妊娠13周内药物流产失败及流产不全影响因素分析

目的 了解早期(孕周<13周)妊娠孕妇药物流产失败及流产不全影响因素,从而为降低妊娠13周内药物流产不全以及流产失败的发生率提供临床理论依据,提升药物流产成功率。 方法 选择黄陂区妇幼保健院2013年5月-2016年5月期间800名自愿进行米索前列醇+米非司酮药物流产的孕早期妇女,通过查阅临床资料以及问卷调查的形式记录所有孕妇年龄、文化程度、职业、经济收入、孕期、既往流产史、慢性盆腔炎、子宫位置、孕囊直径、阴道炎、孕产次、宫颈物理治疗史等因素与流产结果的联系,通过单因素χ²检验与多因素logistic回归分析其药物流产不全以及流产失败的影响因素。 结果 800名药物流产孕早期妇女出现药物流产失败及流产不全的孕妇共64例,流产失败及流产不全率为8.00%;单因素χ²检验分析显示不同年龄、文化程度、职业、经济收入水平、孕期、子宫位置、孕囊直径、孕期是否患慢性盆腔炎、宫颈物理治疗史、孕产次其流产失败及流产不全率差异有统计学意义(均P<0.05);进一步多因素logistic回归分析结果显示有流产史(OR=4.187, 95%CI:1.972~8.882)、孕期50~90 d(OR=3.912, 95%CI:1.946~7.854)、子宫后位(OR=3.758, 95%CI:1.602~8.811)、孕期患慢性盆腔炎(OR=4.242, 95%CI:2.246~8.004)、宫颈物理治疗史(OR=3.108, 95%CI:1.747~5.529)是药物流产不全以及流产失败高危因素。 结论 该院三年来药物流产失败高危因素为有流产史、孕期50~90 d、子宫后位、孕期患慢性盆腔炎、宫颈物理治疗史,进行药物流产时要严格把控适应证,用药后要落实随访工作,有问题及时处理。     

异位妊娠发病因素及与盆腔手术的相关性研究

目的研究异位妊娠发病因素及与盆腔手术的相关性。方法选取2013年5月至2014年5月入住我院的223例孕妇为研究对象,收集孕妇的一般资料、既往史、孕产史、避孕史等情况,探析其发生异位妊娠的发病情况及与盆腔手术的相关性影响因素。结果 223例孕妇异位妊娠患者40例,发病率为17.9%。异位妊娠发病情况与盆腔手术史、流产史、附件炎、盆腔炎、输卵管手术史、异位妊娠史、宫内放置节育器史等因素密切相关,差异有统计学意义(P<0.05)。结论异位妊娠的发病与卵巢肿瘤、放置宫内节育器、人工(药物)流产史、异位妊娠史、盆腔手术史、附件炎、盆腔炎等因素密切相关,需降低宫腔手术率,以此来降低异位妊娠的发生。     

异位妊娠相关发病因素的分析

目的:通过对异位妊娠发病因素进行分析,为控制疾病的发生,降低发病率提供理论依据。方法:采用回顾性病例对照研究,以该院2000年4月1日~2003年11月30日共446例异位妊娠患者为研究组,随机抽取同期足月分娩产妇446例为对照组,对末次妊娠史、盆腔炎史、IUD应用及应用史、输卵管手术史、子宫内膜异位症、异位妊娠史、子宫肌瘤等因素进行分析。结果:盆腔炎、流产史、IUD应用及应用史、输卵管手术史对异位妊娠的发生有明显的影响。结论:盆腔炎、流产史、IUD应用及应用史、输卵管手术史是异位妊娠发病的危险因素,其中盆腔炎为最根本原因。     

