使用口服避孕药或宫内节育器后的妊娠结果

英国对5,700例孕妇的分析足以论证,先前使用口服避孕药和宫内节育器,并不会增加对妊娠不良作用的危险性,如:流产、宫外孕、死胎、先天畸形、体重减少或者两性比率的改变。从初产妇或经产妇生的婴儿中所选择的先天性畸形资料显示,畸形率和避孕组间的关系,在统计学上无显著差异。虽然服用避孕药而又意外妊娠者不多(总共66人),但结果表明,口服避孕药对子宫产生的有害     

宫外孕妇女的沙眼衣原体感染

近年来宫外孕发病率显著增高,六、七十年代性传播疾病流行的主要后果为宫外孕和输卵管不孕。加拿大七十年代宫外孕发病率增加63%,美国宫外孕数从1970年至1982年增加2.4倍,瑞典和英国也有相似报告。宫外孕病因复杂,除宫内节育器(IUD)和输卵管结扎可能是增加宫外孕危险的     

避孕措施和宫外孕

任何有妊娠可能的妇女,不管其选择的避孕方法为何种,都有发生宫外孕的可能。94～96%的宫外孕发生在输卵管,3～4%在间质部,0.6%在腹腔,0.2～1.7%在卵巢,0.1%在宫颈。1976年美国女性死亡病例中10%为宫外孕。大约每1,000例宫外孕死亡1例。过去15年间曾有人提出过避孕措施特别是宫内节育器(IUD)的使用可能与发生宫外孕有关,近年认为宫外孕发生率的增加可能与IUD的广泛使用有关。宫外孕的发生率:一系列的研究指出宫外孕与分娩之比率为1∶28至1∶270,宫外孕与宫内孕之比率为1∶35至1∶330。宫外孕与许多因素诸如:年龄、孕次、人工流产史、社会经济状况以及民族史有关,宫外孕率随年龄和妊娠而增加。此外,盆腔感染     

宫内节育器与异位妊娠的关系——(附96例异位妊娠临床分析)

<正> 近年来放置宫内节育器后并发异位妊娠率有明显增加趋势,且因放置节育器避孕后而放松警惕或因病史不清,症状不典型。本文就我院1986年3月～1989年3月收治的异位妊娠96例(其中60例系带宫内节育器并发病例)的临床资料进行分析,并对育龄妇女放置宫内节育器避孕的效应提出了值得注意的问题。     

宫外孕唇的生育力

宫外孕对以后的生育力有明显影响,据报告宫外孕术后的宫内妊娠率为36～52%,复发宫外孕的危险为8～16%。近年宫外孕的发生率正在上升,且宫外孕患者中使用宫内节育器(IUD)的数字亦在增加。本文目的是评价宫外孕手术后的生育力,特别着重于现用或曾用IUD者。作者分析了挪威Haukeland医院1979～1983五年中304例宫外孕,与分娩总数之比为1∶54。将患者分为现用IUD组(83例),曾用IUD组(56例)及从未用IUD组(165例)。术后平均观察期限为51月(21～80月)。三组的平均年龄无显著性差异。未用器组的孕次产次明显地较低。曾用器组从取器至宫外孕时间平均间隔13.3月(1～48月),其中60%在取器一年内发生宫外孕。在纠正避孕情     

异位妊娠170例临床分析

异位妊娠１７０例临床分析季惠娣（江苏省海安县人民医院）异位妊娠常因内出血致休克，病情危急，如处理不当，常危及生命。不典型宫外孕常因缺乏特有症状而误诊，延误治疗。近年随着宫内节育器的广泛使用，人们注意到ＩＵＤ与异位妊娠有关。现就１９８４～１９９０年我们...     

