Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Contraception. 2011 Nov;84(5):447-64. doi: 10.1016/j.contraception.2011.03.007. Epub 2011 May 4.
This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion.
We searched MEDLINE databases for all articles (in all languages) published in peer-reviewed journals from January 1966 through March 2010 for evidence comparing immediate postabortion IUD insertion with either no IUD insertion, insertion at a different time, insertion following first-trimester compared with second-trimester abortion or copper IUD insertion compared with hormone-releasing IUD insertion postabortion. We used standard abstraction forms to summarize and assess the quality of the evidence.
The search strategy identified a total of 990 articles, of which 19 met our inclusion criteria for this review. Studies comparing immediate postabortion IUD insertion with no IUD insertion found that both groups experienced similar rates of pain and infection and a similar number of bleeding days, but one study reported that women with copper IUD insertion experienced a greater amount of bleeding than women without IUD insertion after abortion. Results from studies comparing immediate postabortion IUD insertion and insertion at a time not associated with pregnancy did not report differences between the two groups in the duration of bleeding, pain, expulsions or pelvic inflammatory disease (PID). One study however reported a greater amount of bleeding and another reported more removals for medical reasons among women with postabortion IUD insertion. Evidence from studies that examined immediate vs. delayed postabortion insertion reported minimal differences in bleeding, pain, expulsion and PID between groups. Studies comparing immediate IUD insertion after first- vs. second-trimester abortion reported no difference in removals for pain and bleeding, and an increased risk of expulsion among those women who had insertions after second-trimester abortion. In addition, women with insertions immediately after abortions occurring later in the first trimester had higher expulsion rates than those with insertions after early first-trimester abortions. Studies examining women using a copper IUD compared with a hormone-releasing IUD reported inconsistent results, with one paper reporting more bleeding days in the copper IUD group and another finding higher rates of removal for bleeding in the progesterone-releasing IUD group.
Intrauterine device insertion immediately after abortion is not associated with an increased risk of adverse outcomes compared with use of other contraceptive methods or with no IUD insertion after abortion and compared with IUD insertion at times other than immediately after abortion. Intrauterine device expulsion rates, while generally low, were higher with insertions that occurred after later first-trimester abortion compared with after early first-trimester abortion and higher with IUD insertion after second-trimester abortion compared with after first-trimester abortion.
本综述旨在评估人工流产后立即放置宫内节育器（IUD）的安全性和有效性。
我们检索了 MEDLINE 数据库中所有（各种语言）已发表的同行评议期刊文章，时间从 1966 年 1 月至 2010 年 3 月，以比较人工流产后立即放置 IUD 与不放置 IUD、不同时间放置 IUD、与妊娠第一或第二孕期流产后放置 IUD、与铜 IUD 或激素释放 IUD 放置后的流产。我们使用标准提取表来总结和评估证据的质量。
检索策略共确定了 990 篇文章，其中 19 篇符合本综述的纳入标准。比较人工流产后立即放置 IUD 与不放置 IUD 的研究发现，两组在疼痛和感染发生率以及出血天数方面相似，但一项研究报告称，铜 IUD 放置后的出血量多于无 IUD 放置后的出血量。比较人工流产后立即放置 IUD 与非妊娠时放置 IUD 的研究结果并未报告两组在出血、疼痛、脱落或盆腔炎（PID）方面的差异。然而，一项研究报告称，流产后放置 IUD 的出血量更多，另一项研究报告称，因医疗原因而取出 IUD 的情况更多。研究比较了人工流产后即刻与延迟放置 IUD，发现两组之间在出血、疼痛、脱落和 PID 方面的差异很小。比较第一和第二孕期流产后即刻放置 IUD 的研究报告称，疼痛和出血的取出率无差异，第二孕期流产后放置 IUD 的脱落风险增加。此外，在第一孕期晚期流产后立即放置 IUD 的女性的脱落率高于早期第一孕期流产后放置 IUD 的女性。研究比较了使用铜 IUD 与激素释放 IUD 的女性，结果不一致，一篇论文报告铜 IUD 组的出血天数更多，另一篇论文则发现孕激素释放 IUD 组的出血取出率更高。
与使用其他避孕方法或流产后不放置 IUD 相比，流产后立即放置 IUD 与流产后立即放置 IUD 相比，不良结局的风险无增加。虽然脱落率通常较低，但与妊娠早期流产后放置 IUD 相比，在妊娠第一孕期晚期流产后放置 IUD 的脱落率更高，与妊娠第一孕期流产后放置 IUD 相比，在妊娠第二孕期流产后放置 IUD 的脱落率更高。