260例异位妊娠患者发病相关因素及预防措施分析

目的:探讨异位妊娠发病相关因素及预防措施。方法:回顾性分析该院近年来收治的260例异位妊娠患者的临床资料。结果:异位妊娠组260例患者存在既往流产史、盆腔炎史、宫外孕史、手术史、输卵管手术史与宫内妊娠组271例患者比较,差异具有统计学意义,P<0.05。放置宫内节育器、实施绝育术、服用紧急避孕药的患者与未避孕的患者比较,发生异位妊娠的几率明显增高,经χ2检验具有统计学差异,P<0.05。结论:既往流产史、盆腔炎史、宫外孕史、手术史、输卵管手术史均是导致异位妊娠发生的高危因素,应在全社会范围内加强计划生育宣传教育,提高育龄妇女的自我保护意识,特别对异位妊娠的发生应引起社会的足够重视。     

异位妊娠相关因素分析

目的通过对异位妊娠患者的调查及临床检查,总结归纳与异位妊娠发生相关的危险因素,以进一步明确其病因。方法对唐山市妇幼保健院168例异位妊娠患者住院病例进行前瞻性研究。使用多元统计方法,进行多因素分析。结果盆腔炎、流产史、放置宫内节育器、盆腔手术史、异位妊娠史、卵巢肿瘤对异位妊娠的发生有明显影响作用。结论盆腔炎、流产史、放置宫内节育器、盆腔手术史、异位妊娠史、卵巢肿瘤是异位妊娠发病的危险因素,其中盆腔炎为最重要原困。     

IUD合并异位妊娠38例临床分析

目的:探索IUD合并异位妊娠的关系,为临床提供治疗和预防依据。方法:对38例IUD合并异位妊娠资料进行分析。结果:IUD的发生以24~35岁妇女最多,与妇科炎症主要是输卵管炎和盆腔炎有直接的关系,IUD并不增加异位妊娠的发生率,但与盆腔手术的增加,如人工流产术,剖宫产的关系较为密切。IUD合并异位妊娠与IUD放置时间、种类有很大关系。结论:应降低人工流产率,减少剖宫产手术以预防异位妊娠的发生。应减少对不锈钢圆环及塑料环的应用,尽量应用含铜IUD及含孕酮IUD,以降低妊娠率。放器后定期B超随访,减少异位妊娠的发生。     

放置不同IUD妇女带器妊娠260例分析

目的:探讨放置金属单环、母体乐铜375环及TCu环妇女带器妊娠的有关因素,指导育龄妇女合理避孕。方法:对260例放置上述3种宫内节育器(IUD)妇女带器妊娠有关因素进行分析。结果:放置金属单环者带器妊娠比例明显高于放置母体乐铜375及TCu者;放置3种IUD妊娠者中50%以上有环移位;<35岁组带器妊娠比例明显高于≥35岁组;不同放置年限均可出现带器妊娠,且放置年限越长,带器妊娠比例越高。结论:在指导育龄妇女避孕时尽量选择活性IUD,定期检查环位,及时发现环移位,应根据不同IUD放置年限及时更换,同时提高操作人员技术水平,从而降低带器妊娠率。     

10例异位妊娠临床探讨

目的探讨异位妊娠的有关因素,临床特点。方法对10例异位妊娠患者的孕产史,避孕方式、临床表现、实验室检查、手术方式等进行分析。结果异位妊娠发病因素中有流产史,占60%,有盆腔炎病史占40%,宫内节育器避孕者占50%,临床表现主要为停经、腹痛、阴道流血,应结合相关检查,病情分析及早诊断及治疗。结论对异位妊娠的主要临床表现和症状进行充分的掌握,对于今后临床对该类患者进行更有效更有针对性的治疗有着十分重要的意义。     

异位妊娠发生因素的病例对照研究

目的探讨发生异位妊娠（EP）的相关危险因素,提出预防措施。方法采用病例对照法,将遂平县人民医院收治的EP孕妇130例作为研究组,选择同期行人工流产或药物流产的健康妊娠妇女130例作为对照。收集两组患者的相关信息,包括患者的一般情况、婚育史、妇科疾病史、腹部手术史等,对可能影响EP的因素进行单因素和多因素Logistic回归分析。结果单因素分析结果显示盆腔炎史、流产史、既往分娩史、不孕史、腹部手术史、EP史、IUD使用是EP发病的危险因素（P〈0.05）。多因素分析筛选出4个主要危险因素,即流产史（OR=3.698）、腹部手术史（OR=3.471）、IUD使用（OR=3.207）、盆腔炎史（OR=2.706）。结论 EP与多种因素有关,积极采取相应预防措施,对降低EP的发病率有积极作用。     