2141例使用宫内节育器农村妇女的脱落率及带器妊娠的调查小结

<正> 造成宫内节育器脱落和带器妊娠的因素很多,国内王家光等报道,造成宫内节育器脱落、带器妊娠的主要原因是由于节育器大小和形状与子宫几何形态、大小不相匹配和置器技术尚存在一定问题,从而提出妇女在置器时应进行宫腔测量。李敬之等在分析了70例带器妊娠者中节育器在宫内的位置之后,认为节育器位置下移是导致带器妊娠的主要原因。以上事实充分说明了科学置器和置器技术的重要性。目前,我国农村的育龄妇女中采用宫内节育器避孕比较普遍,这些妇女,特别是山区妇女的劳动强度较大,了解她们节育器使用情况对进一步改进工作有较大意义,为此我们于1983年3～4月间对余杭县三个公社(农村平原区)和桐庐县二个公社(农村山区)的14,739例49周岁以下的育龄妇女进行了回顾性调查,结果如下:     

宫内节育器移位、异位的诊治与预防

宫内节育器移位可导致带器妊娠和节育器脱落。宫内节育器异位不仅可致失败妊娠、脏器损伤、出血和疼痛 ,还可导致取器失败。现将宫内节育器移位、异位的定义和分类、诊断、处理及预防论述如下。1　宫内节育器移位、异位定义和分类1 1　宫内节育器的正常位置应置于子宫底部中央     

放置宫内节育器后异位妊娠患者输卵管超微结构的观察

放置宫内节育器后异位妊娠患者输卵管超微结构的观察郑黎炯张东生放置宫内节育器（ＩＵＤ）是世界上广泛采用的节育措施，我国已有７４００万妇女使用。近年来异位妊娠发生率有上升趋势，放置ＩＵＤ是否会增加异位妊娠，已引起国内外学者的关注。从１９９１年２月至１９９...     

人工流产术后即刻放置宫内节育器的效果

目的 探讨早期妊娠人工流产术后即刻放置宫内节育器的效果。方法 选取2012年9月~2014年1月非洲喀麦隆吉德大区医院放置宫内节育器的育龄妇女80例,根据置环时间分为观察组和对照组,各40例,其中观察组为人工流产术后即刻放置宫内节育器,对照组为下次月经干净后3~7天放置宫内节育器,并于置环后1月、3月和6月月经干净后3~7天随访,观察两组患者的临床效果。结果 比较两组放置宫内节育器的脱落取出、带宫内节育器妊娠、子宫穿孔、不规则阴道出血、术后感染情况,差异无统计学意义(P0.05)。结论 人工流产术后即刻放置宫内节育器安全、有效,值得临床应用。     

Correlation between use of IUD and pelvic inflammatory disease (PID) as independent variables and risk of occurrence of ectopic pregnancy

The relationship between IUD and ectopic pregnancy was evaluated in a study involving 189 controls and 69 women with ectopic pregnancy. The patients involved were between the ages of 18 and 45, sexually active, without previous tubal ligation; they were interviewed about previous pregnancies, diseases, abortions and their socio-economic status. Diagnosis of ectopic pregnancy was made using serum pregnancy tests, needle biopsies of the Douglas pouch and/or ultrasound and/or laparoscope. The results show that there is no statistical difference between patients using the IUD with a history of previous PID and those with previous PID who had never used an IUD; instead, there is a 10-fold risk in women affected by PID, regardless if IUD use. Women who had used an IUD for less than 3 years showed a smaller risk than those who had used the IUD for a greater period of time. Finally there was no difference in women not affected by PID, regardless of IUD use. This ultimately correlates with the notion that one of the mechanisms of action of the IUD consists of an endometrial inflammation as seen in foreign-body reactions.     

Intrauterine devices and extrauterine pregnancy. A literature review

The incidence of ectopic pregnancy has been high over the last decades. Many risk factors are potential causes, among them IUDs use which might have a significant role. According to the current thinking, the use of IUD does not increase the risk of ectopic pregnancy. However, IUDs are more effective in protecting from intrauterine rather than ectopic pregnancy. Our review focuses on current and past IUD use, duration of its use, type of IUD and the associated risk of ectopic pregnancy. Fertility after IUD removal regarding the incidence of ectopic pregnancy is also discussed. Conflicting results regarding the association of ectopic pregnancy risk with the use of intrauterine devices exist.     

