University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota.
University of Minnesota Medical School, Minneapolis, Minnesota.
J Pediatr Adolesc Gynecol. 2024 Apr;37(2):160-164. doi: 10.1016/j.jpag.2023.11.013. Epub 2023 Dec 10.
Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients.
The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history.
We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications.
We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P > .999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%).
IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD.
尽管主要的专业组织支持在青少年和年轻人（AYAs）中使用宫内节育器（IUD），并且 AYAs 也接受并希望使用，但是临床医生可能会担心在年轻患者中放置 IUD 器械的程序难度。
本研究旨在通过阴道分娩（VD）史评估 AYA 人群中首次尝试放置 IUD 的临床结果。
我们对 2017 年 1 月 1 日至 8 月 31 日在生殖健康诊所接受 IUD 放置尝试的 25 岁以下患者进行了回顾性队列研究。我们提取了社会人口统计学特征、妊娠史和程序特征，包括并发症。通过 VD 史比较了首次尝试 IUD 放置的成功率。我们还评估了包括辅助措施使用、提供者类型、手术过程中报告的症状和并发症在内的次要临床结局的发生频率。
我们纳入了 1325 名参与者（中位年龄为 21.3 岁），其中 42 名（3.2%）有 VD 史。几乎所有 IUD 放置都在首次尝试时成功（n=1301，98.2%），并由高级实践临床医生进行（n=1314，99.2%）。有 VD 史和无 VD 史的参与者首次尝试放置成功率相似（P＞.999）。除非甾体抗炎药外，其他辅助措施的使用频率较低（n=16，3.6%）。在放置不成功的参与者中，66.7%返回，所有参与者在第二次尝试时都成功放置了 IUD。放置后 6 个月内记录的并发症很少（n=29），主要是脱落（n=27，93.1%）。
社区生殖健康诊所的 AYA 中 IUD 放置成功率高，且与 VD 史无关。
