基于孕前队列的备孕夫妇生育力及其关联因素分析

目的分析育龄夫妇生育力及其关联因素。方法基于复旦大学孕前队列, 选取2016—2021年参加嘉定区孕前检查的育龄夫妇, 分析夫妇妊娠等待时间(TTP), 采用Cox比例风险回归模型分析影响育龄夫妇TTP的关联因素;应用Kaplan-Meier法计算每个月经周期的累积妊娠率。结果本研究共纳入1 095对孕前夫妇, TTP的M(Q1, Q3)为4.33(2.41, 9.78)个月经周期。女性年龄(FR=0.90, 95%CI:0.85～0.95, P<0.001)、女性孕前超重或肥胖(FR=0.36, 95%CI:0.24～0.55, P<0.001)、女性孕前暴露于二手烟(FR=0.63, 95%CI:0.44～0.92, P=0.016)、女性孕前住处或办公室近2年内装修有异味(FR=0.46, 95%CI:0.26～0.81, P=0.008)与夫妇生育力受损有关;女性月经周期规律(FR=1.64, 95%CI:1.16～2.31, P=0.005)、女性孕前经常饮茶/咖啡(FR=1.55, 95%CI:1.11～2.17, P=0.011)以及男性孕前服用叶酸(FR=2...     

未婚女性抗心磷脂抗体检查结果分析

目的:探讨未生育女性与人工流产抗心磷脂抗体(ACA)的关系。方法:对进行优生健康检查的已婚未育育龄妇女742例,未妊娠者319例,妊娠者423例,采用酶联免疫吸附法(ELISA法)测定血清ACA。结果:①未育女性ACA阳性率11.46%,其中未妊娠者阳性率12.06%,已妊娠者阳性率11.11%;②有人工流产史者ACA阳性率较无人工流产史者增高(P<0.05),随人工流产次数增多ACA阳性率有增高趋势;③一次人工流产史者中距人工流产时间≤2年者较>2年者阳性率增高(P<0.05)。结论:妊娠不增加ACA阳性的发生率;人工流产是引起ACA阳性的重要原因;ACA随着时间的推移有消退的可能。     

人工流产现状及宣教调查分析

目的了解实施流产后宣教的有效性及满意程度,指导避孕,降低重复流产率,减少人工流产术对育龄女性造成的近期或者远期并发症的影响。方法选择2016年10-12月期间在红桥区妇女儿童保健和计划生育服务中心因早期妊娠要求终止妊娠行人工流产手术的100例健康育龄女性作为调查对象,对其年龄、婚否、健康状况、学历和有关资料(包括月经周期、首次性行为年龄、流产相关情况及性与生殖健康知识了解程度等)进行调查,对所有资料进行描述统计。分析人工流产的现状,并对流产后的计划生育服务情况进行总结。结果人工流产妇女年龄19~47岁、高中及以下学历的人工流产女性比例最多,占48%;初次妊娠流产者占10%,有3次及以上流产史者占49%,最高流产次数达9次。妊娠原因以未采取有效避孕措施者居多,避孕失败者为36%。结论人工流产术前宣教、流产后复查、电话随访有助于减少非意愿妊娠发生,降低人工流产对于女性生殖健康的影响。应抓准服务时机,拓展宣教形式,提高宣教质量,增加育龄女性对生殖健康和避孕知识的了解,联合多种措施能有效提高育龄人群的避孕意识,从而明显降低再次流产率。     

青田县婚前检查女性非意愿妊娠情况分析

目的：了解青田县做婚前医学检查的女性青年因非意愿妊娠而导致人工流产的情况。方法：对2009年来青田县妇幼保建所作婚前医学检查的并有过人工流产史的初婚女性进行统计分析。结果：在接受调查的1 821例女性青年中,只有过1次人工流产史者415人,占有人流史总人数的22.8%,有2次及以上人工流产史者1 406人,占有人流史总人数的77.2%。婚前有人工流产史者全部为非意愿妊娠,其中未避孕855例,占47.0%,避孕失败1 134例,占62.3%。结论：婚前非意愿妊娠的增多,与女性青年的生殖健康知识的缺乏或不全面、不正确有关,有针对性地对未婚青年这一特定人群提早进行生殖健康教育,是提高女性青年健康水平、节省医疗费用的重要措施。     

