宫内节育器的新进展

宫内节育器的新进展上海市计划生育技术指导所（２０００３０）杨秀兰宫内节育器的临床应用已有６０余年，它具有安全、长效、简便、可逆、经济等优点。但在使用过程中影响续用率的前三位原因为脱落，意外妊娠及副反应。“八五”期间为了提高宫内节育器的续用率作了大量研...     

宫内节育器的避孕原理

宫内节育器的避孕原理白求恩医科大学第二临床学院妇产科（１３００４１）崔满华，安启哲利用宫内节育器（ＩＵＤ）避孕在我国已有近４０年的历史，大量的临床实践证明，它是一种安全、有效、简便、经济、取环后不影响生育、颇受育龄妇女欢迎的避孕措施。宫内节育器的抗生...     

宫内节育器及其使用的研究进展

宫内节育器及其使用的研究进展庄留琪在临床推广应用宫内节育器（ＩＵＤ）已３０余年，全世界已有８０００余万妇女使用，尤以我国应用最广，占我国育龄妇女所采用各种避孕措施的３９．１％。对于ＩＵＤ和与其相联系的一些进展，不仅计划生育工作者应予掌握，广大妇产科工...     

宫内节育器移位盆腔2例

<正> 例1 患者,25y,G_3P_1,1991年产后3个月在当地乡卫生院放置T型宫内节育器。1993年1月18日因停经2月余来本院妇科门诊就诊,诊断为早孕,X线透视提示T型节育器影在盆腔位置较     

宫内节育器使用系列化的前瞻性研究

使用宫内节育器（ＩＵＤ）避孕的妇女，在整个育龄期间可能选择、更换数种类型的ＩＵＤ，使其达到副反应小、避孕效果好的目的。本文将９００例育龄妇女分为三组，每组３００例，各使用不同的两种（共６种）ＩＵＤ，观察如何才能使系列化使用ＩＵＤ后达到优势互补，提高其避孕的综合效果。结果表明：活性ＩＵＤ避孕有效率高于惰性ＩＵＤ，隋性ＩＵＤ中，宫形ＩＵＤ优于金属单环。所研究的６种ＩＵＤ，其有效率与副作用呈正相关关系；不同ＩＵＤ之间的续用率可能有差别，但若组成优势互补的节育器系列，其二年累积续用率无显著差异     

固定式宫内节育器和TCu380A宫内节育器15年临床对比研究

目的:探讨固定式宫内节育器(固定式IUD)和TCu380A IUD远期应用的效果,观察15年IUD铜结构的保留状况.方法:采用前瞻性临床对比研究方法,共接收受试者200例,固定式IUD组和TCu380A组各100例.于置器后3个月、6个月、12个月及以后每年随访1次,15年时测定受试者血浆中的铜离子含量,并根据年龄设立对照组.整理全部资料,进行统计学分析.结果:两组受试者各年粗累积妊娠率比较,差异无统计学意义(P>0.05).妊娠与置器时年龄有关(P<0.05).固定式IUD第1年的粗累积脱落率显著高于TCu380A组(P<0.01).5年末、15年末两组的粗累积继续使用率比较,差异无统计学意义(P>0.05).15年末,两组各年主诉的发生率比较,差异无统计学意义(P>0.05).两组各年的粗累积因症取出率比较,差异无统计学意义(P>0.05).宫颈细胞学检查未见肿瘤细胞.使用超过15年的受试者血浆铜离子水平两组间比较差异无统计学意义(P>0.05),与正常对照组相比,差异亦无统计学意义(P>0.05).结论:固定式IUD和TCu380A IUD使用15年的避孕效果基本相似,均为高效、长效、安全的宫内节育器.     

固定式不锈钢宫内节育器的临床初步观察

固定式不锈钢宫内节育器的临床初步观察初桂华，杨瑞芳，江平指导，江森（山东医科大学附属医院山东省计划生育研究所）不锈钢单环宫内节育器具有副反应小，安全等优点，但带器妊娠和脱落率较高。为提高使用率并保持其优点，我们研制了不锈钢单环带铜与不带铜固定式宫内节...     

吉妮固定式宫内节育器应用效果的研究

目的 :研究吉妮固定式宫内节育器 (GyneFixIUD)的效果。方法 :对 10 7例放置GyneFixIUD和 80例放置含铜 375IUD的妇女进行 1年的临床观察和对照研究。结果 :(1)Gyne组在去除放置技术或子宫过软所致的脱落因素后 ,脱落率显著低于含铜组 (P <0 .0 5) ;(2 )在放置IUD后 3个月和 6个月时 ,副作用有淋漓出血 ,经量过多和白带增多等 ,Gyne组明显低于含铜组 ,差异有显著性 (P <0 .0 1,P <0 .0 5,P <0 .0 1)。结论 :GyneFixIUD的临床使用效果好于含铜 375IUD ,脱落率和副作用低于含铜 375IUD     

固定式带铜宫内节育器的研制与试用

目的：对固定式带铜宫内节育器（ＦｃｕＩＵＤ）的临床避孕效果及其副作用和可接受性进行探讨。方法：通过离体子宫、动物实验、月经血测量及细菌培养以证实其效果的可靠性、安全性和可行性。结果：自１９９３年４月至１９９４年１２月共放置ＦｃｕＩＵＤ２４３例，总随访率９９．６２％。最短放置３５个妇女月，最长放置５５个妇女月。累计带器妊娠率２．４８％；脱落率与因症取出率各为３．０５％，１～４年续用率分别为９３．５０％、９２．１１％、９１．２５％及９０．８７％。结论：ＦｃｕＩＵＤ是一种脱落率低、副作用小、续用率高、安全性大的新型ＩＵＤ，对有频繁脱器史者更为适宜。     

