剖宫产术中放置宫内节育器观察

目的：探讨剖宫产妇女术中放置宫内节育器（IUD）及时避孕的可行性。方法：选择正常足月宫内妊娠，剖宫产分娩，术中放置IUD妇女100例为观察组；选择同期入院，剖宫产分娩，未放置IUD妇女100例做为对照组；观察2组在院期间产后24 h出血量、产褥病率、血性恶露持续时间及42 d复查子宫复旧情况；并进行1年随访，观察IUD的续用率。结果：观察组与对照组产后24 h出血量、产褥病率、血性恶露持续时间差异无统计学意义（P＞0.05）。观察组随访期间，有1例IUD脱落，无因妊娠、月经量多或其他不适而终止使用者。结论：剖宫产术后放置IUD安全、有效，值得临床推广。     

剖宫产术中同时放置MCuⅡ宫内节育器效果分析

目的:探讨剖宫产妇女术中放置MCuⅡ功能性IUD的避孕效果。方法:选择正常足月宫内妊娠行剖宫产术分娩的妇女,分为A组(120例)术中放置IUD;B组(120例)术中未放置IUD;C组(120例)术后6个月放置IUD。观察A组和B组术中及术后的出血量、产褥病率、血性恶露持续时间及产后42d子宫复旧情况;A组和C组术后1年的月经周期、月经量及经期持续时间,术后带器副反应、IUD的异位率及脱落率、带器妊娠率。结果:A组与B组术中及术后的出血量、产褥病率、血性恶露持续时间及产后42d子宫复旧情况差异无统计学意义(P0.05);A组与C组月经周期、月经量及经期持续时间、带器副反应、IUD的异位率及脱落率、带器妊娠率等差异均无统计学意义(P0.05)。结论:剖宫产术中放置MCuⅡ功能性IUD安全、有效,值得临床推广。     

产后即时放置吉娜宫内节育器临床使用效果的meat评价

目的:比较研究产后即时放置吉娜宫内节育器(IUD)与产后未放置IUD或放置其他类型IUD的临床效果.方法:计算机检索中文数据库CNKI(2002～2013)、CBMdisc(2002～ 2013)、万方(2002～ 2013)、维普(2002～ 2013),纳入有关吉娜IUD临床随机或临床对照试验研究,然后采用RevMan 5.0软件进行meta分析.结果:共检索到367篇文献,根据纳入排除标准,最终纳入11篇已发表文献.结果:剖宫产后即时放置吉娜IUD与未即时放置IUD相比较,均未发现放置吉娜对产时、产后2h和24 h出血量以及恶露持续时间,术后产褥病发生率,子宫内膜炎的发生有影响.与胎盘娩出后同期放置Fix TCu220M IUD相比,吉娜组的不适主诉率(9.6％)明显低于Fix TCu220M组(P＜0.05).剖宫产后即时放置吉娜IUD与剖宫产后6个月放置TCu380 IUD比较,随访12个月时,吉娜组月经异常发生率和腰腹痛发生率均低于TCu380组(P＜0.05).结论:产后即时放置吉娜IUD不会对产妇的产后恢复造成不良影响,其无支架的设计能够有效减少副反应的发生.     

产后即时放置吉娜宫内节育器临床使用效果的meta评价

目的:比较研究产后即时放置吉娜宫内节育器(IUD)与产后未放置IUD或放置其他类型IUD的临床效果。方法:计算机检索中文数据库CNKI(2002~2013)、CBMdisc(2002~2013)、万方(2002~2013)、维普(2002~2013),纳入有关吉娜IUD临床随机或临床对照试验研究,然后采用RevMan 5.0软件进行meta分析。结果:共检索到367篇文献,根据纳入排除标准,最终纳入11篇已发表文献。结果:剖宫产后即时放置吉娜IUD与未即时放置IUD相比较,均未发现放置吉娜对产时、产后2h和24h出血量以及恶露持续时间,术后产褥病发生率,子宫内膜炎的发生有影响。与胎盘娩出后同期放置Fix TCu220MIUD相比,吉娜组的不适主诉率(9.6%)明显低于Fix TCu220M组(P0.05)。剖宫产后即时放置吉娜IUD与剖宫产后6个月放置TCu380IUD比较,随访12个月时,吉娜组月经异常发生率和腰腹痛发生率均低于TCu380组(P0.05)。结论:产后即时放置吉娜IUD不会对产妇的产后恢复造成不良影响,其无支架的设计能够有效减少副反应的发生。     

