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。     

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。     

置入新型MCu功能性宫内节育器1050例24个月临床报告

目的 :为了研究新型MCu功能性宫内节育器 (MCu IUD)的安全性、可接受性及临床效果。方法 :由 4个临床中心共放置MCu IUD10 5 0例 ,并随机抽样MCu IUD与TCu2 2 0C IUD各 10 9例 ,作临床效果对比观察。结果 :放置满 2 4个月时 ,随访率 >95 %。 10 5 0例使用MCu IUD者 2 4个月带器妊娠率为 0 2 9% ,脱落率为 0 ,续用率为 92 6 7%。放置MCu IUD与TCu2 2 0C IUD各 10 9例 ,观察 2 4个月 ,续用率分别为 93 5 8%和 81 6 5 % ;两组累积妊娠率分别为 0 92 %和2 75 % ;两组累积脱落率各为 0和 2 75 % ;两组因症取出率分别为 2 75 %和 9 17% ,差异均有显著性 ,P均 <0 0 5。副反应发生率MCu IUD组少于TCu2 2 0C IUD组 ,12个月时P <0 0 1,差异有非常显著性 ;2 4个月时差异无显著性。结论 :MCu IUD置、取方便 ,具有抗生育效果好、脱落率低、带器妊娠率低、副反应少、安全等特点 ,是当前应用效果比较理想的IUD。     

稽留流产、葡萄胎妇女使用Billings法避孕效果观察

目的:观察稽留流产和葡萄胎妇女刮宫术后采用Billings法避孕的效果。方法:观察组46例,为我院住院治疗的稽留流产和葡萄胎行刮宫术后采用Billings法避孕者,同时随机抽取我院Billings门诊避孕的妇女92例为对照组,观察两组对象24个月内的停用率、续用率和意外妊娠率。结果:138例妇女共观察1501个妇女月,24个月内观察组除6例计划妊娠外,无停用和意外妊娠者,净累积续用率86.95%。对照组24个月内停用17例(18.47%),意外妊娠1例(1.08%),净累积续用率81.52%。结论:稽留流产、葡萄胎妇女采用Billings法避孕,效果良好,值得推荐应用。     

长期哺乳闭经妇女的血清生乳素水平

已知,产后哺乳持续两年的妇女其分娩后闭经时间较分娩后1-3个月即断奶者长的多。血清生乳素水平升高常伴有闭经和不排卵。本工作测定了已恢复月经的和闭经的两组长期哺乳妇女的血清生乳素浓度,试图阐明高生乳素水平与产后闭经的关系。在39例产后1-24个月的哺乳妇女,于哺乳前及开始吸吮后30分钟,分别取血借助于第二抗体技术用放射免疫测定法测定血清生乳素、黄体生成素     

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。     

宫内节育器副反应原因探讨——附宫腔镜和病理组织学检查

<正> 宫内节育器(IUD)是我国育龄妇女应用最广泛的避孕工具。但约有7～15%妇女于放置IUD后出现月经异常、异常出血及腹痛等副作用而停用,影响IUD的续用率。本文根据放置者的病史、体格检查,宫腔镜和子宫内膜病理组织学检查的结果探讨IUD引起副作用的一些原因。     

停用口服避孕药后促性腺激素、生乳素和甾体激素的水平

已知。口服避孕药的主要作用机理是抑制丘脑下部和垂体的功能。几组工作报道了在服用甾体避孕药过程中,血浆促性腺激素及甾体激素的水平。但有关停药后的恢复,即新近停用口服避孕药的妇女血中激素水平的测定却很少研究。作者对停用联合口服避孕药的6例妇女进行了连续2个月的血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、孕酮和生乳素水平的测定。     