异位妊娠发病相关因素及早期诊断的临床分析

目的:探讨异位妊娠的发病原因及早期诊断的方法。方法:回顾性分析2003年1月～2007年1月收治的240例异位妊娠患者,对流产史、盆腔炎史、上环史、异位妊娠史等因素及早期诊断进行分析。结果:盆腔炎、流产史、IUD应用、输卵管病理改变及手术史对异位妊娠的发生有明显的影响。超声、血β-HCG及血孕酮是早期诊断的主要方法。结论:异位妊娠的致病因素是复杂的,盆腔炎、流产史、输卵管病理改变及手术史是异位妊娠发生的危险因素,其中盆腔炎为最根本原因。结合病史、查体及相关辅助检查才能早期诊断异位妊娠,早期得到治疗。     

宫内节育器异位影响因素的分析

目的：了解宫内节育器（intrauterine device,IUD）异位的影响因素,降低IUD严重伤害事件的发生风险,为指导IUD的临床安全使用提供参考依据。方法：对国家人口计生委计划生育药具不良反应监测中心数据库中的IUD异位的前6种类型的IUD异位的不良事件进行分析,了解发生IUD异位事件的人群特征,并分析可能与IUD异位相关的风险因素。结果：数据库中记录发生异位的IUD前6种类型为：爱母功能型、TCu220C、活性165、元宫220、金属单环、宫铜200;236例IUD异位类型为：部分异位210例,占88.98%,完全异位有6例,占2.54%,子宫外异位20例,占8.48%;疼痛在所有临床症状中所占比例最高（38.98%）;随着放置时间增加,闭合型IUD发生异位的风险逐渐增加（趋势性检验P＜0.000 1）。结论：IUD异位可能与其种类、放置时间有关,疼痛可能是发现异位的主要线索,日常工作中要特别注意定期随访。     

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.     

吉妮致美IUD对月经出血模式影响及特殊时期使用的系统评价

目的:系统评价吉妮致美与其他吉妮系列产品对月经出血模式的影响,以及吉妮致美在特殊情况下使用的效果。方法:计算机检索CNKI(1979~2014)、CBMdisc(1978~2014)、万方(1982~2014)、维普(1989~2014)数据库,并结合手工检索相关杂志。根据纳入、排除标准筛选文献,并经质量评价后,采用RevMan 5.0软件进行meta分析。结果:文献检索共检到580篇文献,根据纳入排除标准,最终纳入7篇已发表研究。分析结果显示:1在经量增多发生率、经期延长发生率、点滴出血发生率方面,吉妮致美普遍低于吉妮IN和吉妮柔适;2在人工流产后即时放置吉妮致美和宫铜200宫内节育器(IUD)的比较中,吉妮致美具有更低的脱落相关终止率和因症取出率;3在有剖宫产史的妇女中,带器妊娠率、脱落相关终止率、因症取出率方面,吉妮致美均低于元宫Cu220IUD或TCu220CIUD,在脱落相关终止率、因症取出率方面,吉妮致美均低于TCu380AIUD。结论:吉妮致美可以有效改善月经出血模式,同时在人工流产后即时放置或者有剖宫产史的妇女中放置时,可以有效预防妊娠、降低IUD脱落率并减少因症取出率,进而提高续用率,值得推广应用。     

Statement on intrauterine devices (IUDs)

