哺乳期妇女放置缓释黄体酮阴道环和铜T380A宫内节育器避孕效果…

本文对产后４２￣６０天的哺乳妇女放置每天释放１０ｍｇ天然黄体酮的阴道环（１６０例）与铜Ｔ３８０Ａ宫内节育器（１００例）进行避孕效果及其安全性比较研究。结果表明：通过宣教，产后４２￣６０天落实节育方法是可行的，放置铜Ｔ３８０Ａ宫内节育器在哺乳期无妊娠发生，哺乳期避孕对母儿健康无不良影响，围产保健和计划生育并行对提高母乳喂养率，落实计划生育方法，降低人工流产率，保障母儿健康收效显著，值得推广。     

剖宫产术后即时放置固定式宫内节育器120例的临床观察

产后避孕最主要的问题是节育器脱落和带器妊娠。近年，有学者认为产后立即放置(immediate postplacental insertion，IPPI)含铜宫内节育器(IUD))是较好的产后避孕方法。我们在固定式宫内节育器广泛用于人工流产术后即时放置的基础上，在剖宫产术后即时放置固定式宫内节育器，探讨固定式宫内节育器用于产后避孕的安全性及可行性。     

GyneFix IN与TCu 380A宫内节育器的随机比较性临床研究

目的观察新型ＧｙｎｅＦｉｘＩＮ宫内节育器（ＩＵＤ）的临床性能。方法采用随机对比性多中心临床研究方法,对６０７例健康经产妇女由经过培训的专人以随机方法于月经间期放置ＧｙｎｅＦｉｘＩＮＩＵＤ３２０例（ＧｙｎｅＦｉｘＩＮ组）及ＴＣｕ３８０ＡＩＵＤ３０５例（ＴＣｕ３８０Ａ组）,于放器后１、３、６和１２个月随访,以生命表法统计两种ＩＵＤ的终止情况。结果ＧｙｎｅＦｉＸＩＮ组使用１年无妊娠发生,脱落和因症取出率分别为每百妇女２６７和１０２,与ＩＵＤ使用有关的终止率为每百妇女３６６,明显低于ＴＣｕ３８０Ａ组的每百妇女７８８（Ｐ＜００５）。ＧｙｎｅＦｉｘＩＮ组疼痛的主诉率也低于ＴＣｕ３８０Ａ组。结论此种无支架、铜表面积大并有固定系统的ＩＵＤ,由经过培训的人员放置,具有低脱落率和改善疼痛副反应的特点,有推广前景。     

两种产后立即放置T Cu380A IUD方法的比较——3年随访分析

将产后准备选择ＩＵＤ避孕的３８４例阴道分娩产妇（９８．７０％ 是首次分娩）,随机分为两组,于胎盘娩出后１０ ｍ ｉｎ 内徒手放置（１８９例）或卵园钳放置（１９５例） ＴＣｕ ３８０Ａ ＩＵＤ。以生命表法统计、χ２检验比较这两种不同放置方法放置后６、１２、２４ 和３６ 个月的脱落率和其他停用率。３８４ 例无一发生子宫穿孔、大出血、感染或恶露延长。放置后主要停用原因是脱落。两组６～３６ 个月各项停用指标（脱落、妊娠、因出血／疼痛取出等）的粗累积率均无显著差异（Ｐ＞ ０．０５）。研究认为,不同放置方法对阴道分娩ＩＰＰＩ效果无明显影响;ＴＣｕ ３８０ＡＩＵＤ是适合中国妇女产后立即放置的。本文还对影响ＩＰＰＩ脱落率的因素如哺乳和ＩＵＤ在宫腔内位置等进行了讨论。     

