Colwill Alyssa Covelli, Schreiber Courtney A, Sammel Mary D, Sonalkar Sarita
Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine Rm. 605 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
Contraception. 2018 Mar;97(3):215-218. doi: 10.1016/j.contraception.2017.10.012. Epub 2017 Nov 8.
We sought to evaluate the 6-week clinical outcomes (intrauterine device [IUD] retention, recognized expulsions, ability to visualize or palpate strings, and need for ultrasound evaluation) in women who received a TCu380A postplacental IUD (PPIUD) after vaginal (VD) or cesarean delivery (CD).
We conducted a retrospective cohort study to examine the 6-week retention of TCu380A IUDs placed within 10 min of placental delivery in VD (n=137) and CD (n=73). We used Student's t test and Wilcoxon rank sum tests for continuous data and Pearson χ test and Fisher's Exact Test for categorical data.
Of the 169 women who had follow-up, 151 (89.3%) retained their IUD at 6 weeks (95% CI 84.7%-93.9%). All women who underwent CD retained their IUD at 6 weeks postpartum (56/56), whereas 95/113 (84% [95% CI 76.0%-90.3%]) who underwent VD retained their original IUD (p<.01). Strings were detected more frequently in women who had a VD (93.1% [95% CI 85.6-97.4]) compared to those who delivered by CD (44.2% [95% CI 30.5-58.7]; p<.01). Women who underwent CD had an ultrasound to evaluate IUD location more frequently (42.9% [95% CI 29.7-56.8]) compared to women who underwent VD (13.7% [95% CI 7.5-22.3]; p<.01).
Women are more likely to retain a PPIUD after CD compared to a VD (p<.01); however, women who have a PPIUD placed after CD are more likely to have nonvisible strings with a pelvic exam (p<.01) and undergo pelvic ultrasound evaluation (p<.01) compared to a PPIUD placed at the time of a VD.
我们试图评估在阴道分娩（VD）或剖宫产（CD）后接受TCu380A胎盘后宫内节育器（PPIUD）的女性的6周临床结局（宫内节育器[IUD]留存情况、确诊的排出情况、可视或可触及尾丝的能力以及超声评估需求）。
我们进行了一项回顾性队列研究，以检查在VD（n = 137）和CD（n = 73）胎盘娩出后10分钟内放置的TCu380A宫内节育器的6周留存情况。对于连续数据，我们使用学生t检验和Wilcoxon秩和检验；对于分类数据，我们使用Pearsonχ检验和Fisher精确检验。
在169名接受随访的女性中，151名（89.3%）在6周时保留了宫内节育器（95%置信区间84.7% - 93.9%）。所有接受剖宫产的女性在产后6周都保留了宫内节育器（56/56），而接受阴道分娩的113名女性中有95名（84%[95%置信区间76.0% - 90.3%]）保留了原来的宫内节育器（p <.01）。与剖宫产分娩的女性（44.2%[95%置信区间30.5% - 58.7%]）相比，阴道分娩的女性尾丝检出率更高（93.1%[95%置信区间85.6 - 97.4]；p <.01）。与阴道分娩的女性（13.7%[95%置信区间7.5% - 22.3%]）相比，剖宫产的女性更频繁地进行超声检查以评估宫内节育器位置（42.9%[95%置信区间29.7% - 56.8%]；p <.01）。
与阴道分娩相比，剖宫产术后女性更有可能保留PPIUD（p <.01）；然而，与阴道分娩时放置PPIUD相比，剖宫产术后放置PPIUD的女性盆腔检查时尾丝不可见（p <.01）且接受盆腔超声评估的可能性更大（p <.01）。
