产后避孕服务的研究进展

产后近期意外妊娠对育龄妇女的生殖健康影响较大，产后1年内人工流产率高于育龄妇女的平均水平，低文化程度、低经济收入和社会贫困层次的妇女以及未婚青少年是产后近期意外妊娠的高危人群。尽管目前产后避孕技术成熟，但推广不足，尚未形成针对高危人群和高危行为有效的产后避孕服务规范。随着生育高峰的到来，在加强产前、产时安全的同时，预防产后意外妊娠、减少高危人工流产的发生是生殖健康领域的重要内容。     

紧急避孕方法的社会支持水平及相关因素研究

目的:探讨紧急避孕方法的社会支持水平及相关因素。方法:选择2006年1月以来到嘉峪关市计划生育服务站要求采取紧急避孕的360例育龄女性,进行心理状态与社会支持水平分析。结果:已婚妇女采取紧急避孕的社会支持高于未婚人群;与主观支持显著相关的是婚姻状况、职业和年龄,客观支持与青春期性教育和避孕方法的知晓程度显著相关,与对婚前性行为危害的认知水平密切相关。结论:紧急避孕方法的社会支持与诸多因素相关。对未婚女性健康教育、关怀帮助显著偏低,对婚前性教育的配套系统的社会支持尚未真正建立和运行,从而影响到整体的社会支持水平。     

米非司酮紧急避孕机制的研究

目的:探讨米非司酮(Mifepristone,孕激素受体拮抗剂)对月经不同功能时期中Ley寡糖蛋白表达的影响。方法:取34例患子宫肌瘤志愿者手术后的内膜,经病理检测,分为4组:增生期(8例)、分泌期(8例)、分泌期服用米非司酮(8例)及增生期服用米非司酮(10例),每例均重复实验。应用Western免疫印迹法,观察Ley寡糖抗原的表达。结果:①每组样品中Ley寡糖蛋白均有4种分子量68kD、60kD、52kD、27kD表达;②分析结果显示:Ley寡糖在分泌期高表达,增生期表达低,两组间差异有显著性(P<0.001);③分泌期服用米非司酮的表达较分泌期明显减少(P<0.001),较增生期无明显变化(P>0.05);④增生期服用米非司酮的表达较增生期有所增多(P<0.001),仍较分泌期明显减少(P<0.001)。结论:在分泌期Ley寡糖蛋白的含量呈高表达,在月经不同功能时期服用米非司酮后,Ley寡糖蛋白表达均较分泌期明显减少。提示人子宫内膜Ley寡糖蛋白的表达可能与胚泡着床密切相关,并且米非司酮可能是通过减少Ley寡糖蛋白的表达而达到紧急避孕的目的。     

米非司酮合并米索前列醇房事后避孕临床多中心研究

在黄体早、中、晚期应用米非司酮合并米索前列醇与单用米非司酮进行房事后避孕临床多中心比较性研究。５４１名自愿接随机序号参加本研究的健康、月经规律妇女，组Ⅰ口服米非司酮２５ｍｇ，ｑ１２ｈ共４次，第三天上午加服米索前列醇０．４ｍｇ，妊娠率为０．４％。组Ⅱ单服米非司酮２５ｍｇ，ｑ１２ｈ，共４～６次，妊娠率为３％。二者差异有显著性（Ｐ＜０．０５）。两者引起出血类型和时间均与正常月经相似，且无明显副反应发生，错过了服用传统房事后避孕药时，采用本研究的方法可不考虑性生活时间、次数。这种方法提供了一种新型有效避孕方法。     

米非司酮黄体期用药对垂体－肾上腺轴的影响

征集健康育龄妇女９例于连续若干周期的黄体晚期单次口服米非司酮，剂量分别依次为２５ｍｇ、１００ｍｇ、４００ｍｇ和６００ｍｇ，并于服药前以及服药后４、８、１２、２４、４８、７２、９６和１２０ｈ采血，以测定血清ＡＣＴＨ和皮质醇。另征集健康育龄妇女１５例，随机分成三组（组Ⅰ～Ⅲ），分别在黄体早、中、晚期给于米非司酮２５ｍｇｑ１２ｈ×６，在ｄ１～ｄ７期间每天采血以测定血清ＡＣＴＨ、皮质醇和米非司酮水平。结果显示米非司酮２５ｍｇ和１００ｍｇ单次口服对ＡＣＴＨ、皮质醇水平及其昼夜分泌节律并无明显影响，可是一次口服高剂量（４００ｍｇ和６００ｍｇ）后，ＡＣＴＨ和皮质醇上午分泌水平增加，昼夜变化幅度明显减少。米非司酮多次用药（２５ｍｑｑ１２ｈ×６）期间，每天上午ＡＣＴＨ和皮质醇几乎无明显变化，黄体期早、中、晚期服药的对象，其血药浓度、ＡＣＴＨ与皮质醇水平均无明显差异。本研究提示对于非妊娠妇女，米非司酮以剂量－依赖的方式显示其抗糖皮质激素活性，只有一次口服大剂量米非司酮才会明显影响其ＡＣＴＨ与皮质醇的昼夜分泌节律。黄体期不同的生殖激素状态对口服米非司酮后的药物吸收及其抗糖皮质激素活性无明显影响。     

Menstrual regulation and contraception in Bangladesh: Competing or complementary?

