1638例人工流产青少年现状分析及实施流产后关爱的随访研究

Follow-up study of 1638 cases of induced abortion and the effect of post-abortion care services on contraception after abortion in juveniles

目的分析青少年女性非意愿妊娠现状,探讨实施流产后关爱服务项目对青少年女性流产后避孕的应用效果。方法收集2015年8月—2016年7月在宁波市妇女儿童医院计划生育门诊因非意愿妊娠自愿在门诊接受人工流产术的青少年女性,在流产前进行流产后关爱服务,分析青少年患者流产前的一般情况、人工流产次数及高危因素、流产前后的避孕方式、避孕方法立即落实率、高效避孕率及术后1、3个月避孕方法持续使用率等。结果青少年患者共1 638例,平均年龄为(21. 83±3. 67)岁,15岁3例(0. 18%),16～19岁的有183例(11. 17%),20～24岁的有1 452例(88. 65%),青少年意外妊娠原因归结为未避孕和避孕失败,所有接受人工流产后关爱(PAC)的青少年患者流产后避孕立即落实率为100. 00%,高效避孕率由流产前1. 70%增加到67. 33%,高效避孕方法主要为复方短效口服避孕药及宫内节育器。随访第1、3个月高效避孕方法使用率呈下降趋势,其中口服避孕药使用率下降明显。随访期间失访461例,坚持随访人员1 177例中有10例(0. 85%)再次妊娠。结论青少年意外妊娠原因归结为未避孕和避孕失败。科学系统的优质人工流产后关爱(post abortion care,PAC)能有效指导青少年落实合适的避孕方法,保证避孕效率,防范青少年重复流产的发生,保障青少年女性的生殖健康。

Objective To analyze the status of induced abortion,and to explore the effect of post-abortion care services on contraception after abortion in juveniles. Methods Patients with an unwanted pregnancy who voluntarily underwent abortion surgery on an outpatient basis of adolescent female between August 2015 to July 2017 before abortion received post abortion care. Analysis was made regarding of adolescent patients with abortion about the general situation,number and risk factors of induced abortion,birth control methods before and after the abortion,the setting rate of contraception,effective contraceptive rate and the rate of continuous utilization of contraceptive method 1,3 months after operation,etc.Results A total of 1 638 cases were collected,with an average age of( 21. 83 ± 3. 67) years old,15 years old 3 cases( 0. 18%),183 cases( 11. 17%) from 16 to 19 years old,and 1,452 cases( 88. 65%) from 20 to 24 years old. Accidental pregnancy among adolescents was due to a failed contraception or non birth control. The implementation success rate of all those teenagers who were treated with PAC abortion was 100. 00%,the rate of effective contraception ranged from 1. 70% up to 67. 33%,and effective birth control method mainly included the compound short-acting oral contraceptives and intrauterine device. The rate of effective contraceptive method decreased in the first and third months of follow-up,with an obvious decrease of oral contraceptive use. A total of 461 cases were lost during the follow-up period,and 10 cases( 0. 85%) of the 1 177 patients in the follow-up were pregnant again. Conclusion The reason of adolescent accidental pregnancy included no contraception and contraceptive failure. Scientific system of quality PAC( post abortion care) can effectively guide the youth to carry out the appropriate contraception,guarantee the efficiency of contraception,and prevent adolescents’ repeated miscarriages,ensuring female adolescents reproductive health.