产后即时放置宫内节育器与妇女健康的探讨

宫内节育器 (IUD)是一种相对稳定、安全有效简便 ,经济而且可逆 ,受广大妇女欢迎的避孕工具。产后即时放置 IUD,即在胎盘娩出后 10 min内放置 IUD脱落率低。由于刚分娩宫腔容积大、宫口松、放置容易、安全、产妇无痛苦 ,而且正常恶露 ,腹痛掩盖节育器的出血 ,疼痛不影响哺乳 ,子宫复旧及以后的性生活 ,减少了产妇的心理压力 ,减少了哺乳期妊娠 ,又可避免用激素避孕影响乳汁质量 ,保护了产妇和婴儿的身体健康 ,又有利于计划生育工作的开展。所以 ,对健康正常的产妇实施产后即时放置。〔1〕1　产后放置 IUD的现况1.1　放置的类型和方法 :…     

产后即时放置宫内节育器安全性分析

产后避孕是防止产后12个月内非意愿妊娠的发生[1],我国产后1年内非意愿妊娠发生水平较高,一项多中心、大样本调查研究显示[2],我国产后12个月累积非意愿妊娠发生率为5.3%(95%CI 4.5～6.1),非意愿妊娠产妇无论是非计划分娩,或是行人工流产术终止妊娠,并发症的发生风险均明显增加[3]。妊娠间隔短发生流产、早产、低出生体质量儿、胎膜早破、妊娠期贫血等概率增加,剖宫产分娩后短时间内再次妊娠增加剖宫产切口瘢痕妊娠及子宫破裂的风险[4],     

剖宫产即时放置新型宫内节育器100例临床效果分析

剖宫产者常规放置宫内节育器(IUD)时期为半年后,健康正常者方可放置。我科从1990年至今,剖宫产即时放置新型IUD100例,随访结果表明是可行的,而且是安全可靠的。资料与方法一、资料来源:从1993年1月至1994年底,年龄选择23至29岁的初产妇,无常规放器的禁忌症,身体健康的产妇100例。以金单器100例,1990年初随访,1988年3月至1989年底统计资料结果作回顾性分析对照。二、操作方法:当胎盘娩出清理官腔后,直视将     

产后即时放置宫内节育器254例临床分析

本文通过对254例产后即时放置宫内节育器3～6年的临床观察,并与212例产后未放置节育器组和3789例常规放置节育器组对照。结果:产后即时放置宫内节育器净脱环率为22.44％,比常规放置组略高,无严重并发症发生,却具有对机体损伤小、副作用小(p<0.005)的优点。认为在目前我国2胎率高,正值生育高峰时期,在人流率较高的情况下,分娩后即时放置宫内节育器,可避免哺乳期怀孕,有利于计划生育,可推广使用。     

人工流产术后即时放置GyneFix IN宫内节育器80例临床观察

GyneFix IN宫内节育器(由天津和杰医疗器械公司生产)，是一种新型无支架IUD，采用专用的放置器将IUD固定在子宫底的肌层内，并悬吊于子宫腔内，以减少传统IUD的脱落或因疼痛、出血而终止。我院于2002年试用于临床．并对80例人工流产术后自愿即时放置吉妮IUD者进行观察、随访，现报告如下。     

放置宫内节育器对子宫肌瘤患病率的影响

全世界约有5亿以上育龄妇女使用宫内节育器(IUD)避孕,在我国更是较多育龄妇女首选的避孕方法。长期实践证明,IUD是一种安全、有效、简单、经济的避孕措施,本文探讨放置IUD对子宫肌瘤的影响。 一、资料和方法 1.资料来源 来自武汉市武昌区中南街计划生育办公室对辖区内125个单位的在职及退休妇女5923人,进行每年1次的妇科普查资料。有效调查人数4688例,平均年龄38.1(20～59)岁。     

未产妇放置宫内节育器的研究

从６０，７０年代起，国外学者对未产妇放置ＩＵＤ进行了大量的研究，结果表明未产妇是可以放置ＩＵＤ的；放置时期最好在月经周期第１１－１７天；选择和ＩＵＤ以带铜的为宜；放置前，后须做好咨询和随访工作；对有盆腔炎史的未产妇禁止使用；有ＳＴＤ高危因素及年龄小于２５岁的未产妇ＩＵＤ不作为首选的避孕     

