应用B超对6000例宫内节育器的定位观察

<正> 宫内节育器(简称IUD)的应用是一种常见避孕节育方法。目前我国城乡育龄妇女普遍采用IUD避孕措施,约占所有措施的40％左右。由于放置节育器的数量增多,因失败而受孕者亦增多。为了提高其有效率及继续存放率,及时发现IUD移位、脱落等异常情况,切实做好计划生育的孕前管理,应用B超对IUD的监护是目前较为理想的监测手段。     

宫内节育器致子宫穿孔27例分析

放置宫内节育器(IUD)最严重的并发症是子宫穿孔.国外报道因放置IUD致子宫穿孔的发生率为0.08%[1],国内为0.02%～0.88%[2].天津市中心妇产科医院计划生育科自1993～2007年共收治IUD致子宫穿孔27例,现报告如下.     

B超监测IUD在宫腔内定位与避孕效果分析

<正> 宫内节育器(IUD)是我国应用最广泛的避孕工具,深受广大育龄妇女的欢迎。如何提高IUD在宫腔内的有效存放率,是提高计划生育工作技术水平的关键。B型超声能准确的测出IUD在宫腔内的位置,及时发现IUD下移、脱落等异常情况。我所采用B超对带器妇女进行了监测,分析报告如下。     

三维超声用于宫内节育器检查的研究进展

<正>1宫内节育器的应用状况宫内节育器(IUD)具有简便、长效、可逆、经济和安全等特点,自1957年在我国开展临床研究与应用以来,对于育龄期妇女计划生育、控制人口增长起到极其重要的作用。国家人口计生委2005年对11     

从知情选择项目调查分析有关技术常规执行情况

江苏省避孕节育知情选择开始于 1993年 ,2 0 0 1年起 ,江苏省人口计生委又以项目和工程的运作形式推进 ,力求实现知情选择广覆盖、全过程、高质量的目标要求。宫内节育器 (IUD)是大多数育龄妇女所选用的避孕方法 ,目前全国和江苏省选用IUD的妇女已分别达 1 1亿和 10 0 0万以上。随着时间的推移和计划生育工作的发展 ,选用IUD避孕的妇女还将增加。本文拟结合知情选择项目基线调查和中期评估获得的信息 ,就放置IUD执行有关计划生育技术常规情况做一回顾与分析 ,旨在加深计划生育服务人员对执行常规重要性的认识 ,进一步提高计划生育技术…     

宫内节育器穿孔异位临床分析

<正> 我国采用宫内节育器(IUD)避孕妇女占世界应用者的70％左右,占我国育龄妇女所采用各种避孕措施的39.1％,因此有必要将IUD在临床应用中遇到的问题进行小结,以提高避孕效果,降低副作用,减少并发症。收集我院1977～1997年宫内节育器穿孔异位10例,现将临床情况总结如下。     

人工流产术后放置吉妮宫内节育器的临床效果观察

<正>放置宫内节育器(IUD)是我国育龄妇女的主要避孕措施[1]。目前IUD种类繁多,各有利弊,尽可能选择适宜于妇女的IUD类型成为广大计划生育工作者的迫切心愿[2]。本文对人工流产术后即时放置3种不同IUD的临床效果进行分析。     

左炔诺孕酮宫内缓释系统应用研究

<正> 宫内节育器(IUD)是育龄妇女的主要避孕工具,其发展与完善大大提高了育龄妇女对IUD的接受性,拓宽了IUD应用范围。而释放左旋18-甲基炔诺酮(LNG)的宫内节育器(LNG-IUD),近年来称之为LNG宫内缓释系统,即LNG-IUS(Levonorgestrel Intrauterine System),是当前国内外公认的性能优良的宫内抗生育系统,具有IUD使用的长效性及口服避孕药的高效性,又减少IUD的副作用,同时还具有治疗多种妇科疾病及绝经后激素替代治疗的辅助作用。     

