Measurement of Prolactin and Estradiol to Estimate Menses Return of Breastfeeding Mothers

Objective To determine whether the measurement of serum prolactin (PRL) and estradiol (E2) is effective and reliable to estimate the returning time of menses during breastfeeding Methods Serum PRL and E2 were measured in 703 breast feeding mothers during the period of ＜ 2, ＞ 2, 3, 4, 5 and 6～9 months postpartum. Radio-immunoassay (RIA) was used to measure the levels of PRL and E2. The cervical mucus, sexual behaviors and vagina bleeding were also monitored since 56 d after postpantum. Results (1) The average level of serum PRL and E2 was 8. 16, 3. 66, 0. 69 in the fully breast feeding, mixed-feeding and bottle-feeding groups respectively. It showed that 92. 55% mother returned menses within 6 months of postpartum in the bottle-feeding group. (2) According to the results, the levels of serum Prolactin and Estradiol were related to the feeding ways, but not completely related to the duration of postpartum. (3) By using the ratio of PRL to E2 to estimate the time of menses return among the breast feeding mothers, we found that when the ratio became 0. 60, the subjects‘ menses would returen. The sensitivity and the specificity of this method were 89. 85% and 90. 68% respectively. Conclusion The measurement of serum PRL and E2 is a simple, effective and reliable method to estimate the return time of menses during breast feeding period. If possible, it should be promoted for clinical use to prepare for their fertility return.     

喂养与生育力的探讨

目的研究哺乳期妇女不同喂养方式的生育力恢复。方法104例对象分为母乳、混合、人工喂养三组,观察和记录宫颈粘液,其中33例连续测定了血生乳素和雌二醇,32例测定了尿雌激素和(或)孕二醇。结果产后第1次来经的平均日三组分别为198．16、175．35和91．44d,第2次与第1次月经间隔的平均日三组分别为67．50、28．57和23．28d,经统计分析,母乳、混合与人工喂养组之间都有显著差异(P<0．05)。宫颈粘液法估计月经恢复的正确性为86．53％,血生乳素和雌二醇的比例预测月经恢复的灵敏度达93．2496、特异性为89．28％,12例混合喂养者尿孕二醇水平均<7．10μmol／24h,表明无排卵发生。结论应用宫颈粘液观察法了解生育力简单、正确,妇女自己能掌握,可推广。遇到识别粘液有困难时,作内分泌测定,可了解生育力的恢复。     

Effect of breast-feeding status on prolactin secretion and resumption of menstruation

This study investigated prospectively the effect of supplementary breast feeding on the duration of lactational amenorrhoea and serum prolactin levels during prolonged breast feeding in a group of 34 Australian mothers. Although supplementary feeding correlated statistically with the decline in mean serum prolactin levels and the subsequent resumption of menstruation, critical analysis of the data revealed that serum prolactin levels were declining with time before the introduction of supplementary feeding. It was concluded that the resumption of menstruation during prolonged lactational amenorrhoea is associated with the introduction of supplementary infant feeding, but other factors may be more important in this process. The good correlation between the decline in serum prolactin levels and the return of cyclic ovarian activity in individual mothers suggests that measurement of serum prolactin level may be a useful predictive index for returning fertility during breast feeding.     

人工流产术后即时放置Gene Fiex IN IUD疗效观察

目的探讨人工流产术即时放置与月经后放置Gene Fiex IN IUD的疗效比较。方法选择停经5～14周要求终止妊娠且需避孕的妇女1 056例,予人工流产术后即时放置Gene Fiex IN IUD;另选择自愿放置宫内节育器的已婚育龄妇女820例于月经后放置Gene Fiex INIUD并进行比较及术后定期随访。结果两组术后副反应、脱落率、带器妊娠率及续用率比较,差异无统计学意义。结论 人工流产术即时放置Gene Fiex IN IUD安全性高,具有脱落率低,避孕效果可靠,副反应少等优点,适于临床应用。     

口服避孕药对血清催乳素及其胃复安兴奋试验的影响

本文报告756例口服短效避孕药Ⅰ号妇女血清催乳素(PRL)值及闭经、泌乳的发生情况,并与37例放置宫内节育器(IUD)妇女作对照。结果表明:长期服用短效避孕药Ⅰ号不引起血清PRL升高。24例接受胃复安兴奋试验表明,服药组的反应峰值较IUD组高(P<0.05),服药后闭经妇女对胃复安刺激的反应较前两者低,但尚属正常范围。     