IUDs and ectopic pregnancy

Recent data indicate that the number of ectopic pregnancies in the US has quadrupled since 1965, while the frequency has tripled, from 38/100,000 women aged 15-44 in 1965 to 113/100,000 in 1981. The frequency of ectopic pregnancies in Sweden has also increased significantly, while in England and Wales a less marked but still notable increase has also occurred. The finding in the 1970s of a correlation between ectopic pregnancy and IUD use raises questions about the causal factors involved which are addressed in this article through an examination of the relevant literature. It has been noted in previous work that rates of ectopic pregnancy associated with inert or copper IUD use in the US are not different from rates associated with use of barrier contraceptives or in the absence of contraception. Comparison of rates of ectopic pregnancy among women using IUDs with those of women using combined oral contraceptives (OCs) sterilization, or sexually inactive are methodologically questionable. In 1981, the Women's Health Study, a large case control study, demonstrated that current IUD use protected against ectopic pregnancy when the control group was composed of women who had never used an IUD. Current IUD users had a relative risk of .4 when compared with women using no contraception. Users of barrier methods had a relative risk very similar to that of IUD users, while women on OCs had a relative risk of .1. Differences in the rates of ectopic pregnancy among users of barrier methods in England and the US are largely explained by the much higher failure rates of barrier methods in the US. The relative risk of ectopic pregnancy among IUD users was also under 1 in a Swedish study. The single study with data on the relative risk of previous IUD users indicates a relative risk of 1.4 compared to women who never used the IUD, but a risk of about .7 compared to women currently at risk of conception but using no method. The 3 large studies analyzing risk of ectopic pregnancy by duration of IUD use yielded conflicting results and have been challenged on methodological grounds. Supplementary proof of a correlation from prospective studies is needed. Studies of the rates of ectopic pregnancy for different types of IUD are difficult to plan and conduct. In general they indicate that inert and copper devices are not associated with an increased risk, although progesterone-releasing devices elevate the risk significantly. It is concluded that there is no causal relationship between use of a nonmedicated or copper bearing IUD and ectopic pregnancy, although OCs and effective barriers afford better protection against ectopic pregnancy than do IUDs.     

Ectopic pregnancy among past IUD users.

The relationship between return to fertility and pregnancy outcome in women with IUD removal for planned pregnancy as well as the frequency of ectopic pregnancy among all former IUD users in comparison with the general population was studied. The cumulative conception rate in the group of women with IUD removal for planned pregnancy (n = 748) was 93.7% after 5 years, 93.4% being intrauterine and 0.3% ectopic. Rates of ectopic pregnancy in women with IUD removed for planned pregnancy were 2.7/1000 women, 3.6/1000 deliveries and 2.9/1000 pregnancies vs. 3.9, 13.4 and 5.6 in the general population. Only when the number of deliveries is used as denominator, have these differences reached statistical significance (P less than 0.05). Except for bleeding/pain and PID removals (6.0 vs. 3.9), in all other groups of former IUD users the incidence of ectopic pregnancy was also lower than in the control group. From the results of this study it was concluded that former IUD users are not at an increased risk for ectopic pregnancy.     

异位妊娠与IUD关系的探讨(附107例分析)

本文根据我院1984～1990年间62,321妊娠妇女的资料分析,宫内妊娠与异位妊娠的发病率发生了高度显著的变化(P<0.01)。特别是带器异位妊娠与未带器异位妊娠、带器异位妊娠与带器宫内妊娠之间的比例,1990年与1984年相比,差别高度显著(P<0.01),说明带器异位妊娠发病率极显著地上升。进一步对107例带器异位妊娠进行分析,发现与环位异常有一定的关系,经B超测定环位异常者占53%(35/66);且大部分发生在带器1～4年期间(68%);输卵管病理未能证实与炎症有关。指出带器异位妊娠发病率逐年增高,应予重视,与IUD之间的关系仍需进一步探讨。     