Topics covered in this statement on IUDs include: mechanism of action; contraindications; efficacy; duration of use; counseling; IUD selection; insertion; the complications of perforation, bleeding and pain, infection, pregnancy, ectopic pregnancies, and expulsion; removal; and follow-up care. The newer copper- and hormone-releasing IUDs have high continuation rates, and the pregnancy rates are low. The removal in February 1986 of the Lippes Loop, the Copper 7, and the Copper T200 from the US market was for commercial reasons and not because of concerns about safety and efficacy. The Food and Drug Administration (FDA) approves these IUDs, and it is likely that the already FDA-approved Copper T380A will be available in the US during 1988. In its December 1986 meeting, the World Health Organization (WHO) scientific group on the mechanism of action, safety, and efficacy of IUDs concluded that all IUDs stimulate a foreign body reaction in the endometrium which is potentiated by the action of copper, and progestagen-releasing IUDs produce endometrial suppression much as that seen when the drug is administered by other routes. Further, the scientific group indicated that it is unlikely that 1 single mechanism of action accounts for the anti-fertility effect of IUDs. Several absolute contraindications to IUDs are recognized, including: acute or chronic pelvic inflammatory disease (PID); known or suspected pregnancy; abnormal uterine bleeding; confirmed or suspected malignancy of the genital tract; and congenital uterine abnormalities or fibroids distorting the cavity in a manner incompatible with proper IUD placement. The newer copper devices (TCu220C, TCu380Ag, TCu380A, and Multiload 375) have the lowest failure rates. Counseling of the IUD user should include telling her about all alternative family planning methods and advising her of the type of IUD to be inserted and the proper time for replacement if it is a medicated device. The available evidence from many countries suggests that properly trained nonphysicians can insert IUDs as well as doctors. The IUD may be inserted at any time convenient to the user if it can reasonably be determined that she is not pregnant. The medical indications for removal are pregnancy, acute inflammatory disease, endometrial or cervical malignancy, perforation and partial expulsion of the IUD, and abnormal or excessive bleeding. Whenever possible, it is useful to examine IUD users 3 months after IUD insertion, and annual checks are useful to ensure the IUD is in place.     

放置与未放置IUD子宫异常出血患者的子宫内膜病理变化对比分析

目的 探讨放置宫内节育器(IUD)后子宫异常出血患者子宫内膜病理变化.方法 选取2012年4月至2015年12月在青岛市黄岛区妇幼保健计生服务中心治疗的子宫异常出血患者318例,其中放置IUD患者186例,未放置IUD患者132例,比较各患者诊断性刮宫病理结果.结果 放置IUD患者子宫内膜病理示增殖期比例为39.25%,明显高于未放置IUD患者(χ2=23.195,P<0.05);放置IUD患者子宫内膜病理示单纯增生的比例为3.23%,明显低于未放置IUD患者(χ2=10.722,P<0.05);两组子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ2值分别为0.011、0.828、1.550和0.030,均P>0.05);放置IUD组>40岁和≤40岁患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ2值分别为0.776、0.095、0.035、0.037和0.923,均P>0.05);IUD放置年限≥5年和<5年患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ2值分别为0.371、0.775、1.600、0.322和0.002,均P>0.05).不同类型IUD患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ2值分别为0.019、2.386、0.401、0.746和2.386,均P>0.05).结论 IUD不会增加子宫内膜炎、子宫内膜息肉、子宫内膜异常增生、子宫肌瘤等的发病率;IUD是一种安全的避孕措施.     

异位妊娠发病相关因素及其与盆腔手术的相关性分析

目的：分析异位妊娠发病相关因素及其与盆腔手术的相关性。方法：随机选取80例异位妊娠与80例正常妊娠孕妇,分别为观察组与对照组,对两组进行问卷调查,对盆腔手术史、附件炎、盆腔炎、流产史、异位妊娠史、不孕史、子宫病变史以及宫内节育器放置等相关情况予以统计,比较与异位妊娠发生的相关性。结果：以上几项指标均与异位妊娠的发生具有相关性,盆腔手术是发生异位妊娠的高危因素。结论：明确发生异位妊娠的相关因素,并积极采取有效的预防措施,严格执行盆腔手术,利于降低异位妊娠发生率。     

