Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

Determinants of Long Acting Reversible Contraception Method Use among Mothers in Extended Postpartum Period, Durame Town, Southern Ethiopia: A Cross Sectional Community Based Survey

Background: After a live birth, there is much unsatisfied interest in, and unmet family planning need for contraception. Waiting at least for 24 months before attempting the next pregnancy was recommended to reduce the risk of adverse maternal, perinatal and infant outcomes. The purpose of this study was to assess the determinants of long acting reversible contraception method use among mothers in extended postpartum period in Durame Town, Southern Ethiopia. Methods: A community based cross sectional study was conducted in Durame Town, Southern Ethiopia in December, 2014. Systematic random sampling technique was employed to recruit a total 460 study participants. Structured and pretested questioner was used to collect the data. Descriptive statistics was employed to characterize the study population using frequencies and proportions. Bivariate logistic regression analysis was conducted to identify all possible factors affecting utilization of LARC method. Multivariable logistic regression model was developed to control the confounding variables. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed in identifying the real factors associated with use of LARC methods. Results: In this study we found that the prevalence of LARC method use among mothers during their extended postpartum period was 36.7% (95%CI: 32.2, 41.0). The unmet family planning need of mothers in the extended postpartum period was 123 (27.9%). The odds of using LARC by literate mother were four fold higher than their counterpart illiterate mothers (AOR 4.09 95%CI: 1.68, 9.58, P value < 0.001). The odds of mother who had pervious experiences of using LARC were up to eight folds higher than mother never used LARC methods (AOR 7.84 95% CI: 3.78, 16.23, P value< 0.001). Mother who received counseling service on LARC methods during delivery was up to three times more likely to utilize the services than not counseled (AOR 3.29 95% CI: 1.53, 7.03, P value < 0.001). And odds of mothers who received counseling service on LARC during immediate postpartum period were up to five fold more likely to opt method than never got the counseling service (AOR 4.55 95 % CI: 1.94, 10.66, P value < 0.001). Conclusions: In the study area, about one third of mothers utilized LARC methods during their extended postpartum period. Another one third of mother had unmet need for family planning. Participant’s education, previous history of using LARC methods, receiving counseling services on LARC during delivery and immediate postpartum periods were found major determinant for LARC use. Educating women, providing counseling service on LARC methods during antenatal, delivery and postnatal were recommended.

Factors Influencing the Choice between IUD and Implant among Long-Acting Reversible Contraceptive (LARCs) Users in Burkina Faso

Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. Among these methods, the Implant has gained popularity in sub-Saharan Africa, whereas the utilization of Intrauterine Devices (IUDs) has remained comparatively low, particularly in Burkina Faso. This study aims to evaluate the shifts in IUD and Implant usage from 2010 to 2020 and to pinpoint the factors influencing the choice of IUDs among LARCs users in Burkina Faso. Data and Methods: We conducted an analysis using data from Burkina Faso, drawn from the 2010 Demographic and Health Survey (DHS) and the 2020 PMA Phase 1 data. The 2010 DHS garnered responses from 17,087 women aged 15 - 49, achieving a response rate of 98.4%. The 2020 PMA data collected responses from 6590 women aged 15 - 49, with a response rate of 95.8%. The final sample of Long-Acting Reversible Contraceptives (LARCs) users consisted of 1502 women, including 576 women from the 2010 survey and 926 women from the 2020 survey. Results: The study demonstrates an expansion of IUD usage to include socioeconomically disadvantaged segments among LARC users. However, higher levels of education, older age, and decisions influenced by healthcare providers are correlated with the preference for IUDs over Implants. The choice of IUDs is also connected to a comprehensive understanding of contraceptive methods, suggesting potential biases in the counseling process. Conclusion: Facilitating the broader adoption of IUDs among disadvantaged groups could be achieved by improving the accessibility of IUD products and services in rural areas. Nevertheless, there should be focused initiatives to enhance access to removal services, as this factor could dissuade specific users. Further efforts are required to train healthcare providers, aiming to mitigate biases in delivering Long-Acting Reversible Contraceptives (LARCs). Providers should provide impartial counseling, irrespective of the selected type of LARC.