流动育龄妇女放置及检查宫内节育器的现况研究

目的:了解宫内节育器(IUD)的使用情况及其影响检查宫内节育器的因素。方法:应用横断面调查的研究方法对流动育龄妇女进行结构式问卷调查,内容包括一般人口学特征、IUD放置及查环情况等。对流动育龄妇女人口学特征、IUD放置情况进行描述性统计分析,对有关影响检查IUD的因素进行单因素和多因素分析。结果:本次调查的1 856人使用宫内节育器作为避孕方法的流动育龄妇女中,63.42%不知道自己使用的宫内节育器种类,使用率最高的IUD是宫型IUD(10.02%),其次是O型165环(8.73%)和Tcu220C(8.35%)。Logistic回归分析发现:相对于工厂员工,白领的研究对象更倾向于查环;自租房、与他人合租、自购房的流动人口查环的可能性大于住集体宿舍的流动人口。结论:超过60%的流动育龄妇女不知道自己使用的宫内节育器种类;研究对象查环受到工作性质和居住条件的影响。今后应继续加强流动人口避孕节育知识宣传教育的同时还应广泛宣传检查IUD的重要性,以提高流动人口到现居住地检查IUD的比例。     

306例育龄妇女因症取出节育器原因分析

放置宫内节育器(IUD)是我国最常用的避孕方法之一,具有安全、长效、经济、简便和可逆的优点,为防止意外妊娠提供了有效保障。但因IUD的副作用降低了其续用率,为此,我们特对2009年1月—2011年12月育龄妇女因症取器的原因进行分析,为今后的计划生育服务工作提供     

新型宫内节育器规范化引入性试验的研究

目的:通过新型宫内节育器(IUD)的引入,提高基层计划生育服务质量,提高新技术的可接受性并鼓励更多的人更有效地使用避孕方法。方法:研究分三阶段进行,第一阶段采用定性和定量方法进行引入前需求评估;第二阶段为干预研究:宣传教育、技术培训和引入新型IUD;第三阶段采用定性方法进行干预后评估。研究现场的选择考虑了地区、社会经济和计划生育工作状况的代表性,分别在江苏省、山东省和重庆市各选择了3个县(市),然后在每个县(市)选择3个乡镇。引入的新型IUD为宫药铜300、TCu380A和γ药铜200。结果:被访的市(县)指导站能提供多种避孕方法和相关手术,如口服避孕药、皮下埋植剂、置取IUD、男/女绝育术、人工流产、男用避孕套和外用药以及一些妇科疾病和避孕药具副反应的处理。可提供的IUD种类较多,以TCu220C、药铜165和宫铜IUD为主。政策因素对避孕方法的选择有一定影响,普遍是‘一孩上环,二孩结扎’。不少妇女不知道自己使用IUD种类,相当多的妇女在放置IUD过程中未获得较规范的咨询服务。技术服务人员对性传播疾病的认识仍非常有限。多数技术人员都希望有进修和培训的机会。服务记录过于简单的问题较为突出,如放置IUD仅记录其形状如宫型、圆形或T型,这将可能影响随访和IUD的到期取出,直接影响服务的可持续性?     

规范化培训乡(镇)节育技术人员提高IUD避孕效果

中国农村放置宫内节育器(IUD)的主要技术力量是乡(镇)节育技术人员。在安徽省全省范围内,选择房屋设备、人员情况等基本相同的34个乡(镇)计划生育服务所,随机分配成规范化培训组和对照组;每组随机放置TCu220C和带铜宫型IUD共3073例。填写统一表格,按期随访。生命表法分析随访一年的结果。两种IUD的妊娠率、脱落率、因出血或疼痛取出率等,规范化培训组明显低于对照组,揭示加强乡(镇)节育技术人员的规范化培训,有助于提高IUD的避孕效果。     

B超监测下吉妮和TCu 380 A宫内节育器592例临床分析

目的:①多中心观察B超监测下放置吉妮和TCu380A宫内节育器(IUD)并随访12月的临床效果;②探讨吉妮IUD近期脱落的原因。方法:随机分组并在B超监测下放置吉妮IUD289例,TCu380AIUD303例,术后1、3、6、12月定期妇科及B超随访,记录受试对象病史、术时和术后情况,用SPSS10.0软件包进行数据处理,以生命表方法统计结果并行显著性检验。结果:①术后疼痛症状发生情况TCu380AIUD组明显高于吉妮IUD组,差异有显著性(P<0.05);术后6、12月随访月经紊乱以TCu380AIUD组为高,差异有显著性(P<0.05)。②术后6月、12月生命表结果提示吉妮IUD组因出血和疼痛的终止率较TCu380AIUD组低,差异有显著性(P<0.05)。③子宫后位者易发生带器妊娠,脱落与月经量及置器医生放置IUD质量有关。结论:吉妮IUD的避孕效果与国际推荐使用的TCu380AIUD一致,置器后出血和疼痛副反应少于后者。引入B超监测IUD放置过程对杜绝放置的不安全隐患有重要作用,也是在监控和验证放置IUD质量、年轻医生的培训过程及基层推广应用中必须注意的问题。     

