四种国产宫内节育器放置五年的临床效果对比观察

为比较国产宫内节育器的临床效果,本文对我院自1973年1月到1975年6月非随机分配、按不同阶段先后放置的1,227例不锈钢金属环、金属塑料混合环、带铜丝的金属V 型和硅胶V 型节育器,采用生命表统计法进行总结分析,并用生命表差别的X~2检验法检验各种节育器之问的差异。随访5年以上者1,147例,5年随访率为93.48%。5年观察结果:两种带铜丝的V 型节育器的带器妊娠率明显低于金属和混合环(p<0.01);金属环脱落率较高,但和其他三种相比无统计学差异;因症取出的主要原因是出血,两种V 型节育器的因症取出率较高,和环型节育器相比p<0.01,也具有明显的差异;四种节育器每年的继续有效率相似,5年后仍然有51.72—62.29%的放置者继续存放,说明它们的避孕效果都比较满意。     

不锈钢环型宫内节育器放置年限的探讨(6250例不锈钢环放置者的15年随访分析)

本文就不锈钢环型节育器长期放置是否安全问题进行了临床观察。通过6250例放置15年的随访,采用生命表法统计,15年净累计妊娠率为5.51、脱落率为17.74、因症取出率21.74、继续存放率6.48/100妇女。带器妊娠、脱落和副反应以第一、二年发生率较高,随着放置时间的延长渐趋稳定,而非因症取出(如到期、绝经等)则增加。6250例中发现宫颈癌5例,宫体癌2例,其发生率低于上海1971—1972年普查的发生率。因感染而取出43例(0.85%),带环宫外孕9例(发生在二年内者6例),金属环子宫外异位2例,未发生严重并发症。通过临床及子宫内膜病理检查,认为不锈钢环型宫内节育器没有增加子宫癌的发病率,并发症又很少,所以使用者如无临床症状,可以存放15—20年。     

带铜不锈钢环形宫内节育器与不锈钢环形宫内节育器放置二年的临床效果比较

本文对1978年1月至1980年4月同期放置带铜不锈钢环形宫内节育器1154例和不锈钢环形宫内节育器1298例进行定期随访,以比较临床效果。资料均满二年,按生命表统计临床效果,结果为:①粗累计带器妊娠率,带铜节育器为2.85/100妇女,明显低于不带铜金属单环7.90/100妇女(p<0.01)。②脱落率,带铜节育器为19.28/100妇女,高于不带铜的15.78/100妇女(p<0.05)。③因症取出率分别为8.74及7.60/100妇女(p>0.05),二组间无差异。④二年继续存放率分别为67.56/100妇女和67.71/100妇女(p>0.05),二组相似。带铜节育器带器妊娠率明显降低,且不明显增加因症取出率,建议扩大使用。对于带铜宫内节育器的脱落率稍高的缺点有待研究和改进。     

人工流产术即时放置吉妮宫内节育器1564例分析

目的探讨人工流产术即时放置吉妮宫内节育器(GyneFixIN/SIUD,INIUD)的效果。方法2002年3月至2003年3月四平市妇婴医院对停经5～10周,要求终止妊娠且同时需避孕的妇女1564例,在人工流产术即时放置INIUD,术后定期随访。结果1564例累计观察15个月,妊娠率0.13%,脱落率0.06%,续用率99.36%,因症取出率0.45%。结论人工流产术即时放置INIUD安全性高,避孕效果可靠,具有脱落率低,副反应少等优点,适于临床应用。     

上海郊区宫内节育器避孕效果的流行病学回顾性调查

本文对上海市郊区3,264例放置金单和硅V 的农村妇女,在五年期间的避孕效果进行回顾性流行病学调查。结果硅V 的脱落率和带器妊娠率明显低于金单,因出血疼痛取出率却明显高于金单,这些差别主要发生在妇女放置节育器后2～3年之内。年龄、产次、放置时期主要影响金单的脱落率,而对硅V 没有明显影响,劳动强度则仅仅引起硅V 在最末二年中脱落率的增加,而对金单没有明显影响。通过对影响金单使用效果的因素分析得知年龄是影响效果的重要因素,26岁以前放置者的脱落率高于26岁以后的放置者,放置金单妇女的脱落是随着年龄的增加而逐渐减少,另外多产次和人流同时放置节育器者,金单的脱落率也减低。     

