Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, PO Box 610, SF-00029 HUS, Helsinki, Finland.
Hum Reprod. 2012 Sep;27(9):2658-63. doi: 10.1093/humrep/des246. Epub 2012 Jul 3.
What are the incidence and factors associated with uterine perforation by modern copper intrauterine device (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS)?
Perforation incidence was similar to that reported in prior studies and did not vary between Cu-IUD and LNG-IUS groups. Lactation, amenorrhoea and a post-partum period of <6 months were common.
The study supports findings in prior studies. The incidence rate was low and factors associated with uterine perforation were similar to those in earlier reports. DESIGN AND DATA COLLECTION METHOD: This retrospective population-based registry study included 68 patients surgically treated for uterine perforation by an intrauterine device (IUD)/intrauterine system (IUS) at clinics in the Helsinki and Uusimaa hospital district.
Records of 108 patients with probable uterine perforation by an IUD/IUS were analysed, leaving 68 patients treated for uterine perforation. RECRUITMENT/SAMPLING STRATEGY: Patients with diagnostic and surgical treatment codes indicating uterine perforation by an IUD/IUS between 1996 and 2009 were retrospectively selected from the Finnish National Hospital Register.
Patients with Cu-IUDs (n = 17) and the LNG-IUS (n = 51) were analysed as one group and also compared using Mann-Whitney and chi-square tests. IUD/IUS sales numbers were used to calculate incidences.
The overall incidence of perforation was 0.4/1000 sold devices, varying annually from 0 to 1.2/1000. The proportion of both sold and perforating LNG-IUSs increased during the study period, but perforation incidence was not affected. Demographic characteristics in the Cu-IUD and LNG-IUS groups were similar. More than half of the devices (55%) were inserted at <6 months post-partum. Breastfeeding at the time of insertion was common, comprising 32% of all patients. Moreover, of the breastfeeding women, 90% had delivered within 6 month prior to insertion.
The population-based study setting represents a good overview of patients experiencing uterine perforation with an IUD/IUS. As previously reported, the post-partum period, lactation and amenorrhoea may increase the risk of perforation.
BIAS, LIMITATIONS AND GENERALIZABILITY: As the study setting revealed only symptomatic patients or those attending regular follow-up, the true incidence might be somewhat higher. As there is no specific diagnostic code for uterine perforation or treatment, it is unlikely that all cases of uterine perforation can be identified in a retrospective study.
现代铜宫内节育器（Cu-IUD）和左炔诺孕酮释放宫内节育系统（LNG-IUS）导致子宫穿孔的发生率和相关因素是什么？
穿孔发生率与先前研究报告的相似，且在 Cu-IUD 和 LNG-IUS 组之间没有差异。哺乳期、闭经和产后 6 个月内是常见的情况。
该研究支持先前研究的发现。发生率较低，与子宫穿孔相关的因素与早期报告中的相似。
这是一项基于人群的回顾性登记研究，包括在赫尔辛基和乌西马地区诊所因宫内节育器/宫内节育系统（IUD/IUS）导致子宫穿孔而接受手术治疗的 68 名患者。
对 108 名疑似因 IUD/IUS 导致子宫穿孔的患者的记录进行了分析，留下了 68 名接受子宫穿孔治疗的患者。
招募/抽样策略：从芬兰国家医院登记处回顾性选择了 1996 年至 2009 年间因 IUD/IUS 出现诊断和手术治疗代码的患者。
将 Cu-IUD（n=17）和 LNG-IUS（n=51）患者作为一组进行分析，并使用 Mann-Whitney 和卡方检验进行比较。使用宫内节育器/宫内节育系统的销售数量来计算发生率。
穿孔的总体发生率为每 1000 个销售设备中发生 0.4 例，每年从 0 例到 1.2 例不等。在研究期间，LNG-IUS 的销售数量和穿孔数量都有所增加，但穿孔发生率没有受到影响。Cu-IUD 和 LNG-IUS 组的人口统计学特征相似。超过一半的设备（55%）在产后 6 个月内插入。插入时正在母乳喂养很常见，占所有患者的 32%。此外，在母乳喂养的女性中，90%的人在插入前 6 个月内分娩。
基于人群的研究环境代表了对因 IUD/IUS 而经历子宫穿孔的患者的良好概述。如前所述，产后、哺乳期和闭经可能会增加穿孔的风险。
偏倚、限制和普遍性：由于研究环境仅揭示了有症状的患者或那些定期接受随访的患者，因此实际发生率可能略高。由于没有专门用于子宫穿孔或治疗的诊断代码，在回顾性研究中不太可能识别所有子宫穿孔病例。