不同分娩方式妇女放置三种IUD的术时评价

目的:研究不同分娩方式妇女放置三种新型含铜宫内节育器(CulUD)的术时评价。方法:将观察对象按经阴道和经剖宫产的不同分娩方式分为两组,每组均随机放置CyneFix IN IUD、MCu功能性IUD和TCu380A IUD,记录两组放置不同种IUD的扩宫情况、置器疼痛反应和置器时间。结果:放置GyneFix IN IUD和TCu380A IUD在不同分娩方式组中扩宫率、痛觉评分、置器时间无显著差异(P>0.05)。放置MCu功能性IUD在剖宫产分娩组扩宫率为92.5％,显著高于阴道分娩组的33.3％(P<0.05);痛觉评分为8.62±0.82分,显著高于阴道分娩组(P<0.01);置器时间为(9.62±3.15)min,较另两种IUD置器时间显著延长(P<0.05)。结论:GyneFix IN IUD和TCu380A IUD置器术时扩宫率低、费时少,疼痛反应轻,不受分娩方式影响。     

Continuation rates and reasons for discontinuing TCu380A IUD use in Tabriz, Iran

PURPOSE: The long-term effectiveness of copper-bearing intrauterine device (IUD) has been documented. This paper reports results from a 60-month study on the use of TCu380A IUD among 401 women in Tabriz, Iran. MATERIALS: In 2003, a 5% sample of women who had had an IUD inserted between May 1997 and May 1999 was taken. Analyses of discontinuation employed Tietze net rate life tables. RESULTS: Continuation of TCu380A IUD use by women at 1 month, 6 month, 1 year, 2 years, 3 years, 4 years and 5 years was 98.2, 89.3, 79.3, 68.3, 57.6, 49.5 and 45.0 per 100, respectively. Among women using the TCu380A IUD, the rate of termination due to pain/bleeding was significantly higher than the rate of termination due to other causes. Overall, two pregnancies were reported within 5 years after insertion. A third pregnancy occurred on Year 6. CONCLUSION: These findings indicate that family planning educators and health care providers should give more emphasis to counseling programs for women desiring IUD insertion and during follow-up.     

Family planning in Britain

In Britain in 1968 there were 780 family planning clinics using all conventional methods except IUDs and 220 IUD clinics. In 1967 of 173,000 new patients, 77,000 chose oral contraceptives, 60,000 chose diaphragms, and 24,000 chose IUDs. A short training course is given to both nurses and doctors. The Family Planning Association is the private agency responsible for promoting birth control advice, information, and services. Since the Family Planning Act was passed in 1967, the National Health Service has the authority to provide family planning service to those who want it for free.     

江苏省不孕不育症双向转诊体系建设的初步总结

目的：对江苏省不孕不育双向转诊体系建设的工作进行总结,使得经培训的妇科内分泌医师能熟练应用不孕不育症临床初筛方案,诊治患者和进行必要的转诊。方法：建立不孕不育诊治规范流程;建立不孕不育病因初筛临床路径;电子化管理数据库系统的运用和升级;多次开展学习班培训以及为期3个月的临床进修学习;专家巡回讲座;专家定期出诊;设立绿色通道;设立不孕不育门诊示范点。结果：2005年1月—2013年10月完成临床病例病因初筛人数271 309例,初筛单位27家,转诊患者7 149例,转诊率2.6%,初筛平均费用1 176.4元,专家出诊74次,接诊1 785人次;实际参加为期3个月进修培训人员236人次;学习班举行28次,参加人员2 529人;设立不孕不育门诊点40家;参加数据库系统学习的单位56家。结论：不孕不育症双向转诊制度的建设取得了很好的效果,已经在江苏省内建立了不孕不育规范化诊治流程,建立了不孕不育病因初筛临床流程,对减少不孕不育症患者来回奔波、减少医疗开支有切实可行的意义。     

