剖宫产术后1年内行人工流产妇女术后放置IUD的避孕效果观察

Contraceptive effect of IUD insertion immediately after induced abortion among women undergoing cesarean section within one year

目的探讨剖宫产术后1年内行人工流产患者术后立即放置宫内节育器(IUD)的避孕效果。方法选取2015年8月至2016年7月于安徽省马鞍市妇幼保健院就诊的人工流产术后立即放置IUD妇女480例,根据患者有无剖宫产史及剖宫产术后时间将所有患者分为A、B、C三组,剖宫产术后12个月内为A组,剖宫产术后12个月以上为B组,无剖宫产史的患者为C组。对比分析所有人工流产患者术后立即放置IUD的避孕效果和副作用。结果置入IUD后1个月中,A组患者经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率高于其他两组,但差异无统计学意义(χ~2值分别为0.28、0.01、0.14、0.01、0.07,均P>0.05)。三组患者在3个月及以后时间点发生经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率比较,差异无统计学意义(χ~2值分别为0.16、0.05、0.07、0.01、0.23,均P>0.05)。所有患者在随访期间无出现闭经(宫腔粘连)的情况。三组患者置入IUD后,术后6个月时因疼痛或因出血取出率最高,三组之间比较差异无统计学意义(χ~2=0.02,P>0.05)。在随访期间,所有患者均未出现带器妊娠0。置入IUD后,B组在术后3个月内完全脱落2例,其余患者未发生完全脱落及部分脱落情况。至术后12个月时,三组患者累计续用率比较差异无统计学意义(χ~2=0.92,P>0.05)。结论剖宫产术后1年内行人工流产的患者术后立即放置IUD是安全、可行的。

Objective To investigate the contraceptive effect of intrauterine device （IUD） insertion immediately after induced abortion among women undergoing cesarean section within one year.Methods Altogether 480 women visiting Ma＇anshan Maternal and Child Health Care Hospital for induced abortion and inserted with IUD immediately afterwards from August 2015 to July 2016 were chosen, and divided into 3 groups according to history of cesarean section and time after operation.Patients within 12 months after cesarean section were set into group A, those at more than 12 months after cesarean section into group B and those with no history of cesarean section into group C.Contraceptive effect and side effect of patients inserted with IUD immediately after induced abortion were compared among three groups.Results Within 1 month after IUD insertion, incidence of prolonged menstruation, increased menstrual volume, lumbar and abdominal pain, irregular bleeding and increased leucorrhea in group A was higher than that in the other two groups, but the difference was not statistically significant （χ2 value was 0.28, 0.01, 0.14, 0.01 and 0.07, respectively, all P〉0.05）.There was no significant difference in incidence of prolonged menstruation, increased volume, lumbar and abdominal pain, irregular bleeding and increased vaginal discharge among three groups on third month after IUD insertion and later （χ2 value was 0.16, 0.05, 0.07, 0.01 and 0.23, respectively, all P〉0.05）.All patients had no amenorrhea （intrauterine adhesion） during follow-up period.Removal rate because of bleeding and pain was highest at 6 months after IUD insertion and difference among three groups was not statistically significant （χ2=0.02, P〉0.05）.During follow-up period, all patients did not appear to be pregnant.Within 3 months after insertion of IUD, expulsion happened in 2 cases in group B, and expulsion or partial expulsion did not occur in the other patients.At 12 months after insertion, there was no significant difference in cumulative continuation rate among three groups （χ2=0.92, P〉0.05）.Conclusion IUD insertion immediately after induced abortion for women who have taken cesarean section within one year could be safe and feasible.