提供有关宫内避孕的国家临床指南。
使用Pubmed和Cochrane库对现有文献进行了系统综述。美国人,英国和加拿大的指导方针也得到了考虑。
宫内避孕(IUC)显示出广泛的适应症,包括青少年,未产,艾滋病患者(B级)和有异位妊娠史的妇女(C级)。对于患有IUC(B级)的女性,不应修改宫颈癌筛查。插入器械前必须进行双手检查和宫颈检查(B级)。患者在插入装置之前不应系统地进行性传播感染(STI)筛查(B级)。应优选在插入前进行STI筛查,但可在无症状女性(B级)插入器械时进行。在插入前不建议进行常规抗生素预防和术前用药(A级)。插入后几周可能会进行后续访问(专业共识)。插入装置后不推荐常规盆腔超声检查(B级)。在IUC患者中,计划外出血,当持续或伴有骨盆疼痛时,需要进一步调查以排除并发症(专业协议)。可疑的子宫穿孔需要进行放射学检查以找到设备(专业共识)。从腹腔选择性取出宫内节育器应首选腹腔镜方法(专业共识)。在宫内节育器原位意外怀孕的情况下,应排除异位妊娠(B级)。在可行和期望的宫内妊娠的情况下,如果可以到达字符串(C级),建议移除宫内节育器。在无症状的宫内避孕患者的子宫颈抹片检查中检测到放线菌样生物不需要进一步干预(B级)。在STI或盆腔炎(B级)的情况下,不建议立即取出宫内节育器。在48至72小时的适当治疗(B级)后,在没有临床改善的情况下,应考虑移除设备。
宫内避孕是一种长效、可逆的避孕方法,疗效好,延续率高。相比之下,并发症发生率低。因此,它应该提供给未产和多产妇女。
To provide national clinical
guidelines focusing on intrauterine contraception.
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian
guidelines were considered as well.
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional
consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional
consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional
consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.