Stanford Program for International Reproductive Education and Services, Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA, USA.
Population Services International, Washington, DC, USA.
Int J Gynaecol Obstet. 2020 May;149(2):154-159. doi: 10.1002/ijgo.13115. Epub 2020 Mar 15.
To evaluate the delivery-to-insertion interval for copper postpartum intrauterine devices (PPIUDs).
Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUDs were inserted within 48 hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (≤10 minutes) or immediate (>10 minutes) insertion. Outcomes were complete expulsion at the 6-8-week follow-up (primary), and IUD-to-fundus distance, as assessed by postinsertion ultrasound (secondary).
Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD. Complete expulsion at follow-up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group (P=0.176; difference in proportions, 4.3%; 95% confidence interval, -2.0 to 8.1). Distance from the fundus did not differ between the two groups (P=0.107); high fundal placement (≤10 mm from the internal endometrial verge) was achieved for most women.
The present data challenge previous guidance on the timing of PPIUD insertion. The 10-minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post-delivery tasks of providers and increase access to PPIUD.
评估产后放置铜宫内节育器（PPIUD）的放置时间。
对 2015 年 3 月至 2016 年 7 月在印度五个学术中心进行的两项相关研究进行二次分析。IUD 在阴道分娩后 48 小时内插入。根据是否行胎盘后（≤10 分钟）或即刻（>10 分钟）放置，将妇女（n=560）分为两组。主要结局为 6-8 周随访时的完全脱落（一级结局），次要结局为放置后超声评估的 IUD-宫底距离。
共 93 名（16.6%）妇女行胎盘后置 PPIUD，467 名（83.4%）行即刻 PPIUD。胎盘后置组和即刻产后组的随访时完全脱落率分别为 3.2%（n=3）和 7.5%（n=35）（P=0.176；差异比例，4.3%；95%置信区间，-2.0 至 8.1）。两组间宫底距离无差异（P=0.107）；大多数妇女宫底位置较高（距子宫内膜内缘≤10mm）。
目前的数据对 PPIUD 放置时间的先前指导意见提出了挑战。10 分钟的放置窗口是使用率的障碍，应重新评估是否纳入服务提供指南。灵活的间隔时间将适应提供者的多项产后任务，并增加 PPIUD 的可及性。
