产后1年内意外妊娠妇女避孕状况调查

目的通过调查产后意外妊娠妇女的避孕状况,探讨产后避孕失败的原因。方法将2008年11月至2013年5月北京大学人民医院计划生育科189例产后1年内意外妊娠妇女作为研究组,同期326例产后1年内未妊娠妇女作为对照组,对其临床资料进行回顾性分析。结果研究组妇女的平均年龄[（30．15±4．15）岁]与对照组[（33．51±6．03）岁]比较,差异有统计学意义（P〈0．05）;两组妇女的文化程度及职业比较,差异无统计学意义（P〉0．05）。研究组未避孕率（28．57％,54／189）与对照组（19．94％,65／326）比较,差异有统计学意义（P〈0．05）。研究组妇女中,阴道分娩组未避孕率（20．93％,27／129）与剖宫产组（45．00%,27／60）比较,差异有统计学意义（P〈0．05）。研究组因避孕措施失败而导致意外妊娠135例（71．43％）,其采用的避孕方法分别为避孕套107例（79．26％）,安全期21例（15．56％）,体外排精6例（4．44%）,宫内节育器1例（0．74％）。结论不避孕或使用效果不稳定的避孕方法,是导致妇女产后1年内意外妊娠的主要原因。     

我国产后二年内非意愿妊娠发生现状及其影响因素

目的:分析我国育龄期妇女产后2年内非意愿妊娠发生现状及其影响因素。方法:在我国东、中、西部地区15个省市自治区的60家医院,采用结构式问卷调查2015年7月至2016年6月分娩的产妇,了解其产后2年内非意愿妊娠发生情况,探讨人口学特征、孕产史、母乳喂养、产后避孕启动及避孕方法等因素对产后非意愿妊娠发生风险的影响,采用描...     

产后妇女盆底器官脱垂情况调查及影响因素分析

目的:调查产后妇女盆底器官脱垂的情况并探讨人口学特征、运动习惯和产科等因素对盆底器官脱垂的影响。方法:纳入2015年10月至2016年4月产后6~8周到上海交通大学附属同仁医院产后门诊做常规体检的产妇852例。采用自填问卷方式收集研究对象人口学特征、产科信息、孕前参加体育锻炼情况等信息,并由妇科医生进行盆底器官脱垂的检查。结果:852例产后6~8周产妇中84.25%有阴道脱垂,55.61%的产妇为Ⅰ度脱垂,28.64%的产妇为Ⅱ度脱垂,未发现Ⅲ度或Ⅳ度阴道脱垂。仅有5例有Ⅰ度子宫脱垂。多分类有序Logistic回归显示,巨大儿(OR 2.469,95%CI 1.029~5.927)、产次≥2次(OR 2.730,95%CI 1.929~3.864)、阴道分娩(OR 43.257,95%CI25.505~73.353)、紧急剖宫产(OR 2.139,95%CI 1.266~3.615)是影响产妇阴道脱垂的高危因素。结论:产后6~8周的产妇轻度阴道脱垂的比例较高。阴道分娩、巨大儿和多产次对阴道脱垂的影响较大。     

产后抑郁的特点及影响因素

目的：分析产后抑郁的特点及影响因素。方法：2011年1月至2013年11月选择在我院住院分娩并进行产后检查的妇女400例为研究对象,都积极进行产后抑郁与各种流行病学资料的调查。结果：发生产后抑郁76例,发生率为19．0％,其中轻度46例,中度24例,重度6例。多元线性回归条件logistic回归分析结果显示高危妊娠、产前抑郁情绪、消极应对方式、缺少社会支持为主要的影响因素（P〈0．05）。结论：产后抑郁比较常见,主要影响因素为高危妊娠、抑郁情绪、消极应对方式、缺少社会支持．要积极加强干预与对症处理。     