高原地区输卵管妊娠104例临床分析

目的:探讨高原地区输卵管妊娠的发病特点。方法:对2004年1月-2004年12月收治的104例输卵管妊娠患者进行回顾性分析。结果:在高原居住时间≤3年发病者81例(占77.9%);既往孕次≥3次发病者65例(占62.5%);既往有人工流产史或盆腔手术史发病者83例(占79.8%)。输卵管妊娠合并失血性休克与不合并失血性休克患者入院时的血红蛋白值相比较明显下降,差异有显著性(P<0.01),但其仍在正常值范围。结论:①高原地区输卵管妊娠的发病与在高原居住时间、既往孕次及既往人工流产史或盆腔手术史相关。②对高原地区输卵管妊娠患者的血红蛋白值观察时应注重动态监测。     

广东省21市育龄女性生育力危险因素暴露现状与卵巢储备功能认知度相关性研究

目的探讨广东省21市育龄女性生育力危险因素暴露现状与卵巢储备功能认知度相关性。方法采用横断面研究,分层抽样选取广东省2个副省级市及19个地级市常住居民中2533名20～40岁智力正常女性作为调查对象。采用问卷调查法收集调查对象的社会人口学特征、生育力危险因素暴露情况和卵巢储备功能认知度信息,并对数据进行统计分析。结果不同年龄段及不同学历调查对象的生育力危险因素暴露条数差异均具有统计学意义(P0.05),其中36～40岁年龄段调查对象和大专及以下学历的调查对象生育力危险因素暴露条数最多。在影响生育力的危险因素中,痛经是暴露率最高的生殖因素(54.84%),其次为月经周期不规律(35.69%),第3位为月经周期35d(17.77%);生活方式因素中,体质指数24kg/m~2是暴露率最高的因素(9.55%),其次为压力(9.51%)。调查对象的卵巢储备功能认知度得分为(40.23±13.79)分。多元逐步回归结果显示:年龄、卵巢储备功能认知度分数联合可解释因变量的26.9%,其中,卵巢储备功能认知度分数的Beta值为-0.501,年龄的Beta值为0.094,说明卵巢储备功能认知越差、年龄越大的调查对象有更多的生育力危险因素暴露(P0.05)。结论提高卵巢储备功能相关知识的认知水平可以帮助育龄女性增强自我保健意识,调整生活方式,减少生育力危险因素的暴露,实现最佳的生殖健康。     

北京市石景山地区人工流产情况及避孕失败相关因素分析

目的:调查了解北京石景山地区人工流产情况以及避孕失败的相关因素。方法:随机整群选取2018年1月—2020年1月北京石景山地区部分计划生育服务机构共5766例人工流产女性,问卷调查并分析人工流产妇女基本情况及避孕失败的影响因素等。结果:发放调查问卷5766份,回收有效问卷5687份,有效问卷回收率为98.6%。5687例被调查对象年龄(33.3±3.4)岁(14～49岁),其中≤20岁14.3%、21≤30岁32.0%、31～40岁45.6%、40岁占8.1%。教育背景以高中/中专(21.5%)和初中及以下(69.3%)居多,职业以无业(34.0%)、农民(30.8%)占比较高;已婚占68.5%、未婚占27.4%、离异4.1%。避孕失败(61.2%)是导致非意愿妊娠主要因素;64.7%有既往生育史,18.9%有过1次既往流产史,49.4%有≥2次流产史。已生育女性主要采用宫内节育器避孕(43.2%),未生育女性主要采用安全套避孕(47.5%),避孕方式有差异(P0.05)。多因素logistic回归分析显示,不掌握避孕知识、无业或农民、初中及以下教育背景、避孕方式使用不当是导致避孕失败的独立风险因素(P0.05)。结论:北京石景山地区人工流产女性以低教育背景、无业或农民、已婚等占比最高,不掌握避孕知识、教育背景、职业、避孕方式不当是导致避孕失败的主要因素。应强化该地区育龄女性避孕知识宣教工作,以降低人工流产发生。     

人工流产女性非意愿妊娠现状调查分析

目的了解天津地区人工流产女性非意愿妊娠的现状,减少女性非意愿妊娠和重复流产的发生,维护和促进女性生殖健康。方法采用现况调查的方法,对天津医科大学第二医院计划生育科8 745例要求人工流产的女性进行问卷调查。主要调查内容包括一般人口学特征、人工流产情况以及非意愿妊娠原因等情况。以人工流产次数≥2次的患者为病例组,只有1次人工流产的患者为对照组,进行病例-对照研究。结果 8 745例人工流产患者,其中重复流产者共5 648例,占65.2%;在重复流产者中,≥3次者占全部对象的33.0%。患者意外妊娠原因主要为未避孕(50.1%)和避孕失败(34.4%)。多因素分析显示,年龄大者(OR=2.38,95%CI:2.10~2.69)和有过生育者(OR=1.50,95%CI:1.32~1.70)发生重复流产的风险较高。结论我国育龄妇女人工流产率及重复人工流产率均较高,应进一步开展人工流产后关爱服务,促进高效避孕方法的使用,从而保障女性身心健康。     