固定式铜宫内节育器与TCu380A宫内节育器的临床比较性研究

目的:探讨固定式铜宫内节育器(CuFixIUD)的避孕效果。方法:采用前瞻性临床对比性研究方法,共接收200例受试者,随机分为CuFixIUD组(n=100)和TCu380AIUD组(n=100),观察8年。结果:8年末随访率为95%。CuFixIUD组1例意外妊娠,无一例带器妊娠,而TCu380AIUD组8年累积妊娠率每百妇女为6.75。CuFixIUD组3个月随访时脱落率每百妇女为9.18,随访1年至5年各年的累积脱落率明显高于TCu380AIUD组,组间相比,差异有统计学意义(P<0.01)。8年末的累积脱落率组间差异无统计学意义(P>0.05)。组间各时期因症取出率以及续用率相比较差异无统计学意义(P>0.05)。结论:CuFixIUD为一种低妊娠率、高效和长效的IUD。     

Intrauterine contraception in nulliparous women (author's transl)

The authors examine the results obtained in 69 nulliparous women personally checked after insertion of an IUD (various types) for a total of 794 months of use. 3 pregnancies, 8 removals for medical reasons, and 10 expulsions were registered. This 30.4% failure rate indicates a more thorough screening of candidates for this method and their careful supervision, in order to ascertain the collateral effects, in particular those -- as in the case of pelvic infection -- which could have sequelae in future fertility. 18.8% of users asked for removal for personal reasons before 24 months of use were over, often due to a mistaken valuation of contraceptive necessity before choice of a method. (Author's modified)     

Amniotomy and the use of oxytocin in labor in nulliparous women

A group of 242 nulliparous women in spontaneous, term, first-stage, true labor, with cephalic presentations and intact membranes, underwent amniotomy in the first stage. Sixty-nine of 242 (29%) received oxytocin prior to complete dilatation. The group that received oxytocin was characterized by fewer women less than 20 years of age, more patients with an additional diagnosis such as preeclampsia, longer labors, and slower mean rates of dilatation before and after amniotomy. There was no correlation between the last dilatation rate before and the first after amniotomy. The only significant predictors of oxytocin use were cervical dilatation at amniotomy and the first rate of dilatation afterward. Of patients with dilatation at a rate of greater than or equal to 1 cm/hr from admission to amniotomy, 16% received oxytocin; if less than 1 cm/hr, 39%. Two different rate standards were used to differentiate "unsatisfactory" from "satisfactory" labor: (1) less than 1 or greater than or equal to 1 cm/hr and (2) no change or some change in dilatation. Neither of these standards, when applied to the first examination after amniotomy, predicts patients who will receive oxytocin with any reasonable degree of efficiency. Examination of cervical dilatation after amniotomy in patients who did not receive oxytocin demonstrated failure of the cervix to dilate in approximately 20% of each of three sequential examinations. Contrariwise, no dilatation for 2 hours was uncommon. Amniotomy appears to enhance the dilatation rate in patients with well-dilated cervices that are already dilating at a satisfactory rate and slows dilatation in some patients, particularly those with cervices that are less dilated. These results suggest that amniotomy should be performed for specific indications only.     

Intrauterine device use and the risk of pelvic inflammatory disease

A number of studies have shown an association between use of the intrauterine device (IUD) and the development of pelvic inflammatory disease. In the nine studies reviewed, the estimated risk varied between 1.6 and 9.3. A number of interacting variables are operant, in addition to IUD use. Further, the use of nonpermanent forms of contraception other than the IUD may exert a protective effect against the development of PID.     

Duration of labor by gestational week in nulliparous women

Abstract

Objectives: To assess whether labor length differs by week of gestation.

Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36?+?0 through 40?+?6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).

Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8?±?1.0?cm/h, 1.5?±?0.9?cm/h, 1.3?±?0.8?cm/h, 1.6?±?1.5, and 1.3?±?1.0?cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.040). Concurrently, the total labor duration (1st?+?2nd?+?3rd stages) increased as gestational age advanced: 423.6?±?180.9?min, 496.5?±?212.6?min, 545.9?±?247.1?min, 483.8?±?256.3?min, and 568.2?±?273.8?min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.013).

Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.     

Experience with three different models of the Copper T intrauterine contraceptive device in nulliparous women

The copper T (TCu) intrauterine device (IUD) has been found to be an effective and well tolerated method of contraception for nulliparous women. Tatum theorized that his TCu's effectiveness was directly related to the amount of copper used. 471 nulliparous women had the TCu 200 device inserted; 347 nulliparous women received the TCu 300; 785 nulliparous women had the TCu 380 inserted. (The figures indicate the sq mm of copper surface area in each device.) Discontinuation rates at 12 months were 25.8, 19.3, and 18.1 per 100 women respectively. Respective pregnancy rates were 1.7, .6, and .2 per 100 women at 12 months. The results of this study suggest that the effectiveness in pregnancy prevention is greater with increased amounts of copper.