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。     

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。     

生物黏附缓释避孕凝胶杀精剂的临床有效性试验

目的　观察外用生物黏附缓释避孕凝胶杀精剂 (凝胶剂 )的临床避孕效果。方法　将2 4 0例育龄妇女志愿者随机分为两组 ,其中 12 0例使用凝胶剂 (凝胶剂组 ) ,12 0例使用避孕栓剂 (栓剂组 )。随访 6个月 ,以生命表法统计、Logrank检验比较两组的妊娠率、因症停用率和非医学原因停用率等。结果　两组使用药剂前后 ,宫颈刮片细胞学检查均无异常。 6个月的随访率 ,凝胶剂组和栓剂组分别为 10 0 0 %和 97 5 % ;粗累积妊娠率分别为 6 39/ 10 0妇女和 2 95 / 10 0妇女 ;因症停用率为3 4 5 / 10 0妇女和 4 5 7/ 10 0妇女 ;非医学原因停用率为 6 89/ 10 0妇女和 14 17/ 10 0妇女。两组比较 ,差异均无显著性 (P >0 0 5 )。结论　凝胶剂的临床效果与避孕栓剂一样 ,是安全、有效的。     

比林斯法在哺乳期应用的实验和临床研究

目的 :观察比林斯生育调节法 (BOM)在哺乳期避免妊娠的可行性和有效性 ,寻找监测哺乳期生育力恢复的指标。方法 :对比研究比林斯法和 IUD法在 1 2个月中的意外妊娠率、停用率和续用率。测定血生乳素、雌二醇用以估计月经恢复 ;检测尿雌激素和孕二醇 ,确定第 2次月经前是否排卵。结果 :哺乳期比林斯法和 IUD法两组妇女分别观察了 2 1 9例和 2 0 0例。妊娠率、停用率和续用率分别为 1 .43 %、1 .5 4 %,8.5 3 %、8.87%和 90 .1 7%、91 .3 5 %,两组间无统计学差异 (P>0 .0 5 )。同期进行的 90例和 2 75次血生乳素、雌二醇的测定发现 ,二者比例以 0 .3 5作为月经恢复的指标。6 1例尿雌激素和孕二醇测定表明 ,宫颈粘液类型与激素水平吻合外 ;混合喂养妇女第 2次月经前排卵发生率为 47.0 5 %。结论 :(1 ) BOM用于哺乳期避孕的效率如同 IUD法 ,也能被哺乳期妇女接受。 (2 )血生乳素和雌二醇测定可估计哺乳期妇女月经恢复 ,方法简单 ,可应用于临床。 (3 )混合喂养有延迟哺乳期生育的作用。     

苯扎氯铵避孕凝胶剂避孕有效性的临床多中心研究

目的 观察苯扎氯铵（BZK）避孕凝胶剂的避孕效果.方法 将240例健康育龄期女性志愿者随机分为两组,其中120例使用BZK避孕凝胶剂（BZK组）,120例使用壬苯醇醚（NP-9）避孕胶冻剂（NP-9组）,随访6个月,以寿命表法、log-rank检验比较两组的妊娠率、因症停用率和非医学原因停用率.结果两组妇女6个月时的随访率,BZK组和NP-9组分别为100.0%（120/120）和99.2%（119/120）;粗累积妊娠率分别为1.72/100妇女和0.91/100妇女;粗累积因症停用率为0和2.68/100妇女;粗累积非医学原因停用率为3.39/100妇女和6.05/100妇女;两组的3种粗累积率分别比较,差异均无统计学意义（P＞0.05）.结论 BZK避孕凝胶剂的避孕作用与NP-9避孕胶冻剂同样有效.     

产后妇女避孕节育干预与效果评价

目的:评价在上海市静安区产后妇女中进行避孕节育干预对提高产后避孕率并降低产后意外妊娠的效果。方法:对居住在静安区的产后1年内已婚妇女进行避孕服务干预,并于干预前和干预后进行问卷调查。结果:干预后0~3个月、4~6个月、7~9个月和9个月以上各时段避孕率均显著高于干预前,尤其是在有性生活的产后妇女中,产后的前6个月累积避孕率从干预前的58.9%提高到干预后的97.6%。产后1年内意外妊娠发生率为1.4%,意外妊娠主要原因为未避孕和避孕套、安全期避孕失败。结论:产后定期避孕干预能有效提高产后1年内妇女的避孕率,降低产后妇女意外妊娠率。     

