两种产后立即放置TCu380A宫内节育器方法的比较——910例12个月随访分析

目的：比较徒手和卵圆钳两种方法对产后立即放置（ＩＰＰＩ）宫内节育器（ＩＵＤ）效果的影响。方法：将９１０例阴道分娩产妇（其中９７．７％是首次分娩）随机分成两组，于胎盘娩出后１０分钟内放置ＴＣｕ３８０ＡＩＵＤ，其中４７０例徒手放置（手放组），４４０例用卵圆钳放置（钳放组）。随访１２个月，以生命表法统计、χ２检验比较两种放置方法的脱落率、妊娠率、因症取出率等。结果：６和１２个月的随访率分别为９５．１６％和９２．６４％。９１０例中未发生子宫穿孔和感染，仅手放组有１例带器妊娠。放置后主要停用原因是脱落，手放组与钳放组１２个月的粗累积脱落率分别为１５．８６／１００妇女和１５．８８／１００妇女，因症（出血、疼痛）取出率分别为２．１１／１００妇女和１．５７／１００妇女，差异无显著性（Ｐ均＞０．０５）。结论：徒手放置或卵圆钳放置对ＩＰＰＩ的效果无明显影响；ＴＣｕ３８０ＡＩＵＤ适合中国妇女产后立即放置。     

两种产后立即放置TCu380A宫内节育器方法的比较

目的；比较徒手和卵圆钳两种方法对产后立即放置（ＩＰＰＩ）宫内器（ＩＵＤ）效果的影响，方法：将９１０例阴道分娩产妇（其中９７．７％是首次分娩）随机分成两组，于胎盘同后１０分钟内放置ＴＣｕ３８０ＡＩＵＤ，其中４７０例徒手放置（手放组），４４０例用卵圆钳放置（钳放组）。随访１２个月，以生命表法统计、χ＾２检验比较两种放置方法的脱落率、妊娠率、因症取出率等。结果：６和１２个月的随访率分别为９５．１６％和９     

四种活性IUD放置三年的临床评价

<正>为进一步探讨活性宫内节育器(IUD)的避孕效果和副反应,优选临床更适合我国妇女子宫的IUD,我们对本中心门诊常用的四种活性IUD进行临床效果评价,现将调查结果比较如下:     

宫内节育器宫腔形Cu300、TCu220C、TCu380A放置10年的临床比较性研究

目的 了解宫腔形宫内节育器(Cu300)及TCu220C、TCu380A3种宫内节育器(IUD)放置10年的临床效果。方法 全国7个IUD临床应用中心,对2699例随机放置Cu300、TCu220C和TCu380A的农村妇女,共观察10年。结果 使用10年时,Cu300、TCu220C和TCu380A的带器妊娠率,分别为2．56、4．82和4．01／100妇女,Cu300明显低于其他两种IUD(P＜0．05)。脱落率分别为4．54、5．46和9．68／100妇女,TCu380A显著高于其他两种IUD(P＜0．001)。因出血、疼痛取出率分别为6．71、5．58和6．80／100妇女,3种IUD比较,差异无显著意义(P＞0．05)。使用10年时,3种IUD的续用率分别为74．86、66．22和63．56／100妇女,以Cu300续用率最高,TCu380A最低(P＜0．01)。结论 Cu300、TCu220C和TCu380A的避孕效果好,可推广使用。     

哺乳期妇女放置缓释黄体酮阴道环和铜T380A宫内节育器避孕效果…

本文对产后４２￣６０天的哺乳妇女放置每天释放１０ｍｇ天然黄体酮的阴道环（１６０例）与铜Ｔ３８０Ａ宫内节育器（１００例）进行避孕效果及其安全性比较研究。结果表明：通过宣教，产后４２￣６０天落实节育方法是可行的，放置铜Ｔ３８０Ａ宫内节育器在哺乳期无妊娠发生，哺乳期避孕对母儿健康无不良影响，围产保健和计划生育并行对提高母乳喂养率，落实计划生育方法，降低人工流产率，保障母儿健康收效显著，值得推广。     

