| 宫内节育器使用效果流行病学调查协作组.十二省市农村育龄妇女宫内节育器使用效果流行病学调查[J].Chinese journal of Epidemiology,1986,7(4):226-232 |
| 十二省市农村育龄妇女宫内节育器使用效果流行病学调查 |
| An Epidemiologic Study on the Effect of the Stainless Steel Ring IUD in Rural Women of 12 Provinces and Municipalities in China |
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| Abstract: |
本次调查是国内首次大规模的按统一设计方案进行的一次探索性研究。调查采取重点整群抽样的方法,从十二个省、市74万5千多名妇女中,根据设计方案的要求,逐个筛选,最后确定25,005人为这次研究样本,由于各种原因,最终进入样本统计的人数为24,633例。样本数达调查点内放置金属单环妇女总数的38%,样本调查率平均为98.80%。
通过本次回顾性流行病学调查表明,金属单环放置一年时的续用率为79.3/每百妇女,五年续用率为55.2/每百妇女,脱落率(11.4~20.73%)占停用原因的首位,因症取出率较低。总的来说,金属单环至少在三年内对大多数省、市是安全、有效、经济、简便的一种节育措施。
本次研究采用了多因素判别分析(Bayes方法)和单因素分析相结合的方法来探索影响金属单环使用效果的诸因素。通过多因素分析选出了9个因素,单因素分析结果表明,影响金属单环脱环率、带器妊娠率和意外妊娠率的因素计有产次、人流次数、医疗技术水平和哺乳期安环。 |
| English Abstract: |
This is the first time in China, that such a large scaled multicentered epidemiological survey on the effect of stainless steel core ring intrauterine contraceptive device in rural women was undertaken. The study was conducted in twelve provinces and municipalities according to a common program and protocol employing the cluster sampling method. 745 thousand women from 1,447 villages of 122 townships in 28 counties of 12 provinces and municipalities were screened individually. Finally, 24,633 women were identified as study subjects. They represented 38% of the women using this type of IUD in the areas surveyed, the total investigation rate was 96—100%.
The retrospective epidemiological survey shows that the continualuse rate was 79.3 per hundred women, at the end of one year after insertion of the ring, and 55.2 per hundred women at the end of 5 years. Expulsion (11.4—20.73/100 women) was the prime cause of termination, next, accidental pregnancies (5.2—13.6/100 women) and pregnancy with ring in situ (2.4—6.7/100 women), removal rate for medical reasons was the lowest. In general, use of the single steel rings was a safe, effective and simple procedure for birth control for at least three years.
Nine determinants were selected out of 14 in the evaluation of their effects on IUD efficiency by multivariate analysis. The order of the nine factors were insertion after menstruation, insertion during the lactating period, age of first birth, insertion after induced abortion, medical expertise, age of women at the time of insertion, physical intensity of work, the number of partuntions prior to insertion and number of induced abortions prior to insertion. Single factor analysis was employed to observe further the effect of each factor. Results showed that the expulsion rate, the rate of pregnancy with rings in situ and the occurrence of accidental pregnancy were affected by the number of previous births, number of induced abortions level of medical technology and insertion during the breastfeeding period. Insertions at different times after menstruation had some effects only on the rate of pregnancy with rings and on accidental pregnancy rates. Different ages at first births had some effects on the rate of accidental pregnancy.
The expulsion rate and the accidental pregnancy rate are the highest when the ring is inserted in the breast-feeding period. The continuause rate is the highest when the rings is inserted after induced abortions or after menstruation.
We hold that non-medical removals should be deleted in evaluating the effectiveness of IUDs.
This survey is in accordance with China's experience of using the stainless steel IUDs over the past twenty years. There was no increased risk of pelvic infection (PID) or mechanical intestinal obstruction. It is a safe and effective contraceptive measure if the technique of insertion conforms to the standard and time of insertion appropriately chosen. The effect of five years use is as good as other IUDs commonly used at home and abroad. |
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