MCu与GT300型含铜宫腔形IUD应用效果观察

目的观察爱母功能性宫内节育器（MCu intrauterine contraceptive device,MCu IUD）与GT300型含铜宫腔形IUD（GT300 IUD）的临床使用效果。方法分别对放置MCu IUD和GT300IUD的各500例育龄妇女置器后随访,分析比较两种IUD脱落率、带器妊娠率、续用率及各种不良反应发生率。结果 MCuIUD组随访12个月和24个月带器妊娠率和脱落率均低于GT300IUD组,差异有统计学意义（P〈0.05）;随访24个月因症取出率明显低于GT300IUD,差异有统计学意义（P〈0.05）;随访24个月续用率明显高于GT300 IUD,差异有统计学意义（P〈0.05）;放置MCu IUD组在不良反应方面明显低于GT300IUD组,差异有统计学意义（P〈0.05）。结论 MCu IUD的临床使用效果优于GT300 IUD。     

Norplant皮下埋植避孕剂与Vcu200宫内节育器5年临床对比观察

为指导育龄妇女选用适宜的避孕方法 ,采用统一的接受标准 ,共接收Norplant使用者 3 1 5例 ,Vcu2 0 0使用者 3 2 0例 ,每 6个月随访 1次 ,直至 5年使用期满或终止使用。用生命表法统计 2组间各种事件率 ,使用WHO的MDS软件统计月经日记卡并分析出血类型 ,对 2组间的差异行统计学检验。结果显示 :Norplant使用者 5年持续使用率和因妊娠、月经问题、医学问题、避孕器反应的终止率分别为 80 .0 7%、0 .3 5 %、1 3 .3 7%、6.1 2 %和 0 .46% ;Vcu2 0 0组分别为 84.42 %、9.5 0 %、1 .71 %、0 .3 7%和 4.40 %。阴道出血类型分析显示 ,Norplant组不规则出血者占 43 .1 %～5 7.6% ,使用 6个月后阴道出血基本正常者占 1 2 .9%～ 3 2 .7% ;Vcu2 0 0组出血基本正常者可达 5 4.8%～ 60 .2 %。结果表明 :Norplant埋植剂和Vcu2 0 0节育器具有相同的持续使用率 ,使用Norplant埋植剂后的妊娠率和脱出率明显低于Vcu2 0 0节育器 ,而阴道出血类型中不规则出血明显高于Vcu2 0 0节育器。提示 :2种避孕方法各有优缺点     

Selective transsphenoidal adenomectomy in women with galactorrhea-amenorrhea.

Thirty women with prolactin (PRL)-secreting adenomas underwent selective adenomectomy via a transsphenoidal route. All had abnormal sella polytomes or visual fields, amenorrhea with low basal serum gonadotropin levels despite decreased serum estradiol concentrations, and elevated basal serum PRL levels with blunted PRL response to neuroendocrine stimulation tests )thyrotropin-releasing hormone, levodopa, chlorpromazine, and hypoglycemia). Of 17 patients with microadenomas, 14 (82.4%) were cured and three (17.6%) improved. None were unchanged or worse. Three (60%) of five patients with larger, but still intrasellar tumors, had normalization of PRL levels, return of menses, and resolution of galactorrhea. The patients with tumors extending out of the sella did not fare as well. Overall, 21 (70%) were cured, six (20%) improved, two (6.7%) were unchanged, and the condition of one (3.3%) became worse. All preoperative neurologic deficits resolved. Postoperative complications were minimal with no neurologic morbidity. When tumors are small, surgical results are excellent with minimal risk.     

宫腔粘连分离术后预防再粘连方法的比较

目的:比较宫腔镜下分离宫腔粘连后两种抗粘连方法的疗效。方法:62例宫腔镜下宫腔粘连分离术后患者,随机分为宫内节育器并戊酸雌二醇(观察组)34例,宫内节育器(对照组)28例,术后1个月随访并详细记录术后月经改善情况及妊娠情况,1个月后宫腔镜下观察两组宫腔内粘连情况。结果:观察组共治疗34例,再粘连10例,再粘连率26.47%,对照组共治疗28例,再粘连15例,再粘连率53.57%,观察组疗效明显优于对照组,经统计学处理,差异有统计学意义(P<0.05)。结论:宫腔粘连宫腔镜分离后宫腔内放置节育环加术后周期性应用戊酸雌二醇可有效预再粘连,提高月经改善率。     