User Perspective of Misplaced PPIUCD and Factors Resulting in PPIUCD Removal: Qualitative Pilot Study

Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up period of two years. Design: A descriptive exploratory study was conducted over three months among fourteen PPIUCD acceptors at a tertiary care health facility in Delhi, India. Face-to-face & telephonic in-depth interviews were conducted with a selected sample of PPIUCD acceptors who had later opted for its removal. Results: Participants (n = 14) aged 24 – 40 exhibited generally positive attitudes towards PPIUCDs indicating an indicate an understanding of the importance of PPIUCD in preventing unintended pregnancies. Menstrual disturbance and misplaced IUCD were major reasons for removal. despite their own experience necessitating the removal of IUCD, positive experience by other family members (mothers in law) in this study helped to keep the confidence on the contraceptive. Themes included (a) general experience of PPIUCD use (b) Health Facility accessed for removal of IUCD (c) Would she recommend it to others? (d) preferred contraceptive after removal of IUCD. Conclusion: Misplaced IUCD, missing thread, menstrual irregularities, and pain are all associated with PPIUCD and are important reasons for dissatisfaction. Appropriate, timely and supportive individualized care that address knowledge gaps, societal perceptions, and healthcare system challenges would certainly help in reducing dissatisfaction due to PPIUCD and thereby the removal rates.

An Investigation on the Utilization of Intra Uterine Contraceptive Device among Women in Kabwe, Central Province

Introduction: Intrauterine contraceptive device (IUCD) is an effective long acting reversible contraceptive but its use is low. This study examined factors contributing to the utilization of intrauterine contraceptive devices (IUCDs) among women in Kabwe Central Province. Methodology: This was an analytical cross sectional study. Primary data was collected from 150 respondents in using simple random sampling method. Data was analysed using the statistical package of social sciences (SPSS) version 22. Chi-square test was used to test associations among the dependent and independent variables. Logistic regression analysis was conducted. The confidence interval was set at 95% and significant level was at 0.05%. Findings: The study found that 44% of the respondents had high level of knowledge about IUCD. About 28% of the respondents, said that they used IUCD because it maintains menstrual bleeding, 26% said that they used because IUCD it does not cause infections, and 19% said that they used IUCD because it does not migrate to other body parts. Majority (81%) of the respondents agreed with a statement that age contributes to underutilization of IUCD. About 77% of the respondents agreed with a statement that marital status contributes to underutilization of IUCD and 75% agreed with a statement that, education level contributes to underutilization of IUCD and was significant. Furthermore, 91% of the respondents agreed with a statement that lack of knowledge about IUCD contributes to underutilization of IUCD and 74% agreed with a statement that religion contributes to underutilization of IUCD. Age (p = 0.003), marital status (p = 0.002), education level (p = 0.003), and employment status (p = 0.02), were found to have a significant relationship with the utilization of IUCD. About 36% of the respondents said that knowledge or education affects the utilization of IUCD at a large extent. The study showed a positive relationship between the utilization of IUCD and all explanatory variables such as age, education/knowledge, marital status, religion, family size and income and acceptability which had a positive correlation ranging from 0.543 to 0.815. Older women with higher education levels were more inclined to use IUCDs compared to younger individuals and those with only a primary education. Religious affiliation influenced IUCD use with Muslim women being less likely to opt for IUCDs. Moreover, being married was associated with lower IUCD utilization. Conclusion: Based on these findings, the study identified age, education/knowledge, marital status, religion, family size and income, and acceptability as the primary drivers of IUCD usage. The study recommends that, there should be a conduct of educational workshops, there should be community awareness programs and there should be comprehensive family Planning Services.

Postpartum intrauterine device contraception: A review

AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.