更新换代后的活性IUD安全性和有效性随访研究

目的 :了解更新换代后的 IUD使用情况及效果 ,为采取相应的干预措施提供依据。方法 :由 1 998年采用历史前瞻性流行病学的调查方法 ,对上海 2 1个区 1 0 387例放置活性 IUD的对象进行临床效果调查。结果 :放置 2 4个月末 ,活性 IUD总的带器妊娠率为1 .0 3% ,意外妊娠率 0 .1 1 % ,脱落率为 2 .52 % ,续用率 94.95%。其中年龄 ,孕产次 ,放置技术 ,放置时期及 IUD的种类等因素影响 IUD的临床效果。结论 :活性 IUD全面使用后 ,其临床效果与科研时的效果相似。但放置技术还需提高 ,各种活性 IUD使用比例的现状还需改变     

第二代吲哚美辛VCu与TCu380A临床比较性研究

目的 :了解第二代吲哚美辛 VCu IUD的临床疗效。方法 :自 1 997.5～ 1 998.2 ,在包括城市和农村的 6个临床单位 ,放置第二代吲哚美辛 VCu IUD1 0 0 0 (V组 )例 ;放置后 6月、1 2月和 2 4月随访 ,并与 1 0 0 0例放置 TCu3 80 A IUD者 (T组 )比较。结果 :两组对象临床特征相仿。随访率 98.2 5 %。净累积续用率随访 6月时 T组 95 .5 % ,V组 97.5 % (P<0 .0 5 ) ;1 2月时分别为 93 .79%和94.78% ;2 4月时分别为 88.2 3 %和 89.77%。脱落率在各阶段均为 T组高于 V组。妊娠率和因出血、疼痛取出率两组基本相似。月经量多、经期延长和腹痛的发生率 T组始终高于 V组。点滴出血者在 1 2月内 T组多于 V组。 V组月经量减少者始终多于 T组。在置器 4～ 6月 ,T组总 B/S、平均B/S及最大 B/S段长均大于 V组 (P<0 .0 1 )。血红蛋白测定在放 IUD前两组相似 ,随访 2 4月时复查 ,T组较放置前有所下降 (P<0 .0 0 1 ) ,且低于 V组 (P<0 .0 0 1 ) ;V组与放置前相似。结论 :第二代吲哚美辛 VCu与 TCu3 80 A比较 ,具有相同的避孕效果及续用率 ,较低的出血、疼痛副反应 ,更有利于保护妇女的生殖健康 ,值得临床推广应用     

用血催乳素和雌二醇比值估计产后月经恢复

目的:测定血催乳素(PRL)和雌二醇(E_2)比值,对估计产后月经恢复的有效性和实用性。方法:采用放射免疫法分别测定产后<2月(134例),2月～(100例),3月～(159例),4月～(118例),5月～(110例),6～9月(82例)妇女的血PRL/E_2。结果:(1)母乳、混合、人工喂养组的PRL/E_2平均值分别为8.16、3.66、0.69,各组间均有统计学差异;(2)PRL/E_2值大小与产后时间无关;(3)妇女月经恢复:产后6月时,55.05％;9月时,97.46％;(4)若以PRL/E_2值=0.6来估计月经恢复,其灵敏度为89.85％,特异性为90.68％。结论:血PRL、E_2测定方法简单、正确、不需昂贵的仪器和设备,可准确估计产后妇女的月经恢复,有利于她们及时采用避孕措施,可推广应用。     

Intrauterine device, the best method for spacing births in breastfeeding mothers]

Twenty-nine breastfeeding women, with a mean age of 36.5 years, were fitted with an IUD, Nova T or Multi load 375, at an average time of 3.6 months after delivery. Insertion at this time was easy, without dilatation, pain or bleeding. During a follow up of 18 months, the IUD has to be discontinued in one woman (3.4%) because of excessive menstrual bleeding, at a time when she was no more fully breastfeeding. The continuation rate was 96.56%, as compared to only 82% for a general population of 216 women fitted with IUD at the same period after delivery and followed up for the same period of time. The IUD is in our opinion the birthspacing method of choice for breastfeeding mothers.     

Progesterone and estradiol patterns in women using an intrauterine contraceptive device.