上海市688对育龄夫妇连续使用Billings自然避孕法的临床效果观察及实验研究

本研究在1988,6～1990,5的两年间,对688对育龄夫妇进行了连续使用Billings 法的避孕效果与续用情况的观察,共10,275个妇女月;其中,550对夫妇连续使用12个月以上。用生命表统计分析,18个月和12个月时净累积停用率分别为34.58%和19.85%,续用率分别为65.42%和80.15%(因方法学意外妊娠分别为1.18%和1.02%,因方法学停用分别为2.84%和1.61%)。在观察临床效果的同时,对67例使用该法的志愿者进行阴道脱落细胞学检查,10例血、尿LH 和35例尿雌、孕激素测定。本文还对两年来临床观察和实验研究的多个方面进行了讨论,并认为该法值得进一步研究,可有组织、有计划地逐步扩大应用。     

“二日法”作为避孕措施的临床初试

目的:初步观察"二日法"在中国育龄妇女中使用的避孕效果。方法:对上海市黄浦区122对志愿使用"二日法"的育龄夫妇进行连续使用≥10个周期避孕情况的观察,随访资料用妇女年统计方法分析。结果:122例共使用1 414个妇女月。其中1例在使用的第11个月时意外妊娠;意外妊娠的Pearl指数为0.849。结论:初步观察的资料显示,"二日法"可以作为"知情选择"的避孕方法之一,但在推广前宜进一步开展扩大的临床有效性试验。     

固定式铜宫内节育器与TCu380A宫内节育器的临床比较性研究

目的:探讨固定式铜宫内节育器(CuFixIUD)的避孕效果。方法:采用前瞻性临床对比性研究方法,共接收200例受试者,随机分为CuFixIUD组(n=100)和TCu380AIUD组(n=100),观察8年。结果:8年末随访率为95%。CuFixIUD组1例意外妊娠,无一例带器妊娠,而TCu380AIUD组8年累积妊娠率每百妇女为6.75。CuFixIUD组3个月随访时脱落率每百妇女为9.18,随访1年至5年各年的累积脱落率明显高于TCu380AIUD组,组间相比,差异有统计学意义(P<0.01)。8年末的累积脱落率组间差异无统计学意义(P>0.05)。组间各时期因症取出率以及续用率相比较差异无统计学意义(P>0.05)。结论:CuFixIUD为一种低妊娠率、高效和长效的IUD。     

新型铜Flaxigard宫内节育器与TCu380A宫内节育器的临床对比研究

目的　了解新型铜FlaxigardIUD(CuFixIUD)的避孕效果和副反应 ,以TCu380AIUD为对照组进行临床实验。方法　采用前瞻性、随机分配原则 ,共接收 2 0 0例受试者。结果　 12个月内两组无一例发生妊娠 ,脱落率为每百妇女 10 2和 1 0 ,有明显统计学意义 (P <0 0 5 )。累积使用率为每百妇女 88 8和 97 0 ,两组无统计学意义 (P >0 0 5 )。 2 4个月时累积使用率两组分别为每百妇女 88 8和 93 0 ,36个月时随访率为 10 0 %。妊娠率两组分别为每百妇女 1 0和 3 0 ,因症取出率为每百妇女 2 0和 5 0。最常见的副反应为出血和疼痛。累积使用率分别为每百妇女 85 7和 89 0 ,两组无统计学意义 (P >0 0 5 )。结论　新型铜FlaxigardIUD为一种低妊娠率、高效和长效的IUD。TCu380A仍不失为一种高效、低副反应的IUD。     

A Randomised Trial and a Comparative Study of the Copper 7 200 and the Multiload Copper 250 Intrauterine Devices

Summary: A randomized trial of the Copper 7 200 (Cu 7 200) and the Multiload Copper 250 (ML Cu 250) intrauterine devices (IUD) was carried out for 13 months. On life table analysis at 12 months, net cumulative closure rates for use-related terminations (net rates) for the Cu 7 200 were higher than for the ML Cu 250 for accidental pregnancy (NS), expulsions (P<0.02) and medical removals for pain and/or bleeding (P<0.01). The continuation rate was lower for the Cu 7 200 (P<0.001). In a larger comparative study, at 12 months there was a highly significant difference (P<0.001) in favour of the ML Cu 250 in accidental pregnancy, expulsions and removals for pain and/or bleeding and continuation of use.
Since the ultimate purpose of the use of an IUD is pregnancy protection with a minimum of side effects, the continued use of the Cu 7 200 is not recommended.     

A new copper IUD (Fincoid) in adolescent and young nulliparous women

The contraceptive performance of a new copper IUD, the Fincoid, in nulliparous adolescent and young women was tested in a clinical trial of 241 1st insertions and 2268 woman-months of use, with an individual 12-month follow-up. The participating women were age 21 or younger with a mean age of 19.7 years. The 1st segment net cumulative rates were: pregnancy 4.2, expulsion 10.4, removals for bleeding 0.9 and for pain 5.5, and removal for infection 2.1. The continuation rate was 73.1 and the lost-to-follow-up percentage 6.8. (author's modified)     

Unplanned pregnancy: does past experience influence the use of a contraceptive method?

