Caddy Sheila, Yudin Mark H, Hakim Julie, Money Deborah M
Edmonton AB.
Toronto ON.
J Obstet Gynaecol Can. 2014 Mar;36(3):266-274. doi: 10.1016/S1701-2163(15)30636-8.
Intrauterine devices provide an extremely effective, long-term form of contraception that has the benefit of being reversible. Historically, the use of certain intrauterine devices was associated with increased risk of pelvic inflammatory disease. More recent evidence suggests that newer devices do not carry the same threat; however, certain risk factors can increase the possibility of infection.
To review the risk of infection with the insertion of intrauterine devices and recommend strategies to prevent infection.
The outcomes considered were the risk of pelvic inflammatory disease, the impact of screening for bacterial vaginosis and sexually transmitted infections including chlamydia and gonorrhea; and the role of prophylactic antibiotics.
Published literature was retrieved through searches of PubMed, Embase, and The Cochrane Library on July 21, 2011, using appropriate controlled vocabulary (e.g., intrauterine devices, pelvic inflammatory disease) and key words (e.g., adnexitis, endometritis, IUD). An etiological filter was applied in PubMed. The search was limited to the years 2000 forward. There were no language restrictions. Grey (unpublished) literature was identified through searching the web sites of national and international medical specialty societies.
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table). Recommendations 1. All women requesting an intrauterine device should be counselled about the small increased risk of pelvic inflammatory disease in the first 20 days after insertion. (II-2A) 2. All women requesting an intrauterine device should be screened by both history and physical examination for their risk of sexually transmitted infection. Women at increased risk should be tested prior to or at the time of insertion; however, it is not necessary to delay insertion until results are returned. (II-2B) 3. Not enough current evidence is available to support routine screening for bacterial vaginosis at the time of insertion of an intrauterine device in asymptomatic women. (II-2C) 4. Routine use of prophylactic antibiotics is not recommended prior to intrauterine device insertion, although it may be used in certain high-risk situations. (I-C) 5. Standard practice includes cleansing the cervix and sterilizing any instruments that will be used prior to and during insertion of an intrauterine device. (III-C) 6. In treating mild to moderate pelvic inflammatory disease, it is not necessary to remove the intrauterine device during treatment unless the patient requests removal or there is no clinical improvement after 72 hours of appropriate antibiotic treatment. In cases of severe pelvic inflammatory disease, consideration can be given to removing the intrauterine device after an appropriate antibiotic regimen has been started. (I-B) 7. An intrauterine device is a safe, effective option for contraception in an HIV-positive woman. (I-B) 8. An intrauterine device can be considered a first-line contraceptive agent in adolescents. (I-A).
宫内节育器是一种极其有效的长期避孕方式，且具有可逆性的优点。从历史上看，某些宫内节育器的使用与盆腔炎风险增加有关。最新证据表明，新型宫内节育器不存在同样的威胁；然而，某些风险因素会增加感染的可能性。
回顾宫内节育器插入时的感染风险，并推荐预防感染的策略。
所考虑的结果包括盆腔炎风险、细菌性阴道病筛查以及衣原体和淋病等性传播感染的影响；以及预防性抗生素的作用。
2011年7月21日通过检索PubMed、Embase和考克兰图书馆获取已发表的文献，使用了适当的控制词汇（如宫内节育器、盆腔炎）和关键词（如附件炎、子宫内膜炎、宫内节育器）。在PubMed中应用了病因过滤器。检索限于2000年以后。无语言限制。通过搜索国家和国际医学专业协会的网站识别灰色（未发表）文献。
本文件中的证据质量根据加拿大预防性医疗保健特别工作组报告中所述的标准进行评级（表）。