Levels of progesterone, estradiol, LH, and FSH were measured in daily serum samples obtained from 4 subjects during a control cycle and during the first and fourth menstrual cycles after insertion of an intrauterine device (IUD). In addition, progesterone and estradiol were measured in serum samples obtained from 6 women 3, 4, or 5 months after IUD insertion, and from 6 women more than 1 year after IUD insertion. These measurements were compared to the data obtained from study of a large group of normal cycles. The results indicated that the IUD does not influence follicular maturation, time of ovulation, or corpus luteum function. The IUD did exert a local effect on the endometrium, causing the onset of menses to take place when steroid levels were higher than in control cycles.     

Fertility after contraception or abortion

There is a very small correlation, if any, between the prior use of OCs and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an OC containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take OCs, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The incidence of postoperative infection after first trimester therapeutic abortion in this country is low. However, increasing numbers of women are undergoing repeated pregnancy terminations, and their risk for subsequent pelvic infections may be multiplied with each succeeding abortion. The incidence of prematurity due to cervical incompetence or surgical infertility after first trimester pregnancy terminations is not increased significantly. Asherman's syndrome may occur after septic therapeutic abortion. The pregnancy rate after treatment of this syndrome is low. The return of menses and the achievement of a pregnancy may be slightly delayed after OCs are discontinued, but the fertility rate is within the normal range by 1 year. The incidence of postpill amenorrhea of greater than 6 months' duration is probably less than 1%. The occurrence of the syndrome does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of OCs may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for patients with spontaneous return of menses. The criteria for defining PID or for categorizing its severity are diverse. The incidence of PID is higher among IUD users than among patients taking OCs or using a barrier method. The excess risk of PID among IUD users, with the exception of the first few months after insertion, is related to sexually transmitted diseases and not the IUD. Women with no risk factors for sexually transmitted diseases have little increased risk of PID or infertility associated with IUD use. There appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users. All present methods of contraception entail some risk to the patient. The risk of imparied future fertility with the use of any method appears to be low.(ABSTRACT TRUNCATED AT 400 WORDS)     

The "treatment" of unexplained infertility with danazol.

In order to investigate the possible stimulating effect of danazol on fertility, a randomized clinical trial was performed on 40 women with unexplained infertility. Of these 40 women, 21 received 200 mg of danazol daily for 100 days and 19 received a placebo treatment during the same period. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, estrone, estradiol, progesterone, and testosterone were followed before, during, and after treatment. Danazol administration induced anovulation in all women, with prompt resumption of normal ovulatory function after discontinuation of the drug. No influence was seen on serum LH, FSH, and testosterone levels, but serum estrone, estradiol, and progesterone levels decreased significantly during treatment. Serum prolactin levels also decreased, but not significantly. No pregnancies occurred in the placebo group during a 6-month follow-up period. In the danazol group, five pregnancies occurred, of which two were ectopic and three went to term. The difference in pregnancy rate between both groups was statistically significant (P less than 0.05).     

Breastfeeding,amenorrhea and contraceptive practice among postpartum women in Zibo,China

This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at 42 days. 4 months and 1 year after delivery. The results showed that the full breastfeeding rate (including exclusive and almost exclusive breastfeeding) was 78% and 43% at 42 days and 4 months after delivery, respectively. The mean reported length of abstinence from sexual intercourse after delivery was 71 days. The mean reported time to menses resumption was 184 days. Ninety-three per cent of women had resumed sexual intercourse at 4 months after delivery. Seventy-three per cent of women were using contraceptive methods when they resumed sexual activity after delivery. After childbirth, the majority of the women interviewed used condoms within 3 months. Thereafter, most of them switched to intrauterine device (IUD). Life table analysis shows that the continuation rates of full breastfeeding and amenorrhea at 4 months after delivery were 35% and 68%, respectively. This implies that if the full breastfeeding rate can be prolonged, it is feasible to use the lactational amenorrhea method (LAM) among Chinese postpartum women. The policy implications of this study are that quality care on contraceptive services and information for postpartum women in urban areas need to be improved further.     

Breastfeeding, amenorrhea and contraceptive practice among postpartum women in Zibo, China.