两种产后立即放置TCu380A宫内节育器方法的比较——910例12个月随访分析

目的：比较徒手和卵圆钳两种方法对产后立即放置（ＩＰＰＩ）宫内节育器（ＩＵＤ）效果的影响。方法：将９１０例阴道分娩产妇（其中９７．７％是首次分娩）随机分成两组，于胎盘娩出后１０分钟内放置ＴＣｕ３８０ＡＩＵＤ，其中４７０例徒手放置（手放组），４４０例用卵圆钳放置（钳放组）。随访１２个月，以生命表法统计、χ２检验比较两种放置方法的脱落率、妊娠率、因症取出率等。结果：６和１２个月的随访率分别为９５．１６％和９２．６４％。９１０例中未发生子宫穿孔和感染，仅手放组有１例带器妊娠。放置后主要停用原因是脱落，手放组与钳放组１２个月的粗累积脱落率分别为１５．８６／１００妇女和１５．８８／１００妇女，因症（出血、疼痛）取出率分别为２．１１／１００妇女和１．５７／１００妇女，差异无显著性（Ｐ均＞０．０５）。结论：徒手放置或卵圆钳放置对ＩＰＰＩ的效果无明显影响；ＴＣｕ３８０ＡＩＵＤ适合中国妇女产后立即放置。     

产时放置宫内节育器的临床应用及效果观察

产时放置宫内节育器的临床应用及效果观察黄艳实行计划生育，控制人口增长是我国的一项基本国策。宫内量节育器是目前国内妇女使用最多的避孕方法，它具有安全、经济、长效和简便的优点。因许多妇女产后未采取避孕措施，造成哺乳期人工流产甚至引产的结果。所以我们从１９...     

294例带器妊娠临床分析

１９９４年至１９９７年我们诊、治了带器妊娠２９４例，探讨了宫内节育器（ＩＵＤ）避孕失败的原因。１临床资料带器妊娠２９４例中，２４～４６ｙ，平均３５ｙ。２１２例为产后哺乳期内放置ＩＵＤ者，５７例为流产时放置者，１５例为脱器后再次放置者。２４３例为１次带...     

剖宫产后节育方法的效果研究

本研究对１９８９年４月到１９９０年３月间在国际和平妇幼保健院及纺织局第二医院内剖宫产及自然分娩产妇各１０００例进行了为期两年的回顾性调查。调查内容包括产后避孕方法采用时间、各类避孕方法的效果及产后人流等情况。结果显示：两组产后两年内年人均人流人次类似，差别无显著性；产后落实避孕措施越早，产后人流的可能性越小。两组人流原因中均以无措施导致为主。各类避孕方法中以宫内节育器效果为最佳，宫内节育器中以活性非圆形ＩＵＤ为最好。因此，在剖宫产后及时落实高效安全的避孕方法，特别是使用活性非圆形宫内节育器，在妇女中大力普及各种避孕知识的同时，加强计划生育技术指导，对降低剖宫产后的人流可能性具有重要的作用。     

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。     

放置富内节育器并发异位妊娠60例分析

放置富内节育器并发异位妊娠６０例分析封莲凤，阳怀安放置宫内节育器（ＩＵＤ），多年来一直是育龄妇女避孕的主要方法之一，但带器受孕已屡有报告，尤其是近２０年来异位妊娠发生率有所上升，是否与使用ＩＵＤ有关，我们对我院１９８４～１９９３年带器并发异位妊娠６０...     

Comparative study of Copper IUDs

A comparative study of 4 copper IUDs, Cu T 200, Cu T 380, and Cu Y, was undertaken in the Peripheral Contraceptive Testing Unit of Indian Council of Medical Research at Madurai. 250 women wearing Cu T 200, 227 wearing Cu T 220, 281 Cu T 380 A and ll9 Cu Y were followed up at 1, 3, 6, 9, 12, and 18 months. Continuation rates were lower with Cu Y and Cu T 380. Expulsion and termination rates due to expulsion were higher with Cu T 200 and Cu T 380 A. Menstrual disorders were highest with Cu T 380A. There were 2 pregnancies with Cu T 200, none in the other groups. Expulsion rates were the lowest for Cu Y, Cu T 220 second lowest. Menstrual disorders occurred least among Cu T 200 users. Minor side effects, abdominal pain, backache, leucorrhea, did not vary with device used. The removal rate for menstrual side effects was highest for Cu T 380 A, 3x that of Cu T 200. Cu T 220 and Cu T 200 had similar removal rates. The Cu T 200 retains its contraceptive efficacy up to a period of 4 years.     

