Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Central Hospital, and Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland.
Obstet Gynecol. 2014 Aug;124(2 Pt 1):345-353. doi: 10.1097/AOG.0000000000000362.
To assess the relationship of preinsertion vaginal ultrasound assessment and menstrual and gynecologic history as predictors of difficult or painful intrauterine device insertion in nulligravid women.
Nulligravid women seeking contraception were invited to participate in this nonrandomized study and given the choice between the levonorgestrel-releasing intrauterine system or a copper-releasing intrauterine device. All 165 enrolled women were interviewed and a pelvic examination, including vaginal ultrasonography, was performed before insertion. Insertion difficulties and pain intensity were recorded and assessed against uterine measurements and background characteristics.
Most insertions were assessed as easy (n=144 [89.4%]) and only two (1.2%) failed. Most women had uterine measurements smaller than the studied devices. Odds for difficulties at insertion decreased with every increasing millimeter in total uterine length (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.78-0.96, P=.006) and cervical length (OR 0.85, 95% CI 0.74-0.97, P=.02) and similarly with every decreasing degree of (straighter) flexion angle (OR 0.96, 95% CI 0.94-0.99, P=.005). No absolute threshold measurements could be determined. Still, the majority of insertions in small and flexed uteri were uneventful. Severe insertion pain was common (n=94 [58.4%]). Severe dysmenorrhea was the only predictor of insertion pain (OR 8.16 95% CI 2.56-26.02, P<.001).
Ultrasonographic evaluation does not give additional information compared with clinical pelvic examination and sound measure. Although smaller uterine length measurements and steeper flexion angle more often predicted difficulties, the majority of insertions were uneventful in women with small measures. Dysmenorrhea was the only predictor of pain.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01685164.
II.
评估经阴道超声检查和月经及妇科病史作为预测未产妇中宫内节育器（IUD）插入困难或疼痛的指标。
招募寻求避孕的未产妇参与这项非随机研究，并在左炔诺孕酮释放宫内节育系统和铜释放宫内节育器之间进行选择。所有 165 名入组的妇女都接受了访谈，并在插入前进行了盆腔检查，包括阴道超声检查。记录插入困难和疼痛强度，并根据子宫测量值和背景特征进行评估。
大多数插入被评估为容易（n=144 [89.4%]），只有 2 例（1.2%）失败。大多数妇女的子宫测量值小于研究器械。插入困难的几率随着总子宫长度（比值比[OR]0.86，95%置信区间[CI]0.78-0.96，P=.006）和宫颈长度（OR 0.85，95%CI 0.74-0.97，P=.02）的每增加 1 毫米而降低，并且弯曲角度（OR 0.96，95%CI 0.94-0.99，P=.005）的每减少 1 度也相似。无法确定绝对阈值测量值。尽管如此，在小子宫和弯曲子宫中，大多数插入都是无并发症的。严重的插入疼痛很常见（n=94 [58.4%]）。严重痛经是插入疼痛的唯一预测因素（OR 8.16，95%CI 2.56-26.02，P<.001）。
与临床盆腔检查和实际测量相比，超声评估没有提供额外信息。虽然较小的子宫长度测量值和更陡峭的弯曲角度更常预示着困难，但在子宫较小的女性中，大多数插入都是无并发症的。痛经是疼痛的唯一预测因素。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT01685164。
II 级。
