放置γ型宫内节育器859例临床观察

γ型宫内节育器(IUD)是一种新型的活性IUD。近年来，我们为有月经过多史的妇女和放置其它种类IUD有频脱落和出血史的妇女，采取放置γ型IUD的方法进行避孕，取得了良好的效果。现将情况报告如下：     

宫内节育器使用效果的调查分析

对2659例已婚育龄妇女放置宫内节育器(IUD)后1年进行了调查,了解IUD的使用效果。结果显示,农村妇女IUD放置后1年使用率为84.2%,低于城市妇女(P<0.001);带器妊娠和IUD脱落是IUD停止使用的主要原因。应加强技术服务,提高IUD的续用率。     

中国宫内节育器停用原因分析

宫内节育器(简称IUD),是一种简便、有效、经济、安全的避孕措施。目前我国约有6000万妇女使用IUD,占全世界使用人数的70％,占我国所有采取避孕措施妇女数的50％左右)。但是,在我国,IUD避孕效果不高,据1991年王绍贤教授报道我国IUD农村的避孕效果为0.78,城市为0.83,而国际推荐的标准为0.95。不过与口服避孕药等短效方法     

宫内节育器停用后怀孕情况分析

我国使用宫内节育器(简称 IUD)避孕的妇女人数很多,但 IUD的避孕效果不高,续用率低。IUD每年停用人数也很多,其中,有相当部分是由于意外怀孕而停用。同时,由于其他原因 IUD停用后大多数妇女尤其是农村妇女又不能及时采取进一步的避孕措施,结果有一段时间处于非避孕状态,就有可能造成不必要的怀孕。分析上述情况下的怀孕结局,以进一步探索我国 IUD使用中的规律,对加强 IUD使用者的管理,提高计划生育工作水平有重要意义。     

人口拾零

新型避孕方法。据美国《世界日报》1992年5月12日报道,国外计划十年内推出6种控制生育新招。——改良避孕丸:新的低剂量口服避孕丸1988年以来已在欧洲上市。——新子宫内避孕装置(IUD):一种新一代的被称为 Flexigard 的铜袖被安置在线上,而非塑胶架上。它的体积较小,可以减少子宫流血和疼痛。这种 FUD 可以持续使用七年,不像现在的 IUD,必须每年更换。——新诺普兰:诺普兰使用6根结实的棒子插在皮肤下,其放射的类固醇可以阻止排卵。美国正在实验中的新诺普兰使用两根棒子,效果一样。     

甘南州计划生育药具管理的调查

为了了解甘南州八县(市)计划生育药具管理和服务的现状,调查了八县(市)的计划生育服务站和363名已婚育龄妇女。结果显示:药具管理人员均为兼职;育龄妇女的避孕方法以IUD为主,占55.27%;育龄妇女接受随访和计生药具知识培训的比例较低。应加强计划生育药具提供者和使用者的知识培训,加强咨询和随访。     

对城市育龄妇女计划生育问题的探讨

目前我国城市已婚育龄夫妇使用的避孕方法主要是可逆性方法,较少采用绝育这种高效但不可逆的避孕手段。在可逆性避孕方法中,可以自己控制的避孕方法使用率比较高。以北京、天津、上海三大城市1992年的统计数字为例,三市的男女绝育率均大大低于全国平均水平,而宫内节育器(IUD)、口服避孕药、避孕套和其他方法的使用则高于全国平均水平(见下表)。     

对我国育龄妇女产后最优绝育时机的探讨

自从1823年Blundell首创输卵管结扎术以来,女性绝育术以其安全、有效的特点,在世界范围内得到了广泛的应用。根据1988年全国2％生育节育抽样调查资料推算,到1988年年中,我国绝育夫妇的总数字已超过7000万。在各种避孕方法中,女性绝育术占38.24％,仅次于IUD(41.48％),成为我国育龄妇女最主要的节育措施之一。可以说,在今后一个时期内,     

