Li Zijun, Zheng Yaqin, Liu Min, Pan Linlin
Department of Gynecology, Longquan City People's Hospital Affiliated to Lishui University, Lishui, Zhejiang, China.
Clinical Laboratory Centre, Longquan City People's Hospital Affiliated to Lishui University, Longquan, Zhejiang, China.
Front Reprod Health. 2025 Aug 25;7:1576265. doi: 10.3389/frph.2025.1576265. eCollection 2025.
A large population of women have intrauterine contractive devices (IUCDs) as a result of China's national family planning policy; this has created a significant economic burden and raised technological challenges related to the safe removal of IUCDs in postmenopausal women. It is very important to develop a risk scoring system for the removal of IUCDs (RSSR-IUCDs) to evaluate the preoperative risk of removal and offer management strategies for postmenopausal women.
A systematic case retrospective analysis was conducted on 320 enrolled women who underwent IUCD removal surgery. After screening, stratifying high-risk factors, and final multifactor Logistic Stepwise Regression Analysis, a model named RSSR-IUCDs was constructed. It was verified using the Hosmer-Lemeshow test and a Receiver Operating Characteristic (ROC) curve was plotted to further analyze the predictive accuracy of IUCD removal failure.
Seven high-risk factors were finally selected, namely duration of menopause, IUCD retention time, a history of uterine surgery, the shape of the IUCD, IUCD position, uterine size, and uterine position. The RSSR-IUCDs was developed and demonstrated goodness of fit (χ = 236.558, = 0.000). The score range of RSSR-IUCDs (Minimum-Maximum) was 0-40. The ROC curve of RSSR-IUCDs demonstrated that the ideal cutoff value was 20 points and the sensitivity and specificity of an initial failure to remove an IUCD were 69.60% and 95.60%, respectively.
The RSSR-IUCD is a scientific, reasonable, and feasible evaluation system which is expected to become a guiding scoring system in accordance with clinical practice for postmenopausal women before the removal of IUCDs.
由于中国的计划生育政策，大量女性使用宫内节育器（IUCD）；这带来了巨大的经济负担，并引发了与绝经后女性安全取出IUCD相关的技术挑战。开发一种用于评估IUCD取出风险的评分系统（RSSR-IUCD）以评估术前取出风险并为绝经后女性提供管理策略非常重要。
对320例接受IUCD取出手术的入选女性进行系统的病例回顾性分析。经过筛选、分层高危因素并进行最终的多因素Logistic逐步回归分析，构建了一个名为RSSR-IUCD的模型。使用Hosmer-Lemeshow检验进行验证，并绘制受试者工作特征（ROC）曲线以进一步分析IUCD取出失败的预测准确性。
最终选择了七个高危因素，即绝经持续时间、IUCD保留时间、子宫手术史、IUCD形状、IUCD位置、子宫大小和子宫位置。开发了RSSR-IUCD并显示出良好的拟合度（χ=236.558，=0.000）。RSSR-IUCD的评分范围（最小值-最大值）为0至40分。RSSR-IUCD的ROC曲线表明理想的截断值为20分，首次取出IUCD失败的敏感性和特异性分别为69.60%和95.60%。
RSSR-IUCD是一个科学、合理且可行的评估系统，有望成为绝经后女性IUCD取出术前符合临床实践的指导评分系统。
