Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Callen-Lorde Community Health Center, New York, NY, USA.
Am Fam Physician. 2018 Sep 1;98(5):304-309.
The use of long-acting reversible contraception is on the rise across the United States and has contributed to a decrease in teen pregnancies. With the increased use of long-acting reversible contraception, physicians may encounter difficult insertions and removals of intrauterine devices (IUDs) and the contraceptive implant. Uterine structure (e.g., extreme anteversion or retroversion, uterine tone during the postpartum period and breastfeeding) can pose challenges during IUD insertion. Special consideration is also needed for IUD insertions in patients who are transgender or gender nonconforming, such as psychosocial support and management of vaginal atrophy. Missing IUD strings may complicate removal, possibly requiring ultrasonography and use of instruments such as thread retrievers, IUD hooks, and alligator forceps. Regarding implant removal, those that are barely palpable (e.g., because of an overly deep insertion or excessive patient weight gain), removal may require ultrasonography, use of vas clamps and skin hooks, and extra dissection.
长效可逆避孕措施在美国的使用呈上升趋势，这有助于减少青少年怀孕。随着长效可逆避孕措施的使用增加，医生可能会遇到宫内节育器（IUD）和避孕植入物的困难插入和取出。子宫结构（例如，极度前倾或后倾、产后和哺乳期的子宫张力）可能会在 IUD 插入时带来挑战。对于跨性别或性别不一致的患者，如社会心理支持和阴道萎缩的管理，也需要特别考虑 IUD 的插入。IUD 缝线缺失可能会使取出复杂化，可能需要超声检查和使用线回收器、IUD 钩和鳄鱼夹等器械。至于植入物的取出，如果植入物几乎无法触及（例如，因为插入过深或患者体重过度增加），可能需要超声检查、使用血管夹和皮肤钩，并进行额外的解剖。