220例绝经后取环临床分析

放置宫内节育器(IUD)是一种相对稳定的避孕方法,因其安全、有效、简便,在我国节育措施中占有重要地位。自60年代在我国推广使用以来,带器进入绝经期的妇女日益增多。由于多种原因,有相当一部分妇女未能在绝经后及时取出。1999年1月—2000年12月,我院通过查环查孕、生殖健康检查及日常门诊,共收治绝经2年以上带器者220人,并采用适当方法给予取器,取得一定效果。报道如下：     

推动避孕节育的健康有效发展

我国实行计划生育以来，全国少生4亿多人，提前实现了人口再生产类型的历史性转变，有效地缓解了人口对资源、环境的压力，有力地促进了经济发展和社会进步，避孕节育方法发挥重要作用。宫内节育器具（IUD）有安全、有效、简便、经济、可逆、长效、不影响生育等优点，为我国妇女乐于接受，一直是我国育龄妇女的主要避孕措施，对控制人口数量、保护广大育龄妇女生殖健康起到了重要的作用。     

'Continuation rate', 'use-effectiveness' and their assessment for the diaphragm and jelly method

Abstract The application of the life-table technique in the calculation of use-effectiveness of a contraceptive was proposed by Potter in 1963.(1) The technique was also found to be useful in assessing the duration for which the use of a contraceptive was continued. The keen interest that existed in the use of IUD in the mid-1960's was reflected in the terminology developed for assessment of the continuity of use. 'Retention rate' was a frequently used index.(2) Because of the development of the concept of segments whose end-period determined either termination of the use of a method or its continuance on a cut-off date, 'closure rate' and 'termination rate' have been used as measures of the discontinuance of the use of methods primarily of the IUD.(3) While discussing concepts relating to acceptance, use and effectiveness of family planning methods, more generally, an expert group suggested that 'continuation' should be used to denote that a client (or a couple) had begun to practise a method and that the method was still being practised.(4) Since this group defined 'an acceptor' as a person taking service and/or advice, i.e. having an IUD insertion or a sterilization operation or receiving supplies (or advice on methods such as 'rhythm' or coitus-interruptus with the intent of using the method), the base for the assessment of continuation rates, according to this group, would be only those acceptors who had begun using the method. The lifetable method has also been used for the study of the continuation rate for pill acceptors.(5) Balakrishnan, et al., made a study of continuation rates of oral contraceptives using the multiple decrement life-table technique.(6).     

Use of the intra-uterine contraceptive device in rural West Pakistan

This paper presents selected aspects of experience with the intra-uterine contraceptive device (IUD) in rural West Pakistan. There were 1,162 IUD cases analyzed with respect to retention or non-retention. Retention rates were estimated, using life table methods, to be between 55 and 75 percent at one year; the smaller figure was obtained when theIUD was considered to be in situ only until the last examination, when it was observed to be in place. The latter or larger figure was obtained when the IUD was considered to be in situ unless known to be out.The extent of follow-up greatly affects estimates of the length of time the IUD remains in situ. Retention also varies with the type of I UD employed; exclusive use of Loop 3, which has the best retention record of those used,may be expected to yield higher retention rates by as much as 5 to 10 percent for one year. A number of other factors were examined that might explain non-retention. The objective variables that were examined in this experience, such as age, previous contraception, and husband's illiteracy, were on the whole rather poor predictors of IUD retention. Expulsion and other medical complications appear to account for most discontinuance of use of the IUD.     

A stochastic approach to the estimation of the prevalence of IUD: Example of Taiwan,Republic of China

Assuming three patterns of changes in number of new IUD insertions, three stochastic models have been developed for the estimation of the “prevalence” of IUD in situ at a given point of time. The advantages of these models, compared with the conventional ways of estimating IUD prevalence, rest with their ease of use and simplicity of method for calculating variances of the estimates. The models are also useful for family planning administrators to set program targets. A correction factor to estimate the number of IUDs which, although “currently in situ,” are worn by women who have “passed over” the upper age limit of their reproductive spans has also been developed. This is particularly useful in estimating the “effective retention” of IUD.     

