人工流产后避孕指导服务效果的研究

目的：评价人工流产后避孕指导服务对降低再次人工流产和妇科疾病的作用。方法：选择2011年1月—2013年1月因意外妊娠而自愿接受人工流产并患有妇科炎症的900例妇女作为研究对象，观察组患者接受流产后避孕指导服务，对照组未接受流产后避孕指导服务。术后电话随访1年，调查2组避孕措施选择的不同，比较重复人工流产率及对妇科疾病的影响。结果：观察组和对照组人工流产术后选择的避孕措施排在前2位的均是宫内节育器和男用避孕套。观察组选择用男用避孕套率低于对照组，差异有统计学意义（χ2=28.145，P＜0.01），而对于口服避孕药和体外排精，对照组的选择率大于观察组（P＜0.05）。观察组发生重复流产者81例（19.29%），而对照组发生重复流产者149例（30.63%），差异有统计学意义（χ2=15.22，P＜0.01）。观察组与对照组重复流产的原因如下，宫内节育器失败、避孕药失败、男用避孕套失败、安全期避孕、体外排精、未避孕。通过多因素Logistic回归分析结果得出，安全期避孕、未避孕、体外排精是重复流产者避孕失败的独立危险因素。结论：人工流产后避孕指导服务可使流产后妇女选择有效的避孕方法，降低妇科疾病的风险，减少再次非意愿妊娠和重复性人工流产。

Evaluation on Efficiency of the Contraceptive Service after Artificial Abortion

Objective：To evaluate the effects of the contraceptive guide and service after artificial abortion on reducing the repeated abortion and gynecological diseases. Methods：900 women with gynecological diseases received induced abortion were divided into two groups, Observation group with the contraceptive guide and service and control group without. Telephone follow-up was performed for one year after operation. The differences of contraceptive choice, repeated abortion rate and the effect on gynecological diseases were compared between two groups. Results：IUD and male condoms were the top two choices in observation group, while IUD and contraceptive drugs were the top in control group. Observation group had higher rates of IUD and male condoms, and its rate of male condoms was significantly higher than that of control group（χ2=28.145, P＜0.01）. The rates of oral contraceptives and coitus interruptus in control group were higher than those in observation group（P＜0.05）. The rate of repeated abortion in control group was significantly lower than that in observation group（19.29% vs. 30.63%, χ2=15.22, P＜0.01）. The factors related to repeated abortion included failing IUD, failing condom, failing oral contraceptives, the rhythm method, coitus interruptus and not use any contraception. By multivariate Logistic regression analysis, safety period contraception, not contraception, and in vitro ejaculation were the independent risk factors of contraceptive failure of repeated abortion. Conclusions：The contraceptive guide and service after abortion allows women to choose the efficient contraceptive methods, which reduce the risk of gynecological diseases and the rates of unwanted pregnancy and repeated abortion.