两种产后立即放置TCu380A宫内节育器方法的比较——910例12个月随访分析

Comparison of Two Techniques Used in Immediate Postplacental Insertion of TCu 380A Intrauterine Device:12 Month Follow up of 910 Cases

目的：比较徒手和卵圆钳两种方法对产后立即放置（ＩＰＰＩ）宫内节育器（ＩＵＤ）效果的影响。方法：将９１０例阴道分娩产妇（其中９７．７％是首次分娩）随机分成两组，于胎盘娩出后１０分钟内放置ＴＣｕ３８０ＡＩＵＤ，其中４７０例徒手放置（手放组），４４０例用卵圆钳放置（钳放组）。随访１２个月，以生命表法统计、χ２检验比较两种放置方法的脱落率、妊娠率、因症取出率等。结果：６和１２个月的随访率分别为９５．１６％和９２．６４％。９１０例中未发生子宫穿孔和感染，仅手放组有１例带器妊娠。放置后主要停用原因是脱落，手放组与钳放组１２个月的粗累积脱落率分别为１５．８６／１００妇女和１５．８８／１００妇女，因症（出血、疼痛）取出率分别为２．１１／１００妇女和１．５７／１００妇女，差异无显著性（Ｐ均＞０．０５）。结论：徒手放置或卵圆钳放置对ＩＰＰＩ的效果无明显影响；ＴＣｕ３８０ＡＩＵＤ适合中国妇女产后立即放置。

Objective: To compare the efficacy of hand insertion and ring forceps insertion of TCu 380A intrauterine device (IUD) in immediate postplacental insertion (IPPI). Methods: 910 vaginal delivery women in Shanghai received a TCu 380A IUD inserted within 10 minutes after delivery of the placenta. Among them, 97.7% were primipara. The women were randomly divided into two groups: 470 cases in hand insertion group and 440 in ring forceps insertion group. Using life table method and χ 2 test, we compared the expulsion rates and other causes of removal after follow up for 12 months in the two groups. Results: The follow up rate at 6 and 12 months were 95.16% and 92.64%, respecitvely. No uterine perforation and infection occurred in the 910 cases, and only one pregnancy in the hand insertion group. Expulsions were the main reason for discontinuation. The 12 month gress cumulative expulsion rates were 15.86 and 15.88 per 100 women in the hand insertion group and ring forceps insertion group, respectively, and the removal rates due to bleeding and (or) pain were 2.11 and 1.57, respectively. No difference was statistically significant ( P >0.05). Conclusion: The two different insertion techniques do not significantly affect discontinuation rates in vaginal IPPI using the TCu 380A IUD; the TCu 380A IUD appears to be suitable for postpartum insertion in Chinese women.