早期与产后间隔放置宫内节育器后12个月排出率：一项随机试验

AJOG global reports Pub Date : 2025-08-01 DOI:10.1016/j.xagr.2025.100547

Sarah Averbach MD, MAS , Florin Vaida PhD , Erica Hinz MD, MPH , Gennifer Kully MSc , Arnab K. Dey PhD, MBA , Monica A. Lutgendorf MD , Sadia Haider MD, MPH , Lisa G. Hofler MD, MPH, MBA

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引用次数: 0

摘要

目的产后2 ~ 4周为宫内节育器启动的最佳时间；安置地点可以与产后早期或婴儿探视同时进行。我们的目的是比较早期放置宫内节育器与标准间隔6周访问的产后12个月排出率。研究设计这是一项在美国四家医疗中心进行的随机对照试验。参与者被随机分配到阴道分娩或剖宫产后早期（14-28天）或间隔（42-56天）放置宫内节育器。我们在6个月时使用阴道超声确认宫内节育器的存在和位置。使用图表审查和电话调查来验证12个月时宫内节育器的存在和位置。结果2018年3月至2021年6月，203名参与者被分配到早期放置，201名参与者被分配到间隔放置；238例（58.9%）通过产后12个月的电话调查（和电子病历审查）提供了结果数据。在接受宫内节育器并提供12个月结局数据的参与者中，完全排出率为124分之4 (3.2%；95%置信区间[CI]， 0.90 ~ 8.2)， 114例为0 (0%；早期组和间隔组的95% CI为0 ~ 3.2)；组间差异为3.2个百分点（95% CI, - 0.01至8.0，P= 0.054）。部分开除计数和率16例(12.9%；95% CI, 7.6 - 20.1)和13 (11.4%；早期组和间歇组的95% CI为6.2 ~ 18.7)；差异为1.5个百分点（95% CI, - 7.2至10.2，P=.75）。在404名参与者中，12个月随访时宫内节育器使用率为113 (55.7%；早期组的95% CI为48.5 - 62.6，而早期组的95% CI为95 (47.3%；95% CI, 40.2 ~ 54.1， P=。10人（间歇组）。与间隔放置相比，参与者对早期更满意，107 (86.3%；95% CI 79.0 ~ 91.8) vs 87 (76.3%, 95% CI 67.4 ~ 83.8 95%) P= 0.048。结论宫内节育器放置在产后早期和间隔期，12个月完全排出率较低（5%）。产后早期放置宫内节育器满意度较高。

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Expulsion rates 12 months after early versus interval postpartum intrauterine device placement: a randomized trial

Objective

The early postpartum period, 2 to 4 weeks postpartum, is an optimal time for intrauterine device (IUD) initiation; placement can be co-located with early postpartum or infant visits. We aimed to compare expulsion rates at 12 months postpartum for IUDs placed early compared to the standard interval 6-week visit.

Study Design

This is a randomized controlled trial conducted at four U.S. medical centers. Participants were randomly assigned to early (14–28 days) or interval (42–56 days) postpartum IUD placement after vaginal or cesarean birth. We used transvaginal ultrasound to confirm IUD presence and position at 6 months. Chart review and telephone surveys were used to verify IUD presence and position at 12 months.

Results

Between March 2018 and June 2021, 203 participants were assigned to early and 201 to interval IUD placement; 238 (58.9%) contributed outcome data by phone survey (and electronic medical record review) at 12-months postpartum. Among participants who received an IUD and provided 12-month outcome data, complete expulsion rates were 4 in 124 (3.2%; 95% confidence interval [CI], 0.90 to 8.2) and 0 in 114 (0%; 95% CI, 0 to 3.2) in the early and interval groups; a between-group difference of 3.2 percentage points (95% CI, −0.01 to 8.0, P=.054). Partial expulsion counts and rates were 16 (12.9%; 95% CI, 7.6 to 20.1) and 13 (11.4%; 95% CI, 6.2 to 18.7) in the early and interval groups; a difference of 1.5 percentage points (95% CI, −7.2 to 10.2, P=.75). Among all 404 participants, IUD utilization rates at 12-month follow-up were 113 (55.7%; 95% CI, 48.5 to 62.6 among participants in the early group) compared to 95 (47.3%; 95% CI, 40.2 to 54.1, P=.10 among participants in the interval group). Participants were more satisfied with early compared to interval placement, 107 (86.3%; 95% CI 79.0 to 91.8) vs 87 (76.3%, 95% CI 67.4 to 83.8 95%) P=.048.

Conclusion

Complete expulsion rates at 12 months are low (<5%) when IUDs are placed in the early and interval postpartum period. Satisfaction is higher with early postpartum IUD placement.

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来源期刊

AJOG global reports Endocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Perinatology, Pediatrics and Child Health, Urology

CiteScore

1.20

自引率

0.00%

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