剖宫产妇女术中放置宫内节育器及时避孕的可行性及其危险因素分析

熊莉芳 谢琴 李景环

【摘要】 目的：探討剖宫产妇女术中放置宫内节育器（IUD）及时避孕的可行性及其危险因素分析。方法：选取2017年1月-2018年1月在本院行剖宫产的妇女80例，依据是否在术中放置IUD分为对照组（n=25）与研究组（n=55），对照组未在术中放置IUD，研究组在剖宫产术中放置IUD。观察两组在住院期间的24 h平均阴道出血量、恶露持续时长及产褥感染发生情况;比较两组产后随访期间发生意外妊娠的情况;观察研究组在随访期间的不良反应发生情况;分析影响研究组发生不良停用的相关危险因素。结果：两组的24 h平均阴道出血量、恶露持续时长及产褥感染发生率比较，差异均无统计学意义（P>0.05）;随访期间，研究组意外妊娠率3.6%（2/55）明显低于对照组的36.0%（9/25），差异有统计学意义（字2=4.594，P<0.05）;研究组在随访期间未出现IUD脱落的现象;有4例（7.3%）将IUD取出，全部因症取出，包括腰腹痛2例，经量过多、经期延长2例。logistic回归分析结果提示，患者年龄、子宫位置及劳动强度是影响IUD发生不良停用的独立危险因素（P<0.05）。结论：在剖宫产术中放置IUD安全性高，避孕效果确切;患者年龄、子宫位置及劳动强度是影响宫内节育器发生不良停用的独立危险因素。

【关键词】 剖宫产; 宫内节育器; 避孕; 危险因素

【Abstract】 Objective：To explore the feasibility and risk factors of timely contraception by placeing intrauterine device（IUD）during cesarean section for women.Method：80 women underwent cesarean section in our hospital from January 2017 to January 2018 were selected and divided into control group（n=25）and research group（n=55）according to whether or not IUD was placed during the operation.The control group was not placed intraoperative IUD，while the research group was placed IUD during the cesarean section.24 h average amount of vaginal bleeding，duration of lochia and the incidence of puerperal infection of hospitalization in the two groups were observed.The occurrence of unexpected pregnancy during postpartum follow-up in the two groups were compared.The adverse reactions of the research group during the follow-up period were observed.The risk factors of adverse discontinuation in the research group were analyzed.Result：There were no significant difference in 24 h average vaginal bleeding volume，duration of lochia and incidence of puerperal infection between the two groups（P>0.05）.During follow-up，the rate of unexpected pregnancy in the research group was 3.6%（2/55）significantly lower than 36.0%（9/25）in the control group，the difference was statistically significant（字2=4.594，P<0.05）.The research group during the follow-up period was without IUD detachment.There were 4 cases（7.3%）with IUD removed，all of them were due to symptoms，including 2 cases of lumbago and abdominal pain，2 cases of excessive menstruation and prolonged menstruation.Logistic regression analysis showed that age，uterine position and labor intensity were independent risk factors for the occurrence of adverse cessation of IUD（P<0.05）.Conclusion：IUD placement during cesarean section is safe and effective，age，uterine position and labor intensity are independent risk factors for the occurrence of adverse cessation of intrauterine devices.

【Key words】 Cesarean section; IUD; Contraception; Risk factors

First-authors address：Luohu District Maternal and Child Health Care Hospital，Shenzhen 518000，China

doi：10.3969/j.issn.1674-4985.2019.17.030

随着临床中剖宫产率的逐年升高及国家在生育政策方面的不断调整，使得临床中瘢痕子宫比例也不断增加[1]。瘢痕子宫如果不能进行有效避孕，十分容易出现瘢痕子宫妊娠的现象。这种妊娠方式易导致女性在妊娠过程中出现胎盘植入，情况严重的甚至会导致子宫破裂，切除子宫，使得妇女彻底丧失生育能力。吉娜宫内节育器（IUD）是专门为手术过程中即时放置而特别设计的一种节育器，在剖宮产手术过程中放置IUD，能够使妇女得到高效、长期且安全的避孕保护，到目前为止，依然是我国临床相关节育措施中最常用的一种节育方式[2-3]。相关实践研究证实，在成功置入IUD之后会出现各种不良反应，对育龄妇女的身心健康产生严重危害，对IUD的正常使用产生影响[4]。为探……