基于Mann-Kendall的广东省长效避孕服务利用和人工流产的趋势与突变分析

目的了解广东省长效避孕服务利用和人工流产变化趋势,为制定有效的生殖保健服务策略,提高妇女生殖健康提供依据。方法采用Mann-Kendall检验法对2008—2021年广东省长效避孕服务利用总例数、各种长效避孕方法例数与占比、人工流产例数、人工流产活产比进行趋势和突变分析。结果2008—2021年广东省长效避孕服务利用总例数呈现下降趋势,长效不可逆避孕方法例数呈先增后降的趋势、长效可逆避孕方法例数呈现下降趋势;这三个指标突变点分别出现在2016、2018、2014年。各种长效避孕方法服务利用上,放置宫内节育器术占67.3%,输卵管绝育术占29.1%,输精管绝育术占3.5%,放置皮下填埋剂术占0.1%。全省人工流产例数呈下降趋势,突变点出现在2018年;人工流产活产比相对稳定,年均人工流产活产比为76.5%。从区域层面看,全省与珠三角地区长效可逆避孕方法例数和人工流产例数的变化趋势呈现出平行关系,粤东、粤西和粤北地区长效可逆避孕方法例数变化趋势与人工流产例数变化趋势的关联各异。结论广东省放置宫内节育器术在长效避孕方法中占主导地位,输卵管绝育术次之,长效避孕责任主要由女性群体承担。区域间长效可逆避孕方法与人工流产变化趋势呈现出不同的关系,有必要深入了解导致这些地区差异的因素,促进不同区域避孕服务的有效落实,避免发生意外妊娠。此外,建议地区积极探讨将避孕服务与妇女全生命周期服务整合,提高妇女生殖健康水平。

品管圈在提高PAC项目长效可逆避孕措施立即落实率中的应用

目的:探讨品管圈在提高PAC项目人流后长效可逆避孕措施(long acting reversible contraception,LARC)立即落实率中的应用。方法:采用随机对照研究及根据样本量计算公式,从2023年12月至2024年2月于本院门诊行人工流产的821例病例中随机选取400例为对照组,经过品管圈质量循环改进后,从2024年6月至2024年8月行人工流产的816例病例中随机选取400例为观察组,利用SPSS 19.0统计软件对数据资料进行统计分析,评价改进效果。结果:单因素分析显示观察组和对照组在年龄、文化程度、产次、流产次数、LARC落实禁忌症证方面,差异无统计学意义(P>0.05);LARC立即落实率由19.5%提升至33.5%,差异有统计学意义(P<0.05);两组1、3、6个月的LARC续用率相比,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示参加品管圈活动(OR=2.262,95%CI=1.542~3.317)、年龄在21~30岁(OR=4.297,95%CI=1.152~16.026)、31~40岁(OR=3.925,95%CI=1.066~14.45)、产次≥2次(OR=1.744,95%CI=1.015~2.996)是LARC落实率的独立影响因素。结论:品管圈可明显提高PAC项目人流后LARC立即落实率和续用率,尤其是年龄在21-40岁和产次≥2次的育龄妇女更易落实,有利于促进PAC项目的推广。

更年期女性人工流产术后避孕方式选择及影响因素分析

目的探讨更年期女性人工流产术后避孕方式选择及影响因素。方法回顾性分析2015年1月至2021年12月于上饶卫生学校附属医院接受人工流产术的100例更年期女性的临床资料,将放置宫内节育环或接受皮下埋植的女性纳入长效可逆避孕方法(LARC)组,将使用避孕套、避孕药等短效避孕措施的女性纳入对照组,统计各避孕方式的使用情况,单因素及Logistic回归分析影响更年期女性人工流产术后避孕方式的独立危险因素。结果LARC使用率低于短效避孕方法,差异有统计学意义(P<0.05)。两组职业、户口所在地、婚姻状况比较差异无统计学意义;LARC组年龄<50岁、了解LARC相关知识、文化程度高中及以上、人流次数≥1次、有剖宫产史、家庭年收入<5万、现有孩数≥2个、高危人流占比均高于对照组,差异有统计学意义(P<0.05)。年龄、LARC相关知识、文化程度、人流次数、剖宫产史、家庭年收入、现有孩数、高危人流是影响更年期女性人工流产术后避孕方式的独立危险因素(P<0.05)。结论接受人工流产术的更年期女性中选择LARC的相对较少,年龄<50岁、了解LARC相关知识、文化程度高中及以上、人流次数≥1次、有剖宫产史、家庭年收入<5万、现有孩数≥2个、高危人流的女性更倾向于选择LARC。

