与子宫内器件相关的子宫穿孔发生率和风险 (APEX-IUD):大型多站点队列研究
Susan D Reed1, Xiaolei Zhou2, Laura Ichikawa3
1Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.
Lancet (London, England)
|June 6, 2022
概括
在分娩后不久插入子宫内置器 (IUD) 会增加子宫穿孔的风险,尤其是在6周内. 哺乳也会稍微增加风险, 但对于大多数人来说,
科学领域:
- 生殖健康
- 医疗器械
- 患者安全
背景情况:
- 宫内器件 (IUD) 的子宫穿孔风险报告不足,特别是在分娩后立即插入的情况下.
- 之前的短时间随访研究可能低估了穿孔风险.
- 哺乳和产后36周内插入与更高的穿孔率有关.
研究的目的:
- 在非产后间隔和产后间隔之间比较IUD相关的子宫穿孔发生率和风险.
- 评估母乳养对产后个体穿孔风险的影响.
主要方法:
- 美国使用电子健康记录 (EHR) 的多站点队列研究.
- 包括在2001年至2018年之间插入IUD的50岁或更年轻的个人.
- 使用经过验证的EHR数据和图表抽象分析的子宫穿孔 (完全和部分).
主要成果:
- 在非产后组中,超过326,000名患者的5年累计发生的子宫穿孔率为0. 29%.
- 与非产后相比,产后插入的风险显著增加 (aHR为2. 73- 6. 71).
- 产后母乳养与穿孔风险略有增加有关 (aHR为1. 37).
结论:
- 虽然产后插入避孕套, 特别是在六周内, 增加穿孔的风险, 它仍然是一个罕见的事件.
- 哺乳和避孕的好处通常超过轻微的穿孔风险增加.
- 插入IUD的时间应优先考虑患者的便利性和避孕的愿望,对高危人群进行仔细的跟踪.
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