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。     

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。     

苯扎氯铵避孕凝胶剂避孕有效性的临床多中心研究

目的 观察苯扎氯铵（BZK）避孕凝胶剂的避孕效果.方法 将240例健康育龄期女性志愿者随机分为两组,其中120例使用BZK避孕凝胶剂（BZK组）,120例使用壬苯醇醚（NP-9）避孕胶冻剂（NP-9组）,随访6个月,以寿命表法、log-rank检验比较两组的妊娠率、因症停用率和非医学原因停用率.结果两组妇女6个月时的随访率,BZK组和NP-9组分别为100.0%（120/120）和99.2%（119/120）;粗累积妊娠率分别为1.72/100妇女和0.91/100妇女;粗累积因症停用率为0和2.68/100妇女;粗累积非医学原因停用率为3.39/100妇女和6.05/100妇女;两组的3种粗累积率分别比较,差异均无统计学意义（P＞0.05）.结论 BZK避孕凝胶剂的避孕作用与NP-9避孕胶冻剂同样有效.     

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。     

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。     

生物黏附缓释避孕凝胶杀精剂的临床有效性试验

目的　观察外用生物黏附缓释避孕凝胶杀精剂 (凝胶剂 )的临床避孕效果。方法　将2 4 0例育龄妇女志愿者随机分为两组 ,其中 12 0例使用凝胶剂 (凝胶剂组 ) ,12 0例使用避孕栓剂 (栓剂组 )。随访 6个月 ,以生命表法统计、Logrank检验比较两组的妊娠率、因症停用率和非医学原因停用率等。结果　两组使用药剂前后 ,宫颈刮片细胞学检查均无异常。 6个月的随访率 ,凝胶剂组和栓剂组分别为 10 0 0 %和 97 5 % ;粗累积妊娠率分别为 6 39/ 10 0妇女和 2 95 / 10 0妇女 ;因症停用率为3 4 5 / 10 0妇女和 4 5 7/ 10 0妇女 ;非医学原因停用率为 6 89/ 10 0妇女和 14 17/ 10 0妇女。两组比较 ,差异均无显著性 (P >0 0 5 )。结论　凝胶剂的临床效果与避孕栓剂一样 ,是安全、有效的。     

活性γ型IUD(记忆合金)与TCu380AIUD的多中心随机对照临床研究

目的:观察活性γ-IUD(记忆合金)的妊娠率、脱落率、因症取出率和续用率、副作用及对生活质量的影响。方法:采用多中心随机对照的研究方法,对活性γ-IUD(记忆合金)与TCu380AIUD作临床效果比较。按常规要求放置IUD,在置器后的第3、6、12个月进行随访,观察临床效果和副作用。结果:共接纳对象1 987例,活性γ组993例,T-IUD组994例,对象的临床特征组间基本相似。置器后12个月的随访率活性γ组和T-IUD组分别为87.0%和86.6%;置器1年净累积续用率活性γ-IUD组为93.40%,T-IUD组为88.67%(P<0.01)。置器1年时粗累积脱落率活性γ-IUD组和T-IUD组分别为每100妇女年1.57和1.91(P>0.05),带器妊娠率分别为每100妇女年0.68和0.12(P<0.01);因IUD下移停用率分别为每100妇女年1.88和4.20(P<0.01);因出血停用率分别为每100妇女年1.13和4.10(P<0.01);因疼痛而停用、因症取出及非因症取出率组间相似。置器后各阶段副反应主诉的发生率活性γ-IUD组均明显低于T-IUD组(P<0.05)。生活质量均得到改善。结论:活性γ-IUD(记忆合金)比TCu380AIUD续用率高,下移和出血副反应少,是一种临床效果较好、副反应发生率较低的新型IUD。     

流产后关爱对于生育妇女在术后落实高效避孕措施的影响

目的:探讨流产后关爱(post-abortion care,PAC)对生育妇女在流产术后即刻落实高效避孕措施的影响。方法:将行人工流产术的811名已生育妇女,分为PAC服务前的对照组385例和PAC服务后的观察组426例。对照组按常规人工流产程序进行,观察组按PAC流程对流产妇女进行干预,并对所有对象随访1年。比较观察组和对照组患者在术后即刻落实高效避孕措施的情况,并比较两者的避孕措施续用率和重复流产率。结果:与对照组相比,观察组在术后采取高效避孕措施的人数明显增多,两者差异具有统计学意义(P0.05)。观察组术后1个月的短效口服避孕药续用率为96.54%,对照组续用率为92.39%,其差异无统计学意义(P0.05)。而观察组术后3个月、6个月以及1年的短效复方口服避孕药(COC)的续用率分别为73.9%、47.8%和39.6%,均高于对照组,其差异具有统计学意义(P0.05)。观察组术后1个月和3个月的宫内节育器(IUD)续用率与对照组相比较,差异无统计学意义(P0.05)。而观察组术后6个月以及1年的IUD续用率为98.94%和96.84%,均高于对照组,其差异具有统计学意义(P0.05)。术后1年,观察组患者的重复流产率为0.23%,低于对照组的1.37%,其差异具有统计学意义(P0.05)。结论:PAC服务对于提高生育妇女流产术后选择高效可逆的避孕方法,有着非常重要的影响,同时提高了IUD和短效口服避孕药的续用率,有效降低了重复流产率,保障了女性生殖健康和身心健康。     

