宫内节育器应用失败和出血的原因分析

<正> 据1980年世界卫生组织的机关刊物《世界健康》报道,世界各地大约有六千万妇女采用宫内节育器避孕。根据浙江省1982年1～6月份统计,使用宫内节育器妇女的人数占采取避孕措施总数的61.7%。这些数字足以说明宫内节育器在计划生育中的重要性。然而,现用的宫内节育器尚不能适应于当前日益增长的避孕需要,这主要是由于还存在自然脱落、带器妊娠、出血及疼痛等副反应。分析这些失败和出血的原因,对于寻求降低失败率和副反应必有裨益。一、自然脱落使用宫内节育器失败率中以自然脱落最为常见,特别是在放置后头三个月。大多数脱落发生在行经     

输卵管绝育后复通手术十年总评

我们随访１９８２年４月至１９９３年６月在我院行显微输卵管复通手术后的１０２９例妇女，发现宫内妊娠率为９３．２９％（９６０／１０２９），术后第一年受孕率最高，为７３．７８％（７５４／１０２９）；术后第一年内前６个月受孕率５４．８１％（５６４／１０２９）明显高于后６个月者４０．８６％（９０／４６５）；前６个月内的前３个月受孕率３７．４１％（３８５／１０２９）又明显高于后３个月２７．８０％（１７９／６４４）。术后各时期宫外孕的发生率均无明显差别；宫内妊娠率与绝育至复通的时间无关；术后的早期通液反而降低宫内妊娠率；抽芯包埋法及夹绝育后复通的宫内妊娠率较高；输卵管峡部吻合后宫内妊娠率最高。因此，我们认为输卵管峡部的抽芯包埋法或夹绝育在目前不失为一种理想的可逆性绝育方法。     

产后1年内意外妊娠妇女避孕状况调查

目的通过调查产后意外妊娠妇女的避孕状况,探讨产后避孕失败的原因。方法将2008年11月至2013年5月北京大学人民医院计划生育科189例产后1年内意外妊娠妇女作为研究组,同期326例产后1年内未妊娠妇女作为对照组,对其临床资料进行回顾性分析。结果研究组妇女的平均年龄[（30．15±4．15）岁]与对照组[（33．51±6．03）岁]比较,差异有统计学意义（P〈0．05）;两组妇女的文化程度及职业比较,差异无统计学意义（P〉0．05）。研究组未避孕率（28．57％,54／189）与对照组（19．94％,65／326）比较,差异有统计学意义（P〈0．05）。研究组妇女中,阴道分娩组未避孕率（20．93％,27／129）与剖宫产组（45．00%,27／60）比较,差异有统计学意义（P〈0．05）。研究组因避孕措施失败而导致意外妊娠135例（71．43％）,其采用的避孕方法分别为避孕套107例（79．26％）,安全期21例（15．56％）,体外排精6例（4．44%）,宫内节育器1例（0．74％）。结论不避孕或使用效果不稳定的避孕方法,是导致妇女产后1年内意外妊娠的主要原因。     

云南白族、贵州苗族已婚育龄妇女节育模式的研究

为了探索少数民族计划生育工作现状和节育模式,调查了云南白族、贵州苗族地区2026例已婚妇女,结果显示白族、苗族计划生育工作成绩显著,育龄妇女节育比例均高于80％,云南白族以宫内节育器为主要避孕方法（62．03％）,贵州苗族以男女绝育为主（76．62％）。Logistic多元回归分析显示夫妇的生育意愿、性别偏好、计生干部作用均影响是否采用绝育措施本道避孕方法较少、曾用避孕方法较多者倾向于绝育。两地相比,云南白族地区的计划生育工作较好,妇女避孕知识较多,自觉节育比例更大。鉴于今后计划生育全程服务和“知情选择”的推广,建议少数民族地区在继续推行现行的长效避孕方法（绝育和宫内节育器）的同时,积极宣传避孕知识,加强对群众生育观念的正确引导,增强基层计生技术力量,逐步向知情选择过渡。     

计划生育

概述 如今尽管有很多不同的避孕方法，但在英国，计划外妊娠率仍高达30％，很多计划外妊娠被迫终止。在英国，口服复合避孕药是最常用的避孕方式，但在发展中国家母乳喂养依然是一种重要的喂养方式。因为口服避孕药有绝对禁忌证，所以医生在开药之前应仔细询问病史。现有的避孕方式包括：激素避孕药，宫内节育器，屏障避孕法，自然避孕法，绝育术。     

