400038 重庆,陆军军医大学(第三军医大学)第一附属医院妇产科
Received:28 July 2020,
Revised:2020-09-02,
Published:15 December 2020
移动端阅览
Xiaoyan LIU, Jia LIU, Huifen CAI, et al. Clinical observation of immediately high-efficiency contraception after unintended pregnancy induced abortion in women over 40 years old[J]. Journal of Third Military Medical University, 2020, 43(23): 2350-2355.
Xiaoyan LIU, Jia LIU, Huifen CAI, et al. Clinical observation of immediately high-efficiency contraception after unintended pregnancy induced abortion in women over 40 years old[J]. Journal of Third Military Medical University, 2020, 43(23): 2350-2355. DOI: 10.16016/j.1000-5404.202007211.
目的
2
分析40岁以上高龄女性人工流产术后即时高效避孕落实和续用情况,评价规范的流产后关爱(post abortion care,PAC)流程在降低高龄女性意外妊娠发生率中的价值。
方法
2
收集本院2019年实施人工流产手术的40岁以上高龄女性临床资料,收集同期实施人工流产手术育龄(20~40岁)女性临床资料。所有病例遵循PAC流程规范服务,术后随访1、3、6个月。比较两组女性日常避孕方法、此次意外妊娠原因和人流术后即时高效避孕落实、高效避孕方法续用和再次意外妊娠情况。
结果
2
此次意外妊娠人流术前,高龄组流产次数显著多于育龄组(
t
=6.986,
P
<
0.001);两组避孕方法的构成比差异有统计学意义(χ
2
=30.612,
P
<
0.001),避孕套仍是最常用的避孕方法(50.79%
vs
72.22%)。此次人流术后,高龄组即时避孕落实率高于育龄组(96.83%
vs
90.87%,χ
2
=4.487,
P
=0.034),但高效避孕措施落实率差异无统计学意义(χ
2
=2.550,
P
=0.110);高龄组术后1、3、6个月随访率高于育龄组(
P
<
0.05),随访至术后3、6个月时,高龄组的高效避孕措施落实率高于育龄组(
P
<
0.05),术后6个月再次意外妊娠发生率低于育龄组(χ
2
=4.845,
P
=0.028)。
结论
2
40岁以上高龄女性意外妊娠人流术后即时高效避孕落实率、续用情况优于育龄女性,再次意外妊娠发生率较低;规范实施PAC服务,有助于高龄女性人流术后即时落实高效长效避孕措施,提高其续用率,降低意外妊娠和重复人工流产率。
Objective
2
To explore the implementation and continued use of high-efficiency contraception in over-40-year-old women immediately after induced abortion
and evaluate the value of post-abortion care (PAC) Performance Standards in reducing the rate of unintended pregnancy in senior women.
Methods
2
Clinical data of 126 women over 40 years of age who underwent abortion in our hospital in the year of 2019
and of 252 woman at childbearing age (20~40 years old) undergoing abortion during the same period were collected in this study. All cases were given services in accordance with the PAC Performance Standards
and then followed up for 1
3
and 6 months. The daily contraceptive methods
cause of this unexpected pregnancy
implementation of immediate and efficient contraception after abortion
rate of continued use of high-efficiency contraceptive methods (long- or short-acting contraceptive methods)
and incidence of another unexpected pregnancy were analyzed and compared between the 2 groups.
Results
2
Before this accidental abortion
the time of abortions was significantly higher in the elderly group than the childbearing age group (
t
=6.986
P
<
0.001). Although the 2 groups differed in the composition ratio of the 2 contraceptive methods (
Chi
-square=30.612
P
<
0.001)
condoms were still the most commonly used method (50.79%
vs
72.22%). The implementation rate of immediate and efficient contraception after abortion was obviously higher in the elderly group than the childbearing age group (96.83%
vs
90.87%
Chi
-square=4.487
P
=0.034)
but no statistical difference was seen (
Chi
-square=2.550
P
=0.110). The elderly group had higher follow-up rate at 1
3
and 6 months postoperatively (
P
<
0.05)
higher implementation rate of effective contraceptive measures (
P
<
0.05) at the time points of follow-up
and lower incidence of unintended pregnancy at 6 months postoperatively (
Chi
-square=4.845
P
=0.028) when compared with the childbearing age group.
Conclusion
2
The women over 40 years of age have higher rates of implementation and continued use of high-efficiency contraception after accidental pregnancy
and lower re-unexpected pregnancy than the women of childbearing age. PAC Performance Standards are helpful to the senior women receiving effective and long-acting contraceptive measures immediately after abortion
increasing their continued rate
reducing the rates unintended pregnancy and repeated abortion.
STEINER A Z, JUKIC A M. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort[J]. Fertil Steril, 2016, 105(6): 1584-1588.e1. DOI:10.1016/j.fertnstert.2016.02.028.
MILLER T A, ALLEN R H, KAUNITZ A M, et al . Contraception for midlife women: a review[J ] . Menopause, 2018, 25(7): 817-827. DOI:10.1097/gme.000000000000 1073.