戊酸雌二醇、米非司酮配伍宫术宁胶棒用于生殖器萎缩妇女取环中的临床观察

目的观察戊酸雌二醇、米非司酮配伍宫术宁胶棒用于生殖器萎缩妇女取环前的宫颈准备效果。方法将2010年6月至2012年10月宝鸡市人民医院妇科符合纳入标准的160例生殖器萎缩妇女根据用药不同分为两组,每组80例。A组:术前口服戊酸雌二醇片3 mg/d,连用7 d;B组:术前连续口服米非司酮片3 d,50 mg/d,取环时两组常规配伍宫术宁胶棒。对比A、B两组取环时的宫颈扩张难易度、术中疼痛反应、取环时间、取环成功率、取环前-后子宫内膜厚度,取环后阴道流血时间。结果 A组阴道分泌物多、疼痛评分低、扩张宫颈容易,A组取环成功率为93.8%(75/80),B组为92.5%(74/80),两组比较差异无统计学意义(P>0.05);A组取环前后子宫内膜厚度为(3.67±0.59)mm和(3.66±0.56)mm,B组取环前后子宫内膜厚度为(3.44±0.80)mm和(3.45±0.76)mm;A、B两组取环后阴道流血时间分别为(3.46±0.84)d和(3.45±0.82)d,两组比较差异均无统计学意义(P>0.05)。结论戊酸雌二醇、米非司酮两种药物用于生殖器萎缩妇女取环前的宫颈准备效果均切实、可靠。术前配伍宫术宁胶棒扩宫更安全。     

The Impact of Breastfeeding Pattern on the Duration of Lactational Amenorrhoea in Chengdu,China

Objective To determine the relation between infant feeding practices (and other fac-tors) and the duration of postpartum amenorrhoea in a sample of Chinese womendinally in 541 mothers and their infants in Pengxian County Sichuan Province. The,durations of breast feeding and of lactational amenorrhoea were estimated throughsurvival analysis. Cox's non-parametric hazards regression analysis was performed todetermine thevariables associated with the duration of lactational amenorrhoea.Results Mothers breast fed frequently per day, the mean frequency ranging from 6. 4per day at 3 weeks postpartum to 5. 4 per day at 6 months. They breast fed for over18. 3 monthson average. The median duration of lactational amenorrhoea was 9. 3months. Theperiod from birth until the first breast feed was a significant determinantof the duration of lactational amenorrhoea, P = 0. 038. Compared with women whoended full breastfeeding earlier, those who ceased full breast feeding at 120 to 24Cdays returned to menses significantly sooner (risk ratio ＝ 1. 34; 95% CI = 1. 06～1. 69). This finding is probably spurious since no relationship between full breast feed-ing duration and the return of menses was found among women who ended full breast-feeding after 240 days.Conclusion The most important determinant of the return of menses was the delay inthe first breast feed after birth, suggesting that the Ten Steps to Successful Breast feed-ing should be more precisely implemented.     

三种释放左旋18-甲基炔诺酮宫内节育器的临床对比观察

本文观察了放置含药宫内节育器(IUD)钥匙形(K-LNG-IUD,2号)、菱形(C-LNG-IUD,3号)、改进NoVaT型(LNG-CU-IUD,4号)和TCu-220 C(1号)各100例妇女使用18个月的避孕效果和可接受性。结果续用率以1号最高,达86.0％,4号最低,仅65.1％(P<0.05);妊娠率2号达2.0％,4号为0(P>0.05);脱落率3号达8.9％,4号仅1.0％(P<0.05);因症取出率4号达29.3％,明显高于其他3种(P<0.05)。3种LNG-IUD各有优缺点,在推广使用之前,尚需进一步调整药物释放量、改进IUD的形状和工艺。     