农村妇女避孕方法使用及其影响因素分析

本文使用的数据来源于1986年在江苏省进行的“农村已婚育龄妇女使用避孕方法的变异”的调查。本次调查的目的是对已婚育龄妇女避孕方法使用的类型及动力学进行综合研究。调查的数据表明,江苏农村已婚育龄妇女的避孕率为85%,其中,宫内节育器和女性绝育术为最普遍使用的方法。在使用避孕方法的妇女中,宫内节育器和女性绝育术的使用比例分别为46.6%和36.4%。妇女对正在使用的避孕方法的评价和希望使用新方法的意愿都存在着差别。从这些差别的分析中不难看出,面对广大育龄妇女的避孕要求,我们应提供较为先进的避孕方法的信息及咨询服务,从而扩大避孕方法的可选择范围,避免一些方法的错误使用,提高使用者的满意程度。     

节育器异位五例诊断与处理

计划生育是妇女生殖健康的重要内容,搞好计划生育,做好避孕工作,对妇女的生殖健康有直接影响。理想的避孕方法应符合安全、有效、简便、实用、经济的原则。对性生活及性生理无不良影响。我国育龄妇女的主要避孕措施约70％妇女选用宫内节育器（IUD）作为避孕方法,占世界IUD避孕总人数的80％。放置宫内节育器常见;并发症有出血、腹痛、盆腔炎、环异位、子宫损伤等。宫内节育器异位不仅可以致失败妊娠,脏器损伤,出血和疼痛,还可致取环失败,致需开腹取环。对手术者造成极大的痛苦和损伤,导致宫内节育器异位,可能原因与置入环的技术,指征的掌握有关。本文对我县发生的5例IUD异位盆腔者进行分析,旨在提高IUD异位早期诊断及正确处理。     

流产后即时放置宫内节育器

无论是自然因素导致的流产(spontaneousabor-tion),还是机械或药物等人为因素终止妊娠的流产(inducedabortion),其流产后避孕的方法选择尤为重要。及时采用正确的避孕措施,将减少非意愿妊娠和不必要的人工流产。目前可供选择的避孕方法包括口服避孕药、避孕针、避孕套、宫内节育器、绝育术、皮     

米非司酮配伍米索前列醇终止早孕的临床应用（附1324例分析）

对１３２４例确诊为早孕的妇女，序贯口服米非司酮（Ｒｕ４８６）与米索前列醇（Ｍｉｓｏｐｒｏｓｔｏｌ），观察终止妊娠效果．结果显示，完全流产率９０．１８％，不全流产率９．６７％，持续妊娠率０．１５％，且配伍方法不同，完全流产率有显著差异，最高达９７．２１％，副反应轻微。认为本配伍方法终止早孕安全、简便、副反应小，有推广价值．     

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。     

The end of IUD marketing in the United States: what does it mean for American women?

The decision to suspend sale of the copper 7 and Copper T 200 IUDs and the Lippes loop in the US will eventually affect most of the US women using them. Although the Progestasert, a progesterone-containing device manufactured by the Alza Corp, will still be available, the Progestasert accounted for only 3% of IUD sales in 1984 compared to 66% for the 2 copper devices and 31% for the Lippes loops. Ortho Pharmaceutical and Searle, the manufacturers of the discontinued devices, were motivated largely by their difficulty in obtaining liability insurance and their desire to avoid excessive financial risk resulting from lawsuits, especially in view of the large judgements against the makers of the Dalkon Shield. Ortho was also influenced by declining sales of the Lippes loop. The 198 National Survey of Family Growth (NSFG) estimated that in that year some 2,152,900 American women used IUDs, representing 7.3% of the 29.5 million contraceptive users in the US and 10.8% of users of reversible methods. 30% of IUD users had stopped oral contraceptive (OC) use on the advice of their physicians. Slightly over 1/2 of IUD users were 30 years old or over. 63% were currently married. 12.8% had no children. 21.2% had already had an unwanted pregnancy and 54.7% said they wanted no more children. OCs were contraindicated for 56.4% of the IUD users because of age, smoking, or medical conditions. Most IUD users thus belonged to the group for whom the method is most suitable: older married women who have already had children. Lippes loops are inert and users can continue indefinitely with the method, but copper IUDs require periodic replacement, usually after 3 years. Some physicians and family planning programs have advised women using Lippes loops or copper IUDs to have them removed at once. It is difficult to predict what method will be utilized in the future by current IUD users; the near total disappearance of a contraceptive method is unprecedented. 3 estimates of the percentage of current IUD users who will have unwanted pregnancies in the next year under different assumptions about contraceptive choices were compared to the proportion risking unwanted pregnancies assuming continued availability of their IUDs: 4.2%. If all IUD users chose the next most effective method available to them--sterilization for those not wanting more children, OCs for those with no contraindications who might want more children, and condoms for the rest--the pregnancy rate would be 2.4%. The other estimates were 9.2% assuming less resort to sterilization and more to diaphragms and spermicides, and 13.0% assuming that 15% of the women would use no other contraceptive. Current users of IUDs are faced with a difficult choice about future method use, and need clear and reliable information from their physicians and the media on the risks and advantages of other methods.     