This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at 42 days. 4 months and 1 year after delivery. The results showed that the full breastfeeding rate (including exclusive and almost exclusive breastfeeding) was 78% and 43% at 42 days and 4 months after delivery, respectively. The mean reported length of abstinence from sexual intercourse after delivery was 71 days. The mean reported time to menses resumption was 184 days. Ninety-three per cent of women had resumed sexual intercourse at 4 months after delivery. Seventy-three per cent of women were using contraceptive methods when they resumed sexual activity after delivery. After childbirth, the majority ofthe women interviewed used condoms within 3 months. Thereafter, most of them switched to intrauterine device (IUD)). Life table analysis shows that the continuation rates of full breastfeeding and amenorrhea at 4 months after delivery were 35% and 68%, respectively. This implies that if the full breastfeeding rate can be prolonged, it is feasible to use the lactational amenorrhea method (LAM) among Chinese postpartum women. The policy implications of this study are that quality care on contraceptive services and information for postpartum women in urban areas need to be improved further.     

The feasibility of suppressing ovarian activity following the end of amenorrhoea by increasing the frequency of suckling.

OBJECTIVE: To determine the feasibility of suppressing ovarian activity by increasing the frequency of suckling episodes. METHOD: Prospective study was carried out with 19 exclusively breastfeeding volunteers. Ten subjects (experimental group) increased the suckling episodes by minimum 50% per day from the beginning of the first postpartum menses. Nine controls continued breastfeeding as before. Estradiol, progesterone, LH, FSH and prolactin were measured in blood samples, drawn twice a week up to the second postpartum menses or for 60 days, by RIA. Student's t-test was employed. RESULT: The higher suckling frequency prevented ovulation in 7 of 10 cases examined according to the plasma progesterone concentration (< 9.5 nmol/l). Significantly higher average prolactin value could also be found in the experimental group (1038 (527) munits/l vs. 518 (245) munits/l; P < 0.05). CONCLUSION: Results suggest that an earlier initiation of the increase in breastfeeding frequency may delay the resumption of ovulation. Frequent, full time lactation may reduce the risk of pregnancy.     

Treatment of functional amenorrhea-galactorrhea with 2-bromoergocryptine.

The present study was undertaken to investigate not only the effectiveness of bromoergocryptine therapy in 13 women with amenorrhea-galactorrhea and hyperprolactinemia without evidence of organic pathology, but also to assess the value of pretreatment evaluation in predicting the response to therapy. Sella turcica tomography, base line serum follicle-stimulating hormone, luteinizing hormone (LH), thyroid-stimulating hormone, T4, plasma cortisol levels, and the growth hormone reserve were normal in all patients. The pretreatment administration of LH-releasing factor (LRF) (100 microng subcutaneously) resulted in either a normal or excessive release of LH. On bromoergocryptine therapy, cyclic menses were reintiated in 10 of the women, while conception occurred prior to reinitiation of menses in the remaining three women. The time required for resumption of menses or conception on therapy correlated well with the magnitude of gonadotropin response to LRF. No correlation was seen with pretreatment prolactin levels nor with the degree of suppression of prolactin during bromoergocryptine therapy. In four women the mean prolactin levels during therapy were above normal, and in one patient prolactin levels approached pretreatment values during therapy. The initiation of cyclic menses despite continued hyperprolactinemia may indicate a possible direct effect of bromoergocryptine on hypothalamic LRF secretion as a partial explanation for its therapeutic action. On discontinuation of bromoergocryptine therapy, serum prolactin levels rapidly returned to pretreatment values or higher in all of the patients studied. In contrast to previous studies in which amenorrhea recurred in all patients after discontinuation of therapy, three of our patients maintained cyclic menses despite continued hyperprolactinemia. The recurrence of hyperprolactinemia after discontinuation of bromoergocryptine would indicate a persistent autonomy of the mechanisms involved. Periodic endocrine evaluation will be necessary to substantiate the presence or absence of pituitary microadenoma in these women.