users.ResultsWe found 8 articles, all of them observational and concerning the Mirena® IUD. Half of the studies do not find an increased risk of breast cancer in LNG-IUD carriers and the other half do. The heterogeneity of these studies, as well as the existence of bias in them, and the absence of control for other factors prevent us from performing a meta-analysis.ConclusionsWith the current scientific evidence we cannot confirm that there is a reater risk of breast cancer in LNG-IUD carriers. Well-designed studies are required to draw clear conclusions.     

IUDs and pelvic infection

The risk of pelvic infection in wearers of IUDs is discussed from the viewpoint of criteria used in epidemiology to indicated cause and effect. There are 3 types of statistical associations in epidemiology: spurious, or false associations; indire ct associations acting through another factor; and causal, by which exposure leads to the outcome. The evidence for IUDs leading to pelvic infection is reviewed using the criteria listed by Hill. First, a large relative risk: reported risks range from 1.5-12, usually 3-5, are not considered due to bias. Second, consistent association across all types of studies: this has been true until recently. Third, specificity of effect, meaning one exposure leads to a single outcome: this is not true for pelvic infection, which is influenced by many factors. Fourth, temporal sequence, meaning the exposure must precede the outcome; although temporal association does not prove causal association. Fifth, biologic gradient or dose-response: in this case, more infections are associated with briefer rather than longer duration of IUD use. Sixth, plausibility: that IUDs could cause infection seem plausible. Seventh, experimental or analogous argument: there are no relevant laboratory models for IUDs in women, nor can IUDs be considered like a foreign body in other tissues. Since PID is sexually transmitted, the literature on IUDs and infection is confounded by use of comparison groups with artificially low infection rates. Diagnosis of PID, and even hospitalization rates in IUD users are inflated because of subjective bias against IUDs with respect to PID, leading to selection bias in epidemiologic studies. Three recent well-designed studies with sexually active controls not using contraceptive methods that protect against STDs show no increase in incidence of PID in IUD users.     

The impact of age and intrauterine contraception on the clinical course of pelvic inflammatory disease

BACKGROUND: The aim of the study was to investigate the clinical course of pelvic inflammatory disease (PID) and factors that could predict failed conservative treatment of PID. Additionally, the study aimed to examine the role of age and intrauterine device (IUD) use on the severity of PID. METHOD: Fifty-one women admitted to hospital with the diagnosis of acute PID were recruited. Of those, 17 patients were subsequently operated because of failed conservative treatment. All women underwent careful examination and completed a questionnaire at admission. Their clinical course was followed and the clinician responsible for the patient completed forms at admission and at discharge. Two groups were established retrospectively, those who were treated conservatively and those who underwent surgery. The outcome results were analyzed with regard to IUD use, duration of IUD use (>or=5 or <5 years), and with regard to age below or above 35 years. All data were analyzed using the statistical package SAS. A p value <0.05 was considered significant. RESULTS: Women who subsequently underwent surgical treatment were significantly older and significantly more frequently, current IUD users. There was no significant difference with regard to other socio-demographic characteristics. Women who subsequently underwent surgery had significantly more frequent complaints of severe abdominal pain, elevated body temperature, symptoms of peritoneal irritation, and appearance of adnexal mass. No differences were found between groups with regard to anaerobic microbiological findings, nor with regard to the finding of Actinomyces. IUD use and age >or=35 were found to be highly significant risk factors for surgery in patients with PID. CONCLUSION: Age over 35 years and IUD use, independently of each other, were factors strongly associated with an increased risk of surgery for PID as a result of failed conservative treatment.     

Urban Adolescents' and Young Adults' Decision-Making Process around Selection of Intrauterine Contraception

Study ObjectiveTo examine adolescent and young adults' priorities, values, and preferences affecting the choice to use an intrauterine contraceptive device (IUD).DesignQualitative exploratory study with analysis done using a modified grounded theory approach.SettingOutpatient adolescent medicine clinic located within an academic children's hospital in the Bronx, New York.ParticipantsTwenty-seven women aged 16 to 25 years of age on the day of their IUD insertion.Interventions and Main Outcome MeasuresWe conducted semistructured interviews exploring participant's decision making process around selecting an IUD. We were specifically interested in elucidating factors that could potentially improve IUD counseling.ResultsWe identified 4 broad factors affecting choice: (1) personal; (2) IUD device-specific; (3) health care provider; and (4) social network. Most of the participants perceived an ease with a user-independent method and were attracted by the high efficacy of IUDs, potential longevity of use, and the option to remove the device before its expiration. Participants described their health care provider as being the most influential individual during the IUD decision-making process via provision of reliable, accurate contraceptive information and demonstration of an actual device. Of all people in their social network, mothers played the biggest role.ConclusionAdolescents and young women who choose an IUD appear to value the IUDs' efficacy and convenience, their relationship with and elements of clinicians' contraceptive counseling, and their mother's support. Our results suggest that during IUD counseling, clinicians should discuss these device-specific benefits, elicit patient questions and concerns, and use visual aids including the device itself. Incorporating the factors we found most salient into routine IUD counseling might increase the number of adolescents and young women who choose an IUD as a good fit for them.     

What happened to the IUD in Ghana?

