Bayer Healthcare, Whippany, New Jersey, USA.
Bayer Oy, Espoo, Uusimaa, Finland.
BMJ Sex Reprod Health. 2023 Apr;49(2):e1. doi: 10.1136/bmjsrh-2022-201579. Epub 2022 Dec 9.
Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.
This systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010-October 2021 were included.
133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013-2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0-41%). Abnormal bleeding, infections, or perforations were rare.
PPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.
宫内节育器（IUD）是一种高效的避孕方法。分娩后立即放置 IUD 可提供即时避孕，并可能减少意外怀孕，包括短间隔怀孕，从而降低健康风险和相关的经济负担。
本系统文献综述包括已发表的全球数据，涉及任何类型的产后宫内节育器（PPIUD）的使用、效果和安全性。纳入了 2010 年 1 月至 2021 年 10 月 MEDLINE、Embase 和 Cochrane 中索引的英文文章。
133 篇文章符合纳入标准（46%为干预性研究；54%为观察性研究；87 篇来自低收入国家；46 篇来自高收入国家）。在高收入国家，PPIUD 的使用率较低（2013-2016 年每 10000 例美国分娩中有 6 例），而在低收入国家差异很大（2%-46%）。在高收入和低收入国家，在大多数研究中（79%），超过 80%的 PPIUD 妇女在 3 个月内有 IUD 放置；在 6 个月和 12 个月时，76%和 54%的纳入研究报告称，超过 80%的妇女有 IUD 放置；停止使用的原因很少报告。妊娠很少见（37 项研究报告数据中有 12191 名妇女发生 96 例妊娠），通常与器械故障无关，而是发生在不再使用 PPIUD 的妇女中。脱落主要发生在早期门诊期间，范围很广（3 个月内：0-41%）。异常出血、感染或穿孔很少见。
PPIUD 是安全有效的。长期随访数据有限。未来的研究需要阐明缺乏 PPIUD 使用的原因。
