产后并发下肢深部静脉血栓妇女的避孕指导

深部静脉血栓(DVT)是孕产期严重并发症之一,为非孕期的5倍,常发生于产后[1]。其临床诊治及预防已有较多报道,随着对避孕方法知情选择的推广,对患者产后避孕问题也应给予关注。本文结合2例患者的情况对产后并发DVT妇女的避孕方法选择进行探讨。一、临床资料例1,36岁,农民,因G3P2、宫内妊娠41 1周、珍贵儿于2004年3月8日在连续硬膜外麻醉下行子宫下段剖宫产术,顺利娩出一男活婴,体重3800g,手术顺利。术后给予抗炎及对症治疗,一般情况好。术后第4日自述输完液体后左下肢及左大腿根部活动时胀痛不适。查体左下肢肿胀、浅表静脉曲张,左侧腹股…     

社会环境因素对妇女产后避孕的影响

对上海市４０３７例产后妇女避孕行为及其影响因素的调查,结果表明妇女产后平均４．６１月开始避孕。年龄在２５～２９岁、职业为干部、文化程度和经济收入较高、接触亲友层次高及孕前接受过避孕宣教的妇女,产后开始避孕的时间较早。妇女产后一般首选的避孕方法为ＩＵＤ,其次为避孕套。经济、文化、人口学特征和社会环境等因素对妇女避孕方法的选择产生一定的影响。３７．５８％的产后妇女未用或未及时使用避孕措施,大部分妇女对产后不孕期有误解（认为不来月经就不会怀孕,认为一直哺乳不会怀孕等）,避孕知识和信息的缺乏是妇女未用避孕方法的重要原因。加强宣传力度,鼓励妇女（特别是年龄较青、职业层次、文化程度、经济收入及接触亲友层次较低的妇女）产后尽早使用避孕措施,是提高妇女生殖健康水平的一个重要方面     

健康教育对产后避孕行为的影响

利用WHO课题\     

产后避孕

产后,无论哪种情况,避孕套(男用或女用)总是一种适宜的避孕方法。非哺乳妇女至少产后4周就应采用避孕措施。非哺乳妇女对各种计划生育措施无特殊禁忌,但要考虑所用方法产后何时开始使用较为适宜。哺乳妇女,首先非激素类措施,次选单纯孕激素类方法;其中,值得推荐的是哺乳闭经避孕法。     

产后避孕

产后，无论哪种情况，避孕套总是一种适宜的避孕方法，非哺乳妇女至少产后４周就应采用避孕措施。非哺乳妇女对各种计划生育措施无特殊禁忌，但要考虑所用方法产后何时开始使用较为适宜的。哺乳妇女，首先非激素类措施，次选单纯孕激素类方法；其中，值得推荐的是哺乳闭经避孕法。     

产后避孕

<正>产后妇女是育龄妇女中的一个特殊群体，她们面临着哺乳、哺乳时限的选择、可能发生的非意愿妊娠以及对避孕方法的认识和应用等一系列问题。因此，产后避孕必须得到夫妇双方、医生以及计划生育工作者等多方面的重视。为提高广大妇女的生殖健康水平，减少人工流产率，近年来国内外学者关于产后避孕进行了大量的综合性研究。     

非意愿妊娠对已婚育龄妇女孕期及产后心理行为的影响分析

非意愿妊娠是严重影响广大育龄妇女生殖健康的一个社会医学问题。文章着重研究了非意愿妊娠对已 婚育龄妇女孕期及产后心理行为改变的影响，主要会引起孕产妇焦虑、易烦恼激动、对担任母亲无心理准备等一系列影 响母子身心健康的心理行为改变，并相应地提出预防性建议及对策。     

个性化避孕指导对避孕效果的影响

目的探讨个性化避孕指导,对重复人工终止妊娠术(ATP)妇女避孕效果的影响。 方法选择2013年1月至2014年4月于深圳市计划生育服务中心、深圳市盐田区人民医院等9家医疗机构门诊进行ATP的782例重复ATP者为研究对象。采用随机数字表法,将其随机分为干预组(n＝388)和对照组(n＝394)。干预组受试者采取个性化避孕指导干预措施,对照组仅实施1次常规的避孕相关健康知识教育。观察两组受试者ATP前及ATP后1、6及12个月时的避孕率,以及ATP后12个月内非意愿妊娠率,并进行统计学分析。本研究分组征得受试者知情同意,并与之签署知情同意书。 结果①干预组与对照组受试者年龄、孕次、产次、最近2次ATP间隔时间、最近半年内重复ATP率等一般临床资料比较,差异均无统计学意义(P>0.05)。②ATP前,干预组受试者避孕率为47.4%(184/388),与对照组的48.7%(192/394)比较,差异无统计学意义(P>0.05)。ATP后1、6、12个月时,干预组受试者避孕率均分别显著高于对照组,并且差异均有统计学意义(χ²＝126.532、3.869、72.894,P＝0.000)。ATP后1、6、12个月时,干预组和对照组各种避孕措施中,避孕套使用率均为最高,并且干预组避孕套使用率均分别显著高于对照组,差异均有统计学意义(χ²＝15.521、33.712、21.628,P＝0.000)。ATP后1个月时,干预组受试者口服避孕药率显著高于对照组,并且差异有统计学意义(χ²＝62.826,P＝0.000)。③ATP后12个月内,干预组受试者非意愿妊娠率显著低于对照组,并且差异有统计学意义(χ²＝7.202,P＝0.007)。 结论个性化避孕指导干预措施,有助于提高重复ATP后的避孕率,降低非意愿妊娠的发生,值得临床推广。     

