62例带器妊娠妇女相关因素分析

宫内节育器（简称IUD）是一种安全、有效、经济、简便、可靠的避孕工具．一次放置能长期避孕．取出后可以很快恢复生育能力，已成为育龄妇女的主要避孕措施。宫内节育器分惰性IUD（如金属单环、宫形环）与活性IUD（如含铜节育器及含甾体激素节育器），它的避孕原理是改变子宫腔内环境，引起局部无菌性炎症，干扰受精卵发育和着床。含铜T型宫内节育器释放的铜离子，能增加子宫内膜的炎症反应，抑制酶活性，干扰精子活动和存活，其释放的铜离子有杀精作用；孕激素类节育器可干扰子宫内膜周期，使子宫内膜明显变薄，并使子宫内膜超前转化，     

带铜宫内节育器用于紧急避孕的优点与不足

我们知道,紧急避孕除可以服用药物外,还可以采用放置带铜宫内节育器的方法。与服用药物相比,放置宫内节育器进行紧急避孕有如下优点：     

宫内节育器避孕后继发不孕不育问题的流行病学研究

目的探讨宫内节育器避孕后继发不孕不育的流行病学因素。方法选择在郑州大学第三附属医院生殖医学中心就诊的300例宫内节育器取出后继发不孕不育的妇女为研究对象,采取门诊问卷调查、进行相关检查并记录结果,分析宫内节育器避孕后继发不孕不育的流行病学因素与放置宫内节育器后的不良反应。结果结果显示放置宫内节育器继发不孕不育的主要因素中女性输卵管因素占41.00%,卵巢储备功能下降占10.33%,男方精液质量问题占11.67%,其次卵泡发育不良、排卵障碍、宫腔粘连、再次妊娠后自然流产等也是影响因素。宫内节育器放置后的并发症主要是放置宫内节育器早期月经增多(10.67%)、腰腹疼痛(8.33%)、移位脱落(5.00%)、月经不调(4.67%)、白带异味及外阴瘙痒(3.33%)、白带增多(2.33%)等。结论本研究显示女性输卵管因素为宫内节育器避孕后继发不孕的首要因素,早期月经增多为置环后主要不良反应,提示应对放置宫内节育器继发不孕不育的流行病学因素给予高度重视,及时发现、及时治疗。     

避免节育器“超期服役”

宫内节育器俗称避孕环，是一种放置在子宫腔内的避孕器具。节育器虽然可以达到避孕的效果，但并非一劳永逸。第四军医大学西京医院妇产科专家叶永清教授介绍说，节育器种类不同，使用年限也不一致。不锈钢金属节育器可放置20年左右，到绝经期半年到1年内取出；塑料型或硅橡胶型宫内节育器可放置3—5年左右；塑钢混合环可放置5—10年左右；带铜宫内节育器可放置3—5年；用铜套代替钢丝者可放置10—15年左右；带孕酮宫内节育器一股在1年后孕酮激素已近于释放完，故须按年更换。     

三类宫内节育器避孕效果的临床观察

目的比较三类宫内节育器放置后的避孕效果。方法将600例放置宫内节育器的患者金属环(元宫型IUD)105例,塑料型(母体乐)环198例,带铜(TCM380A)T环297例随机分成三组,观察和比较其效果和副反应。结果 T型宫内节育器在现今避孕效果最佳。     

宫内节育器有关问题的解答

1、用宫内节育器避孕有哪些优点? 宫内节育器是通过节育器在子宫内,使官腔内局部环境变化而起避孕作用。它的避孕作用是局部的,不是通过周身内分泌变化而起避孕作用。放置宫内节育器是一种长效的避孕方法。放置一个节育器可以避孕10年以上。具有一次放置,长期避孕,方法简便的优点。如果需要再次妊娠时,取出节育器短时间内即可恢复生育能力而受孕。     

紧急避孕药依靠不依赖

目前,常用的紧急避孕的方法主要有放置带铜宫内节育器和口服药物两种。其中,在无保护性生活后5天之内放置带铜宫内节育器,是现在紧急避孕有效率最高的方法。一般采取这一措施的人都是已经生育过的妇女,且此法对有生殖道感染的人不适用。所以,有相当部分避孕失败后的妇女选择了口服紧急避孕药物。     

放环后容易出现哪些性“问题”

宫内节育器是我国育龄妇女中使用率最高的一种避孕工具。它简便、有效，一次放入能避孕多年，不影响性生活，取出后能迅速恢复生育力，是一种值得推荐的避孕方法。然而由于个体差异、卫生习惯、放置技术等因素，有的育龄妇女放置宫内节育器后可能会出现一些与性有关的问题。     

