Chifukwa chimodzi chomwe ntchito ya IUD idakhumudwitsidwa ndi amayi omwe ali ndi nulliparous ikukhudzidwa ndi nkhaŵa za matenda opatsirana m'mimba (PID) ndi kusabereka. Izi zimachokera ku lingaliro lakuti amayi kapena achinyamata omwe sanakhale ndi ana komanso osakwatirana ayenera kuti anali ndi zibwenzi zambiri zogonana, kuziika pa chiopsezo chachikulu cha matenda opatsirana pogonana.
Kuonjezera apo, kufufuza kwa IUD m'ma 1970 ndi 1980 kunali kosokoneza ndi kusocheretsa. Maphunzirowa analetsa akazi kuti asagwiritse ntchito IUD chifukwa adanena kuti pID yawonjezeka ndi amayi oposa 60% omwe amagwiritsira ntchito IUDs. Komabe maphunzirowa analibe magulu oyerekeza bwino (mwachitsanzo, iwo sankawerengera mbiri ya PID, njira zina zowonetsera amayi kapena amayi omwe ali pachiopsezo chachikulu chotenga PID). Anagwiritsanso ntchito njira zowonetsera zopanda pake.
Kafukufuku wopangidwa bwino omwe amagwiritsira ntchito njira zowonjezera zowononga deta apeza kuti palibe kuwonjezeka kwakukulu kwa chiopsezo cha PID ndi kugwiritsa ntchito IUD .
IUDs ndi PID
Matenda a kutupa thupi (PID) amatanthauza matenda omwe amachititsa kutupa kwa chiberekero, mazira kapena mazira. Zomwe zimayambitsa PID ndi mabakiteriya opatsirana pogonana chlamydia ndi gonorrhea. Kugwiritsira ntchito kondomu ( wamwamuna kapena wamkazi ) pa nthawi yogonana kungathandize kuteteza kupewa kutenga matenda.
Kafukufuku amasonyeza kuti chiŵerengero cha PID pakati pa amayi omwe amagwiritsa ntchito IUDs ndi otsika kwambiri komanso chogwirizana ndi chiwerengero cha PID chiwerengero cha anthu ambiri.
Zomwe zikunenedwa, zikuwoneka kuti pali mgwirizano pakati pa ntchito ya IUD ndi matenda otupa pamimba poyerekezera ndi amayi omwe sagwiritsa ntchito njira iliyonse yoberekera .
Umboni mu mabukuwo, akufotokoza kuti chiopsezo choterechi cha PID sichigwirizana ndi ntchito yogwiritsira ntchito IUD; M'malo mwake, zimakhudzana ndi mabakiteriya omwe alipo panthawi ya kuika . Pambuyo pa mwezi woyamba wogwiritsira ntchito (masiku pafupifupi 20), chiopsezo cha PID sichiri choposa kuposa cha amayi omwe sagwiritsa ntchito IUDs. Kafukufuku watsimikizira kuti kuipitsidwa kwa mabakiteriya kumayanjanitsidwa ndi ndondomeko yowonjezera kuyambitsa matenda ndi chifukwa cha matenda, osati ndondomeko yoyenera.
Ngakhale kuti deta ndi yosagwirizana, zikuwoneka kuti kugwiritsa ntchito Mirena IUD (poyerekezera ndi ParaGard IUD ) kungachepetse chiopsezo cha PID. Zikuganiziridwa kuti progestin levonorgestrel mu mankhwalawa amachititsa kuti kanseri ya kervical isakanike, kusintha kwa endometrial ndi kuchepetsa kuchepa kwa msambo (pamene kusamba kwa magazi kumalowa mu mazira) ndipo kuti izi zikhoza kuteteza kuteteza matenda.
IUDs ndi Infertility
Chimodzi mwa zifukwa zomwe zimayambitsa kusabereka ndi kubisa kwa tubal. Pafupifupi milioni 1 milandu yosabereka ndi chifukwa cha tubal matenda. Ngati sanasamalidwe, PID ikhoza kuyambitsa kutupa ndi kutseka kosatha kwa miyendo ya falsipian. Zikuwoneka kuti palibe umboni wosonyeza kuti kugwiritsira ntchito mankhwalawa kumagwirizana ndi kusabereka kwa mtsogolo.
Kafukufuku amasonyeza kuti kugwiritsiridwa ntchito koyambirira kapena kugwiritsidwa ntchito koyambirira kwa IUD sikugwirizana ndi chiopsezo chowonjezeka cha kutseka kwa tubal. Zotsatira zochokera kwa amayi osapitirira malire, omwe amachititsa kuti azimayi 1,895 azikhala ndi matenda oyambirira a tubal infertility (kugwiritsa ntchito magulu angapo olamulira kuti achepetse kukonda - kuphatikizapo amayi omwe ali ndi ubereki chifukwa cha kutsekedwa kwa tubal, amayi osabereka omwe sankakhala ndi mimba komanso amayi omwe ali ndi pakati nthawi yoyamba), yasonyezedwa:
- Kugwiritsiridwa ntchito koyambirira kwa mkuwa wamtundu (monga ParaGard), poyerekeza ndi amayi omwe sanagwiritsidwe ntchito koyambirira, sikunagwirizane ndi chiopsezo chowonjezeka cha kutsekedwa kwa tubal.