The intrauterine contraceptive device (IUD) is a safe and reversible contraceptive method that requires little effort on the part of the user. Once inserted, it offers 10 years of protection against pregnancy. However, its use in Ghana has stagnated in relation to other contraceptive methods. An exploratory study was, therefore, conducted to examine the client, provider and system characteristics that affect the demand for IUD. Data were gathered through secondary analysis, in-depth interviews, focus group discussions and simulated client survey. The stagnating demand for IUD is attributed to clients' perceptions and rumours about IUD. The fear of excessive bleeding and weight loss discourages potential users. The product design was also perceived to be unacceptable. Demand creation for the IUD has been poor and the number of providers with practical experience of insertion is insufficient. Contrary to the belief that providers' bias contributes to the decline in use, findings show that providers have a favourable attitude towards the product.     

Obstetrician-gynecologists and the intrauterine device: a survey of attitudes and practice

OBJECTIVE: To assess obstetrician-gynecologists' clinical use of the intrauterine device (IUD), their attitudes toward the IUD and how they select IUD candidates, and to test the hypotheses that limited residency training in IUDs, fear of litigation, and a belief that IUDs cause pelvic inflammatory disease decrease IUD use. METHODS: We performed a national mailed survey of 811 practicing obstetrician-gynecologists obtained from systematic sampling of ACOG membership listings to assess use of and attitudes toward the IUD. RESULTS: The survey response rate was 50%. Most respondents agreed that the copper IUD is safe (95%) and effective (98%). However, 20% of respondents had not inserted an IUD in the past year, and of those who had, most (79%) reported inserting 10 or fewer. Fear of litigation and a belief that IUDs cause pelvic inflammatory disease were associated with lower IUD use; the number of IUDs inserted during residency was not. In selecting IUD candidates, respondents were most restrictive about patient monogamy. Having less conservative criteria for selecting IUD candidates was associated with greater IUD use. Respondents with liberal criteria inserted a mean of nine IUDs in the past year, whereas those with conservative criteria inserted four. CONCLUSIONS: Because most obstetrician-gynecologists are inserting few IUDs, educational programs should target these physicians to expand their IUD use. Such programs should highlight modern IUD safety and the rarity of litigation. The number of IUDs inserted in residency may be less important than the development of less restrictive, more evidence-based criteria for selecting IUD candidates.     

Adenocarcinoma of the endometrium following prolonged use of an intrauterine device

An Extremely rare case with the endometrial carcinoma induced by the prolonged (for 20 years) use of IUD (Oota Ring) was reported. The patient was a 57-year-old woman who visited our clinic claiming spotting, and the cancer was revealed by a D & C examination. Since no high risk factors for endometrial carcinogenesis were noted in this patient, it was inferred that prolonged use of IUD played an important role as a cocarcinogen. In particular, the mechanical action of the inserted IUD was thought to be responsible for carcinogenesis. The inflammatory reactions observed in the tumor tissues were considered to be the secondary changes induced by carcinoma.     

Does the human blastocyst implant in the presence of an IUD?

Despite numerous investigations, the method whereby IUDs prevent conception or implantation is still not fully understood. Most workers have concluded that the device expels the blastocyst or exerts harmful effects on it through the inflammatory response arising in the uterus in the presence of an IUD. Some reports have indicated that the IUD may invoke embryonic death after implantation, because short-term peaks of human chorionic gonadotropin (HCG) were detected in many women wearing an IUD using assay methods based on the Pregnosticon test for assaying urinary HCG, or by the application of radioimmunoassays and radioreceptor assays. A new contribution to this debate has not supported the notion of a postimplantation action of the IUD. The extraction of urine for use in the Pregnosticon test resulted in many false positives for HCG probably due to substances which interfered nonspecifically with the assay. Positive results were not detected when a large number of urine samples were assayed for HCG by radioimmunoassay, except in 1 case. The samples had been collected from patients in the luteal phase. Likewise, the use of the rasioimmunoassay for HCG-beta did not detect this hormone in any of the patients with IUDs except 1, and also failed to confirm earlier work on the use of radioimmunoassays. The value of radioreceptor assay is restricted because serum is known to interfere nonspecifically with this assay, and this could have been a complicating factor in interpreting the earlier results. The reports that HCG is present in the urine and serum of women wearing an IUD during the luteal phase must therefore be questioned, and the new data indicate that implantation does not occur in these women.     

Discontinued use of intrauterine contraceptive device and pregnancy loss

To evaluate the risk of spontaneous abortion among former intrauterine contraceptive device (IUD) users, we compared the contraceptive history of 328 women with a spontaneous abortion up to 28 weeks' gestation with that of 1715 women having a term delivery. A similar percentage of case and comparison subjects reported prior IUD use as well as IUD use within the year before pregnancy. However, IUD use lasting more than 12 months was associated with a 1.5-fold increase in the crude risk of spontaneous abortion up to 28 weeks' gestation (p < 0.05), a 1.8-fold increased risk of first-trimester spontaneous abortion, and a 1.7-fold increased risk of incomplete abortion (p < 0.01). The results were not altered by control of individual confounding factors. When confounding factors were controlled simultaneously in a multiple logistic regression analysis, the relative risks were 1.4, 1.7 and 1.6, respectively; however, they were no longer statistically significant. The results suggest that prolonged IUD use may be associated with a modest increase in risk of subsequent spontaneous abortion.