Current status of contraceptive use among rural married women in Anhui Province of China

Objectives  This study aims to explore the current status of married women in regard of their use of contraceptive methods (permanent methods versus non-permanent methods) and to find out factors that affect the use of contraceptive methods in rural areas of Anhui Province of China.
Design  Survey.
Setting  Anhui, China.
Population  A total of 53,652 married women aged 18–49 years.
Methods  A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18–49 years. All women were asked to provide detailed information by completing detailed questionnaires.
Main outcome measures  Contraceptive prevalence and influence factors.
Results  The total birth control rate of the sample was 95.2%. Samples choosing the permanent and nonpermanent contraceptive methods have taken up 46.7 and 48.5% respectively. Female sterilisation was the first choice with a usage rate of 43.6%, followed by intrauterine device (IUD), which was used by 41.1% of samples. Single-variable analysis showed that the choice of contraceptive methods was associated with age, education level, parity, frequency of sex intercourses in a month, contraceptive knowledge, RTI symptom and the gender of the last child of rural married women.
Conclusions  A significant increase in contraceptive use of rural married women in Anhui Province of China. Female sterilisation and IUD still play the dominant role. Effective family planning methods should be advocated through adequate counselling on the correct use and proper management, with consideration of the background of custom and belief.     

A review of contraceptive practices among married and unmarried women in China from 1982 to 2010

ABSTRACT

Objective To analyse the contraceptive prevalence rate (CPR) among – and contraceptive methods used by – married and unmarried women in China, from 1982 to 2010.

Method Data concerning married women were collected from national surveys conducted by the Chinese government. Those pertaining to unmarried women were obtained by searching the China Academic Journal Network Publishing database and PubMed.

Results CPR among married women in China was 89% in 2010, the highest in the world. Most married women use long-acting reversible contraceptives, particularly intrauterine devices, and sterilisation. CPR among sexually active unmarried women has fluctuated between 17 and 70% since 1988, although the frequency of condom use has increased (Cochran-Armitage trend test, χ² = 126.1, p < 0.001). More than 25% of unmarried women rely since at least 1982 on less effective contraceptive methods, including rhythm and withdrawal. This has led to an annual induced abortion rate of approximately 20% among those women.

Conclusion In sharp contrast to the high CPR among married women, the rate among sexually active unmarried women in China has remained extremely low since 1988. More efforts should be directed at raising contraception awareness among this population to improve their reproductive health and reduce the rate of unwanted pregnancy.     

Absence of chorionic gonadotropin in sera of women who use intrauterine devices

A controlled study was undertaken to determine whether unnoticed pregnancies routinely occur in users of the intrauterine contraceptive device (IUD). Starting on day 10 of the menstrual cycle and continuing through the onset of menstruation or until the diagnosis of pregnancy, we collected daily blood samples from three groups of normally menstruating young women. The study groups were (A) IUD users (n = 30), (B) women with tubal ligation (n = 30), and (C) women trying to become pregnant (n = 15). The sequential serum samples were analyzed by radioimmunoassay for progesterone (P), human luteinizing hormone (hLH), and human chorionic gonadotropin (hCG). No positive hCG assays in luteal phase blood sera of IUD users were observed. The only positive hCG determinations of IUD users coincided with the preovulatory surge of hLH. Two subjects who became pregnant, as judged by progressive increases in hCG and P levels in the luteal phase, belonged to the group planning pregnancy. The finding of two pregnancies in 15 months of exposure is consistent with the assumption of natural fertility. The probability of no pregnancies in 30 months at risk, as observed among the IUD users, is between 1 in 200 and 1 in 100,000, depending on the assumption made for natural fertility. The study demonstrates that IUD users do not retain their natural fertility, and that IUDs do not exert their antifertility effect as abortifacient agents. If a confirmed pregnancy is detected in an IUD user, it may be assumed to represent an isolated case of contraceptive failure.     

