Andersson K, Ryde-Blomqvist E, Lindell K, Odlind V, Milsom I
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
Contraception. 1998 Apr;57(4):251-5. doi: 10.1016/s0010-7824(98)00029-8.
This survey comprised 50 consecutive perforations occurring with intrauterine devices (IUD) reported to the National Patient Insurance Scheme Register during 1990 to 1993. All 50 women were parous and > 20 years of age at the time of IUD insertion. Forty-two (84%) of the IUD were inserted by a midwife and eight by a gynecologist. A total of 45 women (90%) had their IUD inserted < 1 year after a full-term pregnancy and 31 women (62%) had their IUD inserted < or = 12 weeks after delivery. Of the 50 women, 27 (54%) reported that they were breastfeeding at the time of IUD insertion. No particular IUD was overrepresented in relation to its share on the market. In 31 cases (62%), severe pain at insertion and during the first 24 h was recorded. In 14 women (28%), the perforation was diagnosed early (i.e., within 1 month of insertion) and in 36 women (72%), the perforation was diagnosed > 1 month after insertion. Lower abdominal pain was the most frequent symptom at early diagnosis but in two cases, the main symptom was heavy bleeding. Among the 36 women in whom the perforation was discovered more than 1 month after insertion, the diagnosis was made when an unexpected pregnancy occurred in 20 women (56%). In 15 cases, the IUD strings were not visible during pelvic examination at a routine check-up, which led to efforts to locate the IUD. Thirty-two women (64%) underwent laparotomy for removal. We conclude that lactating women seem to be a risk group for perforation and that a national register of IUD perforations could provide a better means of quality control.
本调查涵盖了1990年至1993年期间向国家患者保险计划登记处报告的50例与宫内节育器（IUD）相关的连续穿孔病例。所有50名女性在放置IUD时均已生育且年龄超过20岁。其中42例（84%）的IUD由助产士放置，8例由妇科医生放置。共有45名女性（90%）在足月妊娠后不到1年放置IUD，31名女性（62%）在分娩后不到或等于12周放置IUD。在这50名女性中，27名（54%）报告在放置IUD时正在哺乳。就其在市场上的份额而言，没有哪种特定的IUD占比过高。在31例（62%）中，记录到放置时及最初24小时内出现严重疼痛。14名女性（28%）的穿孔在早期（即放置后1个月内）被诊断出来，36名女性（72%）的穿孔在放置后1个月以上被诊断出来。早期诊断时最常见的症状是下腹部疼痛，但有两例主要症状是大量出血。在穿孔在放置后1个月以上才被发现的36名女性中，20名女性（56%）在意外怀孕时被诊断出来。在15例中，常规检查盆腔时未见到IUD尾丝，这促使人们努力寻找IUD。32名女性（64%）接受了剖腹手术以取出IUD。我们得出结论，哺乳期女性似乎是穿孔的风险群体，并且IUD穿孔的国家登记册可以提供更好的质量控制手段。