孕期至产后干预对产后意外妊娠影响

目的 分析从孕期至产后开展综合干预对产后避孕知识及意外妊娠的影响。方法 于2011年7月-2012年7月对上海市浦东新区妇幼保健院和普陀区妇婴保健院3542名孕产妇进行干预,按医院分为干预组和对照组,采取结构式问卷进行调查。结果 产后开始避孕时间、产后恢复性生活时间和排卵期计算方法相关知识,对照组回答正确人数分别为364人(45.50%)、622人(77.75%)和374人(46.75%),干预组分别为1905人(69.47%)、2504人(91.32%)和1152人(42.01%);不同避孕方法中,产后意外妊娠103人(3.09%),对照组为35人(4.57%),干预组为68人(2.65%);2组导致产后意外妊娠发生比例最高的分别为口服避孕药和紧急避孕药,其次分别为安全期和体外排精避孕;多因素分析结果显示,干预组产后意外妊娠发生比例较对照组降低45%,文化程度、产后恢复性生活时间与避孕时间的交互作用对产后意外妊娠有影响。结论 以医院为基础的综合干预可有效降低产后意外妊娠发生的可能性。     

Change in contraceptive methods following the Yogyakarta earthquake and its association with the prevalence of unplanned pregnancy

Background

This study was conducted to examine access to contraception and change in contraceptive methods before and after the disaster in Bantul area, and to evaluate the prevalence of unplanned pregnancy.

Study Design

In total, 450 married women participated. Questionnaires, which included participants' background, contraceptive methods, difficulties in accessing contraceptive method, and unplanned pregnancy, were completed.

Results

Within 1 year of the disaster, the percentage of participants who used injections and implants tended to decrease, while the percentage of participants who used pills tended to increase. Use of coitus interruptus significantly increased after the disaster. The prevalence of unplanned pregnancy was significantly higher in a group of participants who had difficulty accessing contraceptive methods compared to a group that did not.

Conclusions

Health personnel should not only actively deliver contraceptive methods in a disaster situation but also educate couples to prevent unplanned pregnancy.     

Miscommunication between healthcare providers and patients may result in unplanned pregnancies

Our objective was to examine the impact of prior healthcare provider counseling on previous use of contraception and knowledge of emergency contraception in women seeking surgical abortion. We performed a retrospective analysis of 342 patient charts from women seeking an office abortion in a private practice setting from January 1999 to June 2001. Data extracted included demographic information, primary method of contraception over the preceding few months, compliance with that method, contraceptive history, knowledge of emergency contraception and postabortion contraception. Patients were primarily white (69%) and unmarried (63%) and had private insurance that covered abortion services (72%). Only 19% of women were using a birth control method with no recognized potential failure. Twenty-two percent of women were using their birth control method correctly but experienced an event that put them at risk for pregnancy, 32% were using their birth control method incorrectly and 27% were using no birth control method at all. Miscommunication between patients and their healthcare provider(s) negatively affected use of a primary contraceptive method in 14% of patients. Of the 77% of women who did not know about emergency contraception, nearly two thirds had an identifiable event for which emergency contraception could have been used. Healthcare providers may contribute to the occurrence of unintended pregnancy if they provide poor medical advice or miscommunicate with patients.     

产后妇女避孕节育知识及避孕应用调查

目的:了解产后妇女避孕节育知识及避孕应用情况,以便为提高产后妇女避孕率,降低意外妊娠提供依据。方法:选取桂林市的191名产后1年内妇女为研究对象,采用问卷调查法调查避孕节育知识及避孕应用情况。结果:①产后1年妇女避孕率为62.8%,使用工具避孕占88.9%,避孕方式夫妻共同选择的占66.5%。②避孕相关知识总体掌握平均(56.7±13.3)分,知识维度得分排名在最后2位的分别是生育能力恢复时间及对人流危害的认知。结论:应采取多种措施加强对产后避孕的宣教,提高产妇避孕相关知识及产后的避孕率,从而避免意外妊娠,保证母婴健康。     

The effects of preabortion depressive symptoms on postabortion contraceptive effectiveness level chosen among women seeking abortions

Objective

We examined whether preabortion depressive symptoms were associated with contraceptive method effectiveness level chosen among women seeking abortions.

