Evaluation of Insertion with the New Inserter of the Intra-Uterine Device of the Postpartum at the Referral Health Center of Commune II of Bamako, Mali

Background: In Mali, contraceptive prevalence is low, while the unmet need for family planning is very high. Postpartum contraception can help to significantly reduce these unsatisfied needs. The introduction of the intrauterine device (IUD) in the postpartum quickly encountered problems with the type of forceps used to make the insertions (Kelly or Heart forceps), and also their availability at the various health centers. Thus, in 2016, the Population Services International Mali (PSI-Mali) introduced the insertion of the IUD in the postpartum with the new inserter in order to counter this forceps problem and to contribute to guaranteeing the quality of postpartum IUD insertions. Objectives: They were to determine the frequency, the socio-demographic and clinical characteristics and to report the side effects and the complications. Methods: This was a descriptive and analytical cross-sectional study from September 1st 2016 to August 31st, 2018. All deliveries that met the eligibility criteria, having chosen and benefited the postpartum intra-uterine device with the new inserter were included. Results: During the 2 years, we recorded 73 cases of insertion of the postpartum intra-uterine device with the new inserter over 7797 clients meeting of the world health organization’s criteria of medical admissibility for the use of an intra-uterine device with a frequency of 0.93%. They were married in 97% of cases, large multiparous in 48% of cases, aged between 30 and 39 years in 62% of cases. We didn’t notice any complications in 96% of cases. Expulsion with 4% was the only complication. The clients didn’t have any side effects in 98% of cases. Conclusion: The insertion of a postpartum intra-uterine device with the new inserter has supplanted the insertion techniques using forceps in our center because of its ease and speed. Its use is worth being popularized to help reduce the unmet need for family planning.

Releasing of Cupric Ion of Three types of Copper-bearing Intrauterine Contraceptive Device in Simulated UterineFluid

Objective To compare the cupric ion releasing in vitro o.f the three IUDs. Methods The stability o.f cupric ion releasing o.f IUDs including TCu 380.4 IUD （TCu 380A）, Multiload Cu375 IUD （MCu 375） and Yuangong 365 copper-bearing indomethacin-releasing IUD （Yuangong 365） by the determination of cupric ion releasing in simulated uterine fluid. The simulated uterine fluid was used for releasing media. Copper ion was determined by flame atomic absorption spectrometer. Results The cupric ion releasing of three IUDs were instable at the beginning and tend to be stable gradually. In the stable phase, the average level of cupric ion releasing of TCu380A, MCu375 and Yuangong 365 were 4.25±2.71-7.62±6.42 μg, 4.92±1.23 -8.62±3.08 μg and 2.19±0.40-4.68±1.66 μg, respectively. TCu380A had higher instable releasing level than those of Yuangong 365 （P〈0. 05）. Conclusion TCu 380.4 and MCu 375 showed a ＂burst release＂ during the first few days and the.former was of great significance（P〈0.05）. The initial cupric ion releasing of Yuangong 365 appeared to be the lowest, followed by MCu375 and TCu380A in a releasing order

Barriers to Intrauterine Device Use at an University-Based Women’s Clinic

Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a convenience sample of subjects receiving obstetrical care at a University-Based Women’s Clinic. Eligible women who consented to participate self-administered a 16-question survey during a routine prenatal visit. Descriptive statistics were used to report participants’ demographics and history of contraception use. Additionally, subjects were asked if they would consider IUD use in the future. Results: A total of 160 women participated in this study. The average age of this sample was 24.9 (SD = 6.3). The majority were in low income and low education categories. Only 5% of women reported previous IUD use. 27% of women surveyed desired more information regarding IUD contraception. 19% of participants would consider using an IUD in the future and 25% would consider?IUD in the future if they knew more about them. Insurance and financial constraints were cited as barriers to IUD use. 4% of the sample reported that they had used an IUD previously and were unhappy with it due to pain and discomfort. 18% would not consider an IUD because they had heard about side effects. 68%?of the surveyed sample reported unintended pregnancies. Conclusion: The two most common barriers to IUD use in this patient population was lack of knowledge?and concern about side effects. Increasing patients’ knowledge of IUDs has the potential to increase IUD utilization in this clinic population which reported a 68% rate of unintended pregnancy.

Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. Patients and methods: An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. Results and comments: We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.