To examine the relationship between menstrual regulation (MR) and subsequent use of contraception in Bangladesh, we studied the birth control practices of a 6-month cohort of 4359 family-planning acceptors in a family-planning clinic in Dacca. We compared their use of birth control measures before and after MR. We attempted to examine the subsequent pregnancy and induced-abortion rates of 1671 of these women through a 3-year non-concurrent prospective study. Of those 1172 made their first visit to the clinic to obtain an MR and the remaining 499 women, who served as a comparison group, made their first visit to obtain contraceptive services not associated with MR. Three years' followup data were available for 558 women in the MR group and 228 women in the comparison group. Based on these data, the 3-year pregnancy rate for the MR group was 37.6/100 women and the induced abortion rate was 4.3/100 women. The 3-year pregnancy rate for the comparison group was 39/100 women and the induced abortion rate was 3.5/100 pregnancies. Thus, during a 3-year period women in the MR group did not obtain abortions significantly more often than women in the comparison group.     

GS-Ⅰ型(节育花)宫内节育器的研制

<正> GS-Ⅰ型节育花是一种结构独特的宫内节育器,它的外形象一朵盛开的木棉花,因而取名节育花。其形状不仅有花的美观,更主要的是其构型与子宫腔的形状相适应。置于子宫内,两边张开的花瓣正好顶住子宫腔与输卵管之间的通道,正中的花蕾紧贴子宫腔上端,构成一个与子宫腔密切贴合的整体〔图1〕,它能随子宫腔的收缩而作相应的变形,因而避孕效果良好,脱落率低。此种节育花由广东省妇幼保健院的沈育民教授设计,曾用聚乙烯为原料制成     

A comparison of consensus and nonconsensus approaches to modeling contraceptive choice behavior

This paper develops a more general model of contraceptive choice, taking into account a fundamental difference between the condom and the contraceptive pill, the two most commonly used reversible contraceptives in the US. The pill produces a single output of pregnancy prevention, but the condom is an input into a joint production for both pregnancy prevention and disease protection. Since the condom is ultimately used by the male, and the pill by the female, noncooperative game theory is used to model the separate male and female utility functions. Using both Stackelberg and Nash as solution concepts, econometric specifications are derived and the models are compared with the specifications derived from a consensus model of the household. Simultaneous-move Nash best describes the behavior of unmarried and noncohabiting sexual partners, and female-leader Stackelberg outperforms the other models for married or cohabiting couples.     

A randomized comparative study on mifepristone alone and in combination with tamoxifen for emergency contraception

The purpose of the clinical study was to compare the efficacy and side effects of 10 mg of mifepristone alone (Group 1) and with 20 mg of tamoxifen (Group 2) for emergency contraception, especially as used within 72-120 h after coitus. Four-hundred female volunteers with one act of unprotected intercourse or contraception failure (200 cases in each group) were recruited and completed the study. There were 198 women treated < 72 h after coitus (100 in Group 1 and 98 in Group 2), whereas the remaining 202 patients were treated between 72-120 h (100 in Group 1 and 102 in Group 2). In total, four pregnancies occurred; one treated < 72 h in each group, two between 72-120 h in Group 1. Efficacy for prevention of unwanted pregnancy by Trussell method is 84% for Group 1, and 95% for Group 2, and which is not significantly different between the two groups and even subgroups. The side effects (15.5% for Group 1 and 14.5% for Group 2) and changes in menstruation were infrequent and mild in both groups. Further studies should be conducted to determine whether tamoxifen combined with mifepristone for emergency contraception is more effective as compared with mifepristone alone.     

Anti-implantation effects of indomethacin and celecoxib in rats

Pregnant Wistar rats were used to investigate the anti-implantation effect of cyclooxygenase (COX) inhibitors, indomethacin (nonselective COX-1/COX-2 inhibitor) and celecoxib (specific COX-2 inhibitor). Indomethacin at doses of 2.5 and 5 mg/kg/day and celecoxib at doses of 40, 80, and 160 mg/kg/day were orally administered once daily to each group (n = 8) on Days 3-5 of pregnancy (Day 1 = sperm detection). Indomethacin and celecoxib at anti-implantation dosages were further investigated for the effects on changes in endometrial vascular permeability in pregnant rats and uterine decidualization in pseudopregnant rats. The results demonstrated that indomethacin at a dose of 5 mg/kg/day as well as celecoxib at doses of 80 and 160 mg/kg/day could significantly reduce the proportion of pregnant rats. At the anti-implantation dosages, they exhibited no significant effect on proportion of rats with blue dye sites in the endometrial vascular permeability study, but they could significantly reduce the uterine decidualization. From these findings, the anti-implantation effect of the two COX inhibitors may principally be from decidualization defects, and COX inhibitors should, therefore, be used with caution in childbearing age women. On the other hand, specific COX-2 inhibitors with their good gastric safety profile may have a potential role in nonhormonal postcoital contraception.