带环妊娠的危险因素及临床特点分析

Risk Factors and Clinical Features of Pregnancy in IUD Users:A Case-control Study

目的:探讨带环妊娠的危险因素及临床特点。方法:收集2012年1月至2018年1月在我院接受治疗的82例带环妊娠患者作为带环妊娠组,170例带环未妊娠者作为对照组,排除拒绝参与该临床研究及临床资料提供不全者,采用1∶2病例对照研究探讨带环妊娠的危险因素及临床特点。结果:多因素Logistic回归分析显示,带环妊娠危险因素包括节育器位置异常(OR8.705,95%CI4.130~18.346)、子宫腔深>8.5cm(OR5.816,95%CI1.365~24.788)及子宫畸形(OR6.751,95%CI1.483~30.734),而放置左炔诺孕酮宫内节育系统(OR0.113,95%CI0.013~0.967)是其保护因素。带环妊娠中偏宫角妊娠、异位妊娠及切口妊娠的发生率均较高,分别为6.1%、4.9%及6.1%。结论:节育器位置异常、子宫腔深>8.5cm、子宫畸形是带环妊娠的危险因素,放置左炔诺孕酮宫内节育系统是其保护因素。带环妊娠中偏宫角妊娠、异位妊娠及切口妊娠的发生率均较高。该研究可指导预防并减少带环妊娠及其相关妊娠合并症的发生率。

Objective:To investigate the risk factors and clinical features of pregnancy in intrauterine device(IUD)users.Methods:A case-control study was conducted from January 2012 to January 2018.82 women with an IUD and a confirmed pregnancy were recruited as the case group,170 women with IUDs and who were not pregnant were matched as controls at a ratio of 1∶2.Women who refused interviews or provided incomplete information were excluded.Results:Multivariate Logistic regression analysis showed that the displacement of the IUD(OR 8.705,95%CI 4.130-18.346),uterine cavity depth(>8.5 cm)(OR 5.816,95%CI 1.365-24.788)and uterine malformation(OR 6.751,95%CI 1.483-30.734)were risk factors of IUD failure.Levonorgestrel intrauterine system(OR 0.113,95%CI 0.013-0.967)was a protective factor.In addition,the IUD induced high incidence of pregnancy with gestational sac near the horn of uterus,ectopic pregnancy and cesarean scar pregnancy,with 6.1%,4.9%and 6.1%respectively.Conclusions:The displacement of the IUD,Uterine cavity depth(>8.5 cm)and uterine malformation are risk factors of IUD failure.while levonorgestrel intrauterine system is a protective factor.The IUD can induce high incidence of pregnancy with gestational sac near the horn of uterus,ectopic pregnancy and cesarean scar pregnancy.