子宫输卵管间质部弹力节育器(UTED)的研制及临床应用

本文介绍一种新型节育器(UTED)的研制和使用过程,其特点是一次可自动堵塞双侧输卵管,并兼有含铜节育器的作用。自1984年12月到1986年1月共放置455例,共使用3030.5妇女月,12个月的累积存放净率为94.5%,带器妊娠净率0.0%,脱落净率3.6%,因症取出净率1.4%。本资料随访率99.1%,主要副作用是出血和疼痛,但发生率并不比其它含铜节育器高。     

第二代爱母牌功能性宫内节育器1000例临床应用研究

目的探讨第二代爱母牌功能性宫内节育器(MCuⅡIUD)的临床效果及安全性。方法 2005年12月至2006年3月在国内临床多中心按统一标准选择2000例要求使用IUD避孕的育龄妇女,随机放置MCuⅡIUD与TCu380AIUD各1000例,放置后1、3、6、12个月定期随访观察。结果放置满12个月时,MCuⅡIUD组与TCu380AIUD组比较,继续使用率分别为96.36%、92.15%,差异有统计学意义(P0.05);累积脱落率分别为0.51%、2.15%,差异有统计学意义(P0.05);累积带器妊娠率分别为0.41%、0.63%,差异无统计学意义(P0.05);因症取出率分别为2.01%、4.14%,差异有统计学意义(P0.05);4次随访主诉发生率差异均有统计学意义(P0.05)。结论 MCuⅡIUD脱落率低、抗生育效果好,置取方便,置器后副反应小,是效果比较理想的IUD。     

北京硅橡胶优生型节育器临床效果观察

本器采用医用高分子硅橡胶为原料,外形仿日本优生型,中间空支架上附有硅橡胶薄膜。经临床前毒理试验和动物试用后,于1980年5月用于临床1136例,满12个月的随访结果(生命表统计法)为:12个月累积存放率为82.45%,带器妊娠率为4.5%;脱落率为8.49%;因症取出率为3.92%;个人原因取出率为0.64%。30例放器后月经量有所增加(放器前为51.96毫升,放器后1、2、3月经量分别为62.9、71.0、75.0毫升,p<0.001),但并不比其他节育器有更多的增高。此器的组织反应(子宫内膜病理及细胞学变化)亦并不比不锈钢节育器严重。     

双异丙酚在宫内节育器取出术中的应用

常规行宫内节育器取出术时 ,一般不需用麻醉剂和镇痛药 ,大多数受术者均可耐受。而对于绝经后的妇女 ,因子宫萎缩 ,宫内节育器放置时间较长等原因 ,取环时有一定的困难。我站对 2 0例绝经后妇女行宫内节育器取出术时采用了双异丙酚静脉麻醉 ,均无痛并顺利地取出宫内节育器。1　临床资料1 1　 2 0例受术者系 2 0 0 1年 8月至 2 0 0 2年 9月自愿来我站行宫内节育器取出术者 ,年龄最大的 5 7岁 ,最小 45岁 ;放置时间最长 2 3年 ,最短 18年 ;从绝经至宫内节育器取出 ,年限最长 7年 ,最短 1年。均系经产妇。1 2　妇科检查　子宫体积正常 12例 ,子…     

人工流产术后即刻放置宫内节育器的效果

目的 探讨早期妊娠人工流产术后即刻放置宫内节育器的效果。方法 选取2012年9月~2014年1月非洲喀麦隆吉德大区医院放置宫内节育器的育龄妇女80例,根据置环时间分为观察组和对照组,各40例,其中观察组为人工流产术后即刻放置宫内节育器,对照组为下次月经干净后3~7天放置宫内节育器,并于置环后1月、3月和6月月经干净后3~7天随访,观察两组患者的临床效果。结果 比较两组放置宫内节育器的脱落取出、带宫内节育器妊娠、子宫穿孔、不规则阴道出血、术后感染情况,差异无统计学意义(P0.05)。结论 人工流产术后即刻放置宫内节育器安全、有效,值得临床应用。     

不锈钢O型宫内节育器的脱落与宫腔形态及收缩压力关系的研究

本文用国产GCH—Ⅰ型宫腔测量器对143例育龄妇女进行宫腔测量,模拟出宫腔形态,探讨不锈钢O 型宫内节育器(IUD)脱落原因。通过测量,80%左右的宫腔近似等腰或等边三角形;14～20%的妇女宫腔下段过窄或过宽。从13例数次脱环者中看出,这些不规则的宫腔形态是IUD 脱落的主要原因之一。对23例妇女置器前后子宫收缩压力测定表明,宫腔内有器时,其子宫收缩压力比无器时大,t 检验结果(P<0.05)有显著性差异。但置器后一周宫缩的振幅又恢复正常,说明单纯置器后在正常范围内的宫缩并不致引起脱落。不锈钢O 型宫内节育器的脱落与不规则的宫腔形态有一定关系。     

