Zaconeta Alberto Moreno, Oliveira Ana Carolina, Estrela Flavielly Souza, Vasconcelos Thalia Maia, França Paulo Sergio, Wanderley Miriam da Silva, Amato Angelica Amorim
Area of Gynecology and Obstetrics, Medical School, Universidade de Brasília, Brasília, DF, Brazil.
Laboratory of Molecular Pharmacology, Faculdade de Ciências da Saúde da Universidade de Brasília, Brasília, DF, Brazil.
Rev Bras Ginecol Obstet. 2019 Aug;41(8):485-492. doi: 10.1055/s-0039-1693677. Epub 2019 Aug 26.
The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections.
This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans.
Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections.
Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.
对于未接受产前避孕咨询的女性，分娩入院时放置宫内节育器（IUD）可能不合适。然而，在剖宫产率高且产前避孕咨询不足的国家，这一策略可能会减少意外怀孕和重复剖宫产。
这是一项前瞻性队列研究，涉及100名未接受产前避孕咨询的女性。分娩入院后在胎盘娩出后提供IUD，并在剖宫产时放置。在6周和6个月时评估IUD持续使用情况、子宫穿孔和子宫内膜炎的发生率，并根据既往剖宫产次数评估6个月时继续使用IUD的女性比例。
97名女性完成了随访。IUD在6周时的持续使用率为91%，在6个月时为83.5%。前6周的排出/取出率与6周和6个月之间的排出/取出率无差异（分别为9%和9.1%）。有2例子宫内膜炎（2.1%），无子宫穿孔病例。在6个月后继续使用宫内节育器的81名女性中，31%仅接受了插入IUD的剖宫产，44%接受了2次剖宫产，25%接受了3次或更多次剖宫产。
6个月时继续使用IUD的女性中有三分之二接受了2次或更多次剖宫产。由于在既往有2次或更多次剖宫产史后进行试产并不常见，我们认为分娩入院后放置IUD可能会降低重复剖宫产及其固有风险。
