Chimwe chikonzero icho kushandisa IUD chave chichiderera mumadzimai asina hupombwe kune chokuita nekufunganya pamusoro pengozi yepachivi inoputira chirwere (PID) uye kuberekwa. Izvi zvinoenderana nekufungidzira kuti vakadzi kana vechidiki vasina vana uye vasina kuroorana vangangodaro vane hutano hwakanaka hwepabonde, vachivaisa pangozi yakanyanya yehutachiona hwepabonde (STI).
Uyezve, kutsvakurudza kweIUD muma1970 ne1980 kwakange kuchivhiringidza nekutsausa. Zvidzidzo izvi zvakadzivisa vakadzi kubva kushandiswa kweIUDs nokuti vaiti pID ngozi yakawedzera nekusvika 60% muvakadzi vakashandisa IUDs. Asi izvi zvidzidzo zvaisava nemaonero akaenzanisa mapoka (somuenzaniso, ivo havana kuverenga nhoroondo yePID, dzimwe nzira dzekudzivirira vana kana vakadzi avo vangave vari pangozi yekuwedzera PID). Vakashandisawo nzira dzisina kunaka dzokuongorora.
Tsvakurudzo yakagadziridzwa yakashandiswa inoshandisa nzira dzakawanda dzekuongorora tsvakurudzo dzakawana kuti hapana kuwedzera kukuru mudambudziko rePID neIUD kushandisa.
IUDs uye PID
Chirwere chechipembenene chinoputira (PID) chinoreva kutapurika kunokonzera kuputika kwechibereko chekuberekwa, fallopian tubes kana mavari. Zvikonzero zvinowanzoitika zvePID ndezvipembenene zvepabonde zvepabonde chlamydia uye gonorrhea. Kushandisa kondomu ( mukomana kana mukadzi ) munguva yepabonde kunogona kudzivirira kudzivisa kubata chirwere.
Kutsvakurudza kunoratidza kuti chiitiko chePID pakati pevakadzi vanoshandisa IUDs zvakanyanya kwazvo uye hachienderani nekufungidzirwa kwechiitiko chePID muhuwandu hwevanhu.
Izvo zvataurwa, panoita seine humwe hukama pakati pekushandisa kweIUD uye chirwere chinopisa chepilvic kana ichienzaniswa nevakadzi vasingashandisi chero upi zvake hwepabonde .
Uchapupu huri mumabhuku, zvisinei, hunotsanangura kuti izvi zvinowedzera dambudziko rePID harina kufanana nekushandiswa kweIUD chaiyo; pane kudaro, zvine chokuita nemaabhakitiriya aripo panguva yeIUD kuiswa . Mushure memwedzi wokutanga wekushandiswa (anenge mazuva makumi maviri), njodzi yePID haisi yepamusoro pane yevakadzi vasina kushandisa IUDs. Kutsvakurudza kwave kwakagumisa kuti kusvibiswa kwebhakitiriya kunobatanidza neIUD kuisa maitiro ndiyo chikonzero chekutapukirwa, kwete IUD pachayo.
Kunyange zvazvo dhiyabhorosi zvishoma zvisingabvumirane, zvinoita sokuti kushandiswa kweMirena IUD (kufananidzwa neParaGard IUD ) kunogona kuderedza ngozi yePID. Inofungidzirwa kuti progestin levonorgestrel mune iyi IUD inokonzera kuwedzera kervical mucus, kushanduka kwemazuva ekupedzisira uye kuderedzwa kwemazuva ekudzoka kwemwedzi (apo kunonoka kwemwedzi kunopinda mu fallopian tubes) uye kuti izvi zvinogona kuita kuti kudzivirirwa kunopesana nehutachiona.
IUDs uye Infertility
Chimwe chezvinhu zvinowanzokonzera kusapera ndezvekuvhara tubal. Inenge mamiriyoni ane mamiriyoni ekushaya rubatsiro anokonzerwa nehutal disease. Kana isina kusiyiwa, PID inogona kukonzera kuvhiringidza nekudzivirira zvachose kwe fallopian tubes. Ikoko kunoratidzika kusina humwe uchapupu hwokuti IUD inoshandiswa inobatanidza nekusava nekushaya simba mune ramangwana.
Kutsvakurudza kunoratidza kuti kushandiswa kwekare kana kushandiswa ikozvino kweIUD hakubatanidzi nehuwandu hwehutachidziro hwehutachi. Migumisiro inobva kune imwe isinganzwisisiki, nyaya-yekuongorora yekudzidzira vakadzi 1 895 vane primary tubal infertility (vachishandisa mapoka mashoma ekudzivirira kuti kuderedza kusagadzikana - kusanganisira vakadzi vane hutachiona nekuda kwekuvhara tubal, vakadzi vasina vana vasina kubvisa tubal uye vakadzi vane pamuviri kutanga nguva), yakaratidza:
- Kushandiswa kwemhangura IUDs (kufanana neParaGard), kana ichienzaniswa nevakadzi vasina kubatwa kwepabonde asati asvika , yakanga isingabatanidzi nengozi yakawanda yekuvhara tubal.
- Vakadzi avo vanoita zvepabonde vanoshandisa kondomu vaiva ne50% muchero wepamusoro wekuvhara tubal kupfuura avo vasina kushandisa zvepabonde.
- Nguva yakareba yekushandiswa kweIUD, kubviswa kweIUD pamusana pemigumisiro yakaipa uye / kana nhoroondo yezviratidzo munguva yekushandisa kweIUD yakanga isingabatanidzi nengozi yakawanda yekuvhara tubal.
