Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P
Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
Gynecol Obstet Fertil Senol. 2018 Dec;46(12):806-822. doi: 10.1016/j.gofs.2018.10.004. Epub 2018 Nov 11.
To provide national clinical guidelines focusing on intrauterine contraception.
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
提供聚焦宫内节育器避孕的国家临床指南。
利用PubMed和考克兰图书馆对现有文献进行系统综述。同时也参考了美国、英国和加拿大的指南。
宫内节育器（IUC）有广泛的适应证，包括青少年、未生育者、艾滋病前期的HIV感染者（B级）以及有异位妊娠史的女性（C级）。使用IUC的女性宫颈癌筛查无需调整（B级）。放置节育器前必须进行双合诊检查和宫颈检查（B级）。放置节育器前患者无需常规进行性传播感染（STI）筛查（B级）。STI筛查最好在放置前进行，但无症状女性也可在放置节育器时进行（B级）。不建议放置前常规预防性使用抗生素和进行术前用药（A级）。放置后几周可安排一次随访（专业共识）。不建议放置节育器后常规进行盆腔超声检查（B级）。使用IUC的患者出现异常出血，若持续存在或伴有盆腔疼痛，则需要进一步检查以排除并发症（专业共识）。怀疑子宫穿孔需进行影像学检查以确定节育器位置（专业共识）。对于从腹腔中择期取出宫内节育器，应首选腹腔镜手术（专业共识）。宫内节育器在位时发生意外妊娠，应排除异位妊娠（B级）。若为存活且期望的宫内妊娠，若能触及尾丝，建议取出宫内节育器（C级）。无症状的宫内节育器使用者巴氏涂片检测发现放线菌样微生物无需进一步干预（B级）。STI或盆腔炎患者不建议立即取出宫内节育器（B级）。经过48至72小时适当治疗后若无临床改善，则应考虑取出节育器（B级）。
宫内节育器是一种长效可逆的避孕方法，效果良好且续用率高。相比之下，并发症发生率较低。因此，未生育和已生育女性均可使用。
