放置含铜V型宫内节育器后的经血量测定

本文研究了116例放置含铜V 型宫内节育器前及放置1、2、3、6、12个月后的妇女经量和血红蛋白的变化。放器前,妇女的平均经量为45.4毫升,放器后不同时间分别为81.8、69.6、69.4、71.0、68.6毫升。经统计学处理差异非常显著(P<0.01)。血红蛋白在放器前后无显著差异(P>0.05)。文内对放置含铜V 型宫内节育器后经量增多的可能因素及血红蛋白变化不明显的原因进行了讨论。     

宫内节育器不锈钢单环放置5年经血量及血红蛋白的观察

观察放置宫内节育器不锈钢单环连续5年月经血量及血红蛋白的变化。结果显示,宫内节育器所致的经血量增多,可用抗纤溶及抗前列腺素合成酶治疗。因放器所致的经血量增多,到放器后的1年至5年可与放器前差异无显著性。经测定血红蛋白及与其自身对照检查,在放器3年后血红蛋白值开始恢复,放器4年血红蛋白值与放器前差异无显著性。     

三种国产宫内节育器临床多中心比较性研究——(五年随访总结)

全国13省市共23个单位,对不锈钢金属单环、V Cu200及T Cu220c三种宫内节育器(IUD)进行随机临床多中心比较性研究。自1987年7月1日至1984年3月31日共接受对象6236例。五年末随访率为96.0%。60个月时每百妇女累积续用率以金单为最低,55.8%,V Cu及T Cu各为68.8%及72.4%。V Cu和T Cu的妊娠率分别为7.32%和7.24%,显著地低于金单的20.2%。60个月时金单、V Cu和T Cu的脱落率分别为19.0%、9.7%和5.6%,三者间呈显著性差异。因出血和/或疼痛取出率以金单为最低,二种带铜宫内节育器间无差别。三种IUD使用情况城市与农村间比较,城市的累积续用率均高于农村;妊娠、脱落和个人原因停用农村均高于城市。用Cox比例危险模型和似然比检验,发现金单的失败危险与以下因素有关:年龄、过去IUD使用史、劳动姿态、孕次和宫腔深度;前四个因素对VCu失败危险有影响;TCu失败危险除与前三个因有关外,哺乳期放器对其失败危险亦有影响。年龄和孕次均影响三种IUD的妊娠危险;过去IUD使用史分别作用于金单和VCu;宫腔深度分别影响金单和TCu的妊娠。T Cu的脱落仅受哺乳期放器影响;年龄、孕次、过去IUD使用史影响着VCu的脱落;金单脱落除上述三因素外,还受宫腔深度的影响,且前三个因素均呈极显著性差异。     

上海郊区宫内节育器避孕效果的流行病学回顾性调查

本文对上海市郊区3,264例放置金单和硅V 的农村妇女,在五年期间的避孕效果进行回顾性流行病学调查。结果硅V 的脱落率和带器妊娠率明显低于金单,因出血疼痛取出率却明显高于金单,这些差别主要发生在妇女放置节育器后2～3年之内。年龄、产次、放置时期主要影响金单的脱落率,而对硅V 没有明显影响,劳动强度则仅仅引起硅V 在最末二年中脱落率的增加,而对金单没有明显影响。通过对影响金单使用效果的因素分析得知年龄是影响效果的重要因素,26岁以前放置者的脱落率高于26岁以后的放置者,放置金单妇女的脱落是随着年龄的增加而逐渐减少,另外多产次和人流同时放置节育器者,金单的脱落率也减低。     

我国四种宫内节育器对月经血量的影响——放器后二年的观察

本文对我国四种节育器(不锈钢单环、Tcu200、上海Vcu200及北京Vcu200)进行放置前后月经血量与血红蛋白测定的连续动态观察。四种节育器放置后月经血量均有明显增加,到一年时尚未恢复到放器前水平(P<0.05)。本文为报道第二年的实验结果,第二年时经血量与月经过多的发生率均已下降并接近放器前水平(P>0.05),但仍有6例(约11%)经血量持续在100ml 以上,Hb 在放器后有逐渐下降趋势,第二年低于12g/100ml 者比第一年有所增加。     

含铜宫腔形宫内节育器临床研究

本文进行了宫铜器两年临床效果观察,一年半宫颈粘液中铜离子浓度及一年月经血量测定,并随机与宫形器和 TCu220C 进行了对比性研究。共接收对象660例,随访率为99.5%。三种 IUD 二年末每百妇女累积续用率分别为95.50、90.00和94.47,宫铜器与宫形器比较有显著差异(P<0.005);妊娠率宫铜器显著低于宫形器(P<0.001)和 TCu220C(P<0.05);脱落率和因出血/疼痛取出率宫铜器与后两种 IUD 比较无显著差异(P>0.05)。宫颈粘液铜离子浓度宫铜器组与 TCu220-C 组相似。月经血量宫铜器组略高于宫形器组,但无显著性差异(P>0.005)。     

