Jatlaoui Tara C, Marcus Michele, Jamieson Denise J, Goedken Peggy, Cwiak Carrie
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Contraception. 2014 Jun;89(6):528-33. doi: 10.1016/j.contraception.2013.10.008. Epub 2013 Oct 23.
To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program.
This was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months.
Ninety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences.
Postplacental IUD insertions can be safely and effectively performed within a training program.
A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.
确定在教学项目中进行胎盘娩出后宫内节育器（IUD）放置是否安全有效。
这是一项前瞻性队列研究，纳入了177名计划经阴道分娩且产前登记希望在胎盘娩出后放置铜T380A宫内节育器或左炔诺孕酮宫内缓释系统（IUS）的受试者。放置主要由住院医师在培训后进行。随访包括4至8周的复诊以及3个月和6个月时的电话随访。
100次尝试中有99名受试者成功在胎盘娩出后放置了宫内节育器。观察到17例排出（17%）：10例完全排出和7例部分排出。研究未发现不同培训水平在结局上存在差异；然而，该研究缺乏评估除巨大差异之外任何情况的统计学效力。
在培训项目中可以安全有效地进行胎盘娩出后宫内节育器放置。
对于之前没有胎盘娩出后宫内节育器放置经验的医生、高级执业临床医生或实习生，可以安全可行地启动一项培训方案。通过开展这种操作，对于难以复诊或难以获得有效避孕方法的患者而言，获得高效避孕措施的机会可能会增加。