月经后放置四种IUD避孕效果的比较研究

本研究用实验流行病学方法,随机对比了单环、TCu 220 C、MLCu 375和宫形器在广东省育龄妇女中的避孕效果。从1988年3月至1989年5月,每种节育器各置384例共1536例。本文报道研究的初步结果:MLCu 375,TCu 220 C和宫形器的一年粗累积继续存放率明显高于单环;粗累积脱落率明显低于单环。MLCu 375和TCu 220 C的粗累积妊娠率明显低于单环和宫形器,皆有极显著统计学意义。本文还对可能影响节育器避孕效果的一些因素进行了单因素和Cox模型多因素生存分析。     

活性γCu3809IUD与TCu380A IUD临床比较性研究

本研究通过增加原γＣｕ２００ＩＵＤ的铜表面积至３８０ｍｍ＾２,其目的为了进一步降低工带器妊娠率,以期达到ＴＣｕ３８０Ａ ＩＵＤ相似的避孕效果,而其副反应发生率明显低于ＴＣｕ３８０Ａ ＩＵＤ。方法：１９９５年８月－１９９６年６月由三个中心参加的随机比较性研究,共随访２４个月,每个中心分别放置γＣｕ３８０与ＴＣｕ３８０ＡＩＵＤ各１００例,共６００例。结果：２４个月末γＣdisplay status     

哺乳期妇女放置缓释黄体酮阴道环和铜T380A宫内节育器避孕效果及其安全性研究

本文对产后４２～６０天的哺乳妇女放置每天释放１０ｍｇ天然黄体酮的阴道环（１６０例）与铜Ｔ３８０Ａ宫内节育器（１００例）进行避孕效果及其安全性比较研究。结果表明：通过宣教，产后４２～６０天落实节育方法是可行的，放置铜Ｔ３８０Ａ宫内节育器在哺乳期无妊娠发生，哺乳期避孕对母儿健康无不良影响。围产保健和计划生育并行对提高母乳喂养率，落实计划生育方法，降低人工流产率，保障母儿健康收效显著，值得推广。     

六种时期放置宫内节育器的临床观察五年随访总结

自1983年7月至1984年2月于常规放置外的六种时期,共放置金属单环5408例,并以产时和剖腹产时未放环1993例为对照组。经五年随访观察,临床效果按生命表法统计60月继续存放率,产时放环组为48.05,剖腹产组为55.73,产后30～70天放置组为63.60,中期妊娠引产清宫术后放环组为49.24,钳刮术组为67.46,经期3～5天放置组为68.07/100妇女。全部对象未发生子宫穿孔,无严重感染或大出血。产时和剖腹产时放环组的失败人流率各为15.27%和29.94%,明显低于产时不放环组的48.72%和剖腹产组的46.09%的人流率。因此六种时期放环是安全、可行和有效的,建议扩大节育器放置时间范围,以适应妇女不同生理阶段的避孕需要。     

不同时期放置宫内节育器TCu380A的临床效果比较

妇女年,但差异无统计学意义(P>0.05).结论 4种不同时期放置TCu380A IUD均安全可行,效果可靠.     

Postplacental Insertion of Levonorgestrel Intrauterine System Versus Copper Intrauterine Device: A Prospective Study