Birth control techniques in China

This article describes the major birth control techniques in use in China, based on data from a contraceptive prevalence study conducted in September, 1982. 118 million of the 170 million married women of child bearing age use birth control. IUD insertion accounts for 50.2% of birth control methods used, tubal ligation accounts for 25.4%, vas deferens ligation 10.0% oral contraceptives (OCs) 8.2%, and condoms 2.0%. A table of clinical data on 9 China made IUDs reveals that pregnancy rates range from 0 (V Cu-300 model) to 5.83% (mixed ring model). A method of IUD insertion immediately after delivery has been researched and adopted, using a silastic Delta IUD with barium added to reduce the high postpartum expulsion rate. fixing the IUD by sutures during Cesarean section has also been developed. Electronmicroscopic studies of the endometrium of women who have used a stainless steel IUD for more than 20 years showes no tendency towards malignancy, nor negative effects on the endocrine functions of the ovaries. 28 million Chinese women have accepted sterilization as of June, 1982. Local anesthesia and the use of acupuncture have reduced complications due to general anesthesia seen previously. Sterilization by means of chemically induced adhesion of Fallopian tube tissue has also been performed successfully; however, this method makes later anastomosis difficult, and is not suitable for young women with only 1 child. Fallopian tube occlusion by means of a silver clip has been performed in 1,128 cases, with a pregnancy rate of only .85%. 10.62 million men have accepted sterilization. While most of the procedures are val ligations, 300,000 men have been sterilized by direct injection of an adhesive agent throuh the skin of the scrotum. No increase in auto immune or vascular disease has been found. 3 low-dose OCs, used since 1969, have proven to be reliable and freer of side effects than higher-dose compounds. In addition, longterm OCs containing quinestrol have been used since 1969 with a success rate of 98.3% women-year. These pills are taken 1x monthly. R and D priority will be given be given to monthly injectable contraceptives; megestrol and norethindrone are the compounds most preferable. In trials so far, the effective rate has been 99.9% with mild side effects. Gossypol, a male contraceptive, has shown an antifertility effect in 99% of 8000 cases studied; however, hypokalemia and irreversibility of spermatogenesis were reported in some cases. Vacuum suction is the most common method for abortion, but Radix Trichosanthis and lilac daphne terpine, traditional abortifacients, anre acceptable for 1st trimester abortions. Prostaglandins are also used.     

New progress in research on contraceptive technology

Considerable progress has been made in China's contraceptive research and development during the country's 6th Five Year Plan because of the cooperation among the relevant institutes. The IUD is the most popular contraceptive method in China. Women who choose the IUD account for 40% in all age groups of reproductive women. Consequently, the IUD is 1 of the priorities in research programs. Progress in research on the IUD includes the following: the normal latitude data of uteri in Chinese women has been established, and the data can be used as a reference for the analysis of morphosis of Chinese women at childbearing age for the selection of IUDs; the clinical control research results demonstrates that the continuation rate of TCu-200, which accounts for 99.91%, is higher than the other 2 types of IUD, TCu220 and VCu200; the IUD is effective, safe, and applicable when it is inserted soon after delivery, cesarean section, early induced abortion, curettage of uterine cavity, and on the 3rd or 5th day of menstruation and 30-70 days after delivery; and the hemostatic therapy is effective to some extent after the administration of flufenamic acid, transamic acid, aprotinin, and Xuening tablets (traditional Chinese medicine) for prevention and treatment of hemorrhagic reaction. The priority in basic medicine research is on the mechanism of hemorrhagic reaction of the uterus caused by the IUD. The research in morphology, histology, and biochemistry focuses on the change in the endometrium before and after the insertion of the IUD and the relation between bleeding and change of fibrinokinase activation and prostaglandin. Contraceptive research in the 6th Five Year Plan also covers 3 types of oral contraceptives, 2 types of injections, 2 types of intravaginal devices, 2 types of spermicide, 2 types of medical membrane, gossypol, and an occlusive agent for vas occlusion. Information has been gathered on the change in the endometrium after taking long lasting oral contraceptives. The clinical observation of 60 women of childbearing age who have used spermicide for 4-10 years demonstrates that 2 types of home-made spermicide, which are harmless to the functions of the liver and kidney, fail to affect the menstrual cycle. Certain causes of the irreversibility of spermatogenesis have been found in the research on the testicle biopsy of men who take gossypol. Some achievements have been disseminated for public use, and some research programs are to be continued into the 7th Five Year Plan.     