金塑混合环等三种宫内节育器比较性研究

本文总结了不锈钢金属单环(金单)、金属塑料混合环(金塑)及TCu220C三种宫内节育器前瞻性观察3年的结果。共接收对象1,199例,3年中失访4例,随访率达99.67%。放置12、24与36个月时的每百妇女累积续用率分别为金单73.76%、66.73%与65.47%;金塑80.86%、72.33%与69.32%;TCu220 C 94.46%、88.42%与83.13%。TCu 220 C的脱落率和妊娠率非常显著地低于金单和金塑(P<0.01),金单的脱落率高于金塑(P<0.05～0.01),而两者的妊娠率无显著差异(P>0.05)。三种IUD因出血取出率均无显著差异(P>0.05)。     

放置宫内节育器妇女的血清铁蛋白测定

229名天津健康妇女血清铁蛋白(Fer)正常对照值为35.5ng/ml。60例放置宫内节育器(IUD)妇女于放器前周期为28.5ng/ml;放器后第6、12周期分别显著下降到18.8和18.6ng/ml,P<0.01,缺铁率分别增加到45.5和48.1%,第24周期Fer回升至22.3ng/ml,P>0.05,缺铁率略有减少。但月经血量(MBL)>80ml者例外,其缺铁率持续进行性增高,第24周期达66.7%。文内结合MBL和Hb值,分析放器妇女Fer改变的临床特点和意义,提出使用Fer测定可及早对缺铁状态进行防治的措施。     

三种宫内节育器(VCu200,金单和TCu200C)放置五年月经血量和血红蛋白浓度变化

本文对三种宫内节育器(IUD)VCu200 241例,金单244例和TCu220C 272例共计放置757例,观察五年。测定其月经血量和血红蛋白浓度。至五年时尚存390例。放器前平均MBL45.2ml。放器后两年内MBL 变化与文献报道相似。至五年时其MBL接近放器前平均水平。三种IUD 放器前其MBL≥80ml 而在放置五年时MBL<80ml者占19.77%。放器前MBL<80ml 在放器后第1年MBL≥80ml,至五年时其MBL<80ml 者占44.35%。放器后Hb 浓度金单组普遍低于放器前Hb 平均水平,VCu200与TCu220C 组的Hb 浓度反较放器前高。     

放置吉妮固定式宫内节育器507例分析

目的 比较放置吉妮宫内节育器（Gyne F：X IN IUD，IN IUD）与放置T型铜节育器（IUD）的近期（30天内）、远期（1～12个月内）、门诊随访、电话随访的效果。方法 1998年3月～2002年3月在我院同期放置IN IUD507例为观察组，T型铜IUD 932例为对照组。结果 观察组在取环率、脱环率、阴道流血、月经增多、疼痛、配偶性交痛、带器妊娠几方面，除配偶性交痛差异无显著性外（P〉0．05），其余各项差异均有非常显著性（P〈0．01）。结论 放置IN IUD具有安全性高、适用范围广、避孕效果好、不良反应少、脱落率低等优点，适于临床推广应用。     

中医辨治宫内节育器致子宫异常出血疗效观察

目的 观察加味失笑散方随症加减治疗宫内节育器致子宫异常出血的效果。方法 2011年1月至2013年3月在蕉岭县人口和计划生育服务站接收的置宫内节育器后子宫异常出血的90例患者,随机分为A组（观察组）和B组（对照组）,A组用加味失笑散方随证加减治疗,B组单用加味失笑散治疗。结果 A、B两组治疗前月经量分别为(124.32±22.73)mL和(126.49±23.76) mL,治疗后月经量分别为(70.38±13.73) mL和(79.92±20.34) mL;A、B两组治疗前月经持续天数分别为(12.32±3.24) d和(11.84±3.10) d,治疗后月经持续天数分别为(6.44±1.22) d和(7.08±2.11) d;A、B两组治疗前血红蛋白分别为(113.31±11.49) g/L和(113.93±7.89) g/L,治疗后血红蛋白含量分别为(133.91±12.96) g/L和(127.62±11.34) g/L;两组月经量、月经持续天数及血红蛋白自身治疗前后比较差异均有统计学意义（P＜0.001）。治疗后A组痊愈34例(75.5%)、B组痊愈25例（55.5%）,治疗后月经量、血红蛋白及痊愈率均A组为优,A、B两组比较差异均有统计学意义（P＜0.05）。结论 加味失笑散方随证加减治疗宫内节育器致子宫异常出血有较满意的效果,值得临床推广应用。     

