稽留流产、葡萄胎妇女使用Billings法避孕效果观察

目的:观察稽留流产和葡萄胎妇女刮宫术后采用Billings法避孕的效果。方法:观察组46例,为我院住院治疗的稽留流产和葡萄胎行刮宫术后采用Billings法避孕者,同时随机抽取我院Billings门诊避孕的妇女92例为对照组,观察两组对象24个月内的停用率、续用率和意外妊娠率。结果:138例妇女共观察1501个妇女月,24个月内观察组除6例计划妊娠外,无停用和意外妊娠者,净累积续用率86.95%。对照组24个月内停用17例(18.47%),意外妊娠1例(1.08%),净累积续用率81.52%。结论:稽留流产、葡萄胎妇女采用Billings法避孕,效果良好,值得推荐应用。     

654例育龄妇女使用比林斯法一年的临床效果

目的: 观察比林斯法用于避孕的临床效果。方法:对2002年4月~2003年8月期间,654例自愿应用比林斯法避孕的育龄妇女,统计12月内的续用、停用、意外妊娠率。结果:654例妇女共观察了7 644个妇女月。1)12个月内的净累积续用率81.89%,停用率18.81%, 意外妊娠率0.98%;2) 654例中有7例意外妊娠,其中1例可能与方法学有关;3)经统计对象的年龄、文化程度与累积继续使用率、停用率和意外妊娠率间无相关性(P>0.05)。结论:比林斯法不仅简单、易接受、无副反应,而且在计划生育知情选择中连续使用率高,故可在全国有组织、有计划地培训教员和推广应用,为提高妇女的生殖健康服务。     

上海市黄浦区社区比林斯自然避孕法的应用研究——115例3年以上随访资料分析

目的:观察基层开展比林斯法避孕效果。方法:对3个街道连续使用比林斯法避孕3年以上的妇女115例进行随访,用生命表法对36个月和48个月的续用、停用和意外妊娠率进行统计分析。结果:115例妇女共观察7578个妇女月,36个月净累积续用率为93.0%,停用率为7.0%;48个月净累积续用率为88.20%,总停用率为11.80%,因妊娠和方法学的停用率为8.16%。结论:比林斯法可作为知情选择的避孕方法之一,可在基层推广,可在≥40岁的近绝经期妇女中应用;自然避孕法的发展,仍然需要考虑如何进一步简化。     

产后妇女避孕节育干预与效果评价

目的:评价在上海市静安区产后妇女中进行避孕节育干预对提高产后避孕率并降低产后意外妊娠的效果。方法:对居住在静安区的产后1年内已婚妇女进行避孕服务干预,并于干预前和干预后进行问卷调查。结果:干预后0~3个月、4~6个月、7~9个月和9个月以上各时段避孕率均显著高于干预前,尤其是在有性生活的产后妇女中,产后的前6个月累积避孕率从干预前的58.9%提高到干预后的97.6%。产后1年内意外妊娠发生率为1.4%,意外妊娠主要原因为未避孕和避孕套、安全期避孕失败。结论:产后定期避孕干预能有效提高产后1年内妇女的避孕率,降低产后妇女意外妊娠率。     

上海市城区产后妇女意外妊娠及影响因素分析

目的:了解上海市城区产后妇女意外妊娠的发生及其影响因素。方法:通过结构式问卷,对1767名产后1-2年妇女的产后意外妊娠情况进行调查。结果:产后第1年和第2年意外妊娠发生密度分别为4.64/100人年和6.57/100人年。产后性生活恢复、避孕开始、母乳喂养和产后闭经的中位时间分别为产后4个月、5个月、6个月和4个月。产后妇女最常用的3种避孕措施为避孕套、安全期和体外排精。产后1年内意外妊娠单因素分析显示:不同年龄组、文化程度、户籍、产后性生活开始早晚、母乳喂养及闭经时间长短间意外妊娠的发生密度差异有统计学意义(P<0.05)。多元Cox逐步回归分析显示,产妇年龄越大、母乳喂养时间越长、性生活开始时间越晚,产后1年内意外妊娠发生的风险越小;而外来人口意外妊娠发生的风险高于户籍人口。结论:产后妇女避孕开始滞后于性生活恢复,大多使用避孕效果相对不太稳定的避孕方法。外来人口、年轻产妇、产后开始性生活较早、母乳喂养时间较短的人群是产后1年内意外妊娠的高危人群。产后应尽早落实可靠的避孕措施及加强避孕套正确使用的宣教。     