Comparison of three different models of the copper T intrauterine contraceptive device.

A random sequential comparative study of three models of the Copper T intrauterine contraceptive device (IUD) was undertaken in 1,792 women. For 7 months, the TCu 300 and TCu 220C were randomly inserted, and then the TCu 380A and 220C were randomly inserted for the next 12 months. The log-risk method of life-table analysis of event rates was performed at the end of each of the first 3 years of use of each device. The TCu 380A had the lowest pregnancy rate during each year of use, although the difference was not significant. At the end of each of the first 2 years, the TCu 300 was removed significantly less than the TCu 220C and TCu 380A for bleeding and pain. At the end of three years, the rates of removal for bleeding and pain for the TCu 380A and TCu 300 were similar and lower than that for the TCu 220C, but the overall difference was not significant. There were no differences among the devices for any other relevant use-related reasons. The TCu 380A was removed for other medical reasons significantly more frequently than the other devices at the end of 2 and 3 years. Adjusting for parity did not alter the results. The findings of this study suggest that the copper sleeves along the horizontal arms together with copper wire on the vertical arm in the TCu 380A model provide greater protection against intrauterine pregnancy, whereas the copper sleeves along the vertical arm as in the TCu 220C caused increased removals for bleeding and pain. The TCu 380A should be studied in a larger number of patients for a longer period of time to determine its clinical effectiveness. It may become the IUD of choice for all women irrespective of parity.     

Interactions between intrauterine contraceptive device use and breast-feeding status at time of intrauterine contraceptive device insertion: analysis of TCu-380A acceptors in developing countries.

OBJECTIVE: This paper is a reassessment of earlier findings from a preliminary analysis of data from a multicenter international trial regimen on breast-feeding and non-breast-feeding women in which events related to insertion, expulsion, and removal of the TCu-380A intrauterine contraceptive device (ParaGard 380) were investigated. STUDY DESIGN: Performance of the TCu-380A through 12 months after insertion was compared with life-table rate analysis, chi 2, Fisher exact test, or Student's t test. Variables were events reported during intrauterine contraceptive device insertion and events throughout the 12 months of study participation by breast-feeding status. RESULTS: Breast-feeding among intrauterine contraceptive device users was associated with fewer insertion-related complaints and lower removal rates for bleeding and pain. No uterine perforations were reported throughout the study. CONCLUSION: Differences in the performance of the TCu-380A intrauterine contraceptive device suggest physiologic effects associated with lactational amenorrhea. The TCu-380A intrauterine contraceptive device is a viable option for women breast-feeding at the time of intrauterine contraceptive device insertion.     

活性γCu380 IUD与TCu380A IUD多中心比较性研究

本研究通过增加原γCu2 0 0 IUD的铜表面积至 380 mm2 ,以期在不增加副反应的基础上进一步降低带器妊娠率 (包括异位妊娠 ) ,而达到与 TCu380 A IUD相似的避孕效果 ,并保持原来的低副反应发生率。方法 :1 998年 1～ 5月由全国五个中心参加的随机比较性研究 ,共随访 1 2个月。每个中心分别放置γCu380与 TCu380 A IUD各 1 0 0例 ,共 1 0 0 0例。结果 :1 2个月末 γCu380与 TCu380 A IUD脱落率每百妇女分别为 0 .80和 1 .99(P>0 .0 5)。带器妊娠率每百妇女均为 0 .2 0。异位妊娠率每百妇女分别为 0 .2 0和 0 .0 0 (P>0 .0 5)。因症取出率每百妇女分别为 1 .0 0和 2 .6 0 (P>0 .0 5)。结论 :γCu380 IUD临床效果与 TCu380 A IUD相似 ,而 γCu380 IUD副反应发生率明显低于 TCu380 A IUD。本研究结果证实载高铜面积 γCu380 IUD是一种优质的 IUD。     

The TCu380 IUD: initial international experimental results with the latest "T" family IUD

