背景:国际妇产科联合会(FIGO),与斯里兰卡妇产科学院(SLCOG)合作,2014年发起了一项倡议,将产后即时宫内节育器(PPIUD)服务制度化,作为斯里兰卡产前咨询和分娩室服务的常规部分。在这项研究中,我们通过一项整群随机阶梯式楔形试验评估了6家医院的FIGO-SLCOGPPIUD干预效果.
方法:将六家医院随机分为两组,每组3家。在3个月的基线期之后,对第一组进行干预,而第二组在基线数据收集9个月后接受干预.我们收集了2015年9月至2017年1月在这些医院分娩的39,084名女性的数据。我们进行了意向治疗(ITT)分析,以确定干预对PPIUD咨询和PPIUD选择的影响,根据接受PPIUD的同意,以及PPIUD摄取(递送后插入)。我们还调查了与咨询相关的因素,比如咨询时间和质量,与PPIUD的选择有关。
结果:我们发现干预措施提高了咨询率,从干预前所有医院的平均咨询率为12%,到干预后所有医院的平均咨询率为51%(0.307;95%CI0.148-0.465).相比之下,我们发现干预措施对PPIUD选择的影响不那么稳健和混合,4.1%的女性在干预前选择PPIUD,而9.8%的女性在干预后选择PPIUD(0.027;95%CI0.000-0.054)。
结论:本研究表明,将PPIUD服务纳入产后护理是可行且潜在有效的。同时考虑咨询和选择PPIUD的证据,我们发现,干预措施对接受PPIUD咨询有普遍的积极影响,在较小程度上,关于PPIUD的选择。然而,很明显,干预的效果可以提高,能够满足妇女产后计划生育的需求。
背景:ClinicalTrials.gov,NCT02718222。2016年3月11日注册(追溯注册)。
BACKGROUND: The International Federation of Gynaecology and Obstetrics (
FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this
study, we evaluate the effect of the
FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge
trial.
METHODS: Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD.
RESULTS: We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054).
CONCLUSIONS: This
study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention\'s effectiveness can be improved to be able to meet the demand for postpartum family planning of women.
BACKGROUND: ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).