茜芷胶囊联合妇科千金胶囊治疗IUD置入后阴道异常出血的临床观察

目的 观察茜芷胶囊联合妇科千金胶囊用于治疗IUD置入后阴道异常出血的临床疗效。 方法 以2016年2月—2018年2月象山县计划生育指导站收治的135例IUD置入后阴道异常出血患者为研究对象，按随机数字表法分为对照组、研究组1和研究组2，每组各45例。对照组不予以药物治疗，研究组1予以宫血宁胶囊口服治疗，研究组2予以茜芷胶囊联合妇科千金胶囊口服治疗。比较各组患者治疗前后血红蛋白和血清TNF-α、IL-6和IL-8含量，记录治疗期间药物不良反应，观察阴道异常出血改善和IUD因症取出情况。 结果 研究组2治疗后血清TNF-α、IL-6和IL-8含量均显著低于研究组1和对照组水平(均P<0.05)，血红蛋白含量显著高于研究组1和对照组水平(均P<0.05)，行经时间显著短于研究组1和对照组水平，月经出血量显著少于研究组1和对照组水平(均P<0.05)；研究组1和研究组2阴道异常出血改善率(100.00%和97.78%)均显著高于对照组水平(80.00%)，均P<0.05，且IUD因症取出率(0.00%和2.22%)均显著低于对照组水平(20.00%)，均P<0.05；各组药物不良反应总体发生率差异无统计学意义(P>0.05)。 结论 茜芷胶囊联合妇科千金胶囊可显著降低IUD置入后阴道异常出血患者炎症反应强度，提高血红蛋白含量，缩短症状改善周期，提高患者IUD续用率，且未增加药物不良反应发生率。      

445例早产儿6个月内纯母乳喂养影响因素分析

  目的  调查早产儿6个月内的母乳喂养情况及其影响因素，以期能为早产儿母乳喂养干预提供一定的参考依据。  方法  使用方便抽样，于2018年4—12月选择在浙江省温州市4所三甲医院早产分娩的493例早产儿母亲作为研究对象，3个月回访时失访21例，6个月回访时失访27例，最终纳入445例。使用一般资料问卷和爱丁堡产后抑郁问卷进行问卷调查。使用χ2检验进行早产儿6个月内纯母乳喂养率影响因素的单因素分析，单因素分析差异有统计学意义的变量纳入多因素logistic回归分析。  结果  早产儿出院时的母乳喂养率为27.2%(134/493)，其中纯母乳喂养率为9.3%(46/493)。矫正月龄3个月时的母乳喂养率为39.2%(185/472)，其中纯母乳喂养率为18.4%(87/472)。矫正月龄6个月时的母乳喂养率为28.1%(125/445)，其中纯母乳喂养率为11.7%(52/445)。回归分析结果显示，母乳喂养史、产后抑郁、产后开始泌乳时间和家庭人均月收入可影响早产儿6个月内纯母乳喂养情况。  结论  医务工作者应提升早产儿母亲的母乳喂养知识与问题解决技能，尤其是对于无母乳喂养史和家庭收入较高的早产儿母亲，保证其正常泌乳开奶，并早期进行心理干预，疏导其不良情绪，以提高早产儿6个月内的纯母乳喂养率。      

Clinical Comparative Study of GyneFix IN and ML Cu375 Intrauterine Devices

Objective To observe the effectiveness and side effects of GyneFix IN intrauterine device (IUD) in clinical useMaterials & methods The present study is a randomized clinical control trial, 1 956healthy parous women were randomly allocated into GyneFix IN group (n= 980) and ML Cu375 group (n= 976). Follow-up was arranged at 1, 3, 6 and 12 months after insertion. The discontinuation rates were calculated by using life table method.Results At the end of the first year, the pregnancy rate with IUDs and expulsion rate were 0. 4% and 2. 3% respectively in GyneFix IN group. It was the same as in ML Cu375 group (0. 4%, 2. 0%, P> 0. 05). The removal rate for medical reasons and the use-related discontinuation rate were 0. 4% and 3.1% respectively in GyneFix IN group, which were significantly lower than that in ML Cu375 group (1. 5%,4. 2%, P< 0. 01).Conclusion GyneFix IN IUD has high effectiveness, low expulsion rate and can significantly reduce the occurrence of side effects of bleeding and pain.     

MCu记忆合金与TCu220两种宫内节育器48个月临床效果观察

目的 探讨观察MCu记忆合金与TCu 220两种IUD的临床应用效果及安全性.方法 2008年1月-2012年12月期间采用对比性研究,对85例健康育龄妇女放置2种不同IUD（MCu记忆合金IUD 43例,TCu 220IUD42例）,于术后1、3、6、12、24、36、48个月分别进行观察.结果 2种IUD48个月的妊娠率、脱落率、因症取出率和累积续用率分别为：MCu记忆合金IUD：2.32％,0.00％,4.64％,88.37％;TCu220IUD：2.38％,4.76％,9.52％,76.19％.2种IUD妊娠率比较,差异无统计学意义（P＞0.05）MCu记忆合金IUD的脱落率低于TCu220IUD,差异有统计学意义（P＜0.01）; MCu记忆合金IUD的因症取出率低于TCu220I-UD,差异有统计学意义（P＜0.05）; MCu记忆合金IUD的48个月的累积续用率高于TCu220IUD,差异有统计学意义（P＜0.01）.结论 MCu记忆合金IUD具有脱落率低,因症取出率低,累积续用率高的优点,值得推广.     