左炔诺孕酮用于紧急避孕102例临床分析

紧急避孕是指未采取避孕措施下的同房或避孕失败（避孕套破损、滑脱、宫内节育器脱落）后７２ｈ内服用药物,或５ｄ内放置带铜的宫内节育器,以避免妊娠发生的一种补救措施。左炔诺孕酮为孕激素,已广泛用于抑制排卵、抗孕卵着床。１９９８年１～１２月,我站有１０２例育龄妇女采用口服左炔诺孕酮（北京第三制药厂）片作为紧急事后避孕,取得满意效果,现报道如下。１　对象与方法１．１　对象　１０２例自愿要求紧急事后避免者年龄在２０～４０岁之间,月经周期规则,身体健康,采取避孕意外失败及无防护性同房者。１．２　方法　于避孕失…     

对4种宫内节育器的临床效果比较

目的 观察放置吉妮致美(GeneFiexIN)、TCu220C、宫铜300、元宫药铜220,4种宫内节育器的避孕效果.方法 对836例受术的育龄妇女随机放置吉妮致美、TCu220C、宫铜300、元宫药铜220宫内节育器,规范的术后随访1年,比较使用效果.结果 4种宫内节育器放置对象的一般情况比较无统计学差异;放置吉...     

含铜IUD,小剂量米非司酮与单方左炔诺孕酮用于紧急避孕的临床？…

为观察米非司酮（Ｒｕ４８６）、左炔诺孕酮以及活性ＩＵＤ用于紧急避孕（ＥＣ）的临床效果、副反应、对月经的影响和活性ＩＵＤ的长期避孕效果，对１５０例身体健康、月经规律、未避孕或避孕失败１２０ｈ以内的妇女按自愿的方式分为放置ＩＵＤ组或服药组，服药组，服药组按随机方法给予口服Ｒｕ４８６或左炔诺孕酮。结果发现Ｒｕ４８６组和活性ＩＵＤ组有效率为１００％，左炔诺孕酮组为７６．８％（均按Ｄｉｘｏｎ方法计算），对月     

Immunoglobulin levels in the serum and cervical mucus of tailed copper IUD users

Immunoglobulin levels were measured by agar gel single radial immunodiffusion in the serum and cervical mucus of 50 tailed copper IUD users, 20 combined oral contraceptive users and 20 women not using contraception (controls). IgG, IgA and IgM levels were significantly higher in the copper IUD users compared to the other two groups. It is not known whether this was related to the small numbers of bacteria found in the uterine cavity of tailed IUD users or to the foreign body reaction of the device.     

What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: a qualitative study

INTRODUCTION: There is a lack of published research into the perceptions of 'non-users' of copper intrauterine contraceptive devices (IUDs). Despite this being one of the most commonly used methods of contraception in other countries, only 5% of contraceptive users in Great Britain aged 16-49 years currently use an IUD. This study explores how women's lay beliefs and perceptions about IUDs lead to rejection of this contraceptive choice. METHODS: One-to-one semi-structured interviews were conducted with 10 women of varying ages and parity recruited from an urban general practice. None of the women had ever used IUDs but all had used contraception in the previous 6 months. Data were subjected to qualitative analysis. RESULTS: Five analytical themes were identified: lack of objective information about IUDs, reported side effects of IUDs, anxieties about the process of fitting an IUD, IUDs as an infection risk and lack of personal control of an IUD, once fitted. CONCLUSIONS: Some of the themes identified mirrored those found in studies of user attitudes to and experiences of IUDs. Others, particularly the prominent worries about mess and embarrassment during fitting and the association between the hidden nature of the fitted device and unreliability, are new and need wider exploration.     

Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.

OBJECTIVES: This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies.     

Barriers to Intrauterine Device Uptake in a Rural Setting in Ghana

Long-acting reversible contraception is an underutilized method in low-resource areas. Our study aims to: (a) assess knowledge and attitudes around contraception; (b) identify barriers to intrauterine device (IUD) uptake; and (c) develop interventions to address this gap in contraceptive care. We conducted focus group discussions with pregnant, postpartum, and reproductive-aged women, males, and health care workers in rural Ghana. Lack of IUD-specific knowledge, provider discomfort with insertion, and incomplete contraceptive counseling contribute to lack of IUD use. Participant- and provider-related barriers contribute to poor uptake of IUDs within the community. Targeted interventions are necessary to improve IUD use.     

Postpartum contraception: needs vs. reality

Background

The postpartum time is a unique time to address patient's contraceptive needs and provide education. There are little data to suggest the best approach to provide information about contraception after delivery.