Mukuongorora kwavo Scientific Group, World Health Organization yainetseka nekutambudzika kwevanhu vakawanda kuti kushandiswa kweUUD kwakabatanidzwa kune inogona kuwedzera mungozi yePID uye tubal kusabereka. Mhedziso yavo inobvumirana nemabhuku akange aripo kuti matambudziko ekugadzirisa mune tsvakurudzo yapfuura yakaita kuti IUD-inobatanidzwa nengozi yePID inofanirwe. WHO inotaurawo kuti hapana kuwedzera kwengozi yekusava nehutano pakati pevashandisi veIUD vanogara vakagadzikana, hukama hwakanaka hwepabonde.
Ichokwadi, izvo zvitsvakurudzo zvinoratidzira ndezvokuti kushaya (nekuda kwekuvhara tubal) kunogona kuva chigumisiro kubva kuTV uye kwete kubva kuIUDs. Zvidzidzo zvinoratidza kuti kuvapo kwechlamydia antibodies muvakadzi kunobatanidza ne tubal kuvhara. Muviri unoita zvirwere zvinorwisana kana zvikaonekwa kune mabhakitiriya e-chlamydia kuti abatsire kurwisa hutachiona. Mishonga inoramba iri muropa iro kunyange kamwechete utachiona hwagadziriswa. Kutsvakurudza kwakawana kuti kuvapo kwechlamydia antibody nenzira yakarurama kunofanotaura kuvepo kwekuvhara tubal 62% yenguva, asi kusina kwechlamydia antibody kunofunga kuti kusavapo kwehutachi kunokanganisa 90% yenguva. Zvinogona kugumiswa kuti kusagadzikana kunoitika mushure mekushandisa kweIUD hakune chokuita neIUD - kusabereka kunogona kunge kwakakonzerwa nehutachiona husina kutenderwa.
ACOG Mirayiridzo pamusoro peIUDs uye zvirwere zvepabonde
Zvinoratidzirwa kuti vakadzi vasingasviki vari pangozi yakawanda yezvirwere zvepabonde (kureva, vane makore makumi maviri nemashanu uye / kana kuva nevarume vakawanda vanoita zvepabonde) vanofanira kuva neHIV kuongororwa kunoitwa zuva rimwechete sekuiswa kweIUD. Kana kuedza kuwanikwa kwakanaka, kurapa kunofanira kugoverwa uye IUD inogona kusara munzvimbo kana mukadzi wacho asina kumira. Chikamu chechipiri chezvikamu (kureva,, kubatsirwa kwekushandisa nzira iyi yekudzivirira inowanzoenderana nematambudziko) kunopiwa mukadzi ane ngozi yakawanda yezvirwere zvepabonde kana kuti kuramba achishandisa IUD mumukadzi akawanikwa ane chirwere chechlamydia kana gonorrhea uye akabatwa mushonga unorwisa maantibiotic.
Chikamu chechitatu chikamu (kureva, njodzi dzedzidziso kana dzakataridzika dzinowanzopfuura zvakanakira kushandisa nzira) inoshandiswa kuvadzimai vane ngozi yakakwirira yega yekutengesa gonorrhea kana chlamydia. Vakadzi vane chlamydia kana gonorrhea hutachiona panguva yeIUD kuiswa kune mikana yekuwedzera PID kupfuura vakadzi vasina HIV. Asi kunyange kuvakadzi vane zvirwere zvepabonde zvisina kutongerwa panguva yekuiswa, ngozi iyi ichiri kuoneka shoma. Mungozi yakakwana yekugadzira PID yakanga yakaderera kumapoka acho ose (0-5% kune avo vane zvirwere zvepabonde apo IUD inowanikwa, uye 0-2% kune avo vasina zvirwere).
Vakadzi vane chirwere chisina kuchena chemukadzi kana nematambudziko anonzi chlamydia kana gonorrhea vanofanira kubatwa vasati vamboiswa IUD. Kune vakadzi vakagamuchira chirwere chechlamydia kana gonorrhea, ACOG uye Centers for Disease Control nekudzivirira zvinorayirazve kudzokorora kuve mwedzi mitatu kusvika kumatanhatu isati yaiswa IUD.
Sources:
American College yezvipfeko uye Gynecologists. "Practice Bulletin # 121 - Kubata-Kubata Kwekuita Zvokudzivirira Kuberekwa: Implants uye Intrauterine Devices." Obstetrics & Gynecology . 2011. 118 (1): 184-196.
Gareen, IF, Greenland, S, & Morgenstern, H. "Intrauterine zvishandiso uye chirwere chinoputira chirwere: Meta-inotsvakurudza yezvidzidzo zvakabudiswa, 1974-1990." Epidemiology. 2000. 1 (5): 589-597.
Grimes, DA. "Intrauterine device uye nepamusoro-genital-tract infection." The Lancet. 2000. 356: 1013-1019.
Hubacher D, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzman-Rodriguez R. "Kushandiswa kwemhangura intrauterine zvishandiso uye njodzi yehutachiona husina hanya pakati pevakadzi vasiri nulligravid." N Engl J Med> 2001. 345: 561-567 .. ..
Mohllajee AP, Curtis KM, Peterson HB. "Kuisa uye kushandiswa kwechigadzirwa chemukati chinowedzera hutachiwana hwehutachiona hwepachivha pakati pevakadzi vane chirwere chepabonde chepabonde here? Kuongorora kwakarongeka. " Kubata pamuviri. 2006. 73: 145-153. Inowanikwa kuburikidza nehurumende yekunyoresa.
WHO. "Nzira yekuita, kuchengeteka uye kubudirira kwezvinhu zve intrauterine: Inyanzvi yehupfumi mutsva 753." Geneva: WHO, 1987.
World Health Organization. "Kurapa kwekurapa kwekushandisa kwekudzivirira kubata pamuviri." 4th ed Geneva: WHO; 2009.