比林斯法在哺乳期应用的实验和临床研究

目的 :观察比林斯生育调节法 (BOM)在哺乳期避免妊娠的可行性和有效性 ,寻找监测哺乳期生育力恢复的指标。方法 :对比研究比林斯法和 IUD法在 1 2个月中的意外妊娠率、停用率和续用率。测定血生乳素、雌二醇用以估计月经恢复 ;检测尿雌激素和孕二醇 ,确定第 2次月经前是否排卵。结果 :哺乳期比林斯法和 IUD法两组妇女分别观察了 2 1 9例和 2 0 0例。妊娠率、停用率和续用率分别为 1 .43 %、1 .5 4 %,8.5 3 %、8.87%和 90 .1 7%、91 .3 5 %,两组间无统计学差异 (P>0 .0 5 )。同期进行的 90例和 2 75次血生乳素、雌二醇的测定发现 ,二者比例以 0 .3 5作为月经恢复的指标。6 1例尿雌激素和孕二醇测定表明 ,宫颈粘液类型与激素水平吻合外 ;混合喂养妇女第 2次月经前排卵发生率为 47.0 5 %。结论 :(1 ) BOM用于哺乳期避孕的效率如同 IUD法 ,也能被哺乳期妇女接受。 (2 )血生乳素和雌二醇测定可估计哺乳期妇女月经恢复 ,方法简单 ,可应用于临床。 (3 )混合喂养有延迟哺乳期生育的作用。     

Cervical hydatidiform mole pregnancy after missed abortion presenting with severe vaginal bleeding: case report and review of the literature

We report a 28-year-old woman presenting with a complete hyaditiform mole localized to the cervix. She had undergone curettage of missed abortion two months previously and the aborted material showed normal placental tissue on histopathologic examination. Two months after curettage she presented with sudden severe vaginal bleeding. Clinical examination revealed a lesion of the epithelial outer surface of the cervix. Due to the bleeding, immediate surgical intervention was necessary. Histological examination revealed a complete hydatidiform mole.Currently, only three cases of this exceedingly rare diagnosis have been published: two reported a partial mole and one a complete hydatidiform mole. In our case, we hypothesize that the pathogenesis took place in two steps. Initially the curettage of the missed abortion damaged the endometrial lining. During a new rapid re-fertilization after the missed abortion, a hydatidiform molar pregnancy developed. Normally this abnormal trophoblast tissue would adhere to the endometrium but in this case we assume that intrauterine implantation was not possible because of endometrial damage at the prior curettage, allowing the abnormal trophoblast tissue to pass the endocervix and emerge into the vaginal vault. Presumably, during the curettage an epithelial defect was produced on the outer surface of the cervix, due to clamping the cervix during dilatation. We speculate that this weak spot on the epithelial surface was responsible for the adherence to the cervix and subsequent bleeding was caused by injury of maternal blood vessels. We propose that careful holding of the cervix with atraumatic clamps during curettage is important to avoid subsequent complications.     

Evacuation of the gravid uterus by negative pressure (suction evacuation)

500 patients treated by suction evacuation of the gravid uterus are described. There were 80 therapeutic abortions, 375 early incomplete abortions, 21 late incomplete abortions, 18 missed abortions, and 6 cases of hydatidiform mole. The suction method was attempted to avoid the trauma of the curette. The 80 therapeutic abortions were done in Weeks 5-10 of pregnancy. To check results, an immediate curettage was made in 56 cases: this verified that no tissue remained in the uterus. In the 18 cases of missed abortion an adherent and fibrotic placenta was encountered in 9. A curettage was then needed to complete the procedure. The suction method was not used for subsequent cases of missed abortion. In the 375 cases of early incomplete abortion suction evacuation was 100% successful; in these cases the cervix was usually already adequately dilated. In the 21 cases of late incomplete abortion, 17 had the fetus already expelled. However, the remaining placenta tended to block the suction tube. Parts of the placenta were then left to be removed by curettage. In the 4 cases in which the fetus had not been expelled it could not be evacuated through the suction tube. Therefore suction evacuation was no longer done for late incomplete abortion. In all 6 cases of hydatidiform mole suction evacuation was quickly performed with minimal bleeding. Damage to the basal layer of the endometrium and the myocardium is avoided in the separation of the placenta by suction evacuation. The method is recommended as better than curettage for early therapeutic abortion, early incomplete abortion, and hydatidiform mole but not for late incomplete abortion or missed abortion.     

