Objective To evaluate the effectiveness of TCu380AIUD comparing with other common IUDs. Methods CBMDISC (1979 to 2005), Wanfang (1994 to 2005), CNKI (1974 to 2005), CMCC (1979 to 2005), CMAC (1994 to 2005), EMbase (1974 to 2004), MEDLINE (1974 to 2005), WHO/RHL (2004 to 2005), The Cochrane Library (Issue 4, 2004), SCI (1985 to 2005), POPLINE (1966 to 2003) and 9 relevant journals were searched for randomized controlled trials (RCTs) comparing TCu380AIUD with other common IUDs. The quality of included trials was critically appraised. RevMan4.2.7 software was used for statistical analysis. Results Fifteen published studies involving 20 417 participants were included. The results of meta-analyses were expressed with OR (cumulative expulsion rate, cumulative pregnancy rate, cumulative rate of removing for medical reasons) and 95% CI. Compared with TCu380A, TCu220C resulted in lower cumulative expulsion rate at 0.5 and 1 year of follow-up [OR 0.36 (0.18 to 0.70); 0.44 (0.31 to 0.62), respectively], higher cumulative pregnancy rate at ten years of follow-up [1.22 (1.04 to 1.43)], lower cumulative rate of removing for medical reasons at 0.5 year of follow-up [0.59 (0.36 to 0.97)]; MLCu375 resulted in higher cumulative expulsion rate at 1 year of follow-up [2.17 (1.29 to 3.67)], higher cumulative pregnancy rate at 1 and 2 years of follow-up [1.72 (1.18 to 2.50); 1.28 (1.02 to 1.60)]; UCD300 resulted in lower cumulative expulsion rate at five years of follow-up [0.38 (0.27 to 0.56)]; Medicated Gamma 380IUD resulted in lower cumulative rate of removing for medical reasons at 1 year of follow-up [0.31 (0.14 to 0.70)]. Conclusions Compared with TCu380A which is considered as a standard of IUDs, the performance of TCu220C is inferior in contraception, but TCu220C is also a good IUD in performance; The overall clinical performance of MLCu375IUD was as good as that of TCu380A; UCD300 is of the characteristic of lower cumulative expulsion rate; Medicated Gamma 380IUD can decrease side effects effectively. However, larger multi-center randomized comparative trials with longer follow-up periods are needed to confirm the conclusion
Objective To evaluate the effectiveness of Medicated γ-IUD compared with other IUDs for contraception. Methods CBMdisc （1986 -2005）, VIP （1989 -2005） , CNKI （1994-2005） , The Cochrane Library （Issue 4, 2005 ） and 10 related journals were searched for randomized controlled trials （R.CTs） and quasi-randomized controlled trials （quasi-RCTs） on the comparison between γ-IUD and other IUDs. The quality of included trials was critically appraised. RevMan 4.2.8 software was used for statistical analysis. Results Ten published studies with 8 381 participants were included. The results of meta-analysis were expressed with Peto OR （ cumulative pregnancy rate, cumulative expulsion rate, cumulative rate of removing for medical reasons） or OIL （ cumulative continuation rate ） and 95% CI. Compared with MSSR-165, Medicated γ-25,200 resulted in lower pregnancy rate at 1, 2, 3 years of follow-up [ with the OR （95% CI） 0. 31 （0.15,0.64） , 0. 31 （0. 17,0.54） , 0. 31 （0.19,0. 51） , respectively], lower cumulative expulsion rate in5 year follow-up [0.26 （0.17,0.40）, 0.28 （0.20,0.41）, 0.30 （0.21,0.42）, 0.29 （0.19,0.44）, 0.32 （0.21, 0. 48 ）, respectively], lower cumulative rate of removing for medical reasons.after 4 year follow-up [0.57 （0.36,0. 92 ） ], and higher rate of cunmlative continuation in 5 years of follow-up 13.35 （ 2.29,4.89 ） , 2.76 （ 2.06,3, 69 ） , 2.41 （1.89,3.08）, 2.22 （1.69,2.91）, 1.99 （1.55,2.55）, respectively]. Compared with TCu220, Medicated γ-25,200 resulted in lower cumulative pregnancy rate after follow-up 2, 3 years [ 0.46 （0.25 ,0.87 ） ; 0.48 （0.27,0. 85 ） ], lower cumulative expulsion rate after 1 year follow-up [ 0. 58 （0.35,0.97） ] , lower cumulative rate of being removed for medical reasons in5 year follow-up [0.37 （0.23,0.59）, 0.38 （0.26,0.56）, 0.45 （0.32,0.64）, 0.47 （0.30,0.73）, 0.58 （0.39,0.87）, respectively ] and higher rate of cumulative continuation in 5 years of follow-up [ 2. 15 （ 1.61,2.87 ）, 2.02 （ 1.56,2.63）, 1.72 （ 1.34,2.20）, 1.44 （ 1.08,1.91 ）, 1, 39 （ 1.07,1.80）, respectively]. Compared with Uterus-Cu, Medicated γ-25,200 resulted in higher rate of cumulative continuation after follow-up 1 year [ 0.51 （0.34, 0.77） ]. Compared with MLCu375, Medicated γ-25,200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation after follow-up for 3 years [ 0. 22 （0.09,0.52） , 2.84 （ 1.64,4. 94 ）]. Compared with TCu380A, Medicated γ-25, 200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation in follow-up for 2 years [ 0.36 （ 0.18,0.73 ）, 0.29 （ 0. 12,0.70 ） ; 3.06 （ 1.72,5.44）, 3.61 （1.75,7.47） ]. Conclusions Available evidence shows that Medicated γ-IUD has better or equal effectiveness when compared with other IUDs. However, more RCTs with high quality and longer follow up period are needed to confirm the conclusion.