吉妮宫内节育器放置时间初探

<正> 吉妮宫内节育器(IUD)采用了固定式放置和无支架设计,旨在降低IUD的脱落率,减少副反应发生,从而增加可接     

吉妮宫内节育器于人工流产后即时放置临床效果观察

放置宫内节育器（IUD）长效、简便、经济、安全，是应用最广泛的一种避孕方法，但其副反应如月经不规律、腹坠、腰痛，以及脱落率高等，常导致续用率低。吉妮IUD是一种全新设计的无支架IUD，可随官腔任意弯曲，具有较高的可接受性。由于其特殊的固定方式，可于人工流产术后即时放置。有资料表明，与TCu220C IUD相比，放置吉妮IUD不会因官腔宽大、宫颈口松弛而易位、脱落。本文比较人工流产术后即时放置与经间期放置吉妮IUD的副反应、脱落率、妊娠率、续用率。现将结果报告如下。     

吉妮宫内节育器放置失败原因

吉妮宫内节育器（IUD）是一种无支架IUD,采用专门的放置器将IUD固定在子宫肌层内,并悬吊于子宫腔内,我国各地医院广泛使用已经十年有余。曾有多篇报道认为：吉妮IUD具有妊娠率低、不良反应小、不良续用率高、脱落率低等特点。我们于2004年7月喇7年7月对我院就诊并志愿放置吉妮IUD的妇女进行了随访,将所有收集到的随访病历进行了回顾性分析,其中重点分析了IUD放置失败的原因。     

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.     

Insertion of intrauterine contraceptives immediately following first- and second-trimester abortions

Background

The study was conducted to assess the continuation and patient satisfaction with intrauterine contraception (IUC) insertion immediately after elective abortion in the first and second trimesters in an urban, public hospital-based clinic.

Study Design

A cohort of 256 women who elected to have insertion of a copper-T IUC (CuT380a) or a levonorgestrel-releasing IUC (LNG-IUC) were followed postoperatively by phone calls or chart review to evaluate satisfaction and continuation with the method.

Results

Of our 256 subjects, 123 had first-trimester abortions and 133 had second-trimester abortions (14 or more weeks). Median time to follow-up was 8 weeks (range 7-544 days). Nineteen discontinuations occurred: eight (6.5%, 95% CI 2.8-12.4%) following first-trimester and 11 (8.3%, 95% CI 4.2-14.3%) following second-trimester abortion (p=.6). Five women reported expulsion; one (0.8%, 95% CI 0.0-4.4%) in the first-trimester group and four (3.0%, 95% CI 0.8-7.5%) in the second-trimester group. (p=.4) Seven infections resulting in discontinuation occurred (2.7%, 95% CI 1.1-5.6%); none were positive for gonorrhea or chlamydia at time of insertion. No perforations occurred. Nearly all (93.8%) of the women were satisfied with IUC. Rates of satisfaction between women after first- and second-trimester abortions were equal.

Conclusion

In an urban clinic, IUC has high initial continuation and high patient satisfaction when inserted immediately following either first- or second-trimester abortions.     

GyneFix330和MCu110宫内节育器比较的系统评估

目的:评价GyneFix330与MCu110宫内节育器(IUD)的有效性、副反应和续用情况。方法:通过电子和手工检索查阅1990年1月～2009年11月国内外发表的相关文献,按照循证医学的方法对纳入文献进行分析评价,Meta分析采用RevMan 4.2.10软件。结果:共纳入5篇正式发表的随机对照临床试验性文章。有效性方面,置器后12个月和24个月,GyneFix330组与MCu110组的带器妊娠率和脱落率均低于2.00/100妇女。GyneFix330的带器妊娠率低于MCu110,但差异无统计学意义。副反应方面,置器后6个月、12个月和24个月,两组副反应各项观察指标的发生率逐渐降低。置器后12个月内,GyneFix330组腰/腹痛的发生率显著低于MCu110组,白带增多、不规则出血的发生率显著高于MCu110组。续用情况方面,置器后24个月内,两组IUD因症取出率均不超过8.00/100妇女,续用率接近95.00/100妇女。GyneFix330组12个月因症取出率显著低于MCu110 IUD,24个月内两组续用率接近。结论:GyneFix330 IUD的临床应用效果略优于MCu110 IUD,但需长期大样本临床观察予以确证。     

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.     

Intrauterine devices for adolescents: a systematic review

Background

The appropriateness of IUDs for adolescents remains unsettled, as does the definition of the term adolescent. Unplanned pregnancy among teenagers remains epidemic, and long-acting methods, such as IUDs, offer the promise of top-tier effectiveness.

Study Design

We conducted a systematic review of the literature concerning IUD use in adolescents using MEDLINE, Popline, EMBASE and CINAHL databases.

Results

Six cohort studies and seven case-series reports met our inclusion criteria; none included IUDs in current use in the United States. Overall, continuation rates were high and cumulative pregnancy rates low, ranging from 2% at 6 months to 11% at 48 months. Compared with combined oral contraceptives, IUDs had similar or better continuation rates; pregnancy rates were similar at 2 years. IUD expulsion rates may be inversely related to age.