Com parison betw een Two Techniques Used in Im m ediatePostplacentalInsertion of TCu 380AIntrauterine Device:36-Month follow-up

Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD insreted by ring forceps. Using Life Table Method and χ 2 test, expulsion and other discontinuation rates were compared at 6, 12, 24, and 36 months post insertion between these two different groups. No uterine perforation, infection or prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events (expulsion, pregnancy, removal for bleeding/pain, etc.) were not statistically significantly different (P>0.05). The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380 A, which appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breast feeding and IUD position in uterine cavity, are also analyzed and discussed in this paper.

瘢痕子宫人工流产术后即时放置元宫IUD与曼月乐IUD临床效果比较

目的:比较瘢痕子宫女性人工流产术后即时放置元宫IUD和曼月乐IUD临床效果。方法:选取2022年6月-2023年6月本院收治的瘢痕子宫行人工流产术女性104例,按照放置IUD种类的不同分组,分别放置元宫IUD(元宫组54例)、放置曼月乐IUD(曼月乐组50例)。随访6个月,比较两组IUD使用效果、阴道出血情况和不良反应。结果:曼月乐组放置1个月、6个月累计续用率(100.0%、90.0%)与元宫组(98.2%、81.5%)无差异(P>0.05);术后阴道出血时间(5.4±2.3 d)及阴道出血量(53.3±10.5 ml)均少于元宫组(7.8±3.1 d、75.7±11.4 ml),不良反应发生率(8.0%)低于元宫组(24.1%)(均P<0.05)。结论:瘢痕子宫女性人工流产术后即时放置两种IUD避孕效果相当,但曼月乐IUD可有效改善术后阴道流血情况,降低不良反应发生率。

放置两种吉妮IUD 18个月临床效果分析

目的:观察吉妮致美与吉妮宫内节育器(IUD)使用18月的临床效果。方法:随机分组分别放置吉妮致美IUD517例,吉妮IUD508例,分别于置器后1、3、6、18个月进行随访,记录病史、放置IUD手术时间及术后随访情况,对数据进行生命表分析和Logistic多因素分析。结果:①随访18个月吉妮致美和吉妮IUD的带器妊娠率分别为0.60/100妇女年和0.61/100妇女年(P>0.05);②置器后6月内月经周期缩短、经量增多、月经期延长情况吉妮致美组低于吉妮组(P<0.05),因出血终止使用的吉妮致美组(1.2/100妇女年)明显低于吉妮组(6.69/100妇女年),P<0.05;③两组均无因疼痛所致的终止。④带器妊娠的危险因素为子宫内口至子宫底外缘距离大和子宫后屈;⑤脱落的危险因素则为体力劳动和哺乳期置器者。结论:吉妮和吉妮致美IUD避孕效率高;吉妮致美IUD对减少置器后近期出血及因出血所致终止率有明显效果,为吉妮IUD系列的扩大应用提供了更多的选择。

B超监测下放置吉妮IN IUD的临床效果观察

目的：观察B超监测放置吉妮IN IUD宫内节育器的临床效果。方法：多中心随机分组在B超监测下放置吉妮IN IUD289例,TCu380A IUD 303例,分别于术后1、3、6、12、24、36个月行妇科及B超随访,以生命表方法统计结果并行显著性检验。结果：①术后疼痛TCu380A组明显高于吉妮IN组（P〈0.05）;术后6~36月,月经紊乱以TCu380A组为高（P〈0.05）。②两组带器妊娠率均较低（吉妮IN组1.04/100妇女,TCu380A组1.32/100妇女,P〉0.05）;脱落率TCu380A组（6.60/100妇女）高于吉妮IN组（4.84/100妇女,P〈0.05）;吉妮IN组因出血和疼痛的终止率（2.77/100妇女）较TCu380A组（5.61/100妇女）低（P〈0.05）。结论：吉妮INIUD具有与TCu380A IUD同样高的避孕效率,其在降低脱落率、因症取出率及副反应发生率方面优于TCu380A IUD。

柴胡止血液对置含铜IUD家兔宫腔液PGI_2和TXB_2含量的影响

为探讨柴胡止血液治疗宫内节育器所致子宫异常出血的作用机理,采用放射免疫法对照观察了柴胡止血液对置含铜宫内节育器(TCuIUD)家兔子宫宫腔冲洗液前列环素(PGF_(1α))和血栓素(TXB_2)含量的影响。结果表明置 TCuIUD后家兔子宫宫腔液中PGF_(1α)含量较未置器对照组明显增高(P<0.01),而TXB_2含量则明显降低(P<0.01),PGF_(1α)/TXB_2比值亦显著高于对照组(P<0.01);经柴胡止血液治疗后,家兔子宫宫腔冲洗液中PGF_(1α)含量与置器对照组比较明显降低(P<0.01),TXB_2含量则明显升高(P<0.01),PGF_(1α)/TXB_2比值亦趋于正常(与置器组比较,P<0.01;与对照组比较,P>0.05)。提示柴胡止血液对置TCuIUD家兔宫腔液的前列环素含量具有较强的调整作用,能使明显升高的PGF_(1α)及明显降低的TXB_2恢复正常,从对抗前列环素的角度阐明了柴胡止血液具有治疗IUD所致子宫出血的作用。