上海市688对育龄夫妇连续使用Billings自然避孕法的临床效果观察及实验研究

本研究在1988,6～1990,5的两年间,对688对育龄夫妇进行了连续使用Billings 法的避孕效果与续用情况的观察,共10,275个妇女月;其中,550对夫妇连续使用12个月以上。用生命表统计分析,18个月和12个月时净累积停用率分别为34.58%和19.85%,续用率分别为65.42%和80.15%(因方法学意外妊娠分别为1.18%和1.02%,因方法学停用分别为2.84%和1.61%)。在观察临床效果的同时,对67例使用该法的志愿者进行阴道脱落细胞学检查,10例血、尿LH 和35例尿雌、孕激素测定。本文还对两年来临床观察和实验研究的多个方面进行了讨论,并认为该法值得进一步研究,可有组织、有计划地逐步扩大应用。     

米非司酮用于紧急避孕110例临床观察

现将我院用米非司酮 2 5ｍｇ用于紧急避孕 110例临床观察结果报道如下。1　资料与方法1 1　研究对象　　 1997年 3月 2 0 0 0年 5月 ,收集我院门诊年龄在 1944岁 ,无避孕或避孕方法失败 ,3天 ( 72小时 )内主动要求采取补救措施 ,以防意外妊娠的健康妇女 110例 ,均符合以下标准 :①本周期内仅有 1次无保护性交 ;②以往月经规律 ( 2 1 42天 ) ;③无使用米非司酮禁忌证 ;④近 3个月内未使用激素类或糖皮质激素类药 ;⑤无烟酒嗜好 ;⑥同意按时随访 ,并愿意在月经复潮前禁欲或保证采用避孕套。1 2　用药方法　　米非司酮由北京第三制药厂提供 ,11…     

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。     

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。     

人工流产妇女避孕知识、避孕方法使用现状及避孕失败原因初探

目的:了解人工流产妇女避孕知识及避孕方法使用现状。方法:对本院519例接受人工流产妇女进行横断面问卷调查。结果:64.9%的妇女本次妊娠是由于未采取避孕措施;35.1%的妇女本次妊娠是由于避孕失败。本次研究中,避孕套(92.7%)和避孕药(90.1%)的知晓率最高,知道避孕套如何正确使用的比率也最高(81.9%)。而避孕膜的知晓率(7.9%)和正确使用率(2.3%)均最低。在168例因避孕失败而导致本次妊娠的育龄女性中,最常用的避孕方法依次是避孕套(41.1%)、避孕药(19.1%)、紧急避孕药(14.3%)、安全期避孕(13.1%)。调查显示:婚姻状况、性伴学历、文化程度、职业、收入因素都对人工流产妇女的避孕知识和既往避孕行为产生不同程度的影响。结论:人工流产妇女对避孕知识的认知程度较低,对很多避孕方法的正确使用也知之甚少,应加强避孕知识的宣传教育,尤其是文化层次较低者和学生中,提高对意外妊娠风险的认识。     

Application of simple fertility awareness-based methods of family planning to breastfeeding women

OBJECTIVE: To determine the potential efficacy of two simple fertility awareness-based methods of family planning-the Standard Days Method and the TwoDay Method-among breastfeeding women. DESIGN: Analysis of pre-existing data set, collected in 1986-1990. SETTING: Pre-existing data from Australia, Britain, and Canada. PATIENT(S): Seventy-three breastfeeding women in Australia, Britain, and Canada, who were followed starting 42 days postpartum, until they had at least two potentially fertile cycles (defined as cycles with adequate levels of urinary estrogens (E) and pregnanediol glucuronide and a long enough luteal phase to support a pregnancy). We examine this existing data set. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Probability of pregnancy from intercourse on different days of the cycle relative to ovulation for breastfeeding women following the instructions of the Standard Days Method or the TwoDay Method. RESULT(S): These two methods may be appropriate for different groups of breastfeeding women at different times. The Standard Days Method may be appropriate after cycle regularity is established, whereas the TwoDay Method may be a more effective option earlier in the postpartum period. CONCLUSION: A need remains for a more appropriate simple fertility awareness-based method during this early period.     

已婚育龄妇女人工流产史及避孕知识态度和行为现况的相关研究

目的：了解育龄妇女的人工流产史及其原因和有关避孕的知识、态度和行为现状,探讨如何提高避孕知识知晓率和改善相关的态度和行为,以及降低非意愿妊娠率及人工流产率,提高育龄妇女的生殖健康水平。方法：对2012年1月至2013年5月在龙岗区龙城街道计生服务中心行人工流产术的510名已婚已育妇女进行有关人工流产和避孕知识、态度和行为的问卷调查,数据应用SPSS／PC10．0软件进行统计分析。结果：53．5％的妇女有人工流产史,其中人工流产3次及以上者达13．7％;未避孕者占32．6％,避孕失败者占46．8％,其中安全期避孕居首位,占避孕失败者的38．5％,其次放置IUD,占避孕失败者的48．2％。54．8％的人不知道任何一种避孕方法的避孕原理：有49．7％的妇女不知道人工流产手术对身体健康有不良影响;83．5％的人不知道有紧急避孕法。结论：迫切需要加强有关避孕知识的健康教育,并将其作为提供优质生殖健康服务的内容,促进合理有效避孕措施的安全使用,减少非意愿妊娠的发生,避免反复流产给育龄妇女身心带来的损害。     

