产后妇女中长效可逆避孕措施的使用现状及影响因素的研究

目的:探讨长效可逆避孕措施(LARC)在产后妇女中的使用现状及影响因素。方法:采用容量比例概率抽样选择湖南省石门县3岁以下儿童母亲503例,采用自行设计的结构式问卷进行调查,用SPSS20.0统计软件对相关资料进行统计分析。结果:被调查的503例3岁以下儿童母亲中,产后采取避孕措施的比例为68.2%,采取LARC的比例有12.7%。logistic回归分析显示:初产妇(OR=3.43,95%CI:1.49~7.89)、26~30岁年龄组(OR=5.26,95%CI:1.43~19.40,处于哺乳期(OR=3.77,95%CI 1.80~7.63)以及剖宫产(OR=3.70,95%CI 1.80~7.63)是被调查者产后未使用LARC避孕的风险因素。结论:目前产后妇女LARC使用率偏低,提高产后避孕率,尤其是提高LARC使用率应是提高我国生殖健康工作的重点之一。     

人工流产后计划生育服务干预实施效果的问卷调查

目的 探讨人工流产后计划生育服务干预实施的效果.方法 选择1 200名行人工流产妇女在流产术前行避孕相关知识问卷调查,将其随机分为两组,干预组实施流产后计划生育服务干预措施,对照组行常规处理,1年后再次对所有研究对象进行避孕相关知识等问卷调查.结果 随访1年后,收回有效问卷1 042份,其中干预组524份,对照组518份.干预组避孕相关知识得分与对照组比较差异有统计学意义(P＜0.01),干预组未采取避孕措施比例与对照组比较有差异有统计学意义(P＜0.01),干预组非意愿妊娠率与对照组比较差异有统计学意义(P＜0.01).结论 人工流产后实施计划生育服务干预措施有利于提高避孕相关知识水平,提高避孕措施使用比率,降低非意愿妊娠率.     

关爱式教育与随访管理对促进青少年人工流产后落实长效可逆避孕方法的效果分析

目的：探讨关爱式教育与随访管理对促进青少年落实长效可逆避孕方法(LARC)的效果。方法：选取因意外妊娠行人工流产的青少年女性共264例,采用随机数字表法分为观察组和对照组,各132例。对照组采用常规流产后关爱服务,观察组采用关爱式教育与随访管理。统计分析两组青少年LARC知识问卷得分,术后即时LARC落实率、术后6个月LARC续用率、重复流产率、终止率及避孕效果满意率等方面的差异。结果：干预前两组问卷回答正确率在50.0%以上的条目(均为3个)及LARC知识得分无统计学差异(P>0.05);干预后观察组回答正确率在50.0%以上的条目及LARC知识得分(10个,10.0±2.0)均好于对照组(5个,6.3±1.8)(P<0.05),且观察组干预前后比较也有差异(P<0.05)。观察组术后即时LARC落实率(51.5%)、术后6个月续用率(48.5%)、终止率(2.9%)、避孕效果满意率(97.1%)均好于对照组(13.6%、9.1%、72.2%,P<0.05)。两组重复流产率(0.8%,2.3%)无差异(P>0.05)。结论：关爱式教育与随访管理有助于提高...     

前牙外伤后即刻种植即刻修复的美学效果观察

目的对前牙外伤后即刻种植修复后的美学效果进行分析。方法对2012年1月—2013年8月行前牙外伤后即刻种植的16例患者的临床资料进行回顾性分析,观察修复后的牙龈乳头状况、牙龈边缘的协调性、牙龈颜色、邻牙协调性及患者满意度。结果 16颗种植体均获得良好的骨结合,牙龈协调性基本一致,牙龈乳头高度全部可见,唇侧牙龈色泽与邻牙一致的13颗,2颗色泽暗红并另有1个牙位略微显示金属色泽。患者对修复效果满意。结论前牙外伤即刻修复应严格掌握适应证,并在手术中精确操作,以达到预期美学效果。     