A study on the relationship between the shape of uterine cavity, uterine contractility pressure and expulsion rate of stainless steel ring IUD]

The uterine cavities of 143 fertile age women were measured with the China-made type GCH-I machine. The causes of expulsion of the stainless steel ring IUD were studied. About 80% of the uterine cavities measured were similar to isosceles or equilateral triangles, and about 14-20% of the uterine cavities were much wider or narrower in the lower segment in 13 cases of repeat expulsion. This is 1 of the main reasons for expulsion. The contractility pressure of the uterus was measured before and after insertion in 23 cases and it is greater with the stainless steel IUD than without. The difference is significant by at test (p0.05). The amplitude of uterine contractions recovered again after insertion of the IUD for a week. It indicates that normal uterine contraction is not the reason for expulsion. The authors thus conclude that the expulsion of the stainless steel ring IUD has a certain relationship with the shape of the uterine cavity. (author's modified)     

Postpartum intrauterine device contraception: A review

AIM: To review the safety (infection, perforation) and efficacy (expulsion, continuation rates, pregnancy) of intrauterine device (IUD) insertion in the postpartum period. METHODS: MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented specifically, immediate post placenta period (within 10 min), early post placenta period (10 min to 72 h), and delayed/interval period (greater than 6 wk). Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS: IUD insertion in the immediate postpartum (within 10 min of placental delivery), early postpartum (10 min up to 72 h) and Interval/Delayed (6 wk onward) were found to be safe and efficacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any significant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal (copper) IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION: IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk benefit ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.     

在剖腹产时用缝合固定法放置宫内节育器的临床报告

利用剖腹产时子宫腔充分暴露这一的特定条件,本院对218例剖腹产妇女,在剖腹产同时,用铬制肠将宫内节育器固定在子宫后壁上。214例带器者作了产后42天、3个月和6个月的随访,相应的累积脱落率分别为0.46%、2%和2.3%,4例脱落均发生在子宫口开大的病例中。8例带器妊娠。6个月的继续存放率达91.77%。所有随访者无严重合并症和明显的副作用,恶露6～75天,平均32.8天,但均无月经血量过多。说明剖腹产时用缝合固定法放置节育器为一安全、有效和及时的方法。但存在带器妊娠率略高的问题有待进一步研究。     

Contraceptive effectiveness of immediate compared with delayed insertion of intrauterine devices after abortion: a decision analysis

OBJECTIVE: To model rates of pregnancy and repeat abortion among women choosing intrauterine contraception after an abortion when the intrauterine device (IUD) is inserted immediately after the procedure or at a follow-up visit. METHODS: We created an evidence-based decision model of women desiring to avoid pregnancy for the 12 months after an abortion. Base case assumptions were pregnancy rates of 0.5% with an IUD and 20% without an IUD, 1-year IUD continuation rate of 80%, an additional 5% risk of IUD expulsion with immediate insertion, and a 35% risk of not returning for a follow-up visit for IUD insertion. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS: Immediate IUD insertion after abortion prevented 52 pregnancies over the following year for every 1,000 women modeled by using base case assumptions. Sensitivity analyses show the model to be most dependent on the rate of expulsion in the immediate-insertion group and the proportion not returning in the delayed-insertion group. Monte Carlo analysis showed that immediate insertion resulted in fewer pregnancies than delayed insertion in 91% of scenarios, with an absolute mean difference of 28 pregnancies per 1,000 women in the initial year after abortion. If 20% of U.S. women undergoing abortion opted for immediate insertion, an estimated 20,000 repeat abortions would be prevented in the first year. CONCLUSION: Women who have an IUD inserted immediately after an abortion are expected to have fewer pregnancies and repeat abortions than women scheduled for insertion of an IUD at a follow-up visit.     