妇产科医生对复方短效口服避孕药的雌激素剂量和服药方案的认知调查研究

目的了解当前我国妇产科医生对不同种类复方短效口服避孕药(COC)服药方案及其雌激素剂量的认识和适应症应用情况,以期为临床个体化用药决策提供参考。方法2022年8月至12月在全国20个省、自治区、直辖市的155家医院邀请妇产科医生进行问卷调查,了解其对国内目前五种常用COC的雌激素剂量和服药方案的认知及适应症应用情况。采用卡方检验、Bonferroni法、Crame' s V系数、雷达图等方法对数据进行统计分析及归纳总结。结果向653名妇产科医生发放调查问卷,回收有效问卷650份,回收率99.54%。妇产科医生对国内目前五种常用COC的知晓率差别较大,其中以屈螺酮炔雌醇片(Ⅱ)(20μg/片,87.69%;24/4方案,84.77%)知晓率最高,去氧孕烯炔雌醇片(20μg/片,45.69%;21/7方案,83.54%)最低。对于治疗痤疮、经前焦虑障碍、易怒、抑郁、经前综合征、多毛症和多囊卵巢综合征,28.77%~31.69%的妇产科医生选择24/4方案,37.54%~47.85%的妇产科医生选择雌激素剂量20μg/片的COC;其中对改善易怒症状(χ^(2)=9.403,P=0.009)方面,硕士及以上妇产科医生选择选择24/4方案的比例高于本科及以下学历者,差异有统计学意义。在改善月经周期规律性、治疗月经过多、经期周期控制效果方面,49.38%~50.00%的妇产科医生选择两方案效果相似,44.46%~56.31%的妇产科医生选择两剂量效果相似;其中在改善月经周期规律性(χ^(2)=8.402,P=0.015)和治疗月经过多(χ^(2)=6.451,P=0.040)方面,选择两剂量相似的副主任医师及以上的比例高于主治医师及以下者,差异均有统计学意义。妇产科医生对不同雌激素剂量和服药方案的选择呈弱相关(0.2<Cramer's V<0.3,P<0.05)。结论国内妇产科医生对不同COC的知晓率参差不齐,普遍存在对COC的作用机制认知不足。鉴于COC应用的广泛性,建议对妇产科医生加强COC药物作用机制的相关培训,了解雌孕激素剂量、种类与服药方案的关系,准确掌握适应症,以期更好地提供个体化推荐用药。

孕激素与短效口服避孕药治疗青春期多囊卵巢综合征的效果及对患者性激素、糖脂代谢和情绪状态的影响

目的 分析孕激素与短效口服避孕药治疗青春期多囊卵巢综合征(PCOS)的效果及对患者性激素、糖脂代谢和情绪状态的影响。方法 前瞻性选取2022年1月至2023年6月在秦皇岛市妇幼保健院就诊的192例青春期PCOS患者作为研究对象,按照随机数字表法将其分为孕激素组和避孕药组,每组各96例。孕激素组患者给予周期性口服地屈孕酮片,避孕药组患者给予口服屈螺酮炔雌醇片。两组患者均同时给予调整生活方式、控制体重和口服盐酸二甲双胍治疗,均连续治疗3个月经周期。比较两组患者的临床疗效及治疗前和治疗后的血清性激素[卵泡刺激素(FSH)、黄体生成素(LH)、睾酮、雄烯二酮、雌二醇]水平、糖脂代谢指标[空腹血糖、空腹胰岛素(FINS)、HOMA-IR、甘油三酯、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分;并记录两组患者治疗期间的不良反应发生情况。结果 两组患者疗效分布和临床有效率比较差异均无统计学意义(P>0.05)。避孕药组患者治疗后的血清睾酮、雄烯二酮水平分别为(29.15±4.23)、(1.23±0.43) nmol/L,均低于孕激素组[(37.76±4.85)、(1.86±0.56) nmol/L],差异均有统计学意义(P<0.05),而两组患者治疗后FSH、LH、雌二醇水平比较,差异均无统计学意义(P>0.05)。避孕药组患者治疗后的血清HDL-C水平为(1.84±0.28) mmol/L,高于孕激素组[(1.70±0.23) mmol/L],差异有统计学意义(P<0.05),而两组患者治疗后其他糖脂代谢指标比较,差异均无统计学意义(P>0.05)。避孕药组患者治疗后的SDS评分、SAS评分分别为(50.31±5.53)、(50.08±5.25)分,均低于孕激素组[(56.06±6.02)、(57.63±6.00)分],差异均有统计学意义(P<0.05)。在治疗过程中,避孕药组患者的总不良反应发生率为19.79%,高于孕激素组(8.33%),差异有统计学意义(P<0.05)。结论 在青春期PCOS治疗中,单独应用孕激素与短效避孕药在临床疗效和降低雌激素水平、缓解胰岛素抵抗方面的效果基本相当,短效避孕药治疗方案在纠正高雄激素血症、提升HDL-C水平和缓解负性情绪方面的作用更加显著,但可能增加治疗的不良反应,临床需要根据患者的实际情况进行合理决策。

