Blumenthal Paul D, Chakraborty Nirali M, Prager Sarah, Gupta Pratima, Lerma Klaira, Vwalika Bellington
a Stanford University School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning Services and Research , Stanford University , Stanford , CA , USA ;
b Family Planning and Reproductive Health Department , Population Services International , WA , USA ;
Eur J Contracept Reprod Health Care. 2016 Oct;21(5):356-60. doi: 10.1080/13625187.2016.1201655. Epub 2016 Jul 1.
The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters.
This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6-12 months after PPIUD insertion and asked to return to the clinic for interview and examination. If the IUD strings were not visible, an ultrasound was performed. Participants were asked about their satisfaction with the PPIUD. Main outcome measures were short-term PPIUD continuation and reported complications according to time of insertion.
Of 591 women enrolled, 305 women attended the follow-up appointment for interview and examination, giving a power of 80% to estimate an expulsion rate of 10 ± 5%. The IUD was inserted within 10 min of placental delivery (post-placental insertion) in 24.3% of participants (n = 74) and within 48 h (immediate post-partum insertion) in 71.1% of participants (n = 217). The total expulsion rate was 5.6%. Expulsion rates for post-placental and immediate post-partum insertions were 10.8% and 4.1%, respectively. No significant difference in expulsion rates was found (p = 0.10). Of those with an expulsion, 76.5% (n = 13) recognised that it had occurred. There were no reported complications, and 94.1% of women reported being satisfied or very satisfied with their PPIUD (n = 287).
Overall, expulsion rates were lower than previously reported, particularly for immediate post-partum insertions. Attention to high fundal placement at insertion is a likely explanation for the low expulsion rates. Contrary to conventional wisdom, these low expulsion rates indicate that previous notions regarding insertion timing may not be accurate. Satisfaction levels were also favourable. PPIUD can be safe, acceptable and feasible in an African setting.
本研究旨在评估产后宫内节育器（PPIUD）使用者的续用率和满意度。
这项前瞻性观察性研究纳入了591名在赞比亚卢萨卡家庭健康协会站点接受PPIUD置入的赞比亚女性。在PPIUD置入后6至12个月联系这些女性，要求她们返回诊所接受访谈和检查。如果看不到宫内节育器尾丝，则进行超声检查。参与者被问及她们对PPIUD的满意度。主要结局指标是PPIUD的短期续用情况以及根据置入时间报告的并发症。
在纳入的591名女性中，305名女性参加了随访访谈和检查，这使得有80%的把握度来估计10±5%的脱落率。24.3%（n = 74）的参与者在胎盘娩出后10分钟内（胎盘娩出后置入）置入了宫内节育器，71.1%（n = 217）的参与者在48小时内（产后立即置入）置入。总脱落率为5.6%。胎盘娩出后置入和产后立即置入的脱落率分别为10.8%和4.1%。未发现脱落率有显著差异（p = 0.10）。在脱落的人中，76.5%（n = 13）意识到脱落发生。没有报告并发症，94.1%的女性报告对她们的PPIUD感到满意或非常满意（n = 287）。
总体而言，脱落率低于先前报告的水平，特别是产后立即置入的情况。置入时注意将节育器放置在宫底较高位置可能是脱落率低的原因。与传统观念相反，这些低脱落率表明先前关于置入时间的观念可能不准确。满意度也较高。在非洲环境中，PPIUD可能是安全、可接受且可行的。