- Akazi omwe amagonana nawo pogonana amagwiritsa ntchito makondomu ali ndi chiwopsezo chochepa cha 50% chokhala ndi chifuwa chachikulu kuposa omwe sanagwiritse ntchito njira zoberekera.
- Kutalika kwa ntchito ya IUD, kuchotsedwa kwa IUD chifukwa cha zotsatira zake ndi / kapena mbiri ya zizindikiro panthawi yogwiritsira ntchito mankhwala osagwiritsidwa ntchito poyendetsa magazi sikunagwirizane ndi chiopsezo chowonjezeka cha kutseka kwa tubal.
Mu Scientific Group yofufuza, bungwe la World Health Organization linkadandaula ndi anthu ambiri kuti kugwiritsira ntchito mankhwalawa kunagwirizanitsidwa ndi chiopsezo chachikulu cha PID ndi kubereka kwa tubal. Mapeto awo amavomereza ndi mabuku omwe alipo omwe mavuto omwe amapezeka mu kafukufuku wakale adayambitsa chiopsezo cha PID chokhudzana ndi PID kuti chiwonetsedwe. WHO imanenanso kuti palibe chiopsezo chowonjezeka cha kusabereka pakati pa ogwiritsira ntchito a IUD amene ali okhazikika, ogonana okhaokha.
Ndipotu, zomwe kafukufukuyo amasonyeza ndizakuti kusabereka (chifukwa cha kutsekera kwa tubal) kungakhale kochokera ku matenda opatsirana pogonana osati ochokera ku IUDs. Kafukufuku amasonyeza kupezeka kwa ma antibodies a chlamydia azimayi akugwirizana ndi kutseka kwa tubal. Thupi limapangitsa tizilombo toyambitsa matenda kuti tipewe matendawa. Mankhwalawa amatsalira m'magazi ngakhale kamodzi kokha kachilombo kamatuluka. Kafukufuku wapeza kuti kukhalapo kwa chlamydia antibody molondola kumalosera kuti patha nthawi 62 peresenti, pomwe kusapezeka kwa chlamydia antibody kuneneratu kuti kutaya kwa tubal sikuwonongeke 90 peresenti. Zingatheke kunena kuti kusabereka kumene kumachitika mutagwiritsira ntchito IUD sikukugwirizana ndi ndondomeko yeniyeni - kuti kusabereka kungakhale koyambitsa matenda opatsirana pogonana.
Zotsatira za ACOG pa ma IUD ndi matenda opatsirana pogonana
Akuti amayi omwe ali ndi chiopsezo chachikulu pa chiopsezo chachikulu cha matenda opatsirana pogonana (mwachitsanzo, zaka 25 ndi / kapena kukhala ndi zibwenzi zambiri) ayenera kukhala ndi matenda opatsirana pogonana omwe amachita tsiku lomwelo monga kulembedwa kwa IUD. Ngati zotsatira zowunika ndi zabwino, chithandizo chiyenera kuperekedwa ndipo IUD ingasiyidwe m'malo ngati mkaziyo ali ndi thupi. Chiwerengero chachigawo chachiwiri (mwachitsanzo, ubwino wogwiritsira ntchito njira iyi yobweretsera mavuto ambiri) zimaperekedwa kwa amayi omwe ali ndi chiopsezo chowonjezereka cha matenda opatsirana pogonana kapena kupitiriza ntchito ya IUD mwa amayi omwe amapezeka kuti ali ndi matenda a chlamydia kapena gonorrhea ndipo amachizidwa ndi mankhwala oyenera a antibiotic.
Gawo la magawo atatu (ie, zovuta kapena zovomerezeka zomwe zimapangitsa kuti zikhale bwino) zimagwiritsidwa ntchito kwa amayi omwe ali ndi chiopsezo chachikulu chodziwika ndi matendawa kapena chlamydia. Azimayi omwe ali ndi matenda a chlamydia kapena gonorrhea panthawi ya kuika IUD amatha kukhala ndi PID kusiyana ndi amayi opanda matenda opatsirana pogonana. Komabe ngakhale kwa amayi omwe ali ndi matenda opatsirana pogonana osatengeredwa panthawi yomwe alowe, chiopsezochi chimawonekere kuti n'chochepa. Chiopsezo chachikulu chokhala ndi PID chinali chochepa kwa magulu onsewa (0-5% kwa omwe ali ndi matenda opatsirana pogonana pamene aikidwapo, ndi 0-2% kwa omwe alibe matenda).
Azimayi omwe ali ndi chiwerewere chachibadwa chosamalidwa kapena matenda ovomerezeka a chlamydia kapena gonorrhea ayenera kuchiritsidwa asanatuluke. Kwa amayi amene anapeza matenda a chlamydia kapena gonorrhea, ACOG ndi Centers for Disease Control and Prevention amalimbikitsa kuyesedwa mobwerezabwereza patatha miyezi itatu kapena sikisi asanayambe kulemba.
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