The Gyne T 380 IUD is similar to the Gyne-T 200 available in France since 1979 except that it contains a ball on the extremity of the vertical arm designed to prevent cervical perforation and it has a higher copper content. A multicenter study found cumulative annual event rates/100 women for the Gyne T 200 and the Gyne T 380 respectively of 4.9 and .7 for pregnancy, 10.1 and 6.8 for expulsion, 13.7 and 21.5 for removal because of pain or bleeding, 4.9 and 4.3 for removal because of other medical reason, and 5.9 and 10.4 removal to achieve pregnancy. The continuation rates were 54.9 and 50.1, while number of months of utilization were 82,800 for the Gyne T 200 and 17,652 for the Gyne T 380. An American study of 3536 insertions of the Gyne T 380 showed rates after 1, 2, and 3 years of use respectively of .7, .8, and 1.1 for pregnancy, 5.5, 7.5, and 8.5, for expulsion, 13.1, 21.8, and 26.7 for removal because of pain or bleeding, 3.0, 4.6, and 5.4 for removal for other medical reasons, and 73.0, 53.7, and 41.1 for continuation. 68.2% of participants in the American study were under 25 and 63.7% were nulliparas. Additional data after 4 years of use of the Gyne T 380 showed a cumulative net pregnancy rate of 1.9. The risk of extrauterine pregnancy was estimated at .38/1000 women after 3 years. The frequency of expulsions appeared to be negatively connected with age and parity. Rates of removal for pain or bleeding appeared to be negatively correlated with age. In the comparative study, rates of removal for pain or bleeding were higher in nulliparas. Most medical reasons for removal other than pain or bleeding referred to pelvic inflammations, salpingitis, endometritis, or vaginitis, and their frequency declined after the 1st 6 months of use. Continuation rates were identical for the Gyne T 380 and for the other T devices in the American study. Among 293 women requesting removal of the device for pregnancy, 78.4% became pregnant within the next 12 months. 1767 women in the American study had Pap smears before and during Gyne T 380 use; the proportion in classes III and IV did not change after insertion of the device. 2 Indian studies demonstrated no neoplasic transformations or aggravations of dysplasic lesions. Analysis of a small number of randomly selected Gyne T 380 IUDs removed for study showed an average release during the 1st year of 50.3 mcg/day of copper, varying from 17.5 to 63.9 mcg in 8 of the 9 devices. The rate declined with time and was half as high in the 3rd and 4th years. Fragmentation of the copper wire apparently is less frequent in the Gyne T 380 than in the Gyne T 200. The location of the copper wires on both horizontal arms may explain the greater contraceptive efficacy of the Gyne T 380.     

活性γCu380IUD与TCu380AIUD临床比较性研究

本研究通过增加原γCu 2 0 0 IUD的铜表面积至 3 80 mm2 ,其目的为了进一步降低带器妊娠率 (包括异位妊娠 ) ,以期达到 TCu3 80 A IUD相似的避孕效果 ,而其副反应发生率明显低于 TCu3 80 A IUD。方法 :1 995年 8月～ 1 996年 6月由三个中心参加的随机比较性研究 ,共随访 2 4个月。每个中心分别放置γCu 3 80与 TCu 3 80 A IUD各 1 0 0例 ,共 6 0 0例。结果 :2 4个月末 γCu3 80与 TCu3 80 A IUD脱落率每百妇女分别为 0 .997和 2 .4 70 (P>0 .0 5)。带器妊娠率每百妇女分别为 0 .3 3 2和 2 .4 59(P<0 .0 5)。异位妊娠率每百妇女分别为 0 .1 6 1和 0 .3 3 0 (P>0 .0 5)。因症取出率每百妇女分别为 1 .6 6 1和 5.4 95(P<0 .0 5)。结论 :γCu 3 80 IUD临床避孕效果明显优于 TCu 3 80 A IUD;两种 IUD的异位妊娠率相似 ;γCu3 80 IUD的副反应发生率明显低于 TCu3 80 A IUD。本研究结果证实高铜面积 γCu3 80 IUD是一种优质的 IUD。     