A study on IUD retention by curve-fitting

In order to estimate the demographic impact of IUD, there is a need for estimating IUD retention rates beyond the period of actual observation. This article describes a mixed exponential function for this purpose. With this function of IUD retention, it is possible to estimate the “life expectancy” and “half-life” of an IUD. Another important concept is the “cut-off date”, introduced in estimating the “life expectancy” because in practice no IUD will be worn by a woman forever.     

Technical information via print

The amount that the staff of family planning clinics learn through technical publications is discussed in this article on the Philippine Population Center Foundation's Study of the flow of scientific information. The main questions raised include to what extent doctors, nurses and midwives learn from publications sent to their clinics, or from colleagues who have read the journals. If the latter is true, do the staff members teach one another or merely refer each other to the technical information available? 99 copies of "Population Reports" were sent out to various clinics throughout the Philippines. A 3rd of the issues were on the pill, a 3rd were on the IUD, and a 3rd were on the condom. 6 weeks after the information was sent out, tests on all 3 contraception methods were given to all staff members who were part of the survey. Ideally clinic staffs would perform best on the tests of the method on which they had received information. Tables giving breakdowns on the individual areas tested show that while clinics which had been sent information on the IUD scored best on the IUD test, clinics which had been sent pill and condom information did not do better on their respective tests than the others. Nurses and midwives from clinics with good interpersonal relations scored higher on the tests on which they had been sent information. Results also showed that the more involved a professional was with a contraceptive, the more he/she read about it. While encouragement and referral occurred between colleagues, teaching did not. A 2nd study was then run on how levels of interpersonal communication could be determined. A multiple regression analysis showed that the best predictors of intraclinic communication were age difference among clinic staff, similarity in clinic staff's length of family planning service, family planning caseload, similarity of clinic staff's reading of professional literature, average length of service of staff members in the medical profession, and average age of clinic staff.     

Changes in the use of birth control methods

Abstract Information on changes in the methods of contraception used was collected from women in a KAP Survey of Trinidad and Tobago in 1970-71. Using methods analagous to those used in the study of internal migration, it is found that 54% of contraceptors were still using the method they first used, and 46% had changed. In general, the net changes tended to be from less to more efficient methods. This is demonstrated with data showing: 1. the number of changes from one method to another; 2. the number of changes these women have made, considering the first and last methods only; and 3. the number of changes, including intermediate changes. Nevertheless, there is also an appreciable movement away from the more effective methods either to other methods, or out of contraceptive practice entirely. The rate of dropout from contraception has been increasing in recent years for all methods, and, apparently, for all ages of women. The principal reasons given for stopping the use of the various methods were: 1. pregnancy; 2. that the method was uncomfortable or too much trouble; 3. that the method made the user ill (in the case of the pill and the IUD); and 4. that the partner disliked the method (in the case of the condom and withdrawal). More positive reasons include: 1. that the woman wanted more children; and 2. that she no longer had a partner.     

A study on the demographic impact of an IUD programme

Abstract This paper discusses and presents data obtained through various studies and surveys on the effect of the IUD contraceptive programme in Taiwan. It has been demonstrated that the fertility of IUD acceptors before first acceptance was 58 % higher than that of married women in general and that, after acceptance, it declined by about 76%. The corresponding fertility decline among married women in general was only about %. Acceptors had had more recent births, as indicated by their shorter 'open interval' of 20.7 months, compared with 374 months among the women in the KAP survey sample. If the fertility of IUD acceptors had declined at the same rate as that of married women in general in the absence of IUD, the insertion of about 4 IUDs would probably prevent one live birth in the following year. Observation over a longer period, however, is needed to determine the demographic effect of IUD. Data on fertility control practice after termination, type of termination of pregnancies after first acceptance, life-table rates by various socio-demographic characteristics of acceptors, and the 'life expectancy' of the first segment of IUD are also presented.