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与子宫内器械相关的子宫穿孔和驱逐的风险
Michael J Fassett1, Susan D Reed, Kenneth J Rothman
1Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, the Department of Clinical Science and the Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, and the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, and the Division of Research, Kaiser Permanente Northern California, Oakland, California; the Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; RTI Health Solutions, Research Triangle Park, North Carolina; Bayer AG, Berlin, Germany; Bayer AG and Bayer OY, Espoo, Finland; Bayer Pharmaceuticals, Whippany, New Jersey, and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, Indiana.
宫内器械 (IUD) 插入时间 产后和大量月经出血影响穿孔和排泄的风险. 咨询应纳入这些因素,以便患者在IUD使用方面做出明智的决定.
科学领域:
- 生殖健康 生殖健康
- 医疗器械安全 医疗器械安全
- 临床妇科 临床妇科
背景情况:
- 宫内器械 (IUD) 广泛用于避孕.
- 了解与IUD插入相关的风险,如子宫穿孔和驱逐,对于患者的安全至关重要.
- 诸如产后时间和患者特征等因素可能会影响这些风险.
研究的目的:
- 评估IUD插入的产后时间,母乳养,大量月经出血和IUD类型与子宫穿孔和排出的风险之间的关联.
- 为考虑使用IUD的患者提供临床咨询和共享决策.
主要方法:
- 使用美国医疗保健数据 (2001-2018) 的回顾性队列研究.
- 包括50岁或更年轻的IUD插入和电子健康记录的个人.
- 计算的累计发病率和估计的调整危险比率 (aHRs) 穿孔和驱逐.
主要成果:
- 子宫穿孔的绝对风险总体上很低.
- 在产后1年内插入的IUD中观察到穿孔风险增加,特别是产后4天至6周.
- 产后立即插入 (0-3天) 时发生的IUD驱逐风险最大.
- 哺乳期显示孔径略高,排泄风险降低.
- 严重的月经出血与更大的排泄和略高的穿孔风险有关.
- 与铜IUD相比,Levonorgestrel释放型IUD的穿孔率略高,排泄风险较低.
结论:
- 与IUD相关的不良事件的绝对风险很低.
- 在咨询患者时,临床医生必须考虑特定的产后插入时间和严重月经出血的诊断.
- 关于IUD插入的知情决策应该整合这些风险因素.
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