三城市医院流产妇女避孕知识的干预研究

目的:探讨两种干预方案对流产妇女避孕知识、态度的影响及其影响因素。方法:采取以医院为基础的干预性实验研究方法。结果:接受全面干预的人群避孕知识得分(9分)高于接受基本干预(7分)的人群(Z=16.6,P<0.01)和干预前(8分)的人群(Z=12.7,P<0.01);接受基本干预的人群避孕知识得分不比干预前高(Z=1.5,P=0.14)。全面干预组流产后愿意使用和准备使用避孕套避孕的比例最高,三组比较差异有统计学意义。Logistic回归分析结果表明,去除了其它变量对避孕知识得分的影响后,年龄越大、出生在城市、女方及其男伴教育水平越高和接受全面干预的人群避孕知识得分也越高。结论:提供流产后计划生育服务的全面干预能提高流产妇女的避孕知识水平和避孕药具使用率;年龄、本人及男伴文化程度和出生地是避孕知识的影响因素。     

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Background

This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

Study Design

Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

Results

Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

Conclusion

Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.     

城市妇女产后哺乳期闭经和避孕行为的随访研究

为探讨城市妇女在产后1年内的哺乳类型、闭经状况和避孕行为,本研究采用前瞻性随访研究方法,对1996年6月起在山东省淄博市5所区级医院分娩的496名产妇进行登记,并对其中有活产的494名妇女于产后42天、4个月和1年时进行访视。1年访视率为98.8％。被访视对象96.1％为初产妇。访视结果显示,完全母乳喂养妇女产后4个月时月经恢复率为14.7％,而混合喂养者为29.2％(P<0.05)。产后第1个月37.7％的妇女避孕,第2个月为62.3％,前3个月以使用避孕套为主。自产后3个月起宫内节育器使用率逐渐增加。寿命表法分析表明,依产后顺序月为序,完全哺乳概率与产后闭经概率的降低呈一致趋势。在产后4个月时产后闭经概率仍为68.2％,提示提高完全母乳喂养率,有助于哺乳期自然避孕的可行性。为保护母婴健康,防止产后非意愿妊娠的发生,应加强服务网络间联系和适时地为产后妇女提供优质服务。妇幼保健与计划生育服务相结合应成为我国基层初级生殖保健的方向。     

Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007

Background

This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions.

Study Design

Since 1997, representative samples of Spanish women of childbearing potential (15–49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used.

Results

During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women.

Conclusions

The factors responsible for the increased rate of elective abortion need further investigation.     

Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity

Background

This study was conducted to determine whether increased body mass index (BMI) affects oral contraceptive (OC) pharmacokinetics and suppression of hypothalamic-pituitary-ovarian (HPO) axis activity.

Study Design

Ovulatory reproductive-age women with normal weight (BMI <25 kg/m²; n=10) and with obesity (BMI >30 kg/m²; n=10) received OCs for two cycles (prospective cohort). Subjects were admitted for two 48-h inpatient stays at the beginning and end of the hormone-free interval. Ethinyl estradiol and levonorgestrel (LNG) levels were evaluated during both inpatient stays. Gonadotropin pulsatility (follicle-stimulating hormone and luteinizing hormone) was measured during the second inpatient stay. Estradiol (E₂) and progesterone (P) were measured daily during inpatient stays and twice per week in Cycle 2.

Results

BMI was greater in the obese compared to the normal-BMI group [37.3 kg/m² (SD, 6.0) vs. 21.9 kg/m² (SD, 1.6); p<.05]. The LNG half-life was significantly longer in the obese group (52.1±29.4 vs. 25.6±9.3 h, p<.05), which correlated with a lower maximum LNG concentration on Cycle 2, Day 1 [1.9 ng/mL (SD, 0.5) vs. 2.5 ng/mL (SD, 0.7)] and a longer time to reach steady state (10 vs. 5 days) in obese women. There were no significant differences in volume of distribution between groups. LH pulse parameters did not differ statistically between groups but trended toward greater HPO activity in the obese group. Additionally, more obese (6/10 vs. 3/10 normal BMI, p>.05) women exhibited E₂ levels consistent with development of a dominant follicle and P levels consistent with ovulation (2/10 vs. 1/10) during Cycle 2.

Conclusions

Compared to women with normal BMI, obese women exhibit differences in OC pharmacokinetics that are associated with greater HPO activity.     

健康信念模式在青少年流产女性避孕行为实施中的应用研究

随着经济的迅速发展和社会观念的改变,我国青少年婚前性行为发生率显著增加,非意愿妊娠和人工流产率也急剧上升,对青少年女性的身心健康造成严重危害。非意愿妊娠的发生与不安全的性行为有关。研究表明,采取有效的避孕措施可以避免非意愿妊娠的发生,但避孕行为的实施受到多方面因素的影响和制约。探讨健康信念模式在青少年流产女性避孕行为实施中的应用,可为降低青少年女性人工流产率,促进女性生殖健康寻找有效的途径。