剖宫产术中放置宫内节育器安全性及有效性的系统评价和Meta分析  

Systematic review and Meta analysis of the safety and effectiveness of intrauterine device placement during cesarean section

作　　者：吕永焕[1] 冯丽珍 侯成祯 张雪松 刘燕萍 顾向应[1] Lü Yonghuan;FENG Lizhen;HOU Chengzhen;ZHANG Xuesong;LIU Yanping;GU Xiangying(Department of Obstetrics and Gynaecology,General Hospital of Tianjin Medical University,Tianjin 300052,P.R.China)

机构地区：[1]天津医科大学总医院妇产科,天津300052

出　　处：《中国计划生育和妇产科》2020年第11期70-77,共8页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的系统评价剖宫产术中放置宫内节育器(intrauterine device,IUD)的安全性及有效性。方法检索PubMed、Embase、Cochrane图书馆、维普、CNKI、万方数据库、中国生物医学文献数据库,发表时间自1966年1月至2019年12月所有与剖宫产术中放置IUD相关的研究,其观察组为剖宫产术中胎儿胎盘娩出后立即放置IUD组,对照组为剖宫产术中及术后1年内不放置IUD组,及剖宫产术后6个月放置IUD组。对纳入的文献进行资料提取和质量评价,使用RevMan 5.3软件进行Meta分析。结果共纳入文献22篇,其中3篇文献为随机对照试验(randomized controlled trial,RCT),其余均未能随机。干预措施包括剖宫产术中放置IUD及剖宫产术后6个月放置IUD。剖宫产术中放置IUD与不放置IUD相比明显增加了手术时间,差异有统计学意义(MD=1.3,95%CI:0.23-2.36,P=0.02),剖宫产术中放置IUD与不放置IUD相比增加了产后恶露持续时间,差异有统计学意义(MD=0.17,95%CI:0.01-0.34,P=0.03)。两组间术中和术后出血量(术中出血量MD=-2.58,95%CI:-6.21-1.06,P=0.16;产后2 h出血量MD=2.35,95%CI:-5.31-10.02,P=0.55;产后24 h出血量MD=3.64,95%CI:-1.14-8.43,P=0.14)、产褥感染发生率(OR=1.1,95%CI:0.57-2.11,P=0.78)比较,差异均无统计学意义。剖宫产术中放置IUD与术后6个月放置IUD相比,1年随访带器妊娠发生率(OR=0.93,95%CI:0.25-3.42,P=0.91)、IUD脱落发生率(OR=0.96,95%CI:0.36-2.52,P=0.93)、因症取出发生率(OR=0.38,95%CI:0.1-1.48,P=0.16)、月经改变发生率(OR=0.45,95%CI:0.17-1.23,P=0.12)差异均无统计学意义。结论剖宫产术中胎盘娩出后放置IUD是安全有效的,虽然因剖宫产术中放置IUD导致手术时间延长,恶露持续时间延长,但并不增加术中和术后出血量及产褥感染发生率,对患者无明显影响。放置IUD后随访1年,带器妊娠率、IUD脱落率及因症取出率均在允许范围。Objective Systematic evaluation of the safety and effectiveness of intrauterine device(intrauterine device,IUD)during cesarean section.Methods We searched PubMed,Embase,Cochrane Library,Weipu,CNKI,Wanfang Database,Chinese Biomedical Literature Database,published from January 1966 to December 2019 for all studies related to IUD placement during cesarean section.The observation group was the group with IUD placed immediately after the fetal placenta was delivered during cesarean section,and the control group was the group with no IUD placed during and 1 year after cesarean section,or the group with IUD placed 6 months after cesarean section.Data extraction and quality evaluation were performed on the included literature,and RevMan 5.3 software was used for Meta analysis.Results A total of 22 articles were included,of which 3 articles were randomized controlled trials(RCT),and the others were not randomized.Interventions include IUD placement during cesarean section and IUD placement 6 months after cesarean section.IUD placement during cesarean section significantly increased the operation time compared with no IUD placement,and the difference was statistically significant(MD=1.3,95%CI:0.23-2.36,P=0.02).IUD placement during cesarean section was compared with No IUD placement significantly increased the duration of postpartum lochia,and the difference was statistically significant(MD=0.17,95%CI:0.01-0.34,P=0.03).Intraoperative and postoperative blood loss between the two groups(intraoperative blood loss MD=-2.58,95%CI:-6.21-1.06,P=0.16;2h postpartum blood loss MD=2.35,95%CI:-5.31-10.02,P=0.55;24h postpartum bleeding MD=3.64,95%CI:-1.14-8.43,P=0.14),the incidence of puerperal infection(OR=1.1,95%CI:0.57-2.11,P=0.78)No statistical significance.Compared with the placement of IUD during cesarean section,the incidence of pregnancy with a device during the 1-year follow-up(OR=0.93,95%CI:0.25-3.42,P=0.91)and the incidence of IUD shedding(OR=0.96,95%CI:0.36-2.52,P=0.93),incidence of removal due to symptoms(OR=0.38,95%CI:0.1-

关 键 词：宫内节育器 剖宫产 产后避孕 避孕 

分 类 号：R719.8[医药卫生—妇产科学] R169.41[医药卫生—临床医学]