两种产后立即放置T Cu380A IUD方法的比较——3年随访分析

Comparison of Two Techniques Used in Immediate Postplacental Insertion of TCu 380A Intrauterine Device: 36Month Followup

将产后准备选择ＩＵＤ避孕的３８４例阴道分娩产妇（９８．７０％ 是首次分娩），随机分为两组，于胎盘娩出后１０ ｍ ｉｎ 内徒手放置（１８９例）或卵园钳放置（１９５例） ＴＣｕ ３８０Ａ ＩＵＤ。以生命表法统计、χ２检验比较这两种不同放置方法放置后６、１２、２４ 和３６ 个月的脱落率和其他停用率。３８４ 例无一发生子宫穿孔、大出血、感染或恶露延长。放置后主要停用原因是脱落。两组６～３６ 个月各项停用指标（脱落、妊娠、因出血／疼痛取出等）的粗累积率均无显著差异（Ｐ＞ ０．０５）。研究认为，不同放置方法对阴道分娩ＩＰＰＩ效果无明显影响；ＴＣｕ ３８０ＡＩＵＤ是适合中国妇女产后立即放置的。本文还对影响ＩＰＰＩ脱落率的因素如哺乳和ＩＵＤ在宫腔内位置等进行了讨论。

Three hundred and eighty four women in Shanghai who delivered vaginally and who chose to use an IUD for contraception received a Copper T380A IUD inserted vaginally within 10 minutes after delivery of the placenta (i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primiparae. The women were randomly divided into two groups: IUD inserted by hand and IUD via ring forceps. Using life table method and χ 2 test, the expulsion and other discontinuation rates were compared at 6,12,24,and 36 months afterinsertion between the two different insertion techniques. No uterine perforation, infection or a prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events ( expulsion,pregnancy, removal for bleeding/pain, etc.)were not statistically significant (P>0.05). The results suggest that the two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380A, and the TCu 380A appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breastfeeding and IUD placement in uterine cavity, are also analyzed and discussed in this paper.