注册 | 登录 | 充值

首页-> 学术资讯 -> 文献解读

【热门文献】宫内节育器相关的子宫穿孔发生率和风险(APEX-IUD)研究

文献解读

2022-06-17      

601 0


Reed SD et al. Lancet. 2022 Jun 4;399(10341):2103-2112.


关于产后立即置入宫内节育器(iud)和非产后个体穿孔风险的报道很少。节育器插入会增加哺乳和产后36周内插入节育器与子宫穿孔的风险。该研究目的是比较节育器插入时与非产后间隔时间、产后间隔时间、产后个体中节育器相关子宫穿孔的发生率和风险,以评估母乳喂养对这些结果的影响


研究纳入326 658例患者和产后亚队列中的94 817例患者数据。在整个队列中,5年累积发生率在非产后组达到最低(0.29%,95% CI 0.26 - 0.34)。5年累积发生率为1.37% (95% CI 1.24 - 1.52),母乳喂养的风险增加(aHR =1.37, 95% CI 1.12 - 1.66)


产后4天至6周或更短时间内插入节育器导致子宫穿孔的风险是非产后插入节育器的近7倍。在放置IUD时母乳喂养会轻微增加穿孔的风险,但利大于弊临床影响较小。因此,放置IUD的时间应根据个人对IUD避孕意愿和患者来确定。对子宫穿孔高危人群进行仔细随访是有必要的


Background: Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum have been associated with increased risk of uterine perforation. The aim of these analyses was to compare the incidence and risks of IUD-related uterine perforations by non-post-partum and post-partum intervals at IUD insertion, and among post-partum individuals, to assess the impact of breastfeeding on these outcomes.

Methods: We did a multisite cohort study in the USA, using electronic health records (EHR). Study sites were three health-care systems and a site that used data from a health-care information exchange. The study population included individuals who were aged 50 years or younger and had an IUD insertion between Jan 1, 2001, and April 30, 2018. Individuals were excluded if they had not been in the health-care system for at least 12 months before IUD insertion. The primary outcome for this analysis was any IUD-related uterine perforation diagnosis for the first IUD insertion in this time period. Both complete and partial IUD-related perforations were identified. Chart abstraction was done to validate EHR-based algorithms or confirm perforations. The crude rate and cumulative incidence of uterine perforation were evaluated by non-post-partum and post-partum intervals at IUD insertion in the full cohort, and by breastfeeding status in a subcohort of post-partum individuals. Cox models estimated crude and adjusted hazard ratios (aHRs).

Findings: Data from 326 658 individuals in the full cohort and 94 817 individuals in the post-partum subcohort were analysed. In the full cohort, we identified 1008 uterine perforations (51·2% complete), with the 5-year cumulative incidence being the lowest in the non-post-partum group (0·29%, 95% CI 0·26-0·34). The aHR for the post-partum interval relative to non-post partum ranged from 2·73 (95% CI 1·33-5·63; 0 to 3 days post partum) to 6·71 (4·80-9·38; 4 days to ≤6 weeks post partum). The post-partum subcohort of individuals with breastfeeding information had 673 uterine perforations (62% complete), with a 5-year cumulative incidence of 1·37% (95% CI 1·24-1·52) and an increased risk with breastfeeding (aHR 1·37, 95% CI 1·12-1·66).

Interpretation: Although the risk for uterine perforation with IUD insertion 4 days to 6 weeks or less post partum is nearly seven times that of insertion non-post partum, perforation remains an incredibly rare event for all clinical time points. Despite a slight increased risk of perforation with breastfeeding at IUD insertion, the benefits of breastfeeding and effective contraception generally outweigh risks and should have little clinical impact. Therefore, IUD insertion timing should be based on individual desire for IUD contraception and patient convenience to assure an IUD insertion can occur. Careful follow-up of individuals at higher risk of uterine perforation is warranted.



科研资讯(站内):

  1. 最新!2022年影响因子预测,6月数据

  2. 重磅!2022年影响因子正式发布!抢先看

  3. 中国惊现首例猴痘!密接19人!一文看懂猴痘传播途径和预防措施..

  4. 2022年医保谈判,3图预测

  5. 定了!这些地区,取消常态化核酸检测

  6. 医护人员支援核酸采样的补贴怎么补,谁来补?文件来了!..

  7. 北京发布最新消息:部分餐厅停止堂食!还有这些堂食、外卖新规定..

  8. 重磅!首个国家医学中心建设项目实质落地

百度浏览   来源 : 医微客   


版权声明:本网站所有注明来源“医微客”的文字、图片和音视频资料,版权均属于医微客所有,非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源:”医微客”。本网所有转载文章系出于传递更多信息之目的,且明确注明来源和作者,转载仅作观点分享,版权归原作者所有。不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。 本站拥有对此声明的最终解释权。

科研搜索(百度):医学科研





评论区

注册或登后即可发表评论

登录注册

全部评论(0)

没有更多评论了哦~

科研资讯 更多>>
  • 国家自然科学基金委员会监督委员..
  • 自然科学基金委党组成员、副主任..
  • 港媒:中美新冠死亡人数对比令美..
  • 新冠抗体快速检测法了解下?无需..
  • 推荐阅读 更多>>
  • 【热门文献】eGFR和种族能否影响..
  • 【热门文献】俯卧位对COVID-19急..
  • 【热门文献】通过原发性人乳头瘤..
  • 【热门文献】癌症患者是否应接种..
    • 相关阅读
    • 热门专题
    • 推荐期刊
    • 学院课程
    • 中华肿瘤
      期刊级别:北大核心期刊
      发行周期:月刊
      出版地区:北京
      影响因子:1.90
    • 中华医学
      期刊级别:CSCD核心期刊
      发行周期:周刊
      出版地区:北京
      影响因子:0.94
    • 中华骨科
      期刊级别:统计源期刊
      发行周期:半月刊
      出版地区:天津
      影响因子:2.14