产后早期妇女骨密度及影响因素分析

目的:了解妊娠哺乳妇女骨密度的影响因素,为防止妊娠哺乳有关的骨量降低提供依据.方法:从2004年1月到2007年1月在镇江市第二人民医院住院分娩的产妇中随机抽取106例产后早期妇女,准确记录其年龄、身高、体重、孕周、新生儿体重、分娩日期、有无症状、孕期补钙、牛奶摄入情况及日照情况,采用双能X线骨密度仪检测腰椎L1～L4骨密度(BMD).结果:106例产妇平均腰椎低骨量发生率18.87%,腰椎骨密度值与身高、体重、体重指数呈正相关;产妇年龄、有无症状、是否补钙、分娩季节不同,其骨密度差异无显著性,P>0.05;新生儿体重≥3500 g组产妇骨密度高于新生儿体重<3500 g组,差异有显著性(P<0.05);牛奶摄入量≥200ml的产妇骨密度高于牛奶摄入量<200 ml的产妇,差异有非常显著性(P<0.01).结论:妊娠哺乳妇女应增加膳食钙含量,多喝牛奶,合理补充钙剂,以减少骨量的丢失;身高体重较小的产妇尤其应监测骨密度的变化.     

发生异位妊娠的影响因素分析

目的：对发生异位妊娠的影响因素进行对照研究和分析。方法：选择68例于2010年1月至2012年12月间在我院进行异位妊娠治疗的患者资料进行研究和分析,将上述患者作为观察组,选择同期于我院行流产的68例正常妊娠产妇作为对照组,对照和分析两组患者的妊娠相关指标。结果：异位妊娠与性伴侣个数、不孕史、口服避孕药、宫内节育器、腹部手术、孕产史和妇科炎症以及文化程度等关联性较强（P〈0.05）,与婚姻状况、停经时间、初孕年龄等关联性较差（P〈0.05）。不孕史、口服避孕药物、宫内节育器、妇科炎症以及孕产史都是导致异位妊娠的危险因素。结论：异位妊娠为多因素或者单一因素作用的结果,为了降低异位妊娠发生率,必须加强健康宣教,及道德教育,使妇科炎症和非意愿妊娠得到有效减少。     

产后暴露于无避孕措施的性行为及其影响因素分析

本文利用上海市两个区和两个郊县3898名妇女产后15个月的随访资料．对产后意外妊娠的危险因素—暴露于无避孕措施的性行为及其影响因素进行了分析。结果显示,产后意外妊娠的妇女中,44．1％因未用避孕措施而妊娠,其中95．5％的妇女妊娠前从未使用过任何避孕措施。产后首次性生活时妇女避孕措施使用的比例仅34．53％,市区高于郊县。产后一年内恢复性生活的妇女仅33．0％每次性生活都用避孕措施。性生活未立即使用避孕措施的主要原因为：认为哺乳期不会怀孕,认为未转经不会怀孕及认为性生活次数少不会怀孕。影响妇女产后性生活时是否使用避孕措施的因素有：居住地、妇女受教育程度、职业、首次性生活时是否已转经、夫妇产后是否接受过有关产后性生活和产后避孕的宣教及产后性生活开始时间等。研究结果提示：应加强对产后避孕的宣教,纠正错误的传统观念,提高妇女产后的避孕率。     

影响产后出血量多因素分析

目的 :分析胎儿娩出后 2h出血量 ,探讨影响产后出血量的危险因素。方法 :搜集5 11例产妇 97个变量的资料 ,对可能影响产后出血量的每个因素进行回顾性相关回归分析。结果 :与胎儿娩出后 2h出血量有统计学意义的相关因素有孕前和临产前体重 ,体重指数 ,腹围 ,宫高 ,胎儿体重和身长 ,第二产程时间 ,不孕史 ,难产家族史 ,并发妊高征 ,双胎 ,悬垂腹 ,手术产 ,胎盘位置等。宫颈评分高产后出血量减少。结论 :通过分析影响产后出血量的危险因素 ,可以预测产后出血量 ,采取措施预防产后出血     