复方短效避孕药治疗流产后患者的效果分析

目的探讨流产患者采用复方短效避孕药的治疗效果。方法选取68例流产患者为研究对象,根据电脑随机分配方式分为对照组和研究组,每组34例。对照组给予常规治疗,研究组给予复方短效避孕药治疗,比较两组心理健康、避孕药耐受性、生活质量及避孕效果。结果治疗前,两组心理健康评分比较差异无统计学意义(P>0.05);治疗后,研究组心理健康评分低于对照组(P<0.05);治疗后,研究组不良反应发生率为5.90%(2/34),对照组不良反应发生率为11.80%(4/34),两组不良反应发生率比较差异无统计学意义(P>0.05)。治疗后,研究组工作、社交方面评分均高于对照组(P<0.05);两组日常生活方面评分比较,差异无统计学意义(P>0.05)。治疗后,研究组意外怀孕率为2.90%(1/34),对照组意外怀孕率为5.90%(2/34),两组意外怀孕率比较差异无统计学意义(P>0.05)。结论流产患者采用复方短效避孕药治疗效果较好,可改善患者心理状态,提高其生活质量,且安全性较好,值得临床推广与应用。

左炔诺孕酮宫内缓释系统与短效避孕药治疗无排卵性功血的临床疗效研究

目的分析左炔诺孕酮宫内缓释系统与短效避孕药治疗无排卵性功血的临床疗效。方法选择70例为研究对象,根据患者入院先后顺序分组,参照组35例实施短效避孕药治疗,试验组35例实施定左炔诺孕酮宫内缓释系统治疗,比较两组患者雌激素指标水平、临床指标状况、月经状况、治疗效果。结果治疗前,两组患者雌激素指标水平比较,差异无统计学意义(P>0.05);治疗后,试验组患者雌激素指标水平优于参照组(P<0.05)。试验组患者闭经率低于参照组,正常月经率高于参照组(P<0.05);两组月经过多率、月经稀少率比较,差异无统计学意义(P>0.05);试验组患者总有效率高于参照组(P<0.05)。结论在左炔诺孕酮宫内缓释系统对无排卵性功血患者的治疗中了解,可以缓解临床表现,优化患者雌激素指标水平,调节患者月经状况,进而提高治疗效果。

聚己内酯在体内的降解、吸收和排泄

研究了聚己内酯 (PCL )在大鼠体内的降解 ,结果表明起始分子量 6 .6万的聚己内酯胶囊在体内可完整存在两年 ,两年中分子量逐渐下降 ,两年后降解为低分子量。用氚标记低分子量聚己内酯植入大鼠皮下 ,测定其吸收和排泄 ,结果表明植入 15 d后在血中开始测出放射性 ,同时在粪尿中开始出现放射性排出物。16 5 d后血中放射性基本消失 ,从粪尿中累积排出给入量的 92 % ,植入后 6 0 d及 16 5 d各脏器中放射性分布全部接近本底水平。证明该材料不在体内积蓄 。

复方短效口服避孕药在未婚女性流产后服务中的优势及安全性

【目的】比较、探讨复方短效口服避孕药(短效COC)在未婚女性人工流产后服务中应用的优势及安全性。【方法】110例行人工流产术的未婚女性,随机分为:口服避孕药(达英-35)组43例、人工周期替代药(克龄蒙)组35例、空白对照组32例。达英-35组和克龄蒙组人流术后均即时开始服药,建议连用3个周期,三组均予流产后相关服务。术后随访观察术后出血时间、月经转归时间、月经紊乱发生率、术后妊娠、子宫内膜厚度,药物不良反应、评价用药依从性。【结果】达英-35组坚持服用3周期的共25例,其术后阴道出血持续和术后第一次月经转归时间均较空白对照组短(P<0.05);术后3个月内月经紊乱发生率较克龄蒙组和空白对照组低(P<0.05)。克龄蒙组坚持服用3周期的共22例,其术后阴道出血持续时间、术后第一次月经转归时间、术后3个月内月经紊乱发生率与空白对照组差异无统计学意义(P>0.05)。达英-35组术后3个月内无再次妊娠;克龄蒙组、空白对照组术后各2例再次妊娠。连续使用3个月达英-35,未出现明显严重不良反应。三组患者经流产后服务,术后自动采用有效避孕措施比率较术前均增加(P<0.05)。【结论】人工流产术后立即服用复方短效口服避孕药更合理、有益、安全。加强流产后服务对保护未婚女性生殖健康有意义。