环境重金属内暴露与既往不良妊娠结局的相关性研究

目的探讨广西河池地区环境重金属内暴露与既往不良妊娠结局的关系。方法于2013—2014年在广西河池长老乡5个村抽取180名有妊娠史的成年女性,按照是否有既往不良妊娠结局分为不良妊娠组与对照组,以电感耦合等离子质谱法(ICP-MS)检测全血中铅、镉、砷、铬水平。以多因素logistic回归分析环境重金属内暴露与既往不良妊娠结局的关系。结果不良妊娠组血Pb几何均值(41.86μg/L)明显高于正常女性(30.48μg/L)(P0.05),两组间血镉、砷、铬的水平并没有明显差异。血铅的多重线性回归显示,血Pb与年龄及家庭年收入水平呈正相关(P0.05)。既往不良妊娠结局的多因素logistic回归分析显示,血铅每升高1μg/L,不良妊娠结局发生风险增加3.5%[OR:1.035(95%CI:1.001～1.072)];与肉类日摄入量100 g的女性相比,肉类日摄入量≥100 g的女性不良妊娠结局发生风险降低[OR:0.112(95%CI:0.011～0.568)]。结论本次调查的广西长老乡女性铅暴露可能与既往不良妊娠结局有关,建议生育期妇女应尽量避免重金属铅暴露。     

年轻女性重复人工流产状况及其影响因素分析

目的分析年轻女性重复人工流产状况及其影响因素。方法采用现场调查方式对2011~2013年东营市东营区东城街道计生服务站进行人工流产的部分年轻女性进行问卷调查,内容主要包括年龄、文化程度、婚姻状况、职业、首次性行为年龄、避孕认知及主要避孕措施、既往人工流产及流产后避孕服务情况等,并采用Logistic回归分析探讨其中重复人工流产的相关影响因素。结果 1 089例人工流产的年轻女性中,重复人工流产338例(31.1%);在重复人工流产对象中,流产2、3、≥4次分别有254例(75.1%)、61例(18.1%)和23例(6.8%)。已婚为年轻女性重复人工流产的保护因素(OR=0.43,95%CI:0.25~0.75),首次性行为过早(18岁)(OR=2.13,95%CI:1.32~3.44)、避孕认知差(OR=3.02,95%CI:1.75~5.20)、私企职工(OR=2.81,95%CI:1.65~2.99)和在校大、中学生以及无固定职业的年轻女性(OR=5.16,95%CI:2.88~9.21)为重复人工流产的危险因素。结论年轻女性重复人工流产率较高,其发生与婚姻状况、职业、首次性行为年龄、避孕认知等密切相关。     

Induced abortion and the risk of subsequent ectopic pregnancy.

This study assessed the effect of legal induced abortion on ectopic pregnancy risk by using a comparison group of reproductive-age women who were at risk of becoming pregnant during the same time period the women with ectopic pregnancy conceived. Cases were members of Group Health Cooperative of Puget Sound who were hospitalized for ectopic pregnancy from October 1981 through September 1986 (N = 211). Controls were randomly selected members matched to cases on age and county of residence (N = 457). All subjects in this analysis had had one or more prior pregnancies. Eighty-eight cases (41.7 per cent) and 177 controls (38.7 per cent) had a history of one or more induced abortions. The relative risk of ectopic pregnancy associated with one abortion was 0.9 (95 per cent confidence interval 0.6, 1.3), adjusted for age, county, reference date, religion, gravidity, age at first pregnancy, lifetime number of sexual partners, and miscarriage history. Among women with two or more prior pregnancies, the risk associated with two or more abortions was 1.2 (0.6, 2.4). Controlling for pelvic inflammatory disease and use of intrauterine devices did not alter these risks. We conclude that legal abortion as performed in the US since 1970 has little or no influence on a woman's risk of ectopic pregnancy in subsequent pregnancies.     