宫腔镜联合B超用于IUD取出困难98例分析

目的探讨宫腔镜联合B超在宫内节育器（IUD）取出困难中的应用价值。方法回顾分析自2009年10月至2012年10月因宫内节育器取出困难于吉林医药学院附属医院行宫腔镜检查及取器的患者资料98例，手术均行B超定位或监测。结果在98例患者中，绝经患者45例，占45．92％；有经腹子宫手术史者67例，占68．37％；人工流产后直接放置IUD者21例．哺乳期放置IUD者27例，共占48．98％。宫腔镜下成功取器95例，占96．94％，未出现并发症。结论宫腔镜联合B超用于处理宫内节育器取出困难安全、有效、微创，效果满意。

人工流产术后即刻放置两种不同IUD应激反应分析

目的:探讨人工流产术后即刻放置两种不同IUD应激反应情况。方法:选取2017年7月—2019年10月于本院实施人工流产术440例,根据术后是否置器及其放置类型分为未置器对照组(n=120)、置入吉妮致美IUD组(n=160)和花式IUD组(n=160)。检测3组妇女术前30min(T0)及其术后30min(T1)、6h(T2)、24h(T3)、48h(T4)血清皮质醇(Cor)、丙二醛(MDA)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NA)、血管紧张素Ⅱ(Ang-Ⅱ)等应激反应因子水平。结果:3组血清应激因子水平T0时无差异(P<0.05),T1时均高于其他时刻(P<0.05)。吉妮致美IUD组、花式IUD组在T1、T2、T3、T4时刻血清Cor、MDA、ACTH、NA及Ang-Ⅱ均高于对照组(P均<0.05),但两组间无差异(P均>0.05)。结论:流产术后即刻放置不同IUD均会对女性机体产生应激反应,但观察的两种IUD未见差异。提示临床须引起重视。

活血化瘀法对置Cu-IUD家兔子宫内膜超微结构的影响

目的从形态学角度探讨以活血化瘀立法的SQ重组复方治疗置带铜宫内节育器(Cu—IUD)所致子宫异常出血的作用机制。方法建立置Cu—IUD家兔的动物模型,用吲哚美辛为对照,观察SQ重组复方对置Cu—IUD家兔子宫内膜形态学变化的影响。电镜下观察置Cu—IUD家兔子宫内膜血管内皮细胞、平滑肌细胞、间质细胞的超微结构改变。结果SQ重组复方能改善置Cu—IUD家兔子宫内膜血管内皮细胞及平滑肌细胞线粒体水肿及空泡变,改善间质细胞的泡沫样变。结论SQ重组复方对置Cu—IUD家兔子宫内膜有保护和修复作用。

用多聚酶链反应方法检测IUD诱发出血的子宫内膜人巨细胞病毒感染的研究

用聚含酶链反应(PCR)技术检测73份置宫内节育器(IUD)诱发出血人群及50例置IUD后月经周期正常人群的子宫内膜病毒分离培养物中的HCMV—DNA,有9份为HCMV—DNA 阳性,其中8份是病毒分离阳性,用细胞学鉴定及单克隆抗体鉴定为HCMV,有1份为病毒分离阴性,而PCR检测为阳性.

固环止血胶囊对置IUD大鼠血浆及子宫组织ET和TXB_2的影响

目的:研究固环止血胶囊对放置宫内避孕器(IUC)大鼠血浆及子宫组织内皮素(ET)和血栓烷(TXB2)的影响。方法:采用放射免疫法测血浆及子宫匀浆ET和TXB2。结果:固环止血胶囊高剂量组血浆及子宫组织内ET和TXB2分别为(198.90±31.31)、(359.23±61.34)pg/m l和(152.50±21.38)、(48.63±7.70)pg/m l,与模型组[(119.22±48.34)、(218.06±40.52)和(100.92±29.00)、(31.03±7.3)pg/m l]比较有统计学意义(P<0.05)。结论:固环止血胶囊止血作用与增加大鼠血浆及子宫组织内ET和TXB2的含量有关。

