Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study.
Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study.
复制标题
DOI：
10.1186/s40834-021-00153-w
复制
发表时间：
2021-03-02
影响因子：
2.9
通讯作者：
Mugyenyi G
中科院分区：
文献类型：
--
作者：
Muhumuza J;Migisha R;Ngonzi J;Kayondo M;Mugyenyi G
产后宫内节育器（PPIUD）使用是指分娩后但在出生后48小时内放置宫内节育器（IUD）。在乌干达，现代避孕方法的普遍使用率很低，采用宫内节育器作为避孕方法的妇女不到1%。一个重要的限制因素，以增加吸收立即产后宫内节育器插入可能是其脱落率，差异很大。在乌干达，产后期间PPIUD脱落率和与PPIUD脱落相关的因素的文件很少。我们的目的是确定TCu 380 A（铜）宫内节育器的比例，产后6周排出，并确定在乌干达西南部姆巴拉拉地区转诊医院（MRRH）分娩的妇女中排出的风险因素。我们于2014年9月1日至2015年1月31日在MRRH进行了一项前瞻性队列研究。我们对所有参与者进行了结构化问卷调查，以获取有关其基线人口统计学，临床和产科特征的数据。我们随访了接受PPIUD插入的妇女在插入后6周的任何IUD脱落。我们拟合多变量对数二项回归模型，以确定宫内节育器脱落的危险因素。我们招募了167名插入PPIUD的女性。在144名6周后返回随访的妇女中，13名（9%; 95%CI：4.9-15%）妇女的IUD被取出。在多变量模型中，PPIUD脱落的显著危险因素为：IUD放置时间超过产后10 min（aRR 8.1，95%CI 1.26-51.98，p = 0.027）和血性恶露流出≥15 d（aRR 8.5，95%CI 1.47-48.47，p = 0.017）。在MRRH分娩的妇女中，产后宫内节育器的累积脱落率较低，与间隔插入的脱落率相当。分娩至置器时间较长和血性恶露持续时间较长是产后宫内节育器脱落的主要危险因素。应更加重视产后计划生育的产前咨询，以允许胎盘后宫内节育器插入，这与较低的脱落率有关。
Postpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda. We aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. We conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion. We enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9–15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26–51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47–48.47, p = 0.017). The cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.