Uterine transverse diameter and risk of LNG-IUS malposition in adenomyosis patients: a threshold effect analysis from a retrospective cohort study.

IF 2.7 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Yin Lin, Junying Jiang, Hao Lin, Hong Yan, Ting Deng
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Abstract

Objective: The malposition of the levonorgestrel-releasing intrauterine system (LNG-IUS) can have a considerable impact on the treatment outcomes for patients with adenomyosis. This study was designed to explore the relationship between the transverse diameter of the uterus and the occurrence of LNG-IUS malposition.

Methods: This retrospective cohort study enrolled 99 adenomyosis patients treated at Fujian Maternity and Child Health Hospital between May 2021 and May 2023. Preoperative uterine transverse diameter was measured using transvaginal ultrasound examinations. We defined LNG-IUS malposition as either downward displacement or expulsion of the device. Data analysis employed Cox regression models with adjustments for relevant demographic, clinical, and laboratory variables.

Results: Our analysis revealed a notable non-linear relationship between the transverse diameter of the uterus and subsequent risk of LNG-IUS malposition. We identified 5.4 cm as a significant clinical threshold; beyond this measurement, the risk increased substantially, with malposition hazard rising by 112% per additional centimeter (HR 2.12; 95% CI, 1.28-3.49; p = 0.003). Among the subgroup of patients suffering from severe dysmenorrhea (VAS ≥ 7), this association was considerably stronger, yielding a hazard ratio of 3.43 (95% CI, 1.32-8.89; p = 0.011).

Conclusion: Patients with adenomyosis whose uterine transverse diameter exceeds 5.4 cm face a higher risk of LNG-IUS malposition. This measurement threshold provides clinicians a practical tool for assessing suitable candidates for LNG-IUS placement, which may lead to better outcomes in this patient group.

子宫腺肌症患者子宫横径与LNG-IUS错位风险:来自回顾性队列研究的阈值效应分析
目的:左炔诺孕酮释放宫内系统(LNG-IUS)的错位对子宫腺肌症患者的治疗效果有相当大的影响。本研究旨在探讨子宫横径与LNG-IUS位错发生的关系。方法:本回顾性队列研究纳入2021年5月至2023年5月在福建省妇幼保健院就诊的99万例患者。术前行阴道超声检查测定子宫横径。我们将LNG-IUS错位定义为设备向下移位或排出。数据分析采用Cox回归模型,并对相关人口统计学、临床和实验室变量进行调整。结果:我们的分析显示子宫横径与随后的LNG-IUS位错风险之间存在显著的非线性关系。我们确定5.4 cm为显著的临床阈值;超过这个测量值,风险大幅增加,每增加一厘米,错位风险增加112% (HR 2.12; 95% CI, 1.28-3.49; p = 0.003)。在严重痛经患者亚组(VAS≥7)中,这种关联明显更强,风险比为3.43 (95% CI, 1.32-8.89; p = 0.011)。结论:子宫横径超过5.4 cm的子宫腺肌症患者发生LNG-IUS位错的风险较高。该测量阈值为临床医生提供了一个实用的工具,用于评估LNG-IUS放置的合适候选人,这可能会导致该患者组的更好结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Women's Health
BMC Women's Health OBSTETRICS & GYNECOLOGY-
CiteScore
3.40
自引率
4.00%
发文量
444
审稿时长
>12 weeks
期刊介绍: BMC Women''s Health is an open access, peer-reviewed journal that considers articles on all aspects of the health and wellbeing of adolescent girls and women, with a particular focus on the physical, mental, and emotional health of women in developed and developing nations. The journal welcomes submissions on women''s public health issues, health behaviours, breast cancer, gynecological diseases, mental health and health promotion.
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