剖宫产术中放置GeneFex-IUD73例临床观察

目的:探讨剖宫产时放置GeneFex-IUD对产后出血、血性恶露及产后子宫内膜炎的影响。方法:以剖宫产术中放置GeneFex-IUD者为放器组73例,剖宫产术中未放置IUD者为对照组78例。分别记录两组术中、产后2 h、产后24 h的出血量与产后血性恶露持续时间及产后子宫内膜炎的发生率。结果:剖宫产术中、产后2 h、产后24 h的出血量,子宫内膜炎的发生率及血性恶露持续时间两组间差异无显著性(P>0.05)。结论:GeneFex-IUD对产后出血、产褥感染及血性恶露持续时间无明显影响,具有较好的安全性,是产后立即避孕的一种较好方法。     

不同时期放置宫内节育器的临床效果及副反应初步观察

以前瞻性方法研究不同时期放置宫内节育器(IUD)250例,包括产后即时156例,剖宫产即时60例,产后30～90天32例及中期妊娠引产清宫后2例。随机抽取同期年龄、胎产次、产程和产科情况相似的未放置(IUD)100例产妇作对照,随访一年进行近期产科并发症、避孕效果及副反应观察,随访率100％。结果表明:不同时期置器无一例发生产科并发症和感染,产后出血发生率在产后即时组为0.64％,对照组1％,两组比较无显著性差异(P>0.05);产后恶露天数在产后即时组平均为34天,对照组30天;剖宫产即时组平均38天,对照组33天,以上两项两组比较均无显著性差异(P>0.05)。两组哺乳量及月经恢复时间也基本相似。放置后1,3,6,12个月时每百妇女净累积续用率分别为产后即时组99.36％,96.79％,92.95％,92.95％;剖宫产即时组98.33％,98.33％,98.33％,98.33％。产后即时组6个月时妊娠1例,剖宫产即时组无一例妊娠。主要副反应以月经过多、淋漓不净较多见,3个月时的发生率与12个月时比较有显著性差异P<0.05),而且经对症处理可缓解,无一例因症取出IUD。     

剖宫产与经阴道分娩对早期子宫复旧的影响

目的分析比较剖宫产与经阴道分娩方式对产妇产后子宫复旧的影响。方法分别随机抽取天津市和平区南市街社区卫生服务中心2016年1-10月产后42 d门诊经阴道分娩和剖宫产分娩的两组产妇各100例,观察两组产妇产后子宫宫底下降情况、恶露排出情况,并对这两组产妇的结果进行比较分析。结果阴道产组产后恶露持续时间≤42 d产妇比例明显高于剖宫产组,42 d产妇比例明显低于剖宫产组,差异有统计学意义(P0.05);阴道产组产妇的术后子宫复旧情况明显优于剖宫产组,差异有统计学意义(P0.05)。结论经阴道分娩相对于剖宫产而言更有利于子宫复旧,有助于降低产后子宫复旧不良的发生率,值得临床推广应用。     

