流产后关爱服务患者选用避孕措施的临床研究

Clinical research of post abortion care patients selecting contraception measure

目的探讨流产后关爱（PAC）患者选取避孕措施的现状,优化PAC服务流程。方法选取2013年1月~2014年2月因意外妊娠自愿到本院行人工流产终止妊娠的1013例孕龄妇女作为研究对象,患者全程PAC服务后自愿选择避孕措施的一种,根据选择结果分为4组。A组为皮下埋植法,立即使用29例;B组为短效口服避孕药,立即使用717例;C组为宫内节育器,立即使用201例;D组为避孕套避孕,立即使用66例。分析各组2年内的构成比变化,比较各组避孕后的再孕发生率、不良反应发生率、提前终止率及满意率。结果 PAC服务后,A组立即使用的比例为2.9%,2年后为5.9%;B组立即使用的比例为70.8%,2年后为19.5%;C组立即使用的比例为19.5%,2年后为33.4%;D组立即使用的比例6.5%,2年后为41.3%。A组的不良反应发生率最高,满意率最低;B组的提前终止率最高;C组的满意率最高;D组的再孕率最高。各组比较差异有统计学意义（P〈0.05）。结论 PAC服务后患者能自愿选择有效避孕措施,其中皮下埋植存在认知度低、满意率低等问题。PAC 3个月后,避孕套仍是大部分患者的首选,但具有意外妊娠率较高的缺点,因此需优化PAC随访流程。

Objective To explore the present situation of post abortion care（PAC） patients selecting contraception measure,and to optimize the PAC service process.Methods 1013 gestational age women because of unintended pregnancy and voluntary conducted artificial abortion to terminate pregnancy in our hospital from January 2013 to February 2014 were selected as the research group,one of contraceptive measure was voluntary selected after PAC service,all patients were divided into four groups according to the results.Group A was given subcutaneous embedding method,and 29 cases was immediately used.Group B was given oral short acting contraceptives,and 717 cases was immediately used.Group C was given intrauterine device,and 201 cases was immediately used.group D was given condom,and 66 cases was immediately used.Constituent ratio changes in 2 years in the four groups were analyzed.The repregnancy rate,the incidence rate of adverse effect,premature termination rate and satisfaction rate in the four groups after contraception was compared.Results After PAC service,the immediate use rate in group A was 2.9%,and was 5.9% after 2 years later.The immediate use rate in group B was 70.8%,and was 19.5% after 2 years later.The immediate use rate in group C was19.5%,and was 33.4% after 2 years later.The immediate use rate in group D was 6.5%,and was 41.3% after 2 years later.The incidence rate of adverse reaction in group A was the highest,and the satisfaction rate was the lowest.The premature termination rate in group B was the highest.The satisfaction rate in group C was the highest and the repregnancy rate in group D was the highest,and there was significant difference among the four groups（P〈0.05）.Conclusion After PAC services,the patients can voluntarily choose effective contraceptive measure.Subcutaneous embedding has the disadvantages of low awareness and satisfaction.Three months after PAC,condom is still the first choice for most patients,but with the disadvantage of higher unintended pregnancy rate.PAC follow up process should be optimized.