Wasim Tayyiba, Shaukat Shysta, Javed Lubna, Mukhtar Saima
Department of Obs & Gynecology, Services Institute of Medical Sciences, Lahore.
Services Institute of Medical Sciences, Lahore.
J Pak Med Assoc. 2018 Apr;68(4):519-525.
To determine the outcome of immediate post-placental intrauterine contraceptive device insertion in women.
This quasi-experimental study was conducted at Services Hospital Lahore, Pakistan, from August 2015 to January 2017.Postpartum intrauterine contraceptive device was inserted within 10 minutes of the delivery of the placenta in patients who gave informed consent. They were followed up at 6 weeks and 6 months and those who completed the follow-up were enrolled as study subjects. Data regarding safety, efficacy and continuation was collected at 6 months. Primary outcome measures were safety in terms of associated complications and secondary outcome measure was continuation rates. Efficacy was measured in terms of prevention of pregnancy. SPSS 23 was used for data analysis.
A total of 8,000 eligible patients were counselled, out of whom 3,012(37.6%) exhibited a positive response and had postpartum intrauterine contraceptive device inserted. Of them, 1,250(41.5%) were followed up at 6 months and 833(66.6%) had no complications. Mean age was 30.2±11.4 years. Menstrual disturbances, vaginal discharge, lost string, misplaced device and expulsion were seen in 238(19%), 193(15.4%), 268(21.4%), 14(1.8%) and 75(6%) of the patients respectively. These complications except lost strings were comparable in vaginal and caesarean section insertions (p<0.05). Lost strings were more frequently observed in caesarean section group (p=0.001). Besides, 1,058(84.3%) patients wanted to continue this method of contraception.
Postpartum intrauterine contraceptive device was found to be an effective, acceptable contraception with fewer complications for the patients.
确定产后立即放置宫内节育器的女性结局。
本准实验性研究于2015年8月至2017年1月在巴基斯坦拉合尔服务医院进行。对签署知情同意书的患者，在胎盘娩出后10分钟内放置产后宫内节育器。在6周和6个月时对她们进行随访，完成随访的患者被纳入研究对象。在6个月时收集有关安全性、有效性和持续性的数据。主要结局指标是相关并发症方面的安全性，次要结局指标是持续率。通过预防妊娠来衡量有效性。使用SPSS 23进行数据分析。
总共对8000名符合条件的患者进行了咨询，其中3012名（37.6%）反应积极并放置了产后宫内节育器。其中，1250名（41.5%）在6个月时接受了随访，833名（66.6%）无并发症。平均年龄为30.2±11.4岁。分别有238名（19%）、193名（15.4%）、268名（21.4%）、14名（1.8%）和75名（6%）患者出现月经紊乱、阴道分泌物异常、尾丝丢失、节育器位置异常和节育器排出。除尾丝丢失外，这些并发症在经阴道放置和剖宫产放置中具有可比性（p<0.05）。尾丝丢失在剖宫产组中更常见（p=0.001）。此外，1058名（84.3%）患者希望继续采用这种避孕方法。
产后宫内节育器被发现是一种对患者有效、可接受且并发症较少的避孕方法。