复方短效口服避孕药在人工流产后的应用价值

目的:探讨人工流产后应用复方短效口服避孕药—妈富隆的临床价值。方法:将240例人工流产者随机分成两组,观察组(120例)于人工流产后服用妈富隆、抗生素及益母膏,对照组(120例)仅服用抗生素及益母膏。结果:观察组术后出血量及出血时间低于对照组(P<0.05),术后月经复潮比例高于对照组(P<0.01)。结论:人工流产后应用复方短效口服避孕药妈富隆除避孕外,还能明显缩短出血时间,减少出血量,促进月经恢复。

产后妇女中长效可逆避孕措施的使用现状及影响因素的研究

目的：探讨长效可逆避孕措施（LARC）在产后妇女中的使用现状及影响因素。方法：采用容量比例概率抽样选择湖南省石门县3岁以下儿童母亲503例，采用自行设计的结构式问卷进行调查，用SPSS20．0统计软件对相关资料进行统计分析。结果：被调查的503例3岁以下儿童母亲中，产后采取避孕措施的比例为68．2％，采取LARC的比例有12．7％。logistic回归分析显示：初产妇（OR=3．43，95％CI：1．49～7．89）、26～30岁年龄组（OR=5．26，95％CI：1．43～19．40，处于哺乳期（0R=3．77，95％CI1．80～7．63）以及剖宫产（OR=3．70，95％CI1．80～7．63）是被调查者产后未使用LARC避孕的风险因素。结论：目前产后妇女LARC使用率偏低，提高产后避孕率，尤其是提高LARC使用率应是提高我国生殖健康工作的重点之一。

流动人口避孕方法使用及长效避孕方法使用时机选择

目的:分析中国流动人口长效避孕方法的使用及其避孕时机选择。方法:根据2013年全国流动人口动态监测数据,对70 849名流动已婚有偶育龄妇女的避孕方法选择,特别是其中采取长效避孕措施47 919名妇女避孕方法和采取时机进行生存分析。结果:流动已婚有偶育龄妇女88.8%采取避孕措施,其中75.6%采取长效避孕措施。采取长效避孕措施时机的中位生存时间为末次生育后6.51个月;生育子女数越多,产后采取相同的长效避孕措施与末次生育间隔越短。结论:流动已婚育龄妇女较为普遍采取现代避孕方法,使用长效避孕方法及采取时机因避孕方法类型、育龄妇女年龄、生育子女数、生育子女性别构成而存在差异。

放置节育器与口服避孕药对人工流产术后避孕效果的对照研究

目的:探讨人工流产后避孕的安全、有效及副作用小的避孕方法,避免重复流产发生。方法:临床抽取96名育龄妇女于人工流产后随机分成两组,观察组立即放置曼月乐而对照组开始口服短效避孕药,观察两组的临床效果、副反应。结果:观察组在临床效果、副反应等方面均优于对照组。结论:曼月乐避孕效率高,副作用少,适合于人工流产后即时放置以减少重复流产的发生。

使用长效避孕针醋酸甲孕酮妇女的月经变化

对421例采用醋酸甲孕酮150mg作为三个月注射一针避孕妇女的月经情况进行了分析。结果:随着用药时间增加闭经的比例越来越高,哺乳与非哺乳组闭经之间的差异越来越小;闭经者停用药物后月经逐渐恢复,末次注药后9个月内达到85.6％,21个月达到100％;用药时间的长短(1-6针)与闭经后月经恢复的时间长短无关;月经紊乱者恢复正常月经的时间(中位数)为7·8(2～22)月。结论:醋酸甲孕酮作为长效避孕针可引起月经的变化,随着用药时间增长闭经增多,但可逆,停药后可恢复。