生殖医学杂志

目的分析已生育女性人工流产术后长效可逆避孕方法(LARC)的落实情况并探讨其影响因素。方法收集2018年4月至2019年3月在我院计划生育科门诊就诊、自愿要求终止妊娠行人工流产的已生育女性2 165例,按照术后采取避孕措施的不同分为LARC组(607例,术后落实LARC)和对照组(1 558例,术后未落实LARC)。比较两组的人口学资料,并对影响人工流产术后LARC落实情况的因素进行分析。结果 LARC组高危人工流产占46.1%,75.6%的患者经历过重复人工流产;对照组高危人工流产占37.8%,55.9%的患者经历过重复人工流产;LARC组剖宫产率为41.0%,对照组剖宫产率为35.5%;LARC组中69.2%的患者未来没有生育计划,对照组中35.9%的患者未来无生育计划;LARC组已生育2孩者占40.9%,对照组已生育2孩占16.0%,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示:经历过重复人工流产[OR=1.90,95%CI(1.519,2.371)]、已生育2孩[OR=2.22,95%CI(1.762,2.805)]、有剖宫产史[OR=1.25,95%CI(1.016,1.536)]、无生育计划[OR=2.92,95%CI(2.340,3.650)]的已生育女性在人工流产术后更倾向于选择LARC。人工流产术后未落实LARC的主要原因是担心影响生育能力(27.2%)。LARC组患者术后1年的续用率为93.3%。结论已生育女性中经历过重复人工流产、已生育2孩、既往有剖宫产史、未来无再生育计划者,人工流产术后更倾向于选择LARC。

Objective:To analyze the implementation of long-acting reversible contraception(LARC) after induced abortion in women with children,and explore its influencing factors.Methods:A total of 2 165 pregnant women who visited the Family Planning Department of our hospital for induced abortion voluntarily from April 2018 to March 2019 were collected. According to whether to use LARC after abortion,they were divided into LARC group(n=607,LARC after abortion) and control group(n=1 558,non-LARC after abortion). The demographic data of the two groups were compared,and the factors affecting the implementation of LARC after induced abortion were analyzed.Results:The proportion of high-risk induced abortion in LARC group was 46.1%,75.6% of patients have experienced repeated abortions. The proportion of high-risk induced abortion in control group was 37.8%,and 55.9% of patients have experienced repeated abortions. The cesarean section rate of LARC group was 41.0%,and that in control group was 35.5%. For future family planning,69.2% of the LARC group had no future family plan,compared with 35.9% of the control group;the LARC group had two children accounted for 40.9%,the control group had two children accounted for 16.0%,all the difference was significant(P<0.05). Multivariate logistic regression analysis showed that pregnant women who had experienced repeated abortion [OR=1.90,95%CI(1.519,2.371)],had two children [OR=2.22,95%CI(1.762,2.805)],had a history of cesarean section [OR=1.25,95%CI(1.016,1.536)],and had no birth plan [(OR=2.92,95%CI(2.340,3.650)] were more likely to choose LARC after abortion. The main reason for not receiving LARC after abortion was that they were worried about the impact on fertility(27.2%). The follow-up rate of LARC 1 year after abortion was 93.3%Conclusions:Among the women who have experienced repeated induced abortion,who have two children,who have cesarean section history,and who have no future birth plan are more likely to choose LARC after induced abortion.