妊娠合并脑血管意外10例临床分析

妊娠合并脑血管意外严重威胁孕产妇的生命安全，为先兆子痫及子痫重要并发症之一，应引起临床医生的重视。现就我院1995年4月～2002年4月间收治的10例妊娠合并脑血管意外患者进行回顾性分析。     

孕妇产后的避孕意愿及其影响因素

本文对上海市黄浦区、普陀区、青浦县、奉贤县 40 37名孕妇对产后避孕意愿及影响因素进行了分析。结果显示 :79.96 %的妇女考虑产后避孕。2 5～ 2 9岁的妇女较其它年龄段的妇女考虑产后避孕的比例要高。产后避孕意愿与本人文化程度及职业无关 ,而亲戚朋友的文化程度对产后避孕意愿有影响。工作单位要求在 1年内落实避孕措施、接受过有关避孕知识教育或为此进行咨询或查阅书籍的妇女考虑产后使用避孕方法的比例较高。单位或计划生育部门建议使用的避孕方法以宫内节育器最高 ,占 97.1 4% ,避孕套仅为 1 .0 2 % ;妇女自我选择的避孕方法中宫内节育器为多 ,占 82 .34% ;其次为避孕套 ,占 1 1 .2 1 %。 L ogistic回归分析表明 :年龄、文化程度、职业、家庭收入等对产后避孕意愿影响不大。产后愿意哺乳者、接受过避孕教育、咨询或查阅书籍者、了解避孕知识年龄较小者、知晓宫内节育器者对产后避孕意愿有正面作用。建议在计划生育服务中 ,今后需加强产后避孕教育 ,开展各种避孕方法知情选择的教育和咨询 ,指导妇女在产后选择最适合于自己的避孕方法 ,从而减少产后意外妊娠的发生     

Subsequent Unintended Pregnancy Among US Women Who Receive or Are Denied a Wanted Abortion

Introduction

Seventeen percent of women in the United States experience more than one unintended pregnancy in their lifetimes. However, few studies examine how the resolution of unintended pregnancy, whether in birth or abortion, affects the likelihood of a subsequent unintended pregnancy. Our objective was to determine whether receiving or being denied a wanted abortion is associated with subsequent unintended pregnancy.

Methods

The Turnaway Study, a 5‐year, prospective cohort study, followed women who sought an abortion at one of 30 abortion facilities across the United States between 2008 and 2010. Secondary analysis of the Turnaway data analyzed the effects of various factors on time to subsequent unintended pregnancy.

Results

By 5 years, the rate of unintended pregnancy was 42 per 100 women with no difference between those who received and those who were denied a wanted abortion. Women aged 35 to 46 years (vs those aged 20‐24 years), women with a college degree (vs women who had completed high school or obtained a general education diploma), and foreign‐born (vs native‐born) women had a reduced rate of a subsequent unplanned pregnancy (adjusted hazard ratio [AHR], 0.30; 95% confidence interval [CI], 0.16‐0.57; AHR, 0.54, 95% CI, 0.30‐0.97; AHR, 0.44; 95% CI, 0.25‐0.77, respectively). Higher parity and a history of depression were positively associated with a higher rate of subsequent unintended pregnancy. There was no difference in the outcomes of these unintended pregnancies by study group; approximately one‐sixth ended in miscarriage and one‐quarter of subsequent unintended pregnancies ended in abortion.

Discussion

Neither receiving nor being denied abortion is associated with subsequent unintended pregnancy risk. Other factors such as nativity, parity, age, and mental health history are associated with multiple unintended pregnancies. Ensuring access to abortion services will not increase the likelihood that women will experience subsequent unintended pregnancies.     

Unintended pregnancy and contraception among active-duty servicewomen and veterans

The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.     