8885例早孕人工流产中葡萄胎发生情况调查

目的:探讨葡萄胎发病率及其相关因素。方法:根据8885例早期人工流产患者术后病理结果筛选出葡萄胎患者,对其进行血β-hCG随访及相关检查,应用统计学分析方法,寻找临床出现葡萄胎表现之前的葡萄胎发生的可能指征及其影响因素。结果:8885例早孕人工流产患者中有14例发生葡萄胎,发病率为1.57‰;稽留流产患者葡萄胎发病比例(0.78%)显著高于正常妊娠者(0.10%);葡萄胎患者与正常妊娠者术后转经时间无差异。结论:生育旺盛年龄妇女是发生葡萄胎的主要人群,人流患者(特别是稽留流产患者)的绒毛组织做常规病理学检查可提高葡萄胎的检出率。     

Complete hydatidiform mole in a triplet pregnancy coexisting two viable fetuses: case report and review of the literature

We report a rare case of a complete hydatidiform mole with two or more coexisting fetuses where both infants survived without complications. A male infant weighing 1258 g and a female infant weighing 880 g were delivered without complications and discharged 95 days after the birth. The analysis of DNA microsatellite polymorphisms indicated that the mole was of paternal origin and probably homozygous. The mother suffered from multiple pulmonary metastasis of the hydatidiform mole which was detected 3 days after the surgery and was successfully treated with methotrexate. A complete hydatidiform mole with two or more coexisting fetuses produces a dilemma between immediate termination and pregnancy continuation. Although the present case resulted in a favorable outcome, a review of the 14 reported cases suggests that the high fetal loss rate (90%) must be a consideration in the decision regarding management of such a pregnancy.     

Clinicopathologic characteristics and subsequent pregnancy outcome in 139 complete hydatidiform moles

OBJECTIVE: The most common form of gestational trophoblastic disease is the complete hydatidiform mole (CHM). The study reports our experience of clinicopathologic characteristics and subsequent pregnancy outcome of patients with CHM. STUDY DESIGN: One hundred fifty-one subsequent cases with initial diagnosis of CHM were re-evaluated histopathologically. Clinical characteristics, the need for chemotherapy and subsequent pregnancy outcome were evaluated. RESULTS: Twelve out of 151 cases were re-evaluated as hydropic abortion, as partial hydatidiform moles or were insufficient for morphologic examination and therefore excluded from further analysis. The leading clinical symptoms of the remaining 139 cases were irregular vaginal bleeding (67%) and uterine enlargement (41%). Twenty-six patients (19%) required chemotherapy because of gestational trophoblastic neoplasia (GTN; low-risk: 23 out of 26). All patients were cured successfully. The subsequent pregnancy rate was 15% (21/139). Five patients suffered from abortions, 12 women delivered a healthy offspring. Four women presented with recurrent CHM with a spontaneous normalization of HCG levels after D&C. CONCLUSIONS: The clinical and morphologic diagnosis of CHM is a challenge, and diagnosis as well as treatment should be multidisciplinary and centralised. One fifth of CHM are at risk of a GTN, but the cure rate is 100% with adequate management. Pregnancy outcome following CHM is complicated by an increased risk of abortion.     

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。     

Hydatidiform mole in 59-years-old woman: a case report

We describe a clinical data and histopathological findings in hydatidiform mole found in 59-years-old woman. The patient was admitted to Hospital with vaginal bleeding. Diagnostic curettage revealed hydatidiform mole VI group according to Hertig-Sheldon classification. The patient underwent transabdominal hysterectomy and bilateral oophorosalpingectomy. The serum level of beta-HCG has decreased from initially observed 128.6 U/l to less than 3 U/l after 3 courses of MTX therapy. Patient is under every-six-month observation. No further treatment is planned.     

Treatment of minimal and moderate intrauterine adhesions (Asherman's syndrome)

Fifty-one women with only minimal and moderate intrauterine adhesions (Asherman's syndrome) underwent dilatation of the cervix, lysis of adhesions and insertion of intrauterine contraceptive devices (IUDs). A pregnancy rate of 90% was achieved. In 85% of the pregnancies a viable infant was delivered, and 15% terminated in abortions. No complications of pregnancy or of the third stage of labor were noted. The most common procedure preceding the appearance of intrauterine adhesions was curettage for spontaneous abortion and less frequently for missed and induced abortions. It seems that in mild and moderate Asherman's syndrome, lysis of adhesions and IUD insertion without estrogen administration yield satisfactory results.