Ectopic pregnancy: A case-control study of aetiological risk factors

Summary Aetiological risk factors for ectopic pregnancies were evaluated in a prospective study of 86 consecutive patients with ectopic pregnancy and two age- and parity-matched control groups of women in normal early pregnancy; those with planned pregnancy (65 pairs) and those having legal abortion (51 pairs). Compared with women with planned pregnancy, the patients with ectopic pregnancy more often had an IUD in situ, they had less frequently used hormonal contraception, and they had had more legal abortions, curettages, previous ectopic pregnancies, gynaecological operations and salpingo-oophoritis. Compared with women having legal abortion, the patients with ectopic pregnancy had favoured IUD-usage, or they had been without any contraception, and they had an increased frequency of previous ectopic pregnancies. The frequency of fertility problems was also increased in patients with ectopic pregnancy. Our results show that gynaecological plevic operations, endometrial curettage and evacuation, gynaecological infections, and usage of IUD are important risk factors for ectopic pregnancy, and that infertility seems to be a sign of this risk. In addition, the clinical characteristics of the patients with ectopic pregnancy were similar to those of the patients having legal abortion.     

What we've learned about IUDs from the Women's Health Study

A new look at data from the Women's Health Study, done in 1976-1978, focuses on the outcomes of pelvic inflammatory disease (PID) and its determinants, and ectopic pregnancy, in IUD users. The advantage of this data set is that it does not suffer from bias resulting from the bad publicity that IUDs have since received. 657 cases of PID ascertained by discharge diagnosis were compared to 2566 sexually active controls with non-gynecological conditions. The overall data showed that the Dalkon shield conferred a relative risk of 8.3, and the risk was slightly elevated for Progestasert and Copper-7, compared to women using no method of contraception. Broken down by duration of use, most of the risk was limited to the 1st 4 months of use, and the highest risk was in the 1st month, 3.8. Regarding aspects of sexual behavior, the risks were computed for women claiming only one sexual partner. Single and previously married women had about twice the risk of married or cohabiting women. It is likely that this can be explained by a higher proportion of women whose partners were monogamous among married and cohabiting women, than among single or divorced women. The risk of ectopic pregnancy was 0.4 for IUD and traditional method users, and 0.1 for pill users, compared to non-contracepting women. Thus IUDs put women at a slightly higher risk of ectopic pregnancy, but at a low absolute risk, since they lower the overall change of pregnancy.     

Risk factors for extrauterine pregnancy in women using an intrauterine device

OBJECTIVE: To identify the risk factors for ectopic pregnancy (EP) in women using an intrauterine device (IUD). DESIGN: Case-control study.Setting: Auvergne region (France). PATIENT(S): Women using an IUD and suffering EP (243 cases) or having an intrauterine pregnancy (140 controls). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sociodemographic characteristics, smoking, medical history, and medicines taken before the pregnancy. Type of IUD, duration of use, position and visibility of the thread at diagnosis, and presence of abnormal clinical signs. RESULT(S): Seven factors were associated with an increase in the risk of EP: histories of spontaneous abortion, IUD use, and tubal damage; progesterone IUD at the time of conception; insertion of an IUD during the month following a previous pregnancy; duration of use of the IUD in place at the time of conception; and pelvic pain resulting in medical consultation after the insertion of the IUD. Conversely, five factors were associated with a decrease in the risk of EP: history of treated low genital tract infection; history of contraception using the progestagen pill; use of paracetamol or aspirin before the pregnancy; and displacement of the IUD. CONCLUSION(S): This study suggests that the IUD itself may have an etiological role in EP.     

An investigation of the effects of the intrauterine contraceptive device based on a longitudinal study of a self-selected sample of Barbadian women.

The results of longitudinal study of a self-selected sample of 1,790 Barbadian women who accepted the intrauterine contraceptive device (IUD) as their method of contraception are reported. The accumulated experience of 44,000 woman months of IUD use is presented. The demographic, medical, and obstetric data on admission for 2,797 IUD acceptors and 4,296 nonacceptors are contrasted. The reproductive experience of the two groups prior to the insertion of an IUD with respect to live births, stillbirths, and miscarriages is similar while the incidence of ectopic pregnancy is shown to be different. The association between the IUD and the incidence of tubal pregnancy is evaluated, and the literature dealing with this topic is reviewed. Estimates of the relative risk of an ectopic pregnancy in a woman with an IUD in utero are given.