超声监测在宫内节育器放置中的价值

目的：探讨超声在宫内节育器放置中的价值。方法：将2008年111月～2009年3月在南宁市人口和计划生育服务中心进行宫内节育器放置的育龄妇女452例进行术后超声监测节育器的放置情况、术后并发症的发生率。结果：452例育龄妇女放置宫内节育器立即行超声检查，发现21例节育器下移，下移率为4．6％。节育器嵌顿14例，发生率为3．09％。其中哺乳期妇女与非哺乳期妇女比较发生率高，差异有显著性。T型发生嵌顿率较高为4．76％，元宫型发生下移率较高为5．31％，吉尼节育器则发生率最低。结论：超声监测可准确的显示宫内节育器的位置和形态，可及早的发现节育器放置后的并发症，减少并发症对妇女造成的身心损害。     

放置宫内节育器后发生的输卵管妊娠

<正> 宫内放置节育器(简称带器)后发生输卵管妊娠容易漏诊而延误治疗。为了进一步提高对带器输卵管妊娠的认识,我们将我院1984年1月～1993年10月收治的69例带器输卵管妊娠患者进行分析。 1 临床资料 1.1 一般情况 我院1984年1月～1993年10月共有23 436例因妊娠而就医者,其中输卵管妊娠216例,占妊娠总数的0.92％。在216例输卵管妊娠者中,有69例为带器者,占31.94％,占全部妊娠者0.29％。 1.2 宫内节育器(IUD)使用年限与输卵管妊娠     

人工流产后即刻放置宫内节育器效果观察

目的探讨人工流产术后即刻放置宫内节育器的临床效果。方法A组：到笔者所在医院人工流产并有避孕要求、于人工流产术后即刻放置宫内节育器者150例；B组：正常月经干净3～7d内要求放置宫内节育器者150例；C组：人工流产组150例。对比研究A、B两组患者妊娠率、节育器脱落率和因症取出率；对比研究A、C两组出血量、感染率。结果A、B两组在妊娠率、节育器脱落率和因症取出率方面差异无统计学意义（P〉0．05）；A、C两组出血量、感染率方面均差异无统计学意义（P〉0．05）。结论人工流产术后即刻放置宫内节育器可有效地降低非意愿妊娠和重复流产率，有临床应用价值，值得推广。     

未产妇放置宫内节育器的研究

从６０，７０年代起，国外学者对未产妇放置ＩＵＤ进行了大量的研究，结果表明未产妇是可以放置ＩＵＤ的；放置时期最好在月经周期第１１－１７天；选择和ＩＵＤ以带铜的为宜；放置前，后须做好咨询和随访工作；对有盆腔炎史的未产妇禁止使用；有ＳＴＤ高危因素及年龄小于２５岁的未产妇ＩＵＤ不作为首选的避孕     

GyneFixIN宫内节育器的放置及护理

为探索ＧｙｎｅＦｉｘＩＮ宫内节育器的应用，就我院自１９９８年８月￣１９９９年１２月对９３例放置ＧｙｎｅＦｉｘＩＮ ＩＵＤ的妇女进行观察，术后定期随访，其中随访１年以上５０例，随访率为１００％，１年续用率８６％，未发现失效者。要提高随访率及续用率，必须做好细致的术前咨询，严格执行操作规程，做好术后护理，建立有认真执行随访制度，及时解决其些副反应。     

放置宫内节育器后的注意事项

我打算过几天去放置宫内节育器，请问放置后需要注意什么？     

放置宫内节育器随访分析

为减少放置宫内节育器（IUD）副反应发生和做到发生后的及时解决,自2012年1月至2012年12月,我站对放置宫内节育器（IUD）妇女随访情况进行了分析。     

放置宫内节育器对子宫肌瘤患病率的影响

全世界约有5亿以上育龄妇女使用宫内节育器(IUD)避孕,在我国更是较多育龄妇女首选的避孕方法。长期实践证明,IUD是一种安全、有效、简单、经济的避孕措施,本文探讨放置IUD对子宫肌瘤的影响。 一、资料和方法 1.资料来源 来自武汉市武昌区中南街计划生育办公室对辖区内125个单位的在职及退休妇女5923人,进行每年1次的妇科普查资料。有效调查人数4688例,平均年龄38.1(20～59)岁。     

