| Objectives: Abortion and the high rate of repeat abortion remain as a major social challenge in China. Accidental pregnancy and abortions are major causes of serious social, health, psychological, and financial burden on women. It is common that many women of childbearing age resume ovulation in short time after receiving abortion. Thus if no sufficient contraceptive measures taken, it is likely to lead to pregnancy again. Moreover, the cervix becomes more relaxed right after abortion surgery, and it is easy to operate IUD. The curettage creates an aseptic environment, in which it reduces the pain that a patient has to suffer. At the same time it also release the patient’s tension and anxiety.IUD has less interference on the body, acting on only partial, is a safe, effective, convenient, economical, reversible contraception. It is easy to be accepted by the majority of women of childbearing age. IUD accounts for 40% of contraception. In addition to contraceptive effect by the common intrauterine device(IUD), Levonorgestrel-releasing intrauterine system(LNG-IUS) works by constantly releasing low-dose contraceptive intrauterine. It avoids repeated continuous medications, and reduces the impact of the whole body system. At present, our hospital is applying the Levonorgestrel intrauterine system(Mirena) LNG-IUS(containing levonorgestrel 52 mg / a) produced by German Bayer Pharmaceutical Specialist. Mirena is an effective contraceptive method providing for long, efficient, safe and reversible birth control; the effective rate is up to 99.8%- similar to the rate of female sterilization.This paper studies the different clinical effects of placing both placing Mirena and IUD immediately after abortion surgery. In detail, this paper is to compare the two intrauterine devices from three levels by analyzing the clinical effects of follow-up data from the belt pregnancy, vaginal bleeding patterns, lost or descending rate, side effects incidence after placement, including prolonged menstrual periods, increased menstrual flow, waist pain, amenorrhea or oligomenorrhea, irregular vaginal bleeding. It aims to provide strong support for clinicians to address the problem of which intrauterine devices should be placed after abortion surgery, and also to offer ideas for clinicians as well as patients on the choosing of correct intrauterine devices. I believe it will eventually minimize the chance of unintended pregnancies and reduce the pain and side effects that women have to suffer.Methods:1 The subjects of this study are female patients suffer intrauterine pregnancy, and voluntarily receive IUD treatment immediately after abortion surgery. In the 20-43 year-old age(average age 32.6), received preoperative ultrasound test, routine vaginal examination, pelvic examination, blood tests, the professional physicians applied visual manual vacuum aspiration or curettage, use digitized B-uterine surgery detected by ultrasound-guided to remove the non-bleeding, endometrial totally unorganized scrape residue, no pelvic infection, genital malformations and tumors, no cervix or too loose uterine prolapse, not a variety of more serious systemic chronic disease contraindications, to follow-up with those who are willing to accept the Mirena or copper IUD insertion, respectively. Mirena is produced by Bayer. The two groups were compared, and the results were statistically analyzed. 2 Follow-up 2.1 method of follow-up: invited review of paitients with came back for outpatient or telephone follow-up. 2.1 content of follow-up: conducted follow-up visits to the subjects who voluntarily accept insertion of either Mirena or copper IUD in total 12 months. All subjects who were placed Mirena and copper IUD came back for outpatient or telephone follow-up review at the month of 1st, 3rd, 6th, 12 th. Follow-up review includes the subjects complaints, gynecological examination, routine vaginal examination, transvaginal ultrasound, view the uterus situation and check if the intrauterine device is in the normal position. Focused area: whether wear the device; if fall off or descending; and side effects, including prolonged menstrual periods, increased menstrual flow, waist pain, amenorrhea or oligomenorrhea, irregular vaginal bleeding. The subjects are to receive proper and timely treatment if vaginal bleeding, abdominal pain, fever and discomfort are spotted. The unified forms are to be filled up by appointed personnel. 2.2 Major KPIs for follow-up visits ① whether wear the devices; if the devices fall off or descending; ② ③side effects, including prolonged menstrual periods, increased menstrual flow, waist pain, amenorrhea or oligomenorrhea, irregular vaginal bleeding. 3 Exclusion criteria: the patients who are prone to organized residues, pelvic infections, genital malformations and tumors, loose cervix or uterine prolapse; drug users who are affected blood clotting mechanisms, gestational history, history of ectopic pregnancy, a variety of severe chronic diseases such as systemic contraindications; patients who are not cooperative, and other intrauterine device placement contraindications. 4 Grouping: a total of two groups, one group(No.1) wearing Mirena, 56 subjects in this group;And the other(Group No.2) wearing copper IUD, with the number of 60 subjects in this group. 5 Statistical analysis: Statistical analysis was performed using SPSS17.0 software; the results of two groups were compared using chi-square test; P <0.05 was considered statistically significant.Results:1 Both Group No.1 subjects who wear Mirena and Group No.2 subjects who wear copper surface IUD shows first month pregnancy rate 0, which is believed highly due to prohibition of sex life after surgery and contraception concerns. Group No.1 subjects who wear Mirena shows lower pregnancy rate than Group No.2 subjects who wear were copper IUD, in the 3rd, 6th and 12 th month; the difference is statistically significant(P<0.05). 2 In terms of devices fall off or descending rate, while Group No.1 subjects who wear Mirena shows lower rate than Group No.2 subjects who wear were copper IUD in the 1st and 3rd months, the difference is not statistically significant(P >0.05). The difference between 2 groups in the 6th and 12 th month is statistically significant(P <0.05). 3 From side effects point of view- the incidence of prolonged menstrual period, the increase in menstrual flow, amenorrhea or oligomenorrhea – the difference between 2 groups in all three items are statistically significant(P <0.05). The difference in waist pain is not statistically significant(P > 0.05). Group No.1 subjects who wear Mirena shows no difference the incidence of vaginal bleeding irregularities, compared to Group No.2 subjects who wear copper IUD in the 1st and 3rd months, the difference is not statistically significant(P >0.05). The difference between 2 groups in the 6th and 12 th month is statistically significant(P <0.05).Conclusions:1 Wearing Mirena immediately after abortion surgery has better contraceptive effect is better than normal copper IUD. 2 From long-term viewpoint, wearing Mirena immediately after abortion surgery has less chance to fall off or descend than normal copper IUD. 3 In terms of the incidence of prolonged menstrual period, the increase in menstrual flow, amenorrhea or oligomenorrhea, wearing Mirena shows better effect than wearing copper IUD. Mirena has better performance(lower score) than copper IUD in terms of the incidence of prolonged menstrual period, and the increase in menstrual flow. Meanwhile, the difference in waist pain is not statistically significant. Mirena shows no prominent advantage over copper IUD. The main side effect of Mirena is amenorrhea or oligomenorrhea, the occurrence rate is higher than copper IUD. Both Group No.1 subjects who wear Mirena and Group No.2 subjects who wear copper IUD have vaginal bleeding irregularities, Group No.1 subjects who wear Mirena performs better as times goes on. |
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