Efficacy of the new TwoDay Method of family planning

OBJECTIVE: To test the efficacy of the TwoDay Method, a new fertility awareness-based method of family planning that provides women with simple instructions to identify the days each cycle when they are most likely to become pregnant. Users avoid unprotected intercourse on days when cervical secretions are present on that day or on the day before, to prevent pregnancy. DESIGN: Prospective, nonrandomized, multicenter study. SETTING: Five culturally diverse sites in Guatemala, Peru, and the Philippines. PATIENT(S): Four hundred fifty women, aged 18-39 years, wishing to use a fertility awareness-based method to prevent or delay pregnancy. INTERVENTION(S): Study participants were followed for up to 13 cycles of method use. MAIN OUTCOME MEASURE(S): Life table pregnancy rate. RESULT(S): The first-year pregnancy rate was 3.5 (pregnancies per 100 women/years) with correct use of the method (pregnancies and cycles with no intercourse on identified fertile days), 6.3 with use of a backup method on the fertile days, and 13.7 including all cycles and all pregnancies in the analysis. CONCLUSION(S): The TwoDay Method offers a valuable addition to the services that reproductive health and other programs can offer. Its efficacy compares well with that of other coitus-dependent family-planning methods; it is easy to teach, learn, and use; and it can address the need of women for simple, accurate instructions for identifying their fertile days.     

长效避孕针醋酸甲羟孕酮引入性试验

目的 评价醋酸甲羟孕酮避孕针在中国妇女中常规使用时的避孕有效率、续用率、副反应和可接受程度。方法 本研究为一开放临床随访试验,１９８５例自愿使用避孕针的妇女每３个月接受１次注射,随访１年。结果 １９８５例共使用醋酸甲羟孕酮２０７７２妇女月（１７３１．７妇女年）,１年累积续用率为７７．４％。避孕失败３例,生命表法１年累积失败率为０．２％。其他原因的１年累积停用率为闭经（４．８％）,与出血有关的问题（     

New approaches to fertility awareness-based methods: incorporating the Standard Days and TwoDay Methods into practice

Helping clients select and use appropriate family planning methods is a basic component of midwifery care. Many women prefer nonhormonal, nondevice methods, and may be interested in methods that involve understanding their natural fertility. Two new fertility awareness-based methods, the Standard Days Method and the TwoDay Method, meet the need for effective, easy-to-provide, easy-to-use approaches. The Standard Days Method is appropriate for women with most menstrual cycles between 26 and 32 days long. Women using this method are taught to avoid unprotected intercourse on potentially fertile days 8 through 19 of their cycles to prevent pregnancy. They use CycleBeads, a color-coded string of beads representing the menstrual cycle, to monitor their cycle days and cycle lengths. The Standard Days Method is more than 95% effective with correct use. The TwoDay Method is based on the presence or absence of cervical secretions to identify fertile days. To use this method, women are taught to note everyday whether they have secretions. If they had secretions on the current day or the previous day, they consider themselves fertile. The TwoDay Method is 96% effective with correct use. Both methods fit well into midwifery practice.     

Resolution of Uterine Arteriovenous Malformation and Maintenance of Reproduction in 20 Women Treated with a GnRH Agonist Concomitantly with an Aromatase Inhibitor and Tranexamic Acid

ObjectiveThis study investigated the efficacy of GnRH agonists concomitantly with transient aromatase inhibitor and tranexamic acid to treat women with uterine arteriovenous malformations (AVMs) associated with abnormal uterine bleeding (AUB) to preserve fertility and determine reproductive outcome.MethodsThis was a prospective cohort study in a tertiary centre. Doppler ultrasound demonstrated AVM in 19 women with AUB 1–28 weeks following spontaneous or therapeutic abortion and in one woman 4 years after normal pregnancy while taking an oral contraceptive. On the basis of experience from the first three cases, 17 women were treated with tranexamic acid (1 g three times daily orally for 5 days), a GnRH agonist (3.75–11.25 mg, for 1–3 months), plus an aromatase inhibitor (letrozole 2.5 mg once daily for 5days) with the initial injection of GnRH agonist. Two women required blood transfusion, and one required uterine tamponade with Foley catheter balloon in the first 48 hours to control heavy bleeding (Canadian Task Force Classification II-2).ResultsAll 20 AVMs resolved within 1–3 months of treatment. Of 16 women who attempted pregnancy, all (100%), including two who had uterine artery embolization (one after hysteroscopic septoplasty), conceived spontaneously with 18 live births. Two women are using contraception (one taking an oral contraceptive, one using a levonorgestrel intrauterine system), and one 40-year-old is not using contraception. One woman had hysteroscopic endometrial ablation followed by vaginal hysterectomy for AUB at 1 and 2 years later.ConclusionA GnRH agonist in combination with transient aromatase inhibitor and tranexamic acid is an effective management strategy to treat and maintain reproduction in women with AVMs associated with AUB.     