Non-physician insertion of IUDs: Clinical outcomes among TCu380A insertions in three developing-country clinics

Insertion of IUDs by trained non-physicians is increasing. This secondary analysis of TCu380A IUD acceptors collected at clinics in Nigeria, Turkey and Mexico involved 367 women; 193 insertions were performed by physicians and 174 by non-physicians. Women having their IUD inserted by a non-physician were more likely to experience a pain-free insertion, but also likelier to have the IUD removed for bleeding and pain or to experience an expulsion than women who had their IUD inserted by a physician. Early discontinuation rates were similar between the two groups. Overall continuation rates were statistically higher for IUDs inserted by physicians only at the Mexico site. Trained non-physicians can probably safely insert the TCu380A IUD. Appropriate competency-based training is required to limit the number of expulsions and removals for bleeding and pain by non-physicians.     

人工流产术后即时放置GyneFix IUD、MCu IUD和TCu220 IUD避孕效果分析

目的:评价新型宫内节育器(IUD)GyneFix IUD和MCu IUD及传统节育器TCu220IUD的避孕效果。方法:以人工流产术后志愿放置IUD的690例为对象,随机分为3组,分别于人工流产术后即时放置Gyne Fix IUD、MCu IUD和TCu220IUD。结果:GyneFix IUD,MCu IUD和TCu220IUD使用12个月带器妊娠率分别为0.48%、0.85%、3.75%,脱落率分别为0.93%、0.85%、2.92%,因症取出率分别为2.80%、3.81%、6.25%,续用率分别为95.80%,94.49%,87.08%,放置IUD后月经异常发生率分别为8.88%、5.93%、12.5%。结论:GyneFix IUD、MCu IUD和TCu220IUD避孕效果均较理想,但TCu220IUD可能是放置型号不易掌握,带器妊娠、脱落、月经异常发生率较两种新型IUD高。     

Statement on intrauterine devices (IUDs)

Topics covered in this statement on IUDs include: mechanism of action; contraindications; efficacy; duration of use; counseling; IUD selection; insertion; the complications of perforation, bleeding and pain, infection, pregnancy, ectopic pregnancies, and expulsion; removal; and follow-up care. The newer copper- and hormone-releasing IUDs have high continuation rates, and the pregnancy rates are low. The removal in February 1986 of the Lippes Loop, the Copper 7, and the Copper T200 from the US market was for commercial reasons and not because of concerns about safety and efficacy. The Food and Drug Administration (FDA) approves these IUDs, and it is likely that the already FDA-approved Copper T380A will be available in the US during 1988. In its December 1986 meeting, the World Health Organization (WHO) scientific group on the mechanism of action, safety, and efficacy of IUDs concluded that all IUDs stimulate a foreign body reaction in the endometrium which is potentiated by the action of copper, and progestagen-releasing IUDs produce endometrial suppression much as that seen when the drug is administered by other routes. Further, the scientific group indicated that it is unlikely that 1 single mechanism of action accounts for the anti-fertility effect of IUDs. Several absolute contraindications to IUDs are recognized, including: acute or chronic pelvic inflammatory disease (PID); known or suspected pregnancy; abnormal uterine bleeding; confirmed or suspected malignancy of the genital tract; and congenital uterine abnormalities or fibroids distorting the cavity in a manner incompatible with proper IUD placement. The newer copper devices (TCu220C, TCu380Ag, TCu380A, and Multiload 375) have the lowest failure rates. Counseling of the IUD user should include telling her about all alternative family planning methods and advising her of the type of IUD to be inserted and the proper time for replacement if it is a medicated device. The available evidence from many countries suggests that properly trained nonphysicians can insert IUDs as well as doctors. The IUD may be inserted at any time convenient to the user if it can reasonably be determined that she is not pregnant. The medical indications for removal are pregnancy, acute inflammatory disease, endometrial or cervical malignancy, perforation and partial expulsion of the IUD, and abnormal or excessive bleeding. Whenever possible, it is useful to examine IUD users 3 months after IUD insertion, and annual checks are useful to ensure the IUD is in place.