产后哺乳妇女月经复潮、排卵及卵巢变化与婴儿喂养关系研究

A Study on the Relationship between the Return of Menstruation,Ovulation,Alteration of Ovary Morphology and Infant Feeding in Lactating Postpartum Women

目的探讨产后哺乳妇女卵巢改变及首次排卵时间与婴儿喂养的关系,为哺乳妇女采取避孕措施提供科学依据。方法对791例产后哺乳妇女进行问卷调查,记录哺乳妇女的月经复潮时间和婴儿添加辅食时间。对其中的101例哺乳妇女采用B超监测排卵情况及卵巢变化,并结合基础体温测量及宫颈黏液评分进行连续观察。结果791例产后哺乳妇女给婴儿添加辅食的平均时间为(4.7±1.3)个月。757例月经复潮,占95.7%(757/791),平均复潮时间为(6.6±3.7)个月。通过B超发现101例产后哺乳妇女有53例(52.5%)监测到>1.8cm的卵泡,平均在产后154d(5.1个月),有32例(60.4%)B超监测卵泡>1.8cm后萎缩,结合BBT及宫颈黏液评分,提示排卵多为黄体功能不全。产后4个月内B超监测首次排卵者占10.9%(11/101),4个月后排卵者占41.6%(42/101)。给婴儿添加辅食时间与月经复潮时间及首次排卵时间呈显著正相关(n=100,r=0.4764,P<0.01及n=53,r=0.5554,P<0.01)。结论添加辅食对产后月经复潮及排卵有较大影响。建议产后妇女在以母乳喂养为主的情况下,避孕措施的自行选择以产后60d为宜,具体实施应在产后4个月开始;延期母乳喂养是避孕的一种有效方法。

Objective To determine the relationship between the first ovulation, alteration of ovary and infant feeding after delivery, and to provide science data for contraception in lactating postpartum women. Methods Questionnaires for 791 lactating postpartum women were done about the time of menstruation return and infant feeding, of whom 101 were continuously monitored about their ovulation and alteration of ovary by ultrasound, basal body temperature （BBT） measurement and cervical mucus examination. Results The average time of adding adjuvant food was （4.7±1.3 ） months and the time of the resumption of menstruation was （6.6±3.7） months. The evidences of first ovulation （ follicle 〉 1.8 cm in diameter） were found by ultrasound in 53 （52.5%） women 154 days after delivery on average, 11 （10.9%, 11/101） subjects had first ovulation 4 months after delivery and 42 （41.6%, 42/101） subjects after 4 months. The significant positive correlation was found between time of supplementary feeding and time of the first menses （n=100, r=0.4764, P〈0.01）, also and first ovulation （n=53, r=0.5554, P〈0.01）. Conclusion The first menses and first ovulation are effected by supplementary feeding in lactating postpartum women. Under the condition of the breast feeding, it is suitable for postpartum mothers to choose birth control measures at the end of 60 days after delivery, and begin with birth control methods at 4th month after delivery, and prolonging the breast feeding is also a good method for birth control.