Conclusions

The literature on IUD use among adolescents is scanty and obsolete. Nevertheless, published reports were generally reassuring. Randomized controlled trials and cohort studies comparing contemporary IUDs with other methods are urgently needed.     

上海市流动人口产后即时放置宫内节育器的需求及障碍分析

目的：了解流动人口女性产后立即放置（IPPI）宫内节育器的需求,医务人员对IPPI 的态 度,探讨在平产分娩点提供IPPI 服务的可能性及障碍。方法：对841 例非上海户籍的孕产妇和343 例医务 人员进行问卷调查,并选取16 例医务人员进行小组访谈。定量数据使用EpiData3.1 建立数据库,SAS6.12 进行统计分析。小组访谈资料采用定性研究方法分析。结果：37.0%的孕产妇愿意接受IPPI。多因素分析 提示：随年龄增长,愿意接受IPPI的比例显著增加;剖宫产者较阴道分娩者更易接受IPPI。调查孕产妇不 愿意接受IPPI的原因有：不了解、准备使用其他避孕方法及担心不良反应等。仅有7.3%的医务人员对 IPPI 持赞成态度,不赞成的理由包括：产后生殖系统尚未恢复;IUD 易脱落、移位;哺乳期子宫质软,手术 风险大等。结论：IPPI在外来孕产妇平产分娩点有一定的需求,可利用平产分娩点现有医疗条件,为流动 人口妇女提供IPPI服务。但有必要对医务人员进行IPPI 技术上和理论上的反复培训,转变医务人员的服 务意识和服务态度。     

Barriers associated with the failure to return for intrauterine device insertion following first-trimester abortion

Background

The aim of the study was to identify barriers associated with the failure to return for delayed intrauterine device (IUD) insertion postabortion.

Study Design

This study had two components: (a) a retrospective cohort study of women who chose an IUD as their postabortion contraceptive method to compare characteristics of those who did and did not receive a device within 6 months of the procedure and (b) a prospective survey of women intending IUD use postabortion to assess actual IUD use at 6 weeks, barriers to access and attitudes on insertion timing.

Results

Of the 500 abortion patient charts available for review during the study period, 53 women intended IUD use postabortion. At 6 months, only 32% intending an IUD received one, and there were no significant demographic differences between the groups.For the prospective portion, the response rate at 6 weeks was 54% (27/50), with only 26% (7/27) of responders reporting IUD insertion by this time. The principal reported barrier to IUD insertion was time needed for an additional visit (41%). Most women (67%) desired immediate insertion and believed that they would be more likely to have an IUD inserted if it is performed immediately postabortion (63%). Monthly income was the only statistically significant difference between those who responded to the 6-week follow-up (US$1409.50) and those who did not (US$937.50, p=.05).

Conclusion

A significant number of women that express a preference for IUD use after first-trimester abortion do not return to obtain a device. Most would prefer to have the option of immediate insertion.     

宫内节育器取出困难相关因素分析

目的：分析宫内节育器（IUD）取出困难的相关因素。方法：选择1960例取器妇女临床资料,分析取器年龄、有无人工流产史和妇科疾病史、IUD类型、放置年限、B超检查结果、置器和取器时机、IUD嵌顿、子宫位置与取器困难的关系。结果：取器困难组年龄高于取器容易组;采用金属单环或无尾丝IUD的取器困难比例增加;取器困难者放置IUD年限较长;围绝经期发生取器困难的比例较高,嵌顿可能是造成取器困难的重要原因;子宫后位组取器困难的比例高于子宫前位或中位组;Logistic回归分析表明,IUD无尾丝[2．985（1．555,5．714）]、IUD放置年限[1．042（1．008,1．078）]、取器时机[3．310（2．171,5．045）]、IUD嵌顿[77．078（40．631,146．220）]、子宫后位[2．212（1．358,3．602）],是取器困难的独立相关因素。结论：IUD嵌顿是取出IUD困难的主要危险因素;围绝经期妇女应尽早取器;放置IUD时应选用带有尾丝、非金属单环IUD;取IUD时要注意子宫位置,尤其是前倾或后倾明显者。     

宫内节育器异位31例临床分析

目的 探讨宫内节育器异位的临床表现、产生原因、诊治方法及预防措施.方法 对本院收治的31例宫内节育器异位患者临床资料进行回顾性分析.结果 多数患者的临床表现不典型,主要与节育器异位位置相关.异位产生原因与置环时机、置环方法以及置环时间长短相关.宫腔镜及腹腔镜是取出异位节育器的主要方法.结论 手术操作规范、避免产褥期,哺乳期置环,围绝经期及时取环可以降低节育器异位风险,宫腔镜或腹腔镜手术可及时诊治节育器异位.