A risk-based preoperative evaluation method and management strategy for removing intrauterine contraceptive devices in postmenopausal women.

Background: A large population of women have intrauterine contractive devices (IUCDs) as a result of China's national family planning policy; this has created a significant economic burden and raised technological challenges related to the safe removal of IUCDs in postmenopausal women. It is very important to develop a risk scoring system for the removal of IUCDs (RSSR-IUCDs) to evaluate the preoperative risk of removal and offer management strategies for postmenopausal women.

Methods: A systematic case retrospective analysis was conducted on 320 enrolled women who underwent IUCD removal surgery. After screening, stratifying high-risk factors, and final multifactor Logistic Stepwise Regression Analysis, a model named RSSR-IUCDs was constructed. It was verified using the Hosmer-Lemeshow test and a Receiver Operating Characteristic (ROC) curve was plotted to further analyze the predictive accuracy of IUCD removal failure.

Results: Seven high-risk factors were finally selected, namely duration of menopause, IUCD retention time, a history of uterine surgery, the shape of the IUCD, IUCD position, uterine size, and uterine position. The RSSR-IUCDs was developed and demonstrated goodness of fit (χ² = 236.558, P = 0.000). The score range of RSSR-IUCDs (Minimum-Maximum) was 0-40. The ROC curve of RSSR-IUCDs demonstrated that the ideal cutoff value was 20 points and the sensitivity and specificity of an initial failure to remove an IUCD were 69.60% and 95.60%, respectively.

Conclusions: The RSSR-IUCD is a scientific, reasonable, and feasible evaluation system which is expected to become a guiding scoring system in accordance with clinical practice for postmenopausal women before the removal of IUCDs.