缩短产时放置IUD产后恶露时间的研究

目的:研究产后及时清除脱落宫腔的肥厚蜕膜对产后即时放置IUD的影响。方法:健康产妇胎盘娩出后,随机分为清除蜕膜组和未清除脱膜组并放置宫内节育器。选择同期、同等条件健康产妇为对照组,对产后恶露持续时间、宫腔感染、IUD脱落情况及非意愿妊娠率进行观察随访。结果:产时放置IUD不增加宫腔感染;IUD脱落率与放置正确与否及宫腔大小有关;恶露持续时间延长的原因是多方面的。结论:产后及时清除脱落宫腔肥厚蜕膜可以缩短恶露时间,对IPPI具有推动作用。     

剖宫产术中放置吉娜宫内节育器的临床应用

剖宫产术后避孕是一难题,剖宫产后再次妊娠,无论是终止还是继续,都要承担高并发症的风险。减少剖宫产后意外妊娠的发生已成为临床医生关注的重点。依据国际国内产后及流产后避孕指南,结合吉娜宫内节育器(IUD)具有独特的设计,重点阐述剖宫产术中放置吉娜固定式宫内节育器(Gyne Fix PP IUD)的可行性和安全性,同时描述了患者的选择、放置方法、注意事项及本技术的应用前景。剖宫产术中即时放置吉娜IUD安全性高,避孕效果可靠,具有脱落率低,不良反应少等优点,为临床医生和剖宫产妇女选择适宜的避孕措施提供指导。     

益诺胶囊用于负压吸宫术及分娩后的疗效观察

目的:探讨益诺胶囊用于人工流产负压吸宫术、剖宫产及阴道分娩后的临床疗效。方法:将186例行负压吸宫术流产妇女随机分为观察组和对照组,观察组术后即开始口服益诺胶囊0.64g,Bid,疗程6d,对照组未服用该药,随访至流产后第一次月经来潮。观察并比较两组的阴道出血量、出血持续时间、月经恢复时间及盆腔感染发生率。将248例剖宫产者、202例阴道分娩者分别随机分为观察组和对照组,两观察组均在产后第1天开始口服益诺胶囊0.64g,Bid,疗程8d,并联合缩宫素应用,对照组在产后仅给予缩宫素,随访至产后42d。观察并比较剖宫产及阴道分娩各自观察组与对照组在分娩后恶露持续时间、产褥感染的发生率、产后5d子宫底下降平均速度及产后10d宫腔积液的情况。结果:负压吸宫术观察组术后阴道出血量、出血持续时间及盆腔感染的发生率小于对照组(P0.05),与对照组月经恢复时间比较无差异(P0.05)。剖宫产及阴道分娩观察组产后恶露持续时间、宫腔积液及产褥感染的发生率均小于对照组,产后5d宫底下降速度大于对照组(均P0.05)。结论:人工流产负压吸宫术、剖宫产及阴道分娩后口服益诺胶囊,有促进子宫复旧和防治感染的作用,值得在临床上探索应用。     

Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study

BackgroundImmediate postplacental insertion of intrauterine devices (IUDs) during cesarean delivery could reduce a substantial barrier to access to long-term effective contraception. Initiating IUD use prior to discharge from the hospital postpartum eliminates a 6-week postpartum waiting period and an additional office visit.Study DesignThis was a prospective cohort study of 90 patients undergoing cesarean delivery. After delivery of the placenta, a copper T380A IUD was inserted into the endometrial cavity through the incision. The study participants were followed up at 6 weeks and 6 months postpartum. This study was conducted at the Weiler Division of the Montefiore Medical Center and at the Jacobi Medical Center in the Bronx, NY.ResultsForty-three (48%) women returned for their 6-week follow-up visits, and among those, no expulsions were recorded. Forty-two (47%) women were reached for phone follow-up at 6 months postpartum, and 80% reported being “happy” or “very happy” with their IUD.ConclusionsImmediate postplacental IUD insertion at the time of cesarean delivery is safe and acceptable.     

