左炔诺孕酮避孕植入剂产后立即使用与延迟使用的比较：乌干达的一项随机对照试验
Immediate versus delayed postpartum use of levonorgestrel contraceptive implants: a randomized controlled trial in Uganda.
作者信息
Averbach Sarah, Kakaire Othman, Kayiga Herbert, Lester Felicia, Sokoloff Abby, Byamugisha Josaphat, Dehlendorf Christine, Steinauer Jody
机构信息
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Department of Reproductive Medicine, University of California, San Diego, San Diego, CA.
Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
出版信息
Am J Obstet Gynecol. 2017 Nov;217(5):568.e1-568.e7. doi: 10.1016/j.ajog.2017.06.005. Epub 2017 Jun 10.
BACKGROUND
Use of long-acting, highly effective contraception has the potential to improve women's ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period.
OBJECTIVE
The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion.
STUDY DESIGN
This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum.
RESULTS
From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group.
CONCLUSION
Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals.
背景
使用长效、高效避孕方法有可能提高女性避免短生育间隔的能力，短生育间隔与孕产妇发病和死亡风险增加以及早产有关。在乌干达，产后即时阶段通常无法常规获得避孕植入物。
目的
本研究的目的是比较随机分配至即时植入或延迟植入的女性在产后6个月使用左炔诺孕酮避孕植入物的比例。
研究设计
这是一项在乌干达坎帕拉对女性进行的随机对照试验。希望使用避孕植入物的女性被随机分配至产后即时（分娩后5天内且出院前）植入含75mg左炔诺孕酮的双棒避孕植入系统或延迟植入（产后6周）。主要结局是产后6个月时植入物的使用率。
结果
2015年6月至10月，205名女性被随机分组，103名进入即时组，102名进入延迟组。93%的女性完成了6个月的随访。6个月时，即时组的植入物使用率高于延迟组（97%对68%；P<.001），任何高效避孕方法的使用率也是如此（98%对81%；P=.001）。即时组的女性对植入物放置时间更满意。如果可以选择，即时组81%的女性和延迟组63%的女性会再次选择相同的放置时间（P=.01）。两组均未发生严重不良事件。
结论
为女性提供在产后即时阶段开始使用避孕植入物的选择有可能提高避孕使用率、减少意外怀孕、防止短生育间隔，并帮助女性实现其生育目标。
Zotero 插件