Treatment of primary and secondary dysmenorrhea with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study

Objectives: To evaluate the effect on menstrual pain in women with primary and secondary dysmenorrhea of a novel 'frameless' intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) (Contrel Research, Belgium), releasing 14 μg of LNG per day. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss. Study design: An open label, non-comparative ongoing pilot study. Eighteen insertions were performed in women between 16 and 52 years of age by the first author. Four insertions were performed in nulligravid women. Eight women were categorized as having primary dysmenorrhea and 10 as having secondary dysmenorrhea. Twelve women complained of heavy bleeding. Three women had significant fibroids and three were suspected to have adenomyosis. Results: The trial covers a period from a minimum of 3 months up to 33 months. By the end of August 2001, 12 recruited women had at least 12 months' follow-up and six had between 3 months and 1 year. All women reported much reduced pain, or no pain at all, and strongly reduced bleeding which started as soon as 1 month after insertion of the FibroPlant-LNG IUS. There was one exception; this woman had significant fibroids. She reported much reduced bleeding but this was not as pronounced as in the other women in the study. All women are continuing to use the method. Conclusion: The results of this preliminary study suggest that the FibroPlant-LNG IUS, releasing 14 μg of LNG per day, is a safe and effective method for the treatment of primary and secondary dysmenorrhea. The absence of a frame is particularly advantageous in these women. Of significant added importance is the high effectiveness in reducing menstrual bleeding, a symptom often present in women with menstrual pain complaints, and the fact that the system provides effective contraception. The low daily release rate of LNG from the FibroPlant-LNG IUS results in a virtual absence of hormonal side-effects.     

1450例人工流产女性实施流产后服务的随访研究

目的:对流产后服务(post-abortion care,PAC)进行临床实践和评价。方法:1 450例因非意愿妊娠在计划生育门诊自愿进行人工流产者,在流产后接受相关的流产后服务,比较患者流产前的一般情况、接受流产后服务用的避孕方案及其相应副作用、坚持避孕方案的时间、重复人工流产的发生率及间隔时间等。结果:所有接受PAC的患者术后均立即采用了避孕措施,术后首月主要采用的避孕方式为口服避孕药(n=573)、屏障避孕(n=551)、曼月乐(n=287)及普通IUD(元宫药铜IUD、活性γ型IUD、TCu220IUD、吉妮致美IUD等)(n=39)。随访12个月后曼月乐组100%坚持使用,普通IUD组使用人数则由最初的39例增至83例,比流产术后增加了1倍以上,主要由原口服避孕药组转入。口服避孕药组的坚持使用率为46.4%。所有坚持随访的女性均未发生随访期间意外妊娠。坚持避孕的各组中,起始有痛经、点滴阴道出血、漏服、环位置下移等不适,均遵医嘱来院处理;随访3个月后各组的不适症状均明显缓解;随访6个月后各组均无不适主诉。结论:科学系统的优质PAC能有效防范重复流产发生,保证避孕效率,从而保护女性的生殖健康。     

Intranasal peptide contraception by inhibition of ovulation with the gonadotropin-releasing hormone superagonist nafarelin: six months' clinical results

Forty-seven woman volunteers used a new highly potent stimulatory analog of the hypothalamic gonadotropin-releasing hormone (GnRH) for contraception. The superagonist nafarelin acetate, D-Nal(2)6-GnRH, was administered intranasally in one daily dose of 125 micrograms to 25 women and 250 micrograms to 22 women. Ovulation was consistently inhibited during 261 of 262 treatment months. No pregnancy occurred during 222 months in which no additional contraceptives were used. The mean plasma estradiol level after 6 months of treatment was 162 pmol/l. The predominant bleeding pattern was oligomenorrhea. Three women on the lower dose and six women on the higher dose discontinued the trial prematurely, mainly because of hot flushes. No serious side effects were reported. Ovulatory menstruations returned after a median time of 43 days after discontinuation of therapy. Daily intranasal nafarelin treatment for inhibition of ovulation proved to be an effective and rapidly reversible method of contraception.