人工流产妇女非意愿妊娠的原因及可预测妊娠的比例分析

根据对上海市三所妇幼保健院 6 0 6名人工流产妇女的调查资料 ,分析了人工流产妇女非意愿妊娠的原因及可预测妊娠的比例。结果表明 ,人工流产对象中 98.1 8%为非意愿妊娠 ,其中 6 3.70 %为可预测的妊娠。已婚对象非意愿妊娠的主要原因是避孕失败 (73.1 % ) ,其中以安全期失败、体外排精失败和避孕套破裂或脱落为多 ;未婚对象非意愿妊娠的主要原因为未用或未坚持用避孕措施 (5 5 .4% ) ,而未用措施的主要原因是认为自己不会怀孕。意愿妊娠对象做人工流产的主要原因是优生 ,非意愿妊娠中已婚无子女对象的人工流产原因则主要是想晚点生育及工作学习的需要。本文提示 ,提高妇女的避孕措施使用率 ,鼓励对象使用效果可靠的避孕措施及推广紧急避孕法是降低人工流产的三个重要环节     

Factors Associated with Unwanted Pregnancy among Adolescents in Russia

Study ObjectiveTo identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia.DesignCross-sectional.Setting and ParticipantsThe investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons.InterventionsBoth groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use.Main Outcome MeasuresFactors associated with unintended pregnancy.ResultsIn the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut.ConclusionAlthough the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes.     

剖宫产瘢痕妊娠保守治疗的相关危险因素Meta分析

目的:对剖宫产瘢痕妊娠(CSP)保守治疗的相关危险因素进行系统评价。方法:计算机检索Pubmed、Embase、Google、中国知网、维普、万方数据库,并辅以手工检索,检索时限2000~2013年,纳入研究的CSP为保守治疗失败的患者,其相关危险因素包括超声检查分型、胎血管搏动、治疗前血β-HCG值、年龄、孕周。采用Rev Man 5.0软件对纳入文献的数据进行Meta分析,计算相关危险因素的比值比(OR)及95%可信区间(CI)。结果:共筛选出相关文献8篇,中文文献2篇,英文文献6篇。保守治疗患者254例,失败82例,全部入选患者保守治疗失败率32.28%。Meta分析结果显示:包块型CSP(Z=3.46,OR=0.19,95%CI 0.07~0.48,P=0.0005)为保守治疗失败的危险因素,而高龄孕产妇、治疗前可探及胎血管搏动、血β-HCG值20000 U/L及孕周≥8周为CSP保守治疗失败的不确定因素(P0.05)。结论:包块型CSP显著增加治疗过程中严重并发症的发生而导致保守治疗失败,建议对CSP患者治疗前行超声检测评估分型,以避免严重并发症的发生。     

体外受精-胚胎移植后早期妊娠丢失的相关风险因素分析

目的：分析体外受精-胚胎移植（IVF-ET）后早期自然妊娠丢失及其相关因素。方法：收集2001年5月—2007年12月在中山大学孙逸仙纪念医院生殖中心行IVF-ET治疗获得妊娠的患者547例,根据其妊娠12周时情况分为妊娠丢失组和妊娠持续组,回顾性比较分析2组患者中女方的一般情况、不孕病因;男方的精液检查情况、精子来源和助孕过程。结果：本中心新鲜IVF/胞浆内单精子注射（ICSI）-ET周期的早期妊娠丢失率为26.87%,临床流产率为16.45%。547例患者中女方年龄≥37岁患者的早期妊娠丢失率为46.7%,显著高于≤30岁的患者（27.2%）及30～37岁的患者（21.7%,均P＜0.05）;单孕囊组妊娠丢失率为35.0%,显著高于多孕囊组的10.9%（P＜0.001）。多因素Logistic回归分析显示辅助生殖治疗后早期妊娠丢失相关风险因素依次为：多囊卵巢综合征（PCOS）排卵障碍（OR=7.025,95%CI为2.426～20.341）、女方年龄（OR=1.080,95%CI为1.006～1.160）、孕囊数（OR=0.042,95%CI为0.022～0.081）、人绒毛膜促性腺激素（hCG）注射日子宫内膜厚度（OR=0.904,95%CI为0.808～1.012）。结论：新鲜IVF/ICSI-ET周期的早期妊娠丢失率与自然妊娠流产率相似,早期妊娠丢失与PCOS患者的排卵障碍、女方年龄、着床孕囊数相关,高危患者在进行辅助生殖治疗前应积极治疗,尽早采取安胎措施减少妊娠丢失。     