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。     

长效可逆避孕方法在产后避孕中的重要价值

<正>我国的非意愿妊娠人工流产率呈逐年增高趋势,而已生育妇女在人工流产总数中占到50. 3%[1]。产后是女性的特殊生理时期,多数女性认为哺乳、闭经可以起到暂时避孕的效果,部分女性因担心避孕对泌乳及胎儿生长发育造成不良影响,而忽略或停止这一时期的避孕,导致产后1年内的人工流产率较育龄期女性平均水平高。此外,产后女性恢复排卵时间因是否母乳喂养而有差异。对于不完全母乳喂养的女性,平均恢复排卵的     

影响育龄妇女避孕措施选择及效果的因素分析

目的:了解影响育龄妇女避孕方法选择和避孕效果的因素,为提高妇女避孕有效率提供建议。方法:采用整群抽样的方法,对2006年5月～2007年5月在我校附院妇产科门诊,要求人工流产的妇女826例进行横断面调查。结果:年龄、文化程度、婚育情况不同,避孕方法差异有统计学意义(P<0.01)。结论:年龄、文化程度、婚育情况是影响育龄妇女避孕措施选择的主要因素;避孕知识缺乏、侥幸心理、避孕方法不当是影响育龄妇女避孕效果的主要因素。重视避孕,正确使用避孕方法是提高育龄妇女避孕有效率的重要方面。     

三种麻醉方法在无痛人工流产术中的镇痛效果评价

目的讨论异丙酚＋芬太尼、异丙酚、笑气三种不同麻醉方法在人工流产术中的镇痛效果。方法选择2008年1月至2009年1月在笔者所在医院妇产科门诊就诊的且孕期≥50d且〈70d，或自愿采取无痛人工流产且无手术禁忌证者，年龄在17～40岁之间的312例早孕妇女为研究对象。分A、B、C三组分别应用芬太尼＋异丙酚、异丙酚、笑气采取三种不同的麻醉方法进行无痛人工流产。结果应用芬太尼＋异丙酚的镇痛作用快时间短，效果好，异丙酚次之，笑气作用再次之。结论芬太尼＋异丙酚行无痛人工流产的麻醉，患者术后清醒迅速、完全、可控性强，临床上试行无痛人工流产术时值的推广。     

微管在人工流产中应用的临床效果评价

目的探讨微管用于人工流产的临床效果。方法随机选择2008年1月至2009年1月在笔者所在医院人工流产妇女820例,随机分为观察组和对照组各410例,对照组用传统的金属扩官器和金属吸管连接负压吸引器按常规的方法施术,观察组应用微管实施人工流产。结果两组均完全流产,观察组中发生人_T流产综合征2例低于对照组中的18例,术中出血量（7．17±1．12）ml少于对照组的（17．98±3．49）ml,手术时间（6．38±2．34）min少于对照组的（11．45±4．23）min（P〈0．05）;观察组满意380例、基本满意20例、不满意10例,对照组分别为282例、98例、40例,两组比较差异有统计学意义（P〈0．05）。结论微管具有微创、无痛、预防交叉感染等优点,值得临床广泛使用。     

人工流产后计划生育服务干预效果初探

目的:探讨人工流产后计划生育服务的实施效果。方法:在珠海市6家计划生育服务中心(站、所)选择1500名行人工流产妇女在流产术前进行初始问卷调查;然后将其随机分为流产后计划生育服务组(干预组)和对照组,对干预组进行流产后计划生育服务措施干预,对照组常规处理;1年期满后,对所有的研究对象采用与初始问卷相同的问卷再次进行问卷调查,重点调查避孕节育相关知识知晓情况,避孕措施实施情况,及再次非意愿妊娠情况。结果:随访1年后,收回有效问卷1146份,其中干预组577人,对照组569人。干预组和对照组的避孕相关知识得分分别为9.76和6.07(F=847.87,P0.001)。干预组采取主动避孕措施的比例(83.24%)高于对照组(59.93%),差异有统计学意义(χ2=114.86,P0.001)。干预组的非意愿妊娠率(9.71%)低于对照组(20.74%),差异有统计学意义(χ2=27.08,P0.001)。结论:流产后计划生育服务对育龄女性避孕节育相关知识的掌握,提高避孕措施使用比例,降低非意愿妊娠和人工流产率,提高生殖健康水平有一定的效果。     