第二代吲哚美辛VCu与TCu380A临床比较性研究

目的 :了解第二代吲哚美辛 VCu IUD的临床疗效。方法 :自 1 997.5～ 1 998.2 ,在包括城市和农村的 6个临床单位 ,放置第二代吲哚美辛 VCu IUD1 0 0 0 (V组 )例 ;放置后 6月、1 2月和 2 4月随访 ,并与 1 0 0 0例放置 TCu3 80 A IUD者 (T组 )比较。结果 :两组对象临床特征相仿。随访率 98.2 5 %。净累积续用率随访 6月时 T组 95 .5 % ,V组 97.5 % (P<0 .0 5 ) ;1 2月时分别为 93 .79%和94.78% ;2 4月时分别为 88.2 3 %和 89.77%。脱落率在各阶段均为 T组高于 V组。妊娠率和因出血、疼痛取出率两组基本相似。月经量多、经期延长和腹痛的发生率 T组始终高于 V组。点滴出血者在 1 2月内 T组多于 V组。 V组月经量减少者始终多于 T组。在置器 4～ 6月 ,T组总 B/S、平均B/S及最大 B/S段长均大于 V组 (P<0 .0 1 )。血红蛋白测定在放 IUD前两组相似 ,随访 2 4月时复查 ,T组较放置前有所下降 (P<0 .0 0 1 ) ,且低于 V组 (P<0 .0 0 1 ) ;V组与放置前相似。结论 :第二代吲哚美辛 VCu与 TCu3 80 A比较 ,具有相同的避孕效果及续用率 ,较低的出血、疼痛副反应 ,更有利于保护妇女的生殖健康 ,值得临床推广应用     

Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices.

OBJECTIVES: The objectives were to measure rates of planned pregnancy and factors affecting these rates after use of very-long-acting contraceptive methods (Norplant or Norplant II implants, a levonorgestrel-releasing intrauterine contraceptive device, or the copper T (model TCu 380Ag) intrauterine contraceptive device. STUDY DESIGN: The design was a concurrent, multicenter prospective study of 372 women who stopped contraception for planned pregnancy. Analysis was by life-table, log-rank, and standard chi 2 methods. RESULTS: Pregnancy rates 12 and 24 months after cessation of contraceptive use were 82 and 89 per 100, respectively. Age at removal and family planning intentions at initiation of contraception were both significantly correlated with pregnancy rates (p less than 0.05), but former contraceptive regimen and duration of contraceptive use were not. Pregnancy outcomes did not deviate from normal limits and did not differ by contraceptive formerly used. CONCLUSION: Contraceptive implants releasing 30 micrograms/day of levonorgestrel or intrauterine contraceptive devices releasing 20 micrograms/day of levonorgestrel or having copper surface areas of 380 mm2 are associated with normal fertility after use for women seeking pregnancy at termination. Durations of use do not affect pregnancy rates.     

Contraceptive efficacy of intrauterine devices

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.     

Expression of leukaemia inhibitory factor (LIF) during the window of implantation in copper T380A intrauterine device users.

OBJECTIVE: The mechanism of action of intrauterine devices (IUDs) is not well understood. This investigation was intended to gain further insight into the role of leukaemia inhibitory factor (LIF) in intrauterine contraception. We evaluated the immunohistochemical distribution patterns of LIF in women wearing a copper T380A IUD. METHODS: The immunohistochemical distribution patterns of LIF in women who had been using a copper T380A IUD for different periods of time, two months after removal of the IUD, and in normal fertile women were evaluated. Endometrial biopsies were obtained from four groups of patients according to the duration of T Cu380A IUD use (group I: <5 years, n = 15, and group II: > or = 5 years, n = 15), after IUD removal (group III, n = 15) and normal fertile women (controls, n = 15) during the window of implantation (WOI). Staining intensity of LIF was evaluated using semi-quantitative IRS-scores. RESULTS: The lowest expression of LIF was observed in women using a copper T380A IUD, being statistically significant compared with the control group (p < 0.05). LIF immunostaining remained abnormal two months after IUD removal. CONCLUSIONS: Copper IUDs can inhibit expression of LIF and they may cause inhibition of the implantation stage, which is crucial for pregnancy.