吉妮宫内节育器上市后临床应用

<正> GyneFix宫内节育器(简称吉妮IUD)是一种全新设计的无支架节育器,由比利时妇产科医生Wil-     

Barriers to intrauterine device insertion in postpartum women

OBJECTIVE: The objective of this study was to determine the proportion of postpartum women at the University of New Mexico who choose an IUD for contraception, the number who actually obtain one and the barriers to postpartum IUD insertion. METHOD: We conducted a retrospective chart review of 1627 postpartum women who delivered at the University of New Mexico. Those women who indicated at hospital discharge that they desired an IUD comprised the study group of 193 women. Medical records were reviewed to identify the timing of IUD placement. If an IUD was not inserted, we attempted to determine the reason by reviewing clinic records. RESULTS: Twelve percent of postpartum women requested an IUD. Records were available for 114 women. Of these, only 69 (60%) actually obtained an IUD. Barriers to postpartum IUD insertion included provider advice against the IUD, patient failure to return for a postpartum visit and early repeat pregnancy. CONCLUSION: We conclude that postpartum women desiring an IUD may have difficulty obtaining one.     

Postplacental intrauterine device insertion at a teaching hospital

Objective

To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program.

Study Design

This was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months.

Results

Ninety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences.

Conclusion

Postplacental IUD insertions can be safely and effectively performed within a training program.

Implications

A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.     

宫血宁治疗置宫内节育器后异常出血疗效的Meta分析

目的:分析宫血宁胶囊治疗置宫内节育器(IUD)后子宫异常出血的疗效。方法:应用Meta分析方法的随机效应模型,对国内1990～2009年采用宫血宁胶囊治疗IUD出血副反应并以西医治疗作对照的研究文献进行定量合并分析。结果:治疗组242例患者中218例临床治疗有效,对照组219例患者中154例临床治疗有效(OR=4.05,95%CI=1.11～14.71),两者间差异有统计学意义(P=0.03)。结论:目前掌握的资料证明宫血宁胶囊治疗IUD出血副反应的临床疗效确切。     

Postplacental insertion of the levonorgestrel intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial

Objective

This trial was designed to compare levonorgestrel intrauterine device (LNG-IUD) use at 1 year after delivery between women randomized to postplacental insertion at the time of cesarean delivery and delayed insertion 4–8 weeks after delivery.

Study design

This randomized controlled trial was conducted at two urban medical centers. Eligible pregnant women with planned cesarean deliveries were randomized to immediate postplacental insertion during cesarean or delayed insertion after 4–8 weeks. We used intention-to-treat analysis for the primary outcome of LNG-IUD use 12 months after delivery.

Results

Forty-two women were randomized, 20 into the postplacental group and 22 in the delayed group. Although confirmed use of the LNG-IUD 12 months after delivery was higher in the postplacental group (60.0% vs. 40.9%, p=.35), this difference was not statistically significance. Expulsion was significantly more common in the postplacental group (20.0% vs. 0%, p=.04). There were significant differences between the two sites in baseline population characteristics, follow-up and expulsion. The trial did not answer the intended question as it was halted early due to slow enrollment.

Conclusions

Our results show higher expulsion after postplacental insertion compared to delayed insertion but suggest similar IUD use at 12 months. Moreover, it provides valuable lessons regarding a randomized controlled trial of postplacental LNG-IUD placement due to the challenges of estimating effect size and the nature of the population who might benefit from immediate insertion.

Implications

Postplacental insertion of an IUD may improve use of highly effective contraception during the postpartum period. While our results suggest higher expulsion after postplacental insertion compared to delayed insertion and similar IUD use at 12 months, our trial was insufficient to definitively test our hypothesis.     

以智慧中医康复中心促进中医事业发展的思考

《中共中央国务院关于促进中医药传承创新发展的意见》中提出,加快推进中医药科研和创新以促进中医药传承与开放创新发展.人工智能技术在医疗领域发展日趋壮大,应用前景十分可观.课题组探讨了如何抓住人工智能全面发展的机遇,促使人工智能技术与中医药产业发展深度结合,促进中医药的人工智能研究成果转化的问题.对部分中医院校和相关中药、...     

Accuracy of providers' assessment of pain during intrauterine device insertion

Background

Providers often underestimate patient pain. This study investigated if providers accurately assess pain during intrauterine device (IUD) insertion.

Study Design

This is a secondary analysis of a randomized trial. Participants rated pain on a 100-mm visual analogue scale (VAS). Providers marked a similar VAS for maximum level and timing of participant pain.

