Patil Eva, Darney Blair, Orme-Evans Kaebah, Beckley Ethan H, Bergander Linn, Nichols Mark, Bednarek Paula H
J Midwifery Womens Health. 2016 May;61(3):325-30. doi: 10.1111/jmwh.12412. Epub 2016 Mar 11.
Immediate postabortion intrauterine device (IUD) insertion is a safe, effective strategy to prevent subsequent unplanned pregnancy. Oregon is one of 5 US states where advanced practice clinicians perform aspiration abortions. This study compares outcomes of first-trimester aspiration abortion with immediate IUD insertion between advanced practice clinicians and physicians.
We conducted a historical cohort study of first-trimester aspiration abortions with immediate IUD insertion performed at our center from 2009 to 2011. We extracted demographic and clinical data from patient charts. Immediate complications including excessive blood loss, perforation, and reaspirations were recorded at the time of procedure. We used descriptive statistics and multivariable logistic regression to test for differences in outcomes by clinician type.
Data were available on 669 of the 1134 combined procedures. Advanced practice clinicians performed 224 of these. There were no significant differences in immediate outcomes. The only immediate complications were reaspirations; 1.8% (4/224) in the advanced practice clinician group, and 2.0% (9/445) in the physician group (P = .83).
We found no differences in outcomes between provider type for immediate IUD insertion after first-trimester aspiration abortion. This study helps reinforce that advanced practice clinicians can provide immediate postaspiration abortion IUD insertions with similar outcomes to those of physicians. Many countries do not allow advanced practice clinicians to perform this service, but a change in policy could help address family planning provider shortages.
人工流产后立即放置宫内节育器（IUD）是预防后续意外怀孕的一种安全、有效的策略。俄勒冈州是美国5个允许高级执业临床医生进行负压吸宫流产的州之一。本研究比较了高级执业临床医生和医生在孕早期负压吸宫流产后立即放置IUD的效果。
我们对2009年至2011年在我们中心进行的孕早期负压吸宫流产并立即放置IUD的患者进行了一项历史性队列研究。我们从患者病历中提取了人口统计学和临床数据。手术时记录了包括失血过多、穿孔和再次吸宫等近期并发症。我们使用描述性统计和多变量逻辑回归来检验不同临床医生类型在结局上的差异。
在1134例联合手术中，有669例的数据可用。其中224例由高级执业临床医生操作。近期结局无显著差异。仅有的近期并发症是再次吸宫；高级执业临床医生组为1.8%（4/224），医生组为2.0%（9/445）（P = 0.83）。
我们发现孕早期负压吸宫流产后立即放置IUD，不同类型医疗服务提供者的结局没有差异。本研究有助于强化这样的观点，即高级执业临床医生在人工流产后立即放置IUD的效果与医生相似。许多国家不允许高级执业临床医生提供这项服务，但政策的改变有助于解决计划生育服务提供者短缺的问题。