655名育龄妇女达到妊娠时间(TTP)的研究

目的:了解育龄妇女在人类自然生育状态达到妊娠时间(Time to Pregnancy,TTP)。方法:对655名已婚妇女婚后孕育情况进行随访调查,计算这些妇女在夫妻同居生活、不采用避孕措施情况下达到妊娠的时间(TTP)。估算半数妊娠所需时间,应用Kaplan-Meier生存分析方法计算受孕累积概率,结果比较采用Log-rank检验方法。结果:655名妇女中,597名发生了怀孕,其余58名妇女(8.9%)没有受孕。全部已婚妇女半数妊娠所需时间为5个月,怀孕率在1、3、6、12及24个月分别是13.1%、30.1%、62.0%、80.6%和87.6%;相对而言,597名已经妊娠妇女组,半数妊娠所需时间为5个月,妊娠率分别为14.4%、33.0%、68.0%、88.4%和96.1%。尽管两组累积妊娠数据相似,在调整年龄对TTP的影响后,已妊娠妇女组高于所有妇女组。结论:半数夫妇在5个月经周期不避孕性生活可以怀孕,1年累积妊娠概率为85.3%,TTP和累积妊娠概率与女方年龄存在显著相关。     

子宫肌瘤患者危险因素的病例对照研究

目的研究长春市子宫肌瘤患者发病危险因素。方法以2005年9月—2008年9月在长春市某三甲医院就诊的160例经病理学检查确诊为子宫肌瘤的患者作为病例组,同期在该医院进行诊查的158例非子宫肌瘤妇女作为对照组。按照病例-对照研究设计对所有研究对象进行流行学调查,获取基本信息、月经史、生育节育史、既往与现病史等资料。应用Excel、SPSS12.0软件进行Logistic回归等统计学分析。结果子宫肌瘤患者年龄多集中在31～50岁之间,以41～50岁的妇女最为多见,占患者总数的46.88%。单因素分析显示,多次人工流产会导致子宫肌瘤发生的危险性增加,OR(95%CI)为1.754(1.115～2.759)。非条件Logistic回归分析显示,初潮年龄、妊娠次数、流产次数与子宫肌瘤有关,OR(95%CI)分别为0.114(0.038～0.342),1.900(1.065～3.388),14.681(4.374～49.281)。结论初潮年龄早、妊娠次数多、流产次数多可能是子宫肌瘤发病的危险因素。     

Association of petrochemical exposure with spontaneous abortion

OBJECTIVES: To assess the association between petrochemical exposure and spontaneous abortion, a retrospective epidemiological study in a large petrochemical complex in Beijing, China was conducted. METHODS: Plant employment records identified 3105 women who were married, were 20-44 years of age, and had never smoked. Of those, 3070 women (98.8%) reported at least one pregnancy. From this group, 2853 (93%) of the women participated in the study. According to their plant employment record, about 57% of these women workers reported occupational exposure to petrochemicals during the first trimester of their pregnancy. Trained interviewers administered a standardised questionnaire to this group of women and their husbands, collecting information on reproductive history, pregnancy outcomes, employment history, occupational exposure, smoking habits, alcohol consumption, indoor air pollution, and demographic variables. The results from the womens' first pregnancies were analysed. RESULTS: There was a significantly increased risk of spontaneous abortion for women working in all of the production plants with frequent exposure to petrochemicals (8.8%; range of 5.8%-9.8%) compared with those working in nonchemical plants (2.2%; range of 0.0%-7.1%). Also, when a comparison was made between exposed and non-exposed groups within each plant, exposure to petrochemicals was consistently associated with an increased risk of spontaneous abortion. The overall odds ratio (OR) was 2.7 (95% confidence interval (95% CI) 1.8 to 3.9) after adjusting for potential confounders. When the analysis was performed with the exposure information obtained from the women' interview responses for (self reported) exposures, the estimated OR for spontaneous abortions was 2.9 (95% CI 2.0 to 4.0). The analysis was repeated by excluding those 452 women who provided inconsistent reports between recalled exposure and work history, and a comparable risk of spontaneous abortion (OR 2.9; 95% CI 2.0 to 4.4) was found. In analyses for exposure to specific chemicals, an increased risk of spontaneous abortion was found with exposure to most chemicals, and the results for benzene (OR 2.5; 95% CI 1.7 to 3.7), gasoline (OR 1.8; 95% CI 1.1 to 2.9), and hydrogen sulphide (OR 2.3; 95% CI 1.2 to 4.4) were significant. CONCLUSION: An increased risk of spontaneous abortion was found associated with the exposure to petrochemicals, including benzene, gasoline, and hydrogen sulphide.

