Lassner K J, Chen C H, Kropsch L A, Oberle M W, Lopes I M, Morris L
Department of Information, Evaluation, and Research, Center for Research on Integrated Maternal and Child Care (Centro de Pesquisas de Assistencia Integrada a Mulher e a Criança-CPAIMC), Rio de Janeiro, Brazil.
Bull Pan Am Health Organ. 1995 Sep;29(3):206-15.
To assess whether trained nursing personnel could provide IUD services as safely and effectively as physicians in Brazil, an experimental study was conducted at the main clinic of the Center for Research on Integrated Maternal and Child Care in Rio de Janeiro. From November 1984 through April 1986, a total of 1,711 women who requested IUD insertion at the clinic were randomly assigned to have a Copper-T 200 IUD inserted by one of the clinic's 11 physicians or 13 nurses. All of the physicians and nursing staff members who provided these services had taken the Center's standard clinical family planning training course. Of 860 insertions attempted by the physicians and nurses, 1.3% and 3.3%, respectively, were unsuccessful. Statistically, this difference was very significant (P < 0.01). Also, mainly because the cervix was small and undilated, nulliparous women had a relatively high insertion failure rate of 8.0%, as compared to 1.5% for primiparas and 1.0% for multiparas. The overall rate of complications at insertion was 1.8%, these complications including diaphoresis, vomiting, syncope, cervical laceration, and one case of perforation of the uterus; no significant difference was found between the complication rates for insertions performed by physicians as compared to nurses. However, 9.0% of the study subjects reported severe pain during IUD insertion, with significantly higher percentages reporting pain if the IUD was inserted by a physician, or if the subject was nulliparous, had preinsertion symptoms, or had a history of pelvic inflammatory disease (PID) or sexually transmitted disease (STD). It was also found that the nurses had a dramatically high insertion failure rate (11.6%) with nulliparous subjects, while the physicians' failure rate with such subjects was a significantly lower 3.4%. No significant difference was found in the groups served by nurses and physicians with regard to postinsertion complaints or termination of use within 12 months of insertion. These findings suggest that future training, besides preparing nursing personnel in IUD insertion, should emphasize preparation in taking the client's medical history and diagnosing existing medical symptoms that could be associated with IUD insertion complications. In addition, if a nulliparous woman requests an insertion, it should be performed by a physician or more experienced nursing staff member with close medical supervision. Because of high rates of reported pain at insertion, such women, as well as those with medical symptoms associated IUD insertion complications and those with a history of PID or STD, should be considered candidates for extra care and counseling.(ABSTRACT TRUNCATED AT 400 WORDS)
为评估在巴西，经培训的护理人员提供宫内节育器（IUD）服务是否能与医生一样安全有效，在里约热内卢母婴综合保健研究中心的主诊所开展了一项实验研究。从1984年11月至1986年4月，共有1711名在该诊所要求放置IUD的女性被随机分配，由诊所的11名医生或13名护士之一为其放置铜T 200型IUD。所有提供这些服务的医生和护理人员都参加了该中心的标准临床计划生育培训课程。在医生和护士尝试的860例放置手术中，未成功的比例分别为1.3%和3.3%。从统计学角度看，这一差异非常显著（P<0.01）。此外，主要由于宫颈小且未扩张，未生育女性的放置失败率相对较高，为8.0%，经产妇为1.5%，多产妇为1.0%。放置时的总体并发症发生率为1.8%，这些并发症包括出汗、呕吐、晕厥、宫颈撕裂以及1例子宫穿孔；医生和护士进行放置手术的并发症发生率之间未发现显著差异。然而，9.0%的研究对象报告在IUD放置过程中出现剧痛，如果由医生放置IUD、或研究对象为未生育女性、有放置前症状、或有盆腔炎（PID）或性传播疾病（STD）病史，则报告疼痛的比例显著更高。还发现，护士对未生育对象的放置失败率极高（11.6%），而医生对这类对象的失败率则显著较低，为3.4%。在护士和医生服务的组中，放置后投诉或在放置后12个月内停用方面未发现显著差异。这些研究结果表明，未来的培训除了让护理人员掌握IUD放置技能外，还应强调了解患者病史以及诊断可能与IUD放置并发症相关的现有医学症状。此外，如果未生育女性要求放置IUD，应由医生或经验更丰富的护理人员在密切医疗监督下进行。由于报告的放置时疼痛发生率较高，这类女性以及那些有与IUD放置并发症相关医学症状以及有PID或STD病史的女性，应被视为需要额外护理和咨询的对象。（摘要截选至400词）