Examining long-acting reversible contraception non-use among Australian women in their 20s: findings from a qualitative study

Australian women use less effective, short-term methods of contraception more often than any other method, despite the availability of much more effective long-acting reversible contraception (LARC). Although research examining the low uptake of LARC among Australian women has increased over the past few years, we still know little about the factors influencing this phenomenon. Using data from semi-structured telephone interviews with 15 Australian women in their 20s, this paper explores contraceptive experience to better understand the non-use of LARC. Findings highlight the ubiquity of the use of the oral contraceptive pill and perceptions of LARC as a more serious contraceptive choice. Among participants, the intrauterine device (IUD) was viewed particularly unfavourably. Furthermore, LARC was shown to be only considered for use after dissatisfaction with shorter-term methods (usually the Pill) if at all. Overall, these findings suggest further education in dispelling myths and discomfort around LARC use, while simultaneously recognising and respecting women’s decisions to not use LARC methods.     

Society of Family Planning clinical recommendations: contraception after surgical abortion

These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy. IUD insertion immediately following uterine aspiration is safe. While this may be associated with a higher risk of device expulsion than with interval placement, expulsion rates remain low, and this risk must be weighed against the fact that patients often do not receive their desired IUD at an interval insertion and therefore experience higher rates of subsequent unintended pregnancy. Many patients experience barriers that prevent access to the full spectrum of postabortion contraceptive options, particularly IUDs and implants. Advancements in health-systems-based point-of-care provision and policies are needed to improve comprehensive contraceptive availability following surgical abortion. These recommendations will address clinical considerations for postabortion contraceptive provision and recommend interventions to improve contraceptive access following uterine evacuation.     

Opportunity,satisfaction, and regret: Trying long-acting reversible contraception in a unique scientific circumstance

Increased use of long-acting reversible contraception (LARC) can reduce unintended pregnancies. However, significant barriers exist to LARC uptake, particularly high up-front costs. In North Carolina in 2014, we interviewed thirty-four purposively selected participants (aged 20–30 years) enrolled in a partially randomized patient preference trial to learn about their experiences with and attitudes toward contraception in this unique trial context. Cost of LARC was important in participants’ decision-making. Experiencing an unintended pregnancy motivated women to switch to LARC. No participants who tried LARC, even those who experienced side effects, regretted it. Several participants regretted discontinuing their LARC. Concerns about insertion and removal did not influence future willingness to try LARC. Participants discussed the importance of affordability and feeling in control when choosing a contraceptive method. Cost, combined with uncertainty over whether LARC is the right method for them, may deter young women from trying LARC. Intrauterine devices (IUDs) and implants should be made affordable so that women can try them without significant financial commitment. Affordability will likely increase uptake, which will reduce unintended pregnancies. Regret from discontinuing LARC was more frequently reported than regret from trying LARC. Providers should offer young women LARC and counsel to support continuation.     

Uptake and adherence to long-acting reversible contraception post-abortion

Background

This study aimed to increase use of long-acting reversible contraceptive (LARC) methods by women post-abortion.

Study Design

Ten-week intervention at a public abortion clinic involving free access to three LARC methods (DMPA, LNG-IUS, Multiload Cu375); posters promoting LARC; updated information for clinic staff. Outcome measures: change in the proportion of women choosing LARC prior to and during the intervention; rate of follow-up and method retention at 6 weeks and at 6 months post-abortion.

Results

Use of post-abortion LARC increased significantly from 44% at baseline (226/510) to 61% (310/510) during the intervention (p<.001). Use of LNG-IUS increased almost sixfold from 6% to 36%. Follow-up rates were 71% at 6 weeks (221/310) and 74% at 6 months (184/249). Method retention was 89% at 6 weeks (197/221) and 86% at 6 months (159/184).

Conclusion

Uptake of LARC by women post-abortion can be achieved by increasing access to these methods — by eliminating cost and raising awareness and benefits of long-acting methods among both clinicians and patients.     

Changes in the use of effective and long-acting reversible contraception in Vietnam

Objectives

To calculate the prevalence and identify correlates of unmet need for contraception and to assess whether prevalence of use of effective contraception and long-acting reversible contraception (LARC) has changed over time among married or cohabiting, reproductive-age women in Vietnam.