PurposeTo compare between postplacental insertion of levonorgestrel intrauterine system versus copper intrauterine device regarding expulsion rates, patient satisfaction, complications, and continuation rates.MethodsThis prospective observational study was conducted on 1100 participants divided in to two groups: group (1) CU-IUD group and group (2) LNG-IUS group where women were assigned for postplacental insertion of either CU-IUD or LNG-IUS, respectively. Follow-up at 6 weeks, 3 and 6 months postpartum and data were collected and analyzed to evaluate outcomes.ResultsNo statistical difference between both groups regarding patients’ characteristics, the overall expulsion rate was higher in LNS-IUS group than CU-IUD group; 77 patients (14%) and 50 patients (9%), respectively, (P value < 0.05), odds ratio: 1.63 at CI: (1.12–2.37). No significant difference between the two groups regarding pain intensity, perforation, abnormal uterine bleeding, and clinical endometritis (P > 0.05). Overall satisfaction rate at six months was 478(87%) in the CU-IUD group and 472(85.8%) in the LNS-IUS group (P value > 0.05), odds ratio: 1.1 at CI: (0.78–1.55). Continuation rate at s6 months was comparable between the two groups 485 (88.2%) and 480 (87.3%) in CU-IUD group and LNS-IUS group respectively, (P value < 0.05), odds ratio: 1.09 at CI: (0.76–1.56).ConclusionThe rate of expulsion of LNG-IUS is higher than copper IUD when inserted postplacental, yet the continuation and acceptability rates were comparable between the two groups.     

Immediate Postpartum Contraception: Intrauterine Device Insertion

Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence‐based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.     

Comparative Efficacy of Vaginal Misoprostol vs Vaginal Dinoprostone Administered 3 Hours Prior to Copper T380A Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial

Study ObjectiveTo compare the effectiveness of misoprostol and dinoprostone tablets administered vaginally 3 hours before copper intrauterine device (IUD) insertion vs placebo in reducing pain and increasing ease of insertion among nulliparous women.DesignRandomized controlled trial.SettingTertiary referral hospital.ParticipantsA total of 129 nulliparous women requesting a Copper T380A IUD insertion.InterventionsWomen were randomized to receive 200 μg misoprostol or 3 mg dinoprostone or placebo 3 hours before IUD insertion.Main Outcome Measure(s)Primary outcome was patient-reported pain during IUD insertion using a 10-cm visual analog scale (VAS). Secondary outcomes include provider ease of insertion, women satisfaction level, and side effects.ResultsParticipants' baseline characteristics were comparable between the study groups. Mean pain score during IUD insertion was lower with misoprostol than placebo (3.1 ± 2.3 vs 4.4 ± 2.2; P = .02) and dinoprostone compared to placebo (2.4 ± 1.8 vs 4.4 ± 2.2; P < .001). Clinicians reported easier IUD insertion with misoprostol than placebo (2.4 ± 1.7 vs 4.0 ± 2.4; P = .001) and dinoprostone compared to placebo (2.0 ± 1.5 vs 4.0 ± 2.4; P < .001). Women's satisfaction levels were higher with both misoprostol and dinoprostone than placebo (P < .001). Side effects did not differ among the 3 study groups.ConclusionsPremedication with vaginal misoprostol or dinoprostone effectively lowered pain during copper IUD insertion. However, the reduction in pain scores was clinically significant only in women who received dinoprostone. In both the misoprostol and dinoprostone groups, clinicians found the procedure easier, and women were more satisfied with IUD insertion. Side effects and complications were similar in all groups.     

Visibility of Strings After Postplacental Intracesarean Insertion of CuT380A and Cu375 Intrauterine Contraceptive Device: A Randomized Comparative Study

Objectives

To compare the incidence of visible strings after postplacental intracesarean insertion of Cu375 and CuT380A intrauterine contraceptive devices (IUD).

Methods

This was a prospective, randomized comparative study. A total of 100 women fulfilling the inclusion and exclusion criteria underwent postplacental intracesarean insertion of either Cu375 IUD or CuT380A IUD. Women were followed up at 1, 6 weeks and 3 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualize the IUD strings. Data were analyzed by Chi-square test.

Results

At 6-week follow-up, 97.9% women in group A versus 41.7% women in group B had strings visible at the cervical os and at 3 months 100% women in group A versus only 47.9% women in group B (p < 0.001) had visible strings of IUD.