江苏农村育龄妇女避孕方法可接受性的研究

对1986年9月在中国江苏农村进行的“中国农村已婚育龄妇女使用避孕方法的变化”调查资料,应用单因素交叉表及多因素logistic回归分析江苏农村妇女的节育方法使用状况、副作用评价、满意程度及其原因。研究结果表明;江苏农村已婚妇女中,现用的节育方法主要是宫内节育器和女性绝育(分别占46.67%和36.39%)。妇女对各种节育方法的满意程度均较高,尤其对口服避孕药和宫内节育器更为满意。妇女对各种节育方法的评价不尽相同,宫内节育器、针剂、绝育和口服避孕药的优点较为突出,但副作用也较明显。避孕套虽然“使用简便”一项较差,但副作用小。不同特征妇女对各种节育方法的评价有所不同。     

干预性措施对上海和青岛郊区已婚育龄妇女节育状况的影响

对上海和青岛郊区已婚育龄妇女节育状况的调查发现,25岁以下的已婚妇女避孕现用率最低,有孩子的妇女现用率高.研究还发现给予宣教和引进新避孕方法进行干预后.避孕现用率比干预前提高(OR=1.4～1,5),干预后使用皮下埋植剂和新型IUD(T型)的妇女增多,提示干预性措施是有效果的.     

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan.

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.     

已婚育龄妇女人工流产史及避孕知识态度和行为现况的相关研究

目的：了解育龄妇女的人工流产史及其原因和有关避孕的知识、态度和行为现状,探讨如何提高避孕知识知晓率和改善相关的态度和行为,以及降低非意愿妊娠率及人工流产率,提高育龄妇女的生殖健康水平。方法：对2012年1月至2013年5月在龙岗区龙城街道计生服务中心行人工流产术的510名已婚已育妇女进行有关人工流产和避孕知识、态度和行为的问卷调查,数据应用SPSS／PC10．0软件进行统计分析。结果：53．5％的妇女有人工流产史,其中人工流产3次及以上者达13．7％;未避孕者占32．6％,避孕失败者占46．8％,其中安全期避孕居首位,占避孕失败者的38．5％,其次放置IUD,占避孕失败者的48．2％。54．8％的人不知道任何一种避孕方法的避孕原理：有49．7％的妇女不知道人工流产手术对身体健康有不良影响;83．5％的人不知道有紧急避孕法。结论：迫切需要加强有关避孕知识的健康教育,并将其作为提供优质生殖健康服务的内容,促进合理有效避孕措施的安全使用,减少非意愿妊娠的发生,避免反复流产给育龄妇女身心带来的损害。     

Contraceptive methods,induced abortion,first sexual intercourse age,in a group of 1635 students of the University of Rome

The authors report some data about contraceptive choice among young women examined in the Preventive Medicine Center of the University of Rome. Menarche age, menstrual cycle, age at 1st sexual intercourse, contraceptive method used, number of abortions, and pregnancies were examined. Moreover, the relationships between age at 1st sexual intercourse and contraceptive method and abortion were considered. Mean age at 1st intercourse was about 17.5 years. Pill and IUD were used by 11% and 5% respectively of the female students. Coitus interruptus was used among 83.3% of the cases. The prevalence of previous abortion was about 12.6%. The menstrual cycle characteristics did not influence the contraceptive choice of these students. Finally, previous abortion or pregnancy influenced contraceptive choice; in fact about 15% and 16.5% of the women with previous abortion performed or pregnancy experienced adopted the pill and IUD as contraceptive methods. (author's modified)     

Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years' comparative experience of levonorgestrel- and copper-releasing intrauterine devices

A randomized, multicenter comparison of two intrauterine contraceptive devices (IUDs) was carried out. Nine hundred thirty-seven women were fitted with a copper-releasing IUD, the Nova-T, and 1821 women with an IUD that releases 20 micrograms of levonorgestrel daily. After 36 months, the cumulative gross rates of amenorrhea and hormonal side effects were significantly higher in the levonorgestrel-IUD users. The cumulative 36-month gross pregnancy rate was 3.7 for the Nova-T and 0.3 for the levonorgestrel IUD (P less than .001), demonstrating the levonorgestrel IUD's high contraceptive efficacy. For the first time, a protective effect of the levonorgestrel IUD against pelvic inflammatory disease as compared with the Nova-T was seen statistically. The cumulative 36-month gross rate of pelvic inflammatory disease was 2.0 in Nova-T- and 0.5 in levonorgestrel-IUD users (P less than .013). This significantly lowered incidence of pelvic inflammatory disease may help to solve one of the major concerns associated with intrauterine contraception.