左炔诺孕酮宫内缓释系统治疗功能失调性子宫出血的临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗功能失调性子宫出血的临床效果。方法:48例确诊为功能失调性子宫出血的患者,放置LNG-IUS。置宫内节育器前后均行宫腔镜检查、月经量评分、测量子宫内膜厚度;检测卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)和孕酮(P)浓度及子宫内膜雌、孕激素受体(ER/PR)。结果:置宫内节育器3个月后,月经量明显减少,PBAC法月经量评分由置宫内节育器前(128.9±41.5)降至(52.2±13.8),具有统计学意义(P<0.01);子宫内膜由(12.9±4.2)mm降至(8.4±2.0)mm,差异具有统计学意义(P<0.05)。置宫内节育器6个月后,宫腔镜下观察,子宫内膜菲薄,病理显示内膜呈轻度分泌现象及间质蜕膜样变;ER、PR的表达均显著下调(P<0.01)。结论:LNG-IUS能有效地减少月经量,对增生的子宫内膜具有逆转作用,治疗功能失调性子宫出血效果好。     

三种宫内节育器对月经失血量和血铁影响的比较研究

本文用随机的方法对60名健康妇女放置不锈钢单环、Vcu 200和Tcu 220c 3种节育器,并在放器前、后进行月经血量、血红蛋白浓度和血清铁蛋白测定。结果表明,不锈钢单环在放器后无论月经血量、月经过多和缺铁性贫血的发生率均明显比Vcu 200和Tcu 220c为低。Vcu 200和Tcu220c二者的结果则近似。     

18甲基炔诺酮阴道环的临床观察

本文介绍108例妇女使用释放左旋18甲基炔诺酮20微克/天阴道环一年的临床效果和副反应。每100例妇女使用一年的净累积率为:妊娠率3.7,脱落率4.6,与阴道环有关的停用率26.9,持续使用率71.2。副反应主要为月经紊乱,但随使用时间的延长而逐步改善。本文有20例首进行月经血量,血红蛋白和铁蛋白测定。使用阴道环后第一月,经血量略有增加,此后有下降趋势,血红蛋白浓度在放环后第6和第12月有明显增加(P<0.05)。     

A Canadian,Multicentre Study Comparing the Efficacy of a Levonorgestrel-releasing Intrauterine System to an Oral Contraceptive in Women With Idiopathic Menorrhagia

ObjectivesTo evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared with a combined oral contraceptive containing 1 mg norethindrone acetate and 20 μg ethinyl estradiol (OC1/20) in reducing menstrual blood loss (MBL) in women with idiopathic menorrhagia.MethodsA prospective, randomized, open-label study was conducted in nine centres in Canada. Healthy women over 30 years of age suffering from idiopathic menorrhagia were treated either with LNG-IUS (n = 20) or with OC1/20 (n = 19) over 12 months. The primary endpoint was the change in MBL from baseline to 12 months. Secondary endpoints included treatment success (defined as a MBL score < 100 after 12 months), hemoglobin levels, and the menorrhagia severity score.ResultsIn both treatment groups, MBL decreased significantly from baseline to 12 months (P < 0.001). For the primary endpoint, the MBL score decreased significantly more in the LNG-IUS group (median from 228 to 13, mean percent change–83%) compared to the OC1/20 group (median from 290 to 72; mean percent change–68%) (P = 0.002) after 12 months.In the LNG-IUS group, 80% of subjects had treatment success compared with 36.8 % in the OC1/20 group (P < 0.009).Both treatments increased hemoglobin concentrations significantly between baseline and 12 months. The menorrhagia severity score was consistently lower in the LNG-IUS group at all study time points and was significantly lower (P = 0.045) at six months. Both treatments were well tolerated.ConclusionBoth the LNG-IUS and the combined oral contraceptive effectively decreased menstrual blood loss in women with idiopathic menorrhagia. The overall clinical benefit was more pronounced with LNG-IUS than with OC1/20.     

Comparison between mefenamic acid and danazol in the treatment of established menorrhagia

Summary. Forty women with established menorrhagia were treated with either mefenamic acid (500 mg thrice daily for 3–5 days in two cycles) or danazol (100 mg twice daily for 60 days) in an open parallel group randomized study. Mefenamic acid reduced mean menstrual blood loss from 160ml to 127ml (20%, P<0·01). Danazol reduced mean menstrual loss from 163 ml to 65 ml (60%, P<0·001). The percentage reduction in menstrual blood loss was significantly greater in the danazol group than in the mefenamic acid group, but the adverse sideeffects occurred significantly more often in the danazol group (75%) than in the mefenamic acid group (30%, P<0–005). Overall, approximately half the women in each group were prepared to continue with the treatment they received to reduce their menstrual bleeding.     

Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts

OBJECTIVE: To compare the efficacy and tolerability of the levonorgestrel intrauterine system (LNG IUS) with mefenamic acid in the management of objective idiopathic menorrhagia. DESIGN: Phase III, Single centre, open, randomised, comparative, parallel group study. SETTING: District General Hospital in the United Kingdom. POPULATION: Fifty-one women with objective menorrhagia. METHODS: Twenty-five women randomised to receive the LNG IUS and 26 to oral mefenamic acid for six cycles. MAIN OUTCOME MEASURES: Change from baseline in menstrual blood loss (MBL), total menstrual fluid loss (TMFL) and pictorial blood loss assessment chart (PBAC) score at the third and sixth cycle of treatment. RESULTS: After six cycles the median menstrual blood loss was 5 mL in the LNG IUS group and 100 mL in the mefenamic acid group (P < 0.001). Median TMFL was 27 mL in the LNG IUS group and 157 mL in the mefenamic acid group (P < 0.001). Median PBAC score was 25 in the LNG IUS group and 159 in the mefenamic acid group. Changes in menstrual blood loss correlated strongly to changes in TMFL (r= 0.88) but PBAC correlated less well to blood loss and total fluid loss (r= 0.53 and r= 0.58). CONCLUSIONS: Both the LNG IUS and mefenamic acid significantly decreased menstrual blood loss, TMFL and PBAC scores. The LNG IUS produced greater reductions in all parameters than mefenamic acid. Comparison of the different measurements suggests that TMFL assessment may be an easier and a more relevant measure of symptom severity than menstrual blood loss.     

Quantitative cytochemical study of ACP and AKP activity in the endometrial bleeding associated with copper intrauterine devices (IUDs)]

In order to identify the relationship between the changes in endometrial ACP and AKP associated with the use of copper IUDs and excessive menstrual bleeding, the Maternal Hospital of Zhejiang Medical University conducted a study between June 1987 and February 1988. Among the clients aged 25-39 who had IUDs inserted in the hospital during the study period, 3 groups of 14 women each were randomly chosen. These groups were: pre-insertion, post-insertion and normal menstruation, and post-insertion hypermenorrhea. Each group was divided randomly into 7 cases. Samples of endometrium were taken for ACP and AKP activity study using cytochemical methods at the proliferative phase and late secretory phase, respectively. ACP activity of the pre-insertion group was similar to that of the post-insertion and normal menstruation group, but the ACP activity of the post-menstrual hypermenorrhea group was significantly increased as compared to the other two groups. AKP activity between the post-insertion normal menstruation and post-insertion hypermenorrhea group as well as among the three groups at the late secretory phase, was not significantly different. This suggests that the ACP enzymes might have an effect on the excessive menstrual bleeding, associated with the use of copper IUDs, while AKP activity did not. Further investigation is needed to explore the possibility of using enzyme stabilizing or enzyme suppressing agents to treat excessive menstrual bleeding in copper IUD users.     

Comparison between mefenamic acid and danazol in the treatment of established menorrhagia

Forty women with established menorrhagia were treated with either mefenamic acid (500 mg thrice daily for 3-5 days in two cycles) or danazol (100 mg twice daily for 60 days) in an open parallel group randomized study. Mefenamic acid reduced mean menstrual blood loss from 160 ml to 127 ml (20%, P less than 0.01). Danazol reduced mean menstrual loss from 163 ml to 65 ml (60%, P less than 0.001). The percentage reduction in menstrual blood loss was significantly greater in the danazol group than in the mefenamic acid group, but the adverse side-effects occurred significantly more often in the danazol group (75%) than in the mefenamic acid group (30%, P less than 0.005). Overall, approximately half the women in each group were prepared to continue with the treatment they received to reduce their menstrual bleeding.     

Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding

Objectives: To compare the effect of manual removal and spontaneous delivery of placenta on postcesarean bleeding and endometritis. Methods: In this prospective study 400 pregnant women undergoing elective cesarean delivery were randomly assigned to two groups: spontaneous placental delivery (200 women) and manual placental delivery (200). No antibiotic prophylaxis was administered in either group. The significance of blood loss due to cesarean delivery was defined by a drop in hemoglobin concentration of more than 1 g/dl 24 h after delivery in comparison with preoperative hemoglobin concentration. Endometritis was diagnosed in patients who developed clinical signs of fever and suprapubic tenderness 48 h after delivery. We analyzed the data using a t-test. Results: The overall endometritis rate was 27%, in 40 women in the spontaneous placental delivery group (20%) and 68 women in the manual placental removal group (34%). There was a statistically significant difference between the two groups (P=0.001). Significant blood loss was experienced by 52 women (26%) in the spontaneous placental delivery group vs. 100 women (50%) in the manual placental delivery group. There was a statistically significant difference in blood loss between the two groups (P=0.000; RR=1.92). Conclusion: Endometritis and blood loss in cesarean delivery is increased by manual removal of the placenta compared with the spontaneous method of placental removal.