Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
Albert Einstein College of Medicine, Bronx, NY, United States.
Contraception. 2024 Sep;137:110504. doi: 10.1016/j.contraception.2024.110504. Epub 2024 Jun 5.
This study aimed to compare removal timing, techniques, and success of malpositioned intrauterine device (IUDs) to nonmalpositioned IUDs.
We performed a retrospective cohort study of IUD users with ultrasound performed between July 2014 and July 2017 within one medical system. We used Fisher exact and Wilcoxon rank-sum tests to compare clinical characteristics and IUD removal details between patients with malpositioned and nonmalpositioned IUDs.
Of 1759 ultrasounds reporting the presence of an IUD, 436 described IUD malposition. Of these, 150 described the IUD as embedded and 16 as partially perforated. IUDs were more likely to be removed and removed sooner for patients with malpositioned compared with nonmalpositioned IUDs (281/436 vs 545/1323, p < 0.001 and median 17 days vs 236 days from the index ultrasound, p < 0.001). Most IUDs, malpositioned and nonmalpositioned, were removed on the first attempt (82%, 85%), by a generalist obstetrician and gynecologist (75%, 70%), using a ring forceps (73%, 65%). Most embedded and partially perforated IUDs were removed (68%, 69%), using a ring forceps (59%, 67%), on the first attempt (84%, 91%).
Malpositioned IUDs were more likely to be removed and removed sooner than nonmalpositioned IUDs. Most IUDs, even IUDs labeled as partially perforated or embedded, were removed by a generalist obstetrician and gynecologist, using ring forceps, on first attempt.
Ultrasound findings of IUD malposition are not associated with difficult IUD removal.
本研究旨在比较位置不当宫内节育器（IUD）和位置正常 IUD 的取出时间、技术和成功率。
我们对 2014 年 7 月至 2017 年 7 月在一个医疗系统内进行的超声检查的 IUD 用户进行了回顾性队列研究。我们使用 Fisher 精确检验和 Wilcoxon 秩和检验比较了位置不当和位置正常 IUD 患者的临床特征和 IUD 取出细节。
在 1759 份报告存在 IUD 的超声报告中，436 份描述了 IUD 位置不当。其中，150 份描述 IUD 嵌入，16 份描述 IUD 部分穿孔。与位置正常的 IUD 相比，位置不当的 IUD 更有可能被取出，取出时间也更早（436 例中有 281 例与 1323 例中的 545 例相比，p<0.001，从索引超声到取出的中位数时间为 17 天与 236 天，p<0.001）。大多数 IUD，无论是位置不当还是位置正常，都在第一次尝试时被取出（82%，85%），由普通妇产科医生（75%，70%）使用环型钳子（73%，65%）。大多数嵌入和部分穿孔的 IUD（68%，69%），也通过环型钳子（59%，67%），第一次尝试（84%，91%）被取出。
位置不当的 IUD 比位置正常的 IUD 更有可能被取出，且取出时间更早。即使是被标记为部分穿孔或嵌入的 IUD，大多数也由普通妇产科医生使用环型钳子在第一次尝试时取出。
IUD 位置不当的超声表现与 IUD 取出困难无关。
