Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use

Abstract Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterinemalformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p=0.002). Themean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p=0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.

【摘要】 目的：评估产后即时放置宫内节育器（postplacental placement of intrauterine devices, PPIUD）的可接受性、产妇拒绝该措施的原因，以及提升其临床使用率的相关政策建议。
方法：本研究为横断面研究，于巴西圣保罗州坎皮纳斯市坎皮纳斯大学附属医院妇女分院开展。研究为符合纳入标准的分娩入院产妇提供PPIUD放置服务，纳入标准为：无感染、子宫畸形、双胎妊娠及早产情况，且年龄≥18岁。若产妇拒绝该操作，则询问其拒绝原因，并将原因划分为避孕认知误区与其他原因两类。其中，避孕认知误区包括：对操作疼痛、术后出血的恐惧，对避孕失败及未来不孕的担忧。本研究采用双变量分析进行统计学处理。
结果：本研究共邀请241名产妇参与，整体拒绝率为41.9%。其中因避孕认知误区拒绝的案例占所有拒绝案例的50.5%，具体原因依次为：恐惧疼痛（39.9%）、担忧避孕失败（4.9%）、恐惧术后出血（3.9%）、担忧未来不孕（1.9%）；其余拒绝原因占比49.5%。年龄介于18~27岁的产妇，因避孕认知误区拒绝PPIUD的比例更高（67.4%）；而28~43岁的高龄产妇，则更多因其他原因拒绝该服务（63.6%），组间差异具有统计学意义（p=0.002）。因认知误区拒绝PPIUD的产妇平均年龄为27.3±6.4岁，因其他原因拒绝的产妇平均年龄为29.9±5.9岁，组间差异同样具有统计学意义（p=0.017）。
结论：产后即时放置宫内节育器的拒绝率较高，尤其在年轻产妇群体中，且拒绝原因多源于避孕认知误区。因此，需在产前保健环节开展针对性健康教育，向产妇普及避孕知识、生殖健康知识以及非意愿妊娠的相关不良后果。