Grimes D, Schulz K, van Vliet H, Stanwood N
Family Health International, P.O. Box 13950, Research Triangle Park, North Carolina 27709, USA.
Hum Reprod. 2002 Mar;17(3):549-54. doi: 10.1093/humrep/17.3.549.
Insertion of an intrauterine device (IUD) immediately after delivery is appealing for several reasons. The woman is known not to be pregnant, her motivation for contraception may be high and the setting may be convenient for both the woman and her provider. However, the risk of spontaneous expulsion may be unacceptably high. The objective of this study was to assess the efficacy and feasibility of IUD insertion immediately after expulsion of the placenta. Our a priori hypothesis was that this practice is safe, but associated with higher expulsion rates than interval IUD insertion.
We used Medline, Popline, Embase, and Cochrane Controlled Trials Register computer searches, supplemented by review articles and contact with investigators. We sought all randomized controlled trials that had at least one treatment arm that involved immediate post-partum (within 10 min of placental expulsion) insertion of an IUD. Comparisons could include different IUDs, different insertion techniques, immediate versus delayed post-partum insertion, or immediate versus interval insertion (unrelated to pregnancy). Studies could include either vaginal or Caesarean deliveries. We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicentre trials. We abstracted data onto data collection forms. Principal outcome measures included pregnancy, expulsion and continuation rates. Because the trials did not have uniform interventions, we were unable to aggregate them in a meta-analysis.
We found no randomized controlled trials that directly compared immediate post-partum insertion with either delayed post-partum or interval insertion. Modifications of existing devices, such as adding absorbable sutures or additional appendages, did not appear beneficial. Most studies showed no important differences between insertions done by hand or by instruments. Lippes Loops and Progestasert devices did not perform as well as copper devices.
Immediate post-partum insertion of IUDs appeared safe and effective, though direct comparisons with other insertion times were lacking. Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. However, expulsion rates appear to be higher than with interval insertion. The popularity of immediate post-partum IUD insertion in countries as diverse as China, Mexico and Egypt support the feasibility of this approach. Early follow-up may be important in identifying spontaneous IUD expulsions.
产后立即放置宫内节育器（IUD）有诸多吸引人之处。已知该女性未怀孕，其避孕意愿可能较高，且放置环境对女性及其医护人员而言都较为便利。然而，IUD自然排出的风险可能高得令人难以接受。本研究的目的是评估胎盘娩出后立即放置IUD的有效性和可行性。我们预先设定的假设是，这种做法是安全的，但与间隔放置IUD相比，排出率更高。
我们利用医学文献数据库（Medline）、人口信息数据库（Popline）、荷兰医学文摘数据库（Embase）和考克兰对照试验注册库进行计算机检索，并辅以综述文章以及与研究人员的联系。我们查找了所有随机对照试验，这些试验至少有一个治疗组涉及产后立即（胎盘娩出后10分钟内）放置IUD。对照可包括不同的IUD、不同的放置技术、产后立即放置与延迟放置、或产后立即放置与间隔放置（与妊娠无关）。研究可包括经阴道分娩或剖宫产。我们评估了每份报告的方法学质量，并试图识别多中心试验数据的重复报告。我们将数据提取到数据收集表格上。主要结局指标包括妊娠率、排出率和续用率。由于这些试验没有统一的干预措施，我们无法将它们汇总进行荟萃分析。
我们未找到直接比较产后立即放置IUD与产后延迟放置或间隔放置的随机对照试验。对现有器械进行改进，如添加可吸收缝线或额外附件，似乎并无益处。大多数研究表明，手工放置与器械放置之间没有重要差异。Lippes Loop和Progestasert节育器的效果不如铜质节育器。
产后立即放置IUD似乎是安全有效的，尽管缺乏与其他放置时间的直接比较。产后立即放置的优点包括意愿强烈、确保女性未怀孕以及方便。然而，排出率似乎高于间隔放置。在中国、墨西哥和埃及等不同国家，产后立即放置IUD的普及情况支持了这种方法的可行性。早期随访对于识别IUD自然排出可能很重要。