双氯芬酸钾用于预防放置宫内节育器疼痛的临床研究

目的:观察双氯芬酸钾用于预防放置宫内节育器(IUD)所致疼痛的效果。方法:随机选取经剖宫产分娩后和阴道分娩后的两组妇女各100例,两组分别放置宫铜200IUD和TCu380IUD:剖宫产分娩后放置宫铜200IUD的妇女49例(观察组24例,对照组25例),放置TCu380IUD的妇女51例(观察组26例,对照组25例)。阴道分娩后放置宫铜200IUD的妇女50例(观察组和对照组各25例),放置TCu380IUD的妇女50例(观察组和对照组各25例)。观察双氯芬酸钾在置器术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前预防疼痛的效果及服药的副反应等。结果:阴道分娩后置器的妇女,观察组和对照组在术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前的疼痛分级差异均无统计学意义(P>0.05)。剖宫产分娩后放置宫铜200IUD的妇女,观察组和对照组比较,在术中及术后第3日晚睡前疼痛分级差异有统计学意义(P<0.05);放置TCu380IUD的妇女,观察组和对照组术后30min的疼痛分级差异有统计学意义(P<0.05)。结论:双氯芬酸钾用于预防剖宫产分娩后放置IUD所致疼痛有一定的效果,但未发现其能预防阴道分娩后放置IUD所致的疼痛。     

Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section

Background

An intrauterine device (IUD) is an effective reversible form of contraception. We determined the efficacy and safety of immediate postplacental IUD insertion during cesarean section.

Study Design

Two hundred forty-five women with term pregnancies delivering by cesarean section between September 2006 and December 2007 were included in the study. A copper IUD (TCu 380A) was inserted using a ring forceps within 10 min of removing the placenta. The participants were examined before hospital discharge and at 6 weeks, 6 months and 12 months postpartum.

Results

None of the patients were lost to follow-up. There was one case of an unplanned pregnancy (0.4%). There were no serious complications associated with immediate IUD insertion during cesarean section. The cumulative rates of expulsion, removal for bleeding/pain and other medical reasons were 17.6, 8.2 and 2.4 per 100 women per year, respectively. The continuation rates were 81.6% and 62% at 6 and 12 months, respectively.

Conclusion

Immediate postplacental IUD insertion during cesarean section provides adequate protection against pregnancy. However, greater than one fourth of the participants discontinued IUD use due to spontaneous expulsion or other medical reasons.     

西安高校教工产后非意愿妊娠及相关因素调查

目的：调查西安高校教职工初产妇产后非意愿妊娠率和结局,以及避孕知识、需求及方法选择情况,为制定干预措施提供依据。方法采用自行设计的问卷,选择西安市4所非医学类本科高校教职工中2014年11月至2015年10月分娩的初产妇,于产后42天进行问卷调查其避孕知识与态度,于产后1年电话随访其避孕方法和非意愿妊娠情况,并进行分析。结果该时间段内分娩的初产妇共计277例,有效随访率为95．7％;调查对象对宫内节育器和安全套避孕法知晓率接近100％,但安全套正确用法知晓率仅为39．6％,其它避孕方法知晓率不足80％;对口服避孕药避孕法和口服药物紧急避孕混淆率高达77．7％;对自然分娩和剖宫产后放置宫内节育器的时间及哺乳期避孕法了解不足10％;绝大多数被调查者表示需要医务人员指导产后避孕知识;被调查者产后1年内意外妊娠率为9．4％。结论西安高校教职工初产妇产后避孕知识及方法认知水平较低且不全面,产后1年内意外妊娠发生率高达9．4％。多数初产妇对医务人员指导产后避孕知识需求迫切。医院、社区妇保及计划生育部门应加大健康教育指导水平和力度。     

Intrauterine device insertion during the postpartum period: a systematic review

Background

Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications.

Methods

We searched Medline, Lilacs and Cochrane Collaboration databases for articles in any language, between database inception until December 2008, which compared outcomes of postpartum IUD insertion time intervals. Search terms included postpartum, puerperium, postcesarean delivery, cesarean section, IUD(s), IUCD(s), intrauterine device(s) and insertion.