体外受精-胚胎移植后早期妊娠丢失的相关风险因素分析

目的：分析体外受精-胚胎移植（IVF-ET）后早期自然妊娠丢失及其相关因素。方法：收集2001年5月—2007年12月在中山大学孙逸仙纪念医院生殖中心行IVF-ET治疗获得妊娠的患者547例,根据其妊娠12周时情况分为妊娠丢失组和妊娠持续组,回顾性比较分析2组患者中女方的一般情况、不孕病因;男方的精液检查情况、精子来源和助孕过程。结果：本中心新鲜IVF/胞浆内单精子注射（ICSI）-ET周期的早期妊娠丢失率为26.87%,临床流产率为16.45%。547例患者中女方年龄≥37岁患者的早期妊娠丢失率为46.7%,显著高于≤30岁的患者（27.2%）及30～37岁的患者（21.7%,均P〈0.05）;单孕囊组妊娠丢失率为35.0%,显著高于多孕囊组的10.9%（P〈0.001）。多因素Logistic回归分析显示辅助生殖治疗后早期妊娠丢失相关风险因素依次为：多囊卵巢综合征（PCOS）排卵障碍（OR=7.025,95%CI为2.426～20.341）、女方年龄（OR=1.080,95%CI为1.006～1.160）、孕囊数（OR=0.042,95%CI为0.022～0.081）、人绒毛膜促性腺激素（hCG）注射日子宫内膜厚度（OR=0.904,95%CI为0.808～1.012）。结论：新鲜IVF/ICSI-ET周期的早期妊娠丢失率与自然妊娠流产率相似,早期妊娠丢失与PCOS患者的排卵障碍、女方年龄、着床孕囊数相关,高危患者在进行辅助生殖治疗前应积极治疗,尽早采取安胎措施减少妊娠丢失。     

Exploring the Relationships Between Child Maltreatment and Risk Factors for Pregnancy Complications

ObjectiveThis study explored the pathways underlying the relationships between child maltreatment (CM) subtypes (i.e., physical, sexual, and emotional abuse and neglect) and factors associated with a heightened risk of pregnancy complications by examining post-traumatic stress disorder (PTSD) symptoms as a potential mediator.MethodsA sample of 98 pregnant parents between the ages of 18 and 29 years was recruited through social media and community organizations throughout Canada. Participants completed a series of surveys on their exposure to CM, PTSD symptoms, and pregnancy experiences on a secure online platform. Following data cleaning procedures, 85 participants were included in this study.ResultsFour separate mediation analyses were conducted with child neglect, physical abuse, sexual abuse, and emotional abuse as factors associated with a heightened risk of pregnancy complications (i.e., a congregate score of limited prenatal care, weight gain concerns, smoking, second-hand smoke, alcohol consumption, substance use, and insufficient food intake during pregnancy). Each CM subtype was associated with increased PTSD symptoms, which were in turn associated with the presence of more factors known for increasing the risk of pregnancy complications. Neglect, physical abuse, sexual abuse, and emotional abuse were all indirectly associated with the presence of more factors associated with a heightened risk of pregnancy complications through their association with PTSD symptoms.ConclusionsFindings from this study could encourage prenatal care providers to screen for CM history and PTSD symptoms. Furthermore, mental health treatment early in the prenatal period may improve pregnant parents’ health and lower their risk of pregnancy complications.