Agarwal Krishna, Sharma Usha, Acharya Veena
Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, India.
Indian J Med Sci. 2004 Sep;58(9):394-9.
Intrauterine contraceptive device (IUCD) is a commonly used birth-spacing method which is fitted into maternal system. Clinical, microbial and cytopathological monitoring of women using these devices are important for ascertaining their side effects, risk of genital tract infection and carcinogenic potential.
To study clinical, microbial and cytopathological changes in IUCD users in a tertiary care hospital.
Prospective analytic.
Tertiary hospital.
women visiting Family Planning clinic for follow up (IUCD users, n=100) or for IUCD insertion (controls, n=50) were enrolled in the study. Each subject underwent detailed history, general physical, systemic, and per local examination. Vaginal discharge was subjected to pH testing, KOH and wet mount examination, gram staining, and for culture and sensitivity. Bacterial vaginosis was defined using Nugent criteria. Cervical smears were examined and reported as per Bethesda system.
The information was entered into Microsoft Excel spreadsheet. The results were analyzed using EPI Info version-6 and Stata statistical software version 7 packages. Two-tailed t-test, chi2 test with Yates correction and two-tailed Fisher Exact tests were applied.
Most women used CuT 200 (92%). Median duration of use was 2 years. Chief complaints of IUCD users included backache (54%), vaginal discharge (46%), pain lower abdomen (34%), dyspareunia (22%), menorrhagia (18%) and dysmenorrhea (14%). Mean hemoglobin was lower in IUCD users than controls (11.2+/-1.7 versus 11.9+/-1.8 g/dL, p 0.02). Proportion of women with anemia was higher in IUCD users than in controls (29% versus 16%, p 0.12). Cervical erosion was significantly increased in study group as compared the controls (20% versus 0%, p=0.00) whereas only insignificant increase in vaginitis (6% versus 0%, p=0.17). Trichomonas vaginalis and fungal hyphae positivity and gram stain findings and bacterial vaginosis rate were not significantly different in two groups. Vaginal discharge bacterial culture revealed comparable results in two groups. Cytological findings were predominantly inflammatory. None of cases revealed Actinomycosis infection. High-grade squamous intraepithelial lesion (n=2) and low grade squamous intraepithelial lesion (n=1) cytological finding were present in IUCD users compared to none in controls. None of the cases had any malignant transformation.
IUCD use results in lower hemoglobin concentration and cervical erosion. Women using IUCD requires a regular follow up, clinical examination, counseling and further investigation if required.
宫内节育器（IUCD）是一种常用的生育间隔方法，放置于母体系统中。对使用这些装置的女性进行临床、微生物学和细胞病理学监测，对于确定其副作用、生殖道感染风险和致癌潜力非常重要。
研究三级护理医院中IUCD使用者的临床、微生物学和细胞病理学变化。
前瞻性分析。
三级医院。
纳入到计划生育门诊进行随访的女性（IUCD使用者，n = 100）或进行IUCD置入的女性（对照组，n = 50）。每位受试者均接受详细的病史、全身体格、系统及局部检查。对阴道分泌物进行pH检测、氢氧化钾和湿片检查、革兰氏染色以及培养和药敏试验。采用Nugent标准定义细菌性阴道病。按照贝塞斯达系统对宫颈涂片进行检查并报告结果。
将信息录入Microsoft Excel电子表格。使用EPI Info 6版和Stata统计软件7版包对结果进行分析。应用双尾t检验、经Yates校正的卡方检验和双尾Fisher确切概率检验。
大多数女性使用CuT 200（92%）。中位使用时间为2年。IUCD使用者的主要主诉包括背痛（54%）、阴道分泌物异常（46%）、下腹部疼痛（34%）、性交困难（22%）、月经过多（18%）和痛经（14%）。IUCD使用者的平均血红蛋白水平低于对照组（11.2±1.7对11.9±1.8 g/dL，p = 0.02）。IUCD使用者中贫血女性的比例高于对照组（29%对16%，p = 0.12）。与对照组相比，研究组宫颈糜烂显著增加（20%对0%，p = 0.00），而阴道炎仅略有增加（6%对0%，p = 0.17）。两组滴虫和真菌菌丝阳性率、革兰氏染色结果及细菌性阴道病发生率无显著差异。阴道分泌物细菌培养显示两组结果相当。细胞学检查结果主要为炎症性。所有病例均未发现放线菌感染。IUCD使用者中出现高级别鳞状上皮内病变（n = 2）和低级别鳞状上皮内病变（n = 1）的细胞学检查结果，而对照组均无。所有病例均未发生任何恶性转化。
使用IUCD会导致血红蛋白浓度降低和宫颈糜烂。使用IUCD的女性需要定期随访、临床检查、咨询，并在必要时进行进一步检查。