带钩软体Cu140宫内节育器的研制和试用

带钩软体Ｃｕ１４０ＩＵＤ的设计构思为：１．带钩的ＩＵＤ可固定在宫底肌层内；２ＩＵＤ体部柔软，能适应不同大小形态的宫腔和收缩时变形；３．铜套面积１４０ｍｍ２在环的体部分布合理，铜面积减少可获得同样满意的避孕效果。放置３９４例经一年随访按生命表法统计一年净累计带器妊娠率１．０３％，因症取出率１．０４％，脱落率３．３６％，副反应小。脱落与ＩＵＤ的质量和放置技术有关。未掌握放置技术时脱落率达１０．６９％，正确放置到位者脱落率低。提高ＩＵＤ质量和放置技术，钩铜１４０将成为一种理想的新颖ＩＵＤ。     

两种IUD多中心比较性研究

福建省计划生育科学技术研究所组织本省四个单位，对不锈钢金属单环（Ａ组）与ＭＬＣｕ３７５（Ｂ组）两种ＩＵＤ进行随机化临床多中心比较性研究。自１９８９年７月１日至１９９０年２月２８日共接受对象５０８例，其中Ａ组２４９例，Ｂ组２５９例，两组总随访率９９．２％。一年末每百妇女累积续用率Ａ组７５．８％，Ｂ组８９．９％（Ｐ＜０．０１）。放置后工２个月的妊娠率，Ａ组１０．０２％，Ｂ组２．４％；脱落率Ａ组１１．８％，Ｂ组８．９％，（Ｐ＜０．０１）。副反应发生率，两组均以放置后第一个月为最多，６个月与１２个月时均降低，前后相比（Ｐ＜０．０００１）。一年末总副反应发生率Ａ、Ｂ两组之比，无统计学意义，（Ｐ＞０．０５）。通过一年的比较性研究，提示ＭＬＣｕ３７５具有高累积使用率、低妊娠率及低脱落率优点，放置一年的副反应发生率也不比金属单环高。因此可以推广使用。     

Early IUD insertion after medically induced abortion

Objective: There is insufficient evidence on the continuation, safety and acceptability of immediate insertion of the intrauterine device (IUD) after medical abortion. The objective of the present study was to evaluate clinical outcomes of early IUD insertion, compared with those of delayed IUD insertion, following medical abortion.

Methods: Women undergoing medical abortion with mifepristone and misoprostol up to 49 days’ gestation and opting for Copper T 380A IUD contraception underwent early (5–14 days after mifepristone) or delayed insertion (3–4 weeks after mifepristone). The primary outcome measure was 6 month IUD continuation rate after medical abortion. Secondary outcome measures included user acceptability and safety.

Results: Between October 2015 and October 2016, post-medical abortion IUD insertion was performed in 120 eligible women fulfilling the inclusion and exclusion criteria. There was no statistically significant difference in the continuation rates of the early and delayed IUD insertion groups at 6 months (76.7 versus 83.3%, p?=?.75). The 6 month IUD expulsion rates were 6.7 and 3.3% in the early and delayed insertion groups, respectively (p?=?.56). There were 10 (16.7%) removals in the early and eight (13.3%) in the delayed insertion groups (p?=?.77). Level of satisfaction with postabortal IUD use was comparable in both groups. Adverse events were rare and did not differ significantly between the two groups.

Conclusion: We demonstrated high continuation rates, safety and acceptability of early IUD insertion after medical abortion.     

Clinical effects in 1136 cases of Beijing silicon rubber IUD and its effect on the endometrium]

Beijing Silicon Rubber IUD was designed by Xuan Wu Hospital and Beijing Silicon Rubber Manufacturing Research Institute in 1980. Animal experiments of the silicon rubber were done, and toxic effect studied before clinical use. 1136 cases were reported at the end of 12 months by 6 hospitals in Beijing. The followup rate was 93.75%. Life table of 12 months showed the cumulative continuation rate of the IUD was 82.45%, pregnancy rate 4.5%, expulsion rate 8.49%, removal for medical cause 3.9%, and removal for personal reasons 0.64%. Among the side effects, menstrual irregularity was 5.03%, blood discharge 6.35%, dysmenorrhea 11.95%, backache 31.1%, and leucorrhea 18.12%. Menstrual blood loss was measured in 30 cases before and after 1, 2, 3 months of insertion. The mean blood loss before insertion was 51.96 ml (51.71 +or- 15.95), while 1 month after insertion it was 62.9 ml (70.59 +or- 26.81), 2 months after insertion 71 ml, and 3 months after insertion 75 ml. The morphological endometrial change as compared with that by induced stainless steel ring is not much heavier especially in regard to glandular and stromal changes. The endometrial cytologic count of white cells of the IUD group (34 cases) in comparison with that of the control group (36 cases) was about twice as much in number. As Moyer reported, the endometrial cell count of IUD cases was about 6-10 times that of control cases. The authors consider that the cellular reaction of this IUD is not much greater than that of other types of IUDs.