人工流产术后即时放置GyneFix IUD、MCu IUD和TCu220 IUD避孕效果分析

目的:评价新型宫内节育器(IUD)GyneFix IUD和MCu IUD及传统节育器TCu220IUD的避孕效果。方法:以人工流产术后志愿放置IUD的690例为对象,随机分为3组,分别于人工流产术后即时放置Gyne Fix IUD、MCu IUD和TCu220IUD。结果:GyneFix IUD,MCu IUD和TCu220IUD使用12个月带器妊娠率分别为0.48%、0.85%、3.75%,脱落率分别为0.93%、0.85%、2.92%,因症取出率分别为2.80%、3.81%、6.25%,续用率分别为95.80%,94.49%,87.08%,放置IUD后月经异常发生率分别为8.88%、5.93%、12.5%。结论:GyneFix IUD、MCu IUD和TCu220IUD避孕效果均较理想,但TCu220IUD可能是放置型号不易掌握,带器妊娠、脱落、月经异常发生率较两种新型IUD高。     

Long-term use of intrauterine devices

Analysis was performed of data relative to 10,001 IUD insertions (mostly Lippes Loop D and C) in 8091 women in Slovenia between 1965 and 1972. Data were gathered on sociodemographic characteristics of the users; cumulative life-table rates per 100 women for removals due to pregnancy, expulsion, bleeding/pain, other medical reasons, and personal reasons as well as continuation rates and the rate of follow-up; and the proportion of women with bleeding, spotting, vaginitis, and pelvic inflammatory disease (PID) at 1-, 5-, and 10-year follow-up. The most frequent reason for removal was bleeding. Increased duration of IUD use was associated with a smaller number of women with bleeding and PID episodes. Of those with first insertions, 608 were hospitalized for IUD-related complications (49% for bleeding requiring curettage and 20% with PID). IUD use for more than five years carried a relative risk of 3.9 for a severe episode when PID developed. Of the women who terminated use of their first IUD because of expulsions, pregnancy, or bleeding, 28% asked for reinsertion. Over the 15 years of IUD use, 853 pregnancies occurred with an IUD in situ. If the IUD was removed after conception, the pregnancy outcome did not differ from women without IUDs. If the IUD was not removed, there was an increased risk of spontaneous abortion, preterm labor, and intrauterine fetal infection. While the IUD users experienced the same risk of ectopic pregnancy as noncontraceptors, if the IUD user did become pregnant, their risk of ectopic pregnancy was twice as high as that faced by those who did not use IUDs. Duration of IUD use and type of IUD had no effect on time from removal to desired conception. This duration was increased, however, in women with a history of PID and in older women. Women over 40 tolerated the IUD better than younger women but as women approached 50, removals for bleeding became more frequent. In conclusion, the IUD is a very safe contraceptive agent and is well tolerated if users are selected carefully, are motivated, and receive help with side effects.     

近30年异位妊娠发病相关因素的变迁分析

目的：探讨近30年异位妊娠的变化趋势及发病相关因素的变迁特点。方法：收集1978—2007年期间发生在肇庆市端州妇幼保健院、肇庆市第一人民医院、肇庆市医学高等专科学校附属医院、肇庆市端州区人民医院的1968例异位妊娠病例,进行回顾性分析,将1968例异位妊娠患者按发生时间为顺序,每lO年一个阶段划分,统计异位妊娠的发病率,统计如下发病相关因素：异位妊娠发病率、年龄、婚育史、孕产史、教育程度、既往病史：宫内节育器、生殖道感染病史、前次异位妊娠史、下腹部手术史、官颈治疗史、吸烟史、避孕史、辅助生育技术的应用。结果：近年来,异位妊娠的发病率一直呈上升趋势。异位妊娠患者未婚、未育、孕产次数多比例明显上升。前期组异位妊娠的既往病史主要为宫内节育器史,中期组主要为生殖道感染史,而后期组异位妊娠患者的既往病史为前次异位妊娠史、下腹部手术史和生殖道感染史。后期组中宫颈治疗史,吸烟史,避孕史,辅助生育技术使用史均高于前期组和中期组。结论：近三十年异位妊娠发病相关因素发生变化,针对不同的发病相关因素采取切实可行的干预措施,更好地预防异位妊娠的发生,从而降低发病率。