OBJECTIVE: To investigate whether women between the ages of 14 and 25 years with a past unplanned pregnancy were more likely to use a contraceptive method compared with women without a history of unplanned pregnancy. METHODS: We analyzed baseline data of 424 nonpregnant women between the ages of 14 and 25 years enrolled in a randomized trial to prevent sexually transmitted diseases and unplanned pregnancy (Project PROTECT). Women at high risk for sexually transmitted diseases or unplanned pregnancy were included. Participants completed a demographic, substance use, and reproductive health questionnaire. We compared women with and without a history of unplanned pregnancy using bivariate analysis and log binomial regression. RESULTS: The prevalence of past unplanned pregnancy in this sample was 43%. Women reporting an unplanned pregnancy were older, and had less education, and were more likely to be nonwhite race or ethnicity. History of an unplanned pregnancy was not associated with usage of a contraceptive method (relative risk 1.01, 95% confidence interval 0.87-1.16) in bivariate analysis or when potential confounders were accounted for in the analysis (adjusted relative risk 1.10, 95% confidence interval 0.95-1.28). CONCLUSION: Several factors were associated with both unplanned pregnancy and overall contraceptive method use in this population. However, a past unplanned pregnancy was not associated with overall contraceptive method usage. Future studies are necessary to investigate the complex relationship between unplanned pregnancy and contraceptive method use. LEVEL OF EVIDENCE: II-2.     

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。     

Cumulative ongoing pregnancy rate in intracytoplasmic sperm injection cycles

AIM: We investigated the cumulative probability of ongoing pregnancy in intracytoplasmic sperm injection (ICSI) cycles. METHODS: During a period of 6 years, 519 ICSI cycles were performed in 260 infertile couples at the Seoul National University Hospital. The cumulative rate of ongoing pregnancy (> or =12 weeks of gestation) was estimated by the Kaplan-Meier method. RESULTS: The cumulative ongoing pregnancy rate was 54.9% after six consecutive cycles of ICSI. The age of the female had a significant impact; after five consecutive cycles, cumulative ongoing pregnancy rate was 61.8% in < or =30 years of age, 51.7% in 31-35, and 15.3% in > or =36. There was no significant difference in the cumulative ongoing pregnancy rate between groups with severe male factor and previous unexplained low fertilization rate (< or =20%). Among the severe male factor group, cumulative ongoing pregnancy rate was not different according to the methods of sperm retrieval (surgically retrieved or ejaculated). CONCLUSION: Intracytoplasmic sperm injection could be applied successfully both to severe male factor and patients with previous unexplained low fertilization rate. The origin of spermatozoa does not affect ICSI outcome in terms of cumulative probability of ongoing pregnancy.     

Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence

Objective Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion.
Design Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators.
Population Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion.
Methods Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze-Potter gross life table probabilities with denominators of person-time of exposure.
Main outcome measures Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation.
Results Complication rates for immediate post-abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates.
Conclusions Post-abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.     

Presentation of a new IUD: the "Ombrelle 250"

The Ombrelle 250 is a new copper IUD designed and produced in France. Its plastic support has the overall shape of an open umbrella. A copper wire with a surface of 250 sq mm is wrapped around the vertical arm of a T. The device is characterized by great flexibility. 497 devices were inserted by 3 gynecologists between January 1975-October 1982. 134 patients were aged 29 or under, 270 were 30-40, and 93 were 40 or over. 29 had no children, 132 had 1 child, and 336 had 2 or more children. Several women using the device had risk factors for IUD use, including 22 who had experienced expulsions of previous devices, 9 who became pregnant while using IUDs, and 35 who had IUDs removed for poor tolerance. 5 had had ectopic pregnancies, 6 had diabetes, 1 had corticotherapy, and 2 had cervical-isthmic disproportions. At the end of the 3rd study year, the number of cycles of use was 13,768 while 13.5% of patients had been lost to follow-up. The cumulative failure rate after 36 months was .9% and the Pearl index was .4/woman year. 5 pregnancies occurred including 1 extrauterine pregnancy and 1 pregnancy in a woman previously becoming pregnant while using a copper IUD. 4 total or partial expulsions were observed for a rate of .6/woman year at 12 months and a cumulative net expulsion rate of .6 after 3 years. 1 of the 4 expulsions was in a woman who had previously expelled a device. The net removal rate for pain and bleeding was 1.9/100 woman years at 12 months, and the cumulative rate at 3 years was 4/100 woman years. 16 other devices were removed for medical reasons during the 3 years, for a cumulative net removal rate of 2.8% at 3 years. 5 removals were done for endometritis or upper genital infections. Study of 66 endometrial biopsies obtained during IUD removals showed no anomalies apart from 2 cases of endometritis. The continuation rate was 87% at 2 years and 83.9% at 3 years. 16 devices were removed to permit pregnancy. 11 of 14 women followed up for at least 3 months became pregnant.