O'Flynn O'Brien Katherine L, Akers Aletha Y, Perriera Lisa K, Schreiber Courtney A, Garcia-Espana J Felipe, Sonalkar Sarita
Department of Obstetrics and Gynecology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Pediatr Adolesc Gynecol. 2019 Jun;32(3):312-315. doi: 10.1016/j.jpag.2019.01.002. Epub 2019 Jan 8.
Intrauterine device (IUD) utilization in the United States is low among adolescent and young adult women. Longer procedure duration has been proposed as one potential barrier to IUD insertion in this population. We hypothesized that procedure duration would be longer in adolescents compared to young adult women.
DESIGN, SETTING, AND PARTICIPANTS: This study was a secondary analysis of a randomized clinical trial comparing the effectiveness of a lidocaine vs sham paracervical nerve block for pain control during levonorgestrel 13.5 mg IUD insertion. Adolescent and young adult women ages 14-22 years were recruited from 3 outpatient academic sites in Philadelphia, Pennsylvania.
Pain scores were recorded at 7 steps during the procedure from speculum insertion through removal. Time stamps associated with each step were used to calculate the overall procedure duration. Cumulative IUD insertion procedure duration was estimated using the Kaplan-Meier method.
Ninety-five women enrolled. Nineteen (19/95, 20%) were ages 14-17 and 76 (76/95, 80%) were ages 18-22 years. The median procedure duration (seconds ± interquartile range) was longer for adolescents than for young adults (555 ± 428 seconds vs 383 ± 196 seconds; P = .008). After adjusting for study site, the difference in expected median procedure duration between age groups was not significant (P = .3832).
The difference in duration of IUD insertion procedures in adolescent and young adult women is not clinically or statistically significant. Providers should not withhold IUDs from appropriate adolescent and young adult women on the basis of age alone.
在美国，青少年和年轻成年女性中宫内节育器（IUD）的使用率较低。较长的操作时间被认为是该人群放置IUD的一个潜在障碍。我们假设青少年放置IUD的操作时间会比年轻成年女性更长。
设计、地点和参与者：本研究是一项随机临床试验的二次分析，该试验比较了利多卡因与假宫颈旁神经阻滞在放置13.5毫克左炔诺孕酮IUD时控制疼痛的效果。从宾夕法尼亚州费城的3个门诊学术机构招募了年龄在14至22岁的青少年和年轻成年女性。
在操作过程中从放入窥器到取出的7个步骤记录疼痛评分。与每个步骤相关的时间戳用于计算整个操作时间。使用Kaplan-Meier方法估计累积IUD放置操作时间。
95名女性入组。19名（19/95，20%）年龄在14至17岁，76名（76/95，80%）年龄在18至22岁。青少年的中位操作时间（秒±四分位间距）比年轻成年人更长（555±428秒对383±196秒；P = 0.008）。在对研究地点进行调整后，年龄组之间预期中位操作时间的差异无统计学意义（P = 0.3832）。
青少年和年轻成年女性放置IUD的操作时间差异在临床或统计学上均无显著意义。医疗服务提供者不应仅基于年龄就不给合适的青少年和年轻成年女性放置IUD。
