Esinye isizathu sokuthi ukusetshenziswa kwe- IUD kuye kwadonswa abesifazane besifazane abangenalutho ngokuphathelene nokukhathazeka ngengozi yezifo ezivuthayo zesikhumba (PID) nokungabi nabantwana. Lokhu kusekelwe ekutheni abesifazane noma abasha abangabantwana nabangashadile kungenzeka ukuthi babe nabalingani abaningi bezocansi, ababeka engozini enkulu yokutheleleka ngegciwane lesandulela ngculazi (i-STI).
Ukwengeza, ucwaningo lwe-IUD eminyakeni yama-1970 no-1980 lwaludideka futhi ludukisa. Lezi zifundo zavimbela abesifazane ukuba basebenzise ama-IUD ngoba bathi inhlekelele ye-PID yanda okungenani ngamaphesenti angama-60 kubesifazane abasebenzisa i-IUDs. Kodwa lezi zifundo azizange zibe namaqembu afanisa ukuqhathanisa (isibonelo, azizange azilandele umlando we-PID, ezinye izindlela zokulawula ukubeletha noma labo besifazane abangase babe engozini enkulu yokuthuthukisa i-PID). Basebenzisa nezindlela zokuhlaziywa ezingcolile.
Ucwaningo olwakhelwe kahle olusebenzisa izindlela eziningi zokuhlaziywa kwedatha lithole ukuthi akukho ukwanda okuphawulekayo engozini ye-PID ngokusetshenziswa kwe-IUD .
IUDs kanye ne-PID
Izifo ezivuvukala ngama-pelvic (PID) zibhekisela ekutheleleni okubangela ukuvuvukala kwesibindi sesisu, ama-tublopian tubes noma ama-ovaries. Izimbangela ezivame kakhulu ze-PID yi-bacteria chlamydia ne-gonorrhea. Ukusebenzisa ikhondomu ( owesilisa noma owesifazane ) ngesikhathi socansi kungasiza ekuvikeleni ekubhekaneni nesifo.
Ucwaningo lwembula ukuthi izimo ze-PID phakathi kwabesifazane abasebenzisa i-IUD ziphansi kakhulu futhi zihambisana nezilinganiso zesehlakalo se-PID kubantu abaningi.
Lokho kuthiwa, kubonakala sengathi kukhona ubudlelwane phakathi kokusetshenziswa kwe-IUD nesifo sokuvuvukala kwe-pelvic uma kuqhathaniswa nabesifazane abangasebenzisi noma yikuphi ukukhulelwa kwemithi .
Ubufakazi ezincwadini, noma kunjalo, uchaza ukuthi le nengozi eyanda kakhulu ye-PID ayihlobene nokusetshenziswa kwangempela kwe-IUD; Kunalokho, kuhlobene namabhaktheriya akhona ngesikhathi sokufakwa kwe- IUD . Emva kwenyanga yokuqala yokusebenzisa (cishe izinsuku ezingu-20), ingozi ye-PID ayikho ngaphezu kwabesifazane abangasebenzisi i-IUDs. Ngakho-ke ucwaningo luphetha ngokuthi ukungcoliswa kwamagciwane okuhambisana nenqubo yokufaka i-IUD kuyimbangela yokutheleleka, hhayi i-IUD ngokwayo.
Nakuba idatha ingavumelani, kubonakala sengathi ukusetshenziswa kweMirena IUD (uma kuqhathaniswa ne- ParaGard IUD ) kunganciphisa ingozi ye-PID. Kucatshangwa ukuthi i-progestin levonorgestrel kule-IUD ibangele ukwanda komlomo wesibeletho, ukuguqulwa kwe-endometri kanye nokunciphisa kwe-retrograde esikhathini (lapho igazi lokuya esikhathini lingena emathangeni ase-fallopian) nokuthi lezi zimo zingase zibe nomthelela wokuvikela ekutheleleni.
IUDs kanye nokungenzi lutho
Esinye sezimbangela ezivamile zokungabi nalutho kungukuvimba kwe-tubal. Cishe izigidi ezingu-1 zezigameko zokungakhulelwa zibangelwa isifo sohubhu. Uma kushiywe kungalashwa, i-PID ingabangela ukuvuvukala nokuvinjelwa unomphela kwamathebhu we-fallopian. Kubonakala sengathi abukho ubufakazi bokuthi ukusetshenziswa kwe-IUD kuhlotshaniswa nokungazelelwe esikhathini esizayo.
Ukucwaninga kubonisa ukuthi ukusetshenziswa kwangaphambilini noma ukusetshenziswa kwamanje kwe-IUD akuhlotshaniswa nobungozi obandayo bokungena kwe-tubal. Imiphumela evela ekutadisheni okungenakuqhathaniswa, kokulawulwa kwezicabha kwabesifazane abangu-1 895 abane-tubal infertility eyinhloko (besebenzisa amaqembu amaningana okulawula ukunciphisa ubandlululo - kuhlanganise nabesifazane abanesifo ngenxa yokungavimba kwe-tubal, abesifazane abangenalutho abangenayo ukuvinjelwa kwe-tubal nabesifazane abakhulelwe okokuqala), kubonisiwe:
- Ukusetshenziswa kwangaphambilini kwe-IUDs yethusi (njenge-ParaGard), uma kuqhathaniswa nabesifazane abangenakho ukusetshenziswa kokuqala kokukhulelwa, akuzange kuhlotshaniswe nengozi eyengeziwe yokuvinjelwa kwe-tubal.