Study Design

Postpartum patients in an urban university hospital were asked to complete a written survey on postpartum contraception. Participants were asked about contraception counseling offered both antepartum and postpartum. Participants were also asked if they would have elected to have an intrauterine device (IUD) inserted immediately after delivery. Participants were contacted 4–6 months after delivery regarding ongoing contraceptive use.

Results

One hundred seventy-five surveys were completed; 77% (134) reported discussing contraception antepartum, and 87% (153), postpartum. Thirty percent of women reported discussing IUD insertion at an antepartum visit and 31% reported discussing it in the hospital prior to discharge. Twenty-three percent (39) of women would have elected immediate post-placental IUD placement if available. Of the 59 patients who were able to be contacted 4–6 months after delivery, 5% reported using an IUD. Twenty-two percent (13) of the participants contacted at follow-up still desired an IUD, of which 62% would have elected postplacental placement, if available. Twenty-nine percent of women reported using no contraceptive method and 32% reported using a method which is not highly effective.

Conclusions

Prenatal visits and postpartum contact with providers create an opportunity to discuss family planning and contraception and most patients report receiving counseling. However, significantly fewer reported continued contraceptive use at 4–6 months postpartum. Initiation of postplacental IUD placement would be acceptable and would increase contraceptive use at 6 months postpartum.     

IUDs discussed at Exeter

A family planning research conference with special emphasis on the IUD had 3 main areas of discussion. The first was fundamental approaches to contraception--particularly IUDs, the second was clinical evaluation of IUDs, and that third was some sociological aspects of contraception. 4 papers presented at the conference are very briefly reviewed. Important points noted were 1) the action of IUDs could only be said to be local and probably were associated with an inflammatory response, 2) the action of the IUD appeared to be effective both during implantation and the late cleavage of the embryo, and 3) a clinical study stated that 200 sq. mm of copper on an IUD exerted a potent contraceptive action with the highest continuation rate.     

A qualitative exploration of emergency contraception users' willingness to select the copper IUD

BackgroundThe copper T intrauterine device (IUD) is an effective but underutilized method of emergency contraception (EC). This study investigates the factors influencing a woman's decision around which method of EC to select.Study DesignIn-depth interviews with 14 IUD and 14 oral EC users aged 18–30 years accessing public health clinics.ResultsEmergency contraception users associated long-term methods of contraception with long-term sexual relationships. Women were not aware of the possibility of using the copper IUD for EC. Cost was identified as a major barrier to accessing IUDs. Perceived side effects and impact on future pregnancies further influenced the EC method a participant selected.ConclusionsWomen think about contraception in the context of each separate relationship and not as a long-term individual plan. Most women were unaware of the copper IUD for EC. Furthermore, there is little discussion between women and their health-care providers around EC.     

Effect of shared contraceptive experiences on IUD use at an urban abortion clinic

BackgroundWe studied the effect of contraceptive social networking on postabortion intrauterine device (IUD) uptake. This study explores whether women who have heard personal stories of IUD use are more likely to use an IUD for postabortion contraception.Study DesignWe surveyed 299 women undergoing induced abortion at San Francisco General Hospital's Women's Options Center before and after contraceptive counseling. Both English- and Spanish-speaking women, aged 15 years and older, were surveyed.ResultsFifty percent of women surveyed chose to use an IUD for postabortion contraception. Women choosing IUDs were more likely than women choosing other contraceptives or no contraceptives to be multiparous, Latina and interested in IUDs prior to contraceptive counseling. Disclosure of personal IUD use by a clinic staff member was independently associated with the decision to use an IUD (odds ratio 8.1, 95% confidence interval 3.8–17.2).ConclusionsWomen undergoing abortion in an urban clinic have knowledge and high acceptance of IUDs, and sharing of contraceptive experiences is common among women of all demographics. Controlling for demographics and prior knowledge of IUDs, sharing of personal IUD experiences by providers is significantly associated with IUD use.     

宫内节育器的应用进展

宫内节育器的临床应用开始于20世纪30年代,70年代以前,以惰性宫内节育器为主,70年代后,含铜和含孕激素的宫内节育器上市,80年代我国研发了含铜含药(活性)宫内节育器。宫内节育器是中国目前使用最普遍的避孕方法,其使用受到政府主管部门的重视和支持。最近的两项研究显示,由政府采购的宫内节育器,多具有较好的性能,特别是元宫药铜220和活性γ型宫内节育器的失败率更低。失败率较高的单圈式含铜和含铜含药宫内节育器的使用率仍在20%的现象应引起重视。含孕激素宫内节育器具有健康益处,有广阔的使用前景。宫内节育器脱落下移的问题有赖于新材料的开发和应用。