 

     

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.     

Timing of steps and reasons for delays in obtaining abortions in the United States

OBJECTIVE: We studied the steps in the process of obtaining abortions and women's reported delays in order to help understand difficulties in accessing abortion services. METHODS: In 2004, a structured survey was completed by 1209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. RESULTS: The median time from the last menstrual period to suspecting pregnancy was 33 days; the median time from suspecting pregnancy to confirming the pregnancy was 4 days; the median time from confirming the pregnancy to deciding to have an abortion was 0 day; the median time from deciding to have an abortion to first attempting to obtain abortion services was 2 days; and the median time from first attempting to obtain abortion services to obtaining the abortion was 7 days. Minors took a week longer to suspect pregnancy than adults did. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier. The most common reasons for delay were that it took a long time to make arrangements (59%), to decide (39%) and to find out about the pregnancy (36%). Poor women were about twice as likely to be delayed by difficulties in making arrangements. CONCLUSIONS: Financial limitations and lack of knowledge about pregnancy may make it more difficult for some women to obtain early abortion.     

Predictors of delay in each step leading to an abortion

BACKGROUND: Approximately 1 out of 10 abortions in the United States occurs in the second trimester of pregnancy. This study uses survival analysis to identify the factors which delay each step of the process of obtaining an abortion. STUDY DESIGN: This is a secondary data analysis of a cross-sectional study investigating a sample of 398 women who presented for elective abortion at an urban hospital. Respondents completed a survey using an audio-assisted self-interviewing program and provided a timeline for their process of obtaining an abortion. RESULTS: In our analysis, we divided the abortion process into three steps ending in three distinct events (first pregnancy test, calling a clinic, getting an abortion). Factors associated with delay during the first step include obesity [hazard ratio (HR) 0.8, 95% CI 0.6-1.0], abuse of drugs or alcohol (HR 0.7, 95% CI 0.6-1.0), prior second-trimester abortion (HR 0.6, 95% CI 0.4-0.8) and being unsure of last menstrual period (HR 0.6, 95% CI 0.4-0.7) and emotional factors such as being in denial (HR 0.8, 95% CI 0.6-1.0) and fear of abortion (HR 0.7, 95% CI 0.5-1.0). CONCLUSION: This study identified key factors associated with delay in obtaining abortion care. Interventions which seek to address these factors, especially those factors associated with later pregnancy suspicion and testing, may reduce abortion delay and facilitate women obtaining their abortions when medical risk and overall cost are lower.     

The ‘natural’ control of fertility1

The analysis of the reproductive behaviour of married Jewish women seeking abortions in a hospital in Israel, summarized here, indicates that fertility and its control, for these women and their husbands, was often judged on a dimension of ‘natural’-‘artificial,’ where ‘natural’ was the valued pole. Representatives of the medical profession, who de facto controlled access to effective contraceptives, often either intentionally or unintentionally undermined couples’ attempts to control their fertility effectively, and gave support to suspicions regarding the dangers in ‘artificial’ medical contraception. The result, for these women, was unwanted and intolerable pregnancy and request for abortion. Abortion, by medical intervention, reinforced the sense that complete control of fertility was impossible; by further contributing toward their feeling of helplessness, it may also have discouraged couples from changing their contraceptive behaviour.     

A comparison of four methods for determining prevalence of induced abortion, Taiwan, 1970-1971.

A methodological study of four procedures for obtaining information about induced abortion was done in Taiwan in 1970 and 1971. About 2000 women were in a repeat interview group and seen every six weeks for nine rounds; one-half of these were also asked to provide urine on each round for a pregnancy test. Another 2000 women were interviewed only once; about one-half were asked "standard" knowledge, attitude, and practice questions about their reproductive history, including abortion. The other one-half were asked the same questions except they were not queried about their practice of abortion, but rather were asked to participate in the randomized response technique (RRT). Three methods produced estimates that 13-14% of the women had had an induced abortion. The RRT gave a significantly higher estimate, 28%. All methods used were judged feasible, although there is a suggestion that, without some improvement, the RRT may be difficult to use in low literacy populations. The repeat interview did not demonstrate advantage over the single interview in obtaining prevalence of women with a history of induced abortion. Ths use of a shorter interval with probing when the pregnancy test is positive might improve identification of recent abortions.