Conclusion

Both Cu375 and CuT380A IUD are safe postpartum method of contraception but Cu375 if used for intracesarean IUD insertion increases the incidence of visible IUD strings. Hence, it avoids radiological investigations and invasive procedures at follow-up visits required to locate the IUD when strings are not visible. CTRI No. CTRI/2015/09/006221.

     

宫铜300宫内节育器脱落情况的系统评价

目的:系统比较宫铜300宫内节育器(IUD)和其他种类IUD的脱落情况。方法:检索PubMed、Embase、POPLINE等12个国内外数据库/网站,根据纳入与排除标准筛选文献,使用RevMan5.3.3对文献数据进行合并与分析。结果:共检索到6062篇中英文文献,最终纳入涉及脱落结局指标的19篇文献。分析结果显示:①与TCu220C IUD相比,2年随访时宫铜300 IUD脱落率显著增高,相对危险度(RR)及95%CI为2.33(1.43~3.80)(P0.05);②与MCu功能型IUD相比,6月、1年、2年随访时宫铜300 IUD脱落率显著增高,其RR及95%CI分别为5.86(1.89~18.14)、5.46(2.38~12.55)、4.00(1.94~8.25)(P0.05);③与TCu380A、元宫220、活性γ型、HCu280 IUD相比,宫铜300 IUD脱落率差异无统计学意义(P0.05)。结论:在脱落方面,宫铜300 IUD与TCu380A、元宫220、活性γ型、HCu280效果相近,高于TCu220C和MCu功能型IUD,临床使用时需综合宫铜300 IUD的其他临床效果评价指标以及置器对象的健康状况和使用需求进行选择。     

Fertility after Intrauterine Device Removal: A Pilot Study

Abstract

Background Despite high efficacy, only 7.7% of women in the United States currently using contraception use an IUD. There is little published contemporary data about fertility rates after IUD use, especially in nulliparous women and women using the hormonal IUD.

Study Design We recruited sexually active women 18 to 35 years of age enrolled in the Contraceptive CHOICE Project who had discontinued a contraceptive method and desired pregnancy.

Results In this pilot project, we enrolled 69 former IUD users (19 copper and 50 levonorgestrel) and 42 former non-IUD users. Pregnancy rates at 12 months were similar between the two groups; 81% of IUD users became pregnant compared to 70% of non-IUD users (p = 0.18). In the Cox model, there was no difference in the time to pregnancy in IUD users compared to non-IUD users (HR_adj 1.19, 95% CI 0.74–1.92). African American race was the only variable associated with reduced fertility (HR_adj 0.40, 95% CI 0.24–0.67).

Conclusions We found no difference in 12-month pregnancy rates or time to pregnancy between former IUD users and users of other contraceptive methods. However, there was a clinically and statistically significant reduction in fertility in African American women.

Chinese Abstract

摘要：

背景：尽管宫内节育器有效性很高,在美国目前只有7.7%的女性使用宫内节育器避孕。关于当前宫内节育器使用后妊娠率的资料鲜有发表,尤其是有关未产妇和使用含激素宫内节育器的女性的相关资料。

研究设计：我们招募了18- 35岁的性活跃女性参加避孕选择项目,这些女性已经停止避孕,期望妊娠。

结果： 在这项初步研究里,我们招募了69名以前使用宫内节育器的女性（19名使用的是含铜节育器,50名使用的是含左炔诺孕酮节育器）和42名未使用宫内节育器的女性。两组女性12个月后的妊娠率是相似的;使用过宫内节育器的女性和未使用过宫内节育器的女性妊娠率分别为81%和70%（p=0.18）。在Cox模型中,使用过宫内节育器的女性和未使用过宫内节育器的女性妊娠时间没有差异（HR adj 1.19, 95% CI 0.74–1.92）,非洲裔美国人是与生殖力下降相关的唯一变量。

结论：我们发现使用宫内节育器避孕的女性和使用其他避孕方法的女性12个月后的妊娠率及妊娠时间没有差异。然而,非洲裔美国人的生殖力临床上和统计学均显著的下降。