Objective To explore the relationship between macro-economic indicators and incidences of adverse events linked to intrauterine devices (IUDs). Methods Data on IUD-associated adverse events were collected from a cohort study conducted between September 2005 and December 2006. Regional economic data were from the 2006 National Economic and Social Development Statistical Bulletins and Statistical Yearbooks of various regions. A total of 20,220 IUD users in 236 towns in Jiangsu, Shanghai, Guangdong, Anhui, Sichuan, and Chongqing provinces in China were included in this study. Linear correlation and regression analyses were used to analyze the relationships between regional income and total incidences of adverse events, incidences of mild adverse events, and incidences of severe adverse events. Results Incidences of total adverse events and mild adverse events were positively correlated with regional economic level (rs=0.336, Plt;0.05; rs=0.272, Plt;0.05), while incidences of severe adverse events were not correlated with regional economic level. Conclusions The positive relationship between regional economic level and reported IUD-associated mild adverse events likely reflects income-related disparities in women seeking care and receiving treatment for mild adverse events. This points to a need to improve both public health education and the quality of health services, particularly in poorer areas.
Objective To establish a risk evaluation indicator system for intrauterine device (IUD), to determine the weight of indicators, to comprehensively evaluate the risk of IUDs by using a variety of comprehensive evaluation methods according to the data of IUDs, so as to provide references for the government purchasing decision-making. Methods The literature review, long-term monitoring of IUD adverse events, large sample randomized controlled trials (RCTs) and Delphi methods were applied to establish the risk evaluation indicator system for IUD. The weight of each indicator was determined by jointly using the subjective scoring method and CRITIC method. Based on the established indicator system, primary research (RCT) data and secondary research data (literature data), the analytic hierarchy process (AHP), technique for order preference by similarity to ideal solution (TOPSIS) and synthetical scored method were used to assess the risk of IUDs respectively, and then the assessment results of three methods were integrated to obtain a comprehensive rank of various IUDs. Results A two-level risk evaluation indicator system for IUD was established and the seven 1st level indicators included unwanted pregnancy, expulsion, menstruation problems, pain, IUD ectopia, position and shape changes as well as total health problems, which were divided into 26 2nd level indicators. Through the subjective and objective weighting method, the weights of each 1st level indicator were 0.147 5, 0.144 3, 0.140 7, 0.174 8, 0.163 2, 0.132 8, and 0.096 6, respectively. The risk evaluation of the above three methods showed that among the three kinds of IUD in a multicenter RCT, yuangong365 was with the lowest risk, followed by TCu380A and MLCu375. The risk evaluation showed that among the 14 kinds of IUD from literatures, medicated γ IUD was with the lowest risk, followed by HCu280, yuangong365, and Gyne IUD, while the medicated stainless steel ring 165 was with the highest risk. Conclusion The established indicator system has a good representation and credibility, and the ways to identify the weight of indicators are scientific, comprehensive and accurate. Meanwhile, the findings which were demonstrated by various assessing methods are consistent to a large extent. Now that medicated γ IUD and HCu280 have been already included in the National Coverage Plan, it is suggested that if the prices of yuangong365 and Gyne IUD are reasonable, the two IUDs could be considered to be listed in the National Coverage Plan and freely chosen by women of child-bearing age.
目的:探讨宫内节育器(IUD)异位的临床诊治方法。方法:对37例宫内节育器异位的临床资料进行回顾性分析。结果:所有37例IUD异位者均经宫、腹腔镜取器成功。结论:及时诊断并通过宫腹腔镜取器直观、安全、微创、有效。
ObjectiveTo systematically review the efficacy of 10 commonly used intrauterine devices (IUD) by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, POPLINE, CNKI, WanFang Data, SinoMed, CMCI, ChiCTR databases and websites were electronically searched to collect randomized clinical trials (RCTs) on efficacy of 10 IUDs from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using WinBUGS 1.4.3 software and Stata 13.0 software.ResultsA total of 67 RCTs involving 59 991 IUD users were included. The results of network meta-analysis indicated that after 1 year of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165 and MLCu375, and its effectiveness ranked second out of ten IUDs (SUCRA=77.1%). YCu200 had a lower pregnancy rate than that of TCu220C, which ranked third (SUCRA=71.5%). After 2 years of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A and OCu165, which had the highest probability to be the most effective intervention (SUCRA=92.1%). YCu200 had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165, GCu200, GammaCu and MLCu375, and its effectiveness ranked second (SUCRA=81.2%).ConclusionsCurrent evidence shows that the risk of pregnancy of GyneFix and YCu200 are lower at 1 and 2 years of use, which suggests they possess superior short-term effectiveness. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.