宫腔镜联合B超监测下取出宫内嵌顿的IUD的临床分析

目的探讨宫腔镜联合B超监测下取出宫内嵌顿的宫内节育器(IUD)的临床价值。方法采用美国史赛克公司生产的连续灌流式电视宫腔电切镜系列,对36例宫内嵌顿的IUD患者在宫腔镜联合B超监测下行宫内IUD取出术,观察其并发症发生情况。结果36例宫内嵌顿的IUD全部被取出,无1例并发症发生。结论宫腔镜联合B超监测下取出宫内嵌顿的IUD是一种准确、有效、安全、实用的方法。

TGU220 IUD和安舒型IUD临床应用效果比较

目的评价TGU220IUD和安舒型IUD的临床应用效果,为推广新型IUD提供依据。方法随机抽取2011年1月-2012年1月放置TGU220IUD和安舒型IUD已婚育龄妇女各400例,随访1年,观察2种IUD使用效果及不良反应发生情况。结果随访1年,失访37例,TGU220IUD组随访378例,安舒型IUD组随访385例。2组12个月带器妊娠率和非因症取出率比较差异均无统计学意义(P>0.05);安舒型IUD组12个月累计脱落率、因症取出率和总终止率低于TGU220IUD组,12个月总续用率明显高于TGU220IUD组,差异均有统计学意义(P<0.05,P<0.01)。安舒型IUD组不良反应发生率为7.0%低于TGU220IUD组的20.1%,差异有统计学意义(P<0.05)。结论 2种IUD避孕效果可靠,但安舒型IUD在脱落率、因症取出率及不良反应发生率方面均低于TGU220IUD组。

某单位女职工IUD放置情况调查和研究

目的了解成都地区女职工放置IUD情况,并对其引起出血等不良反应的相关因素进行分析,为临床安全使用IUD提供参考。方法对四川省电力系统成都市下属单位所有安置或曾经安置IUD的女职工进行普查,对普查结果进行分析。结果在职已婚女职工置器率为70.2%;在因症取环患者中,55.8%是因出血。出血患者中,阴道炎、子宫内膜息肉、黏膜下肌瘤发生率高。结论城市文化层次较高的职业女性置器率高,也更为主动,说明其对生殖健康更为重视,妇女的自我防护意识在提高;置器后出血是因症取器的首要原因,其中,有反复阴道炎病史者、有子宫内膜息肉或黏膜下肌瘤患者更易发生,应对此类患者积极诊治。

活性γ型含铜含吲哚美辛IUD与TCu380A IUD的临床效果比较

目的:比较分析活性γ型含铜含吲哚美辛宫内节育器(IUD)(安馨环)和TCu380A IUD的临床避孕效果。方法:对2014年1月—2015年1月放置活性γ型含铜含吲哚美辛IUD的362例(观察组)和TCu380A IUD 280例(对照组)育龄妇女的临床资料进行回顾性分析。结果:观察组不良反应发生率明显低于对照组;节育器异常发生率低于对照组;月经改变情况发生率低于对照组。两组比较,差异均有统计学意义(P<0.01)。观察组3个月、6个月、12个月续用率均高于对照组;观察组的满意度高于对照组。两组比较,差异有统计学意义。结论:采用安馨环避孕的方法不良反应发生率低,续用率高,安全、长效,能提高避孕效果和育龄妇女满意度。

B超在绝经期妇女IUD取出术中的临床应用

目的探讨B超在绝经期妇女宫内节育器(IUD)取出术中的临床应用价值。方法 2006年7月至2010年1月对门诊113例绝经期取环妇女常规取环困难的病例均采用B超监测下取环。必要时行腹腔镜监测。结果 113例患者中,B超下成功取出IUD共110例,无一例发生子宫穿孔及子宫大出血等并发症,取环均一次成功,成功率97.3%。结论 B超应用于绝经期妇女IUD取出是一种安全有效的方法,并可提高取器的成功率。

知情选择4种IUD的临床效果分析

目的通过对4种常用IUD避孕效果的分析,为IUD的临床知情选择提供参考依据。方法放置IUD前向育龄夫妻提供知情选择指导,术后进行系统、规范的随访,由区计划生育服务站汇总分析结果。结果在初次放置和二次放置IUD的自主选择方面,4种IUD差异具有显著性意义(P<0.05)。免费供应的TCu380A和元宫型IUD在脱落率、妊娠率、因症取出率,以及副反应发生率方面均显示出作为长效避孕措施的优越性,但新型活性γ型和GyneFixIN型IUD临床效果明显优于前述两种IUD。结论免费IUD的避孕效果可靠,适用于绝大多数有避孕需求的育龄妇女,新型活性γ型和GyneFixINIUD能够有效弥补免费IUD的不足。