Results

From 297 articles, we identified 15 for inclusion in this review: all studies examined the outcomes from copper IUD insertions within the postpartum time period compared to other time intervals or compared routes (vaginal or via hysterotomy) of postpartum insertion. No studies of levonorgestrel IUDs were identified.Immediate IUD insertion (within 10 min of placental delivery) was safe when compared with later postpartum time periods and interval insertion. Immediate postpartum IUD insertion demonstrated lower expulsion rates when compared with delayed postpartum insertion but with higher rates than interval insertion. Immediate insertion following cesarean delivery demonstrated lower expulsion rates than immediate insertion following vaginal delivery.

Conclusion

Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications.     

胎盘娩出后立即放置两种固定IUD临床效果比较性研究

本文对两种新型固定式宫内节育器(Fix-TCu220-M和GyneFix PP)在阴道产或剖腹产胎盘娩出后立即放置后,进行42天,6,12个月时临床妊娠率、脱落率、因症取出率的比较性研究。结果显示Fix-TCu220-M组妊娠率为0.32％,脱落率为0.64％,因症取出率为1.92％;GyneFixPP组分别为0,1.96％和0。由此可见,脱落率GyneFix PP组稍高于Fix-TCU220-M组;出血、疼痛取出率后者稍高于前者。但此两种新型固定式宫内节育器在阴道产或剖腹产后立即放置,其避孕效果一致,皆优于其它类型的宫内节育器,为值得推荐之新型产后避孕器具。     

哺乳期妇女放置宫形Cu300IUD初步临床观察

为观察宫形Cu300IUD在哺乳期妇女中的临床使用效果,接收经阴道分娩42天后,剖宫产6个月后的健康妇女690例,采用内藏式放置器放置宫形Cu300IUD,随访12个月,随访率99.9％。结果显示在使用12个月时累积妊娠率0.74/百妇女,脱落率0.89/百妇女,因出血取出率1.17/百妇女,无术后近期因出血取出者,继续使用率为97.22/百妇女。结论:宫形Cu300IUD作为一种哺乳期避孕工具是安全、有效和可接受的。当月经恢复后,宫形Cu300IUD仍能适应子宫变化,继续存放,不需取出。     

Postplacental insertion of the levonorgestrel intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial

Objective

This trial was designed to compare levonorgestrel intrauterine device (LNG-IUD) use at 1 year after delivery between women randomized to postplacental insertion at the time of cesarean delivery and delayed insertion 4–8 weeks after delivery.

Study design

This randomized controlled trial was conducted at two urban medical centers. Eligible pregnant women with planned cesarean deliveries were randomized to immediate postplacental insertion during cesarean or delayed insertion after 4–8 weeks. We used intention-to-treat analysis for the primary outcome of LNG-IUD use 12 months after delivery.

Results

Forty-two women were randomized, 20 into the postplacental group and 22 in the delayed group. Although confirmed use of the LNG-IUD 12 months after delivery was higher in the postplacental group (60.0% vs. 40.9%, p=.35), this difference was not statistically significance. Expulsion was significantly more common in the postplacental group (20.0% vs. 0%, p=.04). There were significant differences between the two sites in baseline population characteristics, follow-up and expulsion. The trial did not answer the intended question as it was halted early due to slow enrollment.

Conclusions

Our results show higher expulsion after postplacental insertion compared to delayed insertion but suggest similar IUD use at 12 months. Moreover, it provides valuable lessons regarding a randomized controlled trial of postplacental LNG-IUD placement due to the challenges of estimating effect size and the nature of the population who might benefit from immediate insertion.

Implications

Postplacental insertion of an IUD may improve use of highly effective contraception during the postpartum period. While our results suggest higher expulsion after postplacental insertion compared to delayed insertion and similar IUD use at 12 months, our trial was insufficient to definitively test our hypothesis.