- Abesifazane abalingani babo bobulili basebenzisa amakhondomu babe nengozi engaphansi kuka-50% yokuvinjelwa kwe-tubal kunelabo abangasebenzanga ukukhulelwa.
- Isikhathi eside eside sokusetshenziswa kwe-IUD, ukususwa kwe-IUD ngenxa yemiphumela emibi kanye / noma umlando wezimpawu ngesikhathi sokusetshenziswa kwe-IUD akuhlobene nokufaka ingozi yokukhushulwa kwe-tubal.
Ekuhloleni kwabo kweScientific Group, i-World Health Organization yayikhathazekile ngokukhathazeka komphakathi jikelele ukuthi ukusetshenziswa kwe-IUD kwakuxhunywe engozini engakhuphuka ye-PID ne-tubal infertility. Isiphetho sabo sivumelana nezincwadi ezisekhona ukuthi izinkinga zendlela yokucwaninga ekuqaleni zenze ukuba ingozi ehambisana ne-IUD ye-PID ibukezwe. U-WHO uphinde wathi akukho nengozi yokukhulelwa phakathi kwabasebenzisi be-IUD abanobudlelwane obuqinile, obuphathelene nobulili.
Eqinisweni, lokho ucwaningo lubonisa ukuthi ukungabi nalutho (ngenxa yokuvinjelwa kwe-tubal) cishe kuyoba umphumela kusuka ku-STI hhayi ku-IUDs. Izifundo zibonisa ukuthi kukhona ama-anti-chlamydia antibodies abesilisa abathintekayo nokuvinjelwa kwe-tubal. Umzimba wenza ama-antibodies lapho evezwa kubhaktheriya e-chlamydia ukusiza ukulwa nalesi sifo. Ama-antibodies ahlala egazini ngisho nalapho ukutheleleka kususiwe. Ucwaningo luye lwabona ukuthi ukutholakala kwe-chlamydia antibody ngokunembile kubikezela ukuthi ukutholakala kwe-tubal kutholakala ngamaphesenti angama-62 ngesikhathi, kanti ukungabi khona kwe-chlamydia antibody kubikezela ukuthi ukulahlekelwa kwe-tubal kungabi khona isikhathi esingama-90% sesikhathi. Kungaphetha ngokuthi ukungabi nalutho okwenzeka ngemuva kokusebenzisa i-IUD akuhlangene neze ne-IUD - ukuthi ukungabi namuntu kungenzeka ukuthi kubangelwa i-STI engalashwa.
I-ACOG Imihlahlandlela kuma-IUD naku-STIs
Kunconywa ukuthi abesifazane abangenalutho abasengozini enkulu ye-STIs (okungukuthi, abaneminyaka engama-25 ubudala kanye / noma nabalingani abaningi bezocansi) kufanele babe nokuhlolwa kwe-STI okwenziwa ngosuku olufanayo njengokufakwa kwe-IUD. Uma imiphumela yokuhlolwa ihamba kahle, ukwelashwa kumele kuhlinzekwe futhi i-IUD ingasala endaweni uma owesifazane engacabangi. Isilinganiso sesi-2 (okungukuthi, izinzuzo zokusebenzisa le ndlela yokukhulelwa ngokuvamile zidlula izingozi) kunikezwa owesifazane onengozini eyengeziwe ye-STIs noma ukuqhubeka nokusetshenziswa kwe-IUD owesifazane owathola ukuthi une-chlamydia noma i- gonorrhea ukutheleleka bese ephathwa imithi yokwelapha efanelekile.
Ukuhlukaniswa kwesigaba 3 (okungukuthi, izingozi ezingokwemvelo noma ezifakazelwe zivame kakhulu ngaphezu kwezinzuzo zokusebenzisa indlela) kusetshenziselwa abesifazane abanengozi enkulu kakhulu yokutholakala ne-gonorrhea noma i-chlamydia. Abesifazane abane-chlamydia noma igonorrhea ukutheleleka ngesikhathi sokufakwa kwe-IUD banamathuba amaningi okuthuthukisa i-PID kunabesifazane abangenayo i-STI. Kodwa ngisho nakwabesifazane abanesifo sofuba esingelashwa ngesikhathi sokufaka, lokhu kubungozi kubonakala kuncane. Ingozi enkulu yokuthuthukisa i-PID yayiphansi kumaqembu amabili (0-5% kulabo abanezifo ezingculaza uma i-IUD ingeniswa, futhi i-0-2% kulabo abangenayo igciwane).
Abesifazane abanomkhuhlane ongavamile wamagciwane noma amacala aqinisekisiwe okuthiwa i-chlamydia noma i-gonorrhea kufanele aphathwe ngaphambi kokuba i-IUD ingeniswe. Kulabo besifazane abathola ukuxilongwa kwe- chlamydia noma i-gonorrhea, i-ACOG kanye namaCentral for Disease Control and Prevention batusa ukuhlolwa okuphindwe ezinyangeni ezintathu kuya kweziyisithupha ngaphambi kokufaka i-IUD.
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