TEPPER N K, GODFREY E M, FOLGER S G, et al . Hormonal contraceptive use among women of older reproductive age: considering risks and benefits[J ] . J Womens Health (Larchmt), 2018, 27(4):413-417. DOI:10.1089/jwh.2018.6985
中华医学会计划生育学分会. 40岁及以上女性避孕指导专家共识[J].中华妇产科杂志, 2020, 55(4):239-245. DOI: 10.3760/cma.j.cn112141-20200103-00008.
Family Planning Branch of Chinese Medical Association. Expert consensus on contraceptive guidance for women aged 40 and over[J]. Chin J Obstet Gynecol, 2020, 55(4):239-245. DOI:10.3760/cma.j.cn112141-20200103-00008.
中华医学会.临床技术操作规范·计划生育学分册[M].北京:人民军医出版社, 2004.
Chinese Medical Association. Clinical technical operation standards · family planning division[M]. Beijing: People's Military Medical Press, 2004.
中华医学会计划生育学分会.人工流产后计划生育服务指南[J].中华妇产科杂志, 2011, 46(4):319-320. DOI:10.3760/cma.j.issn.0529-567x.2011.04.024.
Family Planning Branch of Chinese Medical Association. Guide to family planning services after abortion[J]. Chin J Obstet Gynecol, 2011, 46(4):319-320. DOI:10.3760/cma.j.issn.0529-567x.2011.04.024.
国家卫生健康委.人工流产后避孕服务规范(2018版)[J].中国计划生育学杂志, 2018, 26(10):888-891.
National HealthCommission of the People's Republic of China. Guideline for contraceptive services after induced abortion(2018)[J]. Chin J Family Planning, 2018, 26(10):888-891.
周灿权, 古芳.重视高龄女性生殖健康[J].中国实用妇科与产科杂志, 2017, 33(1): 59-63. DOI:10.19538/j.fk2017010114.
ZHOU C Q, GU F. Pay attention to the reproductive health of advanced age women[J]. Chin J Pract Gynecol Obstet, 2017, 33(1): 59-63. DOI:10.19538/j.fk2017010114.
WAKTOLA M I, MEKONEN D G, NIGUSSIE T S, et al . Repeat induced abortion and associated factors among women seeking abortion care services at Debre Markos town health institutions, Amhara regional state, Ethiopia, 2017[J ] . BMC Res Notes, 2020, 13(1): 44. DOI:10.1186/s13104-020-4904-x.
[FSRH clinical guideline: Contraception for women aged over 40 Years (August 2017, amended September 2019)[EB/OL ] . https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/ https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/ .
FESTIN M P R. Overview of modern contraception[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 66: 4-14. DOI:10.1016/j.bpobgyn.2020.03.004.
SEDLECKY K, STANKOVIĆ Z. Contraception for adolescents after abortion[J]. Eur J Contracept Reprod Heal Care, 2016, 21(1): 4-14. DOI:10.3109/13625187.2015.1082175.
CLELAND J. The complex relationship between contraception and abortion[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 62: 90-100. DOI:10.1016/j.bpobgyn.2019.04.007.
SCHMIDT-HANSEN M, HAWKINS J E, LORD J, et al . Long-acting reversible contraception immediately after medical abortion: systematic review with meta-analyses[J ] . Hum Reprod Updat, 2020, 26(2): 141-160. DOI:10.1093/humupd/dmz040.
WANG H, LIU Y, XIONG R B. Factors associated with seeking post-abortion care among women in Guangzhou, China[J]. BMC Women Heal, 2020, 20: 120. DOI:10.1186/s12905-020-00980-0.
GAFFIELD M E, EGAN S, TEMMERMAN M. It's about time: WHO and partners release programming strategies for postpartum family planning[J]. Glob Health Sci Pract, 2014, 2(1): 4-9. DOI:10.9745/ghsp-d-13-00156.
PHILLIBER A E, HIRSCH H, BRINDIS C D, et al . The use of ACOG guidelines: perceived contraindications to IUD and implant use among family planning providers[J ] . Matern Child Health J, 2017, 21(9): 1706-1712. DOI:10.1007/s10995-017-2320-1.
OWOLABI O O, BIDDLECOM A, WHITEHEAD H S. Health systems' capacity to provide post-abortion care: a multicountry analysis using signal functions[J]. Lancet Glob Health, 2019, 7(1): e110-e118. DOI:10.1016/s2214-109x(18)30404-2.
KUMAR U, POLLARD L, CAMPBELL L, et al . Specialist follow-up contraceptive support after abortion-Impact on effective contraceptive use at six months and subsequent abortions: a randomised controlled trial[J ] . PLoS ONE, 2019, 14(6): e0217902. DOI:10.1371/journal.pone.0217902.
POHJORANTA E, SUHONEN S, GISSLER M, et al . Early provision of intrauterine contraception as part of abortion care: 5-year results of a randomised controlled trial[J ] . Hum Reprod, 2020, 35(4): 796-8 04. DOI:10.1093/humrep/deaa031.
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