Dedicated providers of long-acting reversible contraception: new approach in Zambia

Background

Long-acting reversible contraception (LARC) is underused in many countries in sub-Saharan Africa. Many previous attempts to increase uptake of this important class of contraception have not been successful.

Study Design

This program in Zambia employed 18 dedicated providers of LARC, placed them in high volume public sector facilities and collected routine, anonymous information over a 14-month period. We tallied uptake of LARC, analyzed user characteristics to see what populations were reached by the program and compared this to nationally representative data. We also estimated costs per couple-year of protection of the program.

Results

In a 14-month period, 33,609 clients chose either a subdermal implant (66%) or an intrauterine device (34%). The program reached a younger and lower parity population compared to nationally representative surveys of Zambian women using contraception. The estimated program costs, including the value of donated commodities, averaged $13.0 per couple-year of protection.

Conclusion

By having the necessary time, skills and materials — as well as a mandate to both generate informed demand and provide quality services — dedicated providers of LARC can expand contraceptive choice. This new approach shows what can be achieved in a short period and in a region of the world where uptake of LARC is limited.     

Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion

BACKGROUND: Of the 1.3 million abortions performed annually in the United States, approximately half are repeat procedures. Immediate postabortal intrauterine device (IUD) insertion is a safe, effective, practical and underutilized intervention that we hypothesize will significantly decrease repeat unintended pregnancy and abortion. STUDY DESIGN: All women receiving immediate postabortal IUD insertion in eight clinics of a Northern California Planned Parenthood agency during a 3-year period comprise the IUD cohort. We selected a cohort of controls receiving abortions but choosing other, non-IUD contraception on the day of the abortion visit in a 2:1 ratio matched by date of abortion. We obtained follow-up data on repeat abortions within the agency for both cohorts through 14 months after the 3-year period. We evaluated differences in repeat abortion between cohorts. All analyses were intent-to-treat. RESULTS: Women who received an immediate postabortal IUD had a lower rate of repeat abortions than controls (p<.001). Women who received a postabortal IUD had 34.6 abortions per 1000 woman-years of follow-up compared to 91.3 for the control group. The hazard ratio for repeat abortion was 0.38 [95% confidence interval (CI), 0.27-0.53] for women receiving a postabortal IUD compared to controls. When adjusted for age, race/ethnicity, marital status, and family size, the hazard ratio was 0.37 (95% CI, 0.26-0.52). CONCLUSION: Immediate postabortal intrauterine contraception has the potential to significantly reduce repeat abortion.     

Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder

Background

Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD.

Correlates of long-acting reversible contraception versus sterilization use in advanced maternal age

Purpose

To identify correlates associated with choosing long-acting reversible contraception (LARC) over female sterilization (FS) from a subsample of women aged 35 to 44 years in a nationally representative survey.

Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners

Objective

Nurse practitioners (NPs) provide frontline care in women's health, including contraception, an essential preventive service. Their importance for contraceptive care will grow, with healthcare reforms focused on affordable primary care. This study assessed practice and training needs to prepare NPs to offer high-efficacy contraceptives — intrauterine devices (IUDs) and implants.

Method

A US nationally representative sample of nurse practitioners in primary care and women's health was surveyed in 2009 (response rate 69%, n = 586) to assess clinician knowledge and practices, guided by the CDC US Medical Eligibility Criteria for Contraceptive Use.

Results

Two-thirds of women's health NPs (66%) were trained in IUD insertions, compared to 12% of primary care NPs. Contraceptive counseling that routinely included IUDs was low overall (43%). Nurse practitioners used overly restrictive patient eligibility criteria, inconsistent with CDC guidelines. Insertion training (aOR = 2.4, 95%CI: 1.10 5.33) and knowledge of patient eligibility (aOR = 2.9, 95%CI: 1.91 4.32) were associated with IUD provision. Contraceptive implant provision was low: 42% of NPs in women's health and 10% in primary care. Half of NPs desired training in these methods.

Conclusion

Nurse practitioners have an increasingly important position in addressing high unintended pregnancy in the US, but require specific training in long-acting reversible contraceptives.