Results

The mean patient maximum pain was 64.8 mm (SD, 27) compared to 35.3 mm (SD, 26) rated by the provider (p<.001). Patient and provider agreement on most painful time point of procedure was weak (kappa statistic, 0.16).

Conclusions

Providers underestimate pain during IUD insertion.

Implications

To our knowledge, this is the first paper to compare provider and patient perceptions of pain during IUD insertion. Understanding this relationship will help guide further research about IUD insertion pain and techniques and could improve patient counseling.     

A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device

BACKGROUND: Postplacental intrauterine device (IUD) insertion is a safe, convenient and effective option for postpartum contraception. Few studies involve ultrasound-guided insertion, and none involve the levonorgestrel IUD or take place in the United States. STUDY DESIGN: The study was conducted to assess the safety and feasibility of ultrasound-guided postplacental insertion of the levonorgestrel IUD following vaginal delivery in a U.S. residency program. Levonorgestrel IUDs were inserted under ultrasound guidance within 10 min of placental delivery by hand or using ring forceps. Subjects were examined at 4 and 10 weeks postpartum for evidence of expulsion or infection. RESULTS: Thirty-four subjects were enrolled and 20 received an IUD. Follow-up data are available for 19 subjects over the 10-week follow-up period; 16 subjects returned for the 4-week follow-up, and 14 returned at 10 weeks. Two additional subjects could be contacted by telephone only. At 4 and 10 weeks postpartum, no subjects had evidence of infection. There were two expulsions (2/19, 10.5%) by 10 weeks postpartum. None of the subjects examined had a partial expulsion (intracervical location of the IUD). CONCLUSIONS: In this pilot study, ultrasound-guided postplacental insertion of the levonorgestrel IUD was feasible and not associated with infection. The risk of expulsion was acceptable. Ultrasound-guided postplacental insertion of the levonorgestrel IUD may be an alternative to delayed insertion but warrants further study.     

Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device

Background

The levonorgestrel intrauterine system (LNG-IUS) combines a uterine foreign body and the continuous release of low-dose levonorgestrel for contraception. Its influence on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women, especially those who develop recurrent vaginosis or Candida vulvovaginitis.

Study Design

Slides of 286 women who had a Pap smear taken before and 1 to 2 years after placement of a LNG-IUS were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV).

Results

Prior to insertion, there were no differences in vaginal flora abnormalities between women using different kinds of contraception. LNG-IUS users did not have different rates of AVF, BV, AV or CV, but the general risk to develop any infection was increased. Uterine bleeding after insertion did not seem to predict a different flora type.

Conclusion

We found that Pap smears suggested more vaginal infections after 1 year of LNG-IUS use than prior to insertion of the device.     

传统知识视角的中医药知识产权保护研究

现行知识产权制度对保护现代知识颇为见效，但对传统知识保护不力。作为传统知识的中医药知识产权的利益遭受严重侵害，急需救济和保护。作者论证了中医药知识产权保护法理上的正当性以及经济上的必要性，将中医药知识产权利益划分为3种类型，并结合现实情况，对中医药知识产权保护的方略进行了讨论。     

双氯芬酸钾用于预防放置宫内节育器疼痛的临床研究

目的:观察双氯芬酸钾用于预防放置宫内节育器(IUD)所致疼痛的效果。方法:随机选取经剖宫产分娩后和阴道分娩后的两组妇女各100例,两组分别放置宫铜200IUD和TCu380IUD:剖宫产分娩后放置宫铜200IUD的妇女49例(观察组24例,对照组25例),放置TCu380IUD的妇女51例(观察组26例,对照组25例)。阴道分娩后放置宫铜200IUD的妇女50例(观察组和对照组各25例),放置TCu380IUD的妇女50例(观察组和对照组各25例)。观察双氯芬酸钾在置器术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前预防疼痛的效果及服药的副反应等。结果:阴道分娩后置器的妇女,观察组和对照组在术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前的疼痛分级差异均无统计学意义(P>0.05)。剖宫产分娩后放置宫铜200IUD的妇女,观察组和对照组比较,在术中及术后第3日晚睡前疼痛分级差异有统计学意义(P<0.05);放置TCu380IUD的妇女,观察组和对照组术后30min的疼痛分级差异有统计学意义(P<0.05)。结论:双氯芬酸钾用于预防剖宫产分娩后放置IUD所致疼痛有一定的效果,但未发现其能预防阴道分娩后放置IUD所致的疼痛。