含25mg吲哚美辛MYCu宫内节育器应用的随机对照研究

目的观察释放吲哚美辛的V形含铜含药宫内节育器（MYCu1UD）的临床效果及安全性。方法采用临床多中心,按统一标准选择2000例要求使用IUD避孕的妇女,随机放置MYCuIUD与T形含铜（TCu380A）IUD各1000例,放置后1、3、6、12个月时定期随访,监测效果及安全性。结果放置12个月时,MYCuIUD组与TCu380AIUD组分别使用11985．9、11753．6个妇女月,累积继续使用率分别为97．80％、94．70％;累积带器妊娠率分别为0．10％、0．31％（P〉0．05）;累积脱落（部分脱落）率MYCuIUD组为0．10％,低于TCu380AIUD组的1．73％（P〈0．01）;累积因医疗原因[出血和（或）疼痛]取出率分别为1．51％、2．94％（P〈0．05）;与IUD使用有关的终止、总终止率两组差异有统计学意义（P〈0．01）;置器后1、3、6、12个月时不规则出血、经期延长、经量增多及疼痛的发生率含吲哚美辛的MYCuIUD组明显少于不含吲哚美辛的TCu380AIUD组（P〈0．01）。结论MYCuIUD脱落率极低,抗生育效果好,置取方便、安全,置器后不良反应小,是比较理想的IUD,应推广使用。     

女性系统性红斑狼疮病人性激素水平

目的：探讨女性系统性红斑狼疮（SLE）病人性激素水平及其在SLE发病中的作用。方法：采取电化学法检测98例SLE病人血清雌二醇（E2）、雌三醇（E3）、睾酮（T）、孕酮（Prog）和泌乳素(PRL)，并与36例健康妇女作对照。结果：SLE病人组E2，E3，Prog和PRL明显高于对照组(P＜0.05)；25～34岁SLE病人E2，Prog，PRL水平较其它年龄组和对照组为高(均P＜0.05)，且活动期E2和PRL明显高于稳定期(P＜0.05)。结论：性激素与SLE的发生发展密切相关。     

重置宫内节育器元宫Cu-365 IUD避孕效果的临床观察

目的:总结重置宫内节育器元宫Cu-365 IUD避孕效果的临床体会。方法:将曾有放置IUD史的,愿意继续使用IUD避孕的育龄妇女500例随机分成2组,分别放置元宫Cu-365 IUD、MCu IUD两种IUD各250例。于放置后1、3、6、12个月进行随访。结果:两种IUD 12个月带器妊娠率分别为0.40%、0.80%,差异无显著性意义(P>0.05);脱落率分别为0.20%、8.40%,差异有非常显著性意义(P<0.01);因症取出率分别为0.80%、3.60%,差异有非常显著性意义(P<0.01);累积续用率分别是94.80%、73.20%,差异有非常显著性意义(P<0.01)。结论:元宫Cu-365IUD具有脱落率低、因症取出率低、累积续用率高的优点,值得临床应用,对于曾有置器失败的育龄妇女,元宫Cu-365 IUD具有可接受性。     

宫内节育器吉妮柔适与TCu380的临床效果比较

目的观察宫内节育器（intrauterine contraceptive device,IUD）吉妮柔适与TCu380的临床避孕效果。方法采用对比性研究,选取2007年1月至2008年1月在建湖县计划生育指导站自愿要求放置IUD、身体健康且无置器禁忌证的已婚育龄妇女800例,用知情选择与随机放置相结合的方法分成两组（各400例）,分别放置吉妮柔适IUD和TCu380IUD,并进行12个月定期随访（术后1、3、6、12个月）。结果吉妮柔适IUD的脱落率（伴下移）和因症取出率显著低于TCu380IUD,而累积续用率显著高于TCu380IUD（P〈0.05）。结论吉妮柔适IUD避孕效果明显,具有脱落率低、不良反应少、累积续用率高的优点,可在临床推广使用。