生殖医学杂志

目的了解全面二孩政策下已生育女性重复人工流产的状况以及影响因素。方法收集2018年4月～12月就诊我院计划生育科门诊自愿要求终止妊娠行人工流产的已生育女性1 773例,其中既往有过至少1次人工流产史为重复人工流产组(1 095例),既往从未行人工流产者为对照组,即非重复人工流产组(678例)。比较两组社会人口学特征、既往生育情况、再生育计划、人工流产前后避孕情况。结果重复人工流产组者主要年龄段集中在35～<40岁(38.9%),而非重复人工流产组年龄段主要集中在30～<35岁(47.5%),差异有统计学意义(P<0.05)。与非重复人工流产组相比较,重复人工流产组大学以上学历、职业女性以及本地户籍所占比例更低,吸烟的比例更高,差异有统计学意义(P<0.05)。重复人工流产组中51.5%未来没有生育计划,显著高于非重复人工流产组(35.7%)(P<0.05)。与非重复性人工流产组相比较,重复性人工流产组人流术更倾向于选择长效可逆避孕方法(LARC),差异有统计学意义(P<0.05)。已生育1孩女性中重复人工流产组年龄≥35岁以上、吸烟者、本科以下学历、未来无再生育计划者、术后落实LARC者比例均显著高于非重复流产组(P均<0.05)。生育1孩高龄重复人工流产组中未来有生育计划的占20.1%,不确定是否再生育2孩占19.1%,显著低于非重复人工流产组(26.0%和24.0%)(P<0.05);重复人工流产组中无再生育计划占60.8%,显著高于非重复人工流产组(50.0%)(P<0.05)。结论已生育女性重复人工流产率高,高龄、仅生育1孩、无再生育计划者比例较高,人流术前避孕方法以避孕套为主,意外妊娠的原因主要是未避孕,人流术后LARC落实率较高。

Objective:To investigate the situation of repeated induced abortion in the women who had birth under the universal two-child policy and the influencing factors.Methods:A total of 1 773 fertile women who voluntarily requested induced abortion to terminate pregnancy in the family planning clinic of our hospital from April to December 2018 were collected.Among them,the women who had at least one induced abortion were in the repeated abortion group(n=1 095),and the women who had no abortion in the past were in the control group,that is,the non-repeated abortion group(n=678).The social demographic characteristics,past fertility status,re-fertility plan,and contraception measures before and after induced abortion were compared.Results:The main age of repeated abortion group was 35 to<40 years old(38.9%),while the age of non-repeated abortion group was 30 to<35 years old(47.5%).The difference was significant(P<0.05).Compared with non-repeated abortion group,the women in repeated abortion group had lower proportion of college education,professional women and local household registration,and higher proportion of smoking,with statistical significance(P<0.05).51.5% of the women in the repeated abortion group had no future fertility plan,which was significantly higher than that of the non-repeated abortion group(35.7%)(P<0.05).Compared with non-repeated abortion group,the women in the repeated abortion group preferred to choose long acting reversible contraceptive method(LARC),the difference was significant(P<0.05).The proportion of women with repeated abortion who were≥35 years old,smokers,below bachelor's degree,no future fertility plan and LARC implementation after operation was significantly higher than that in non-repeated abortion group(all P<0.05).In the women with one child in the repeated abortion group,20.1%had future fertility plan and 19.1%had uncertain re-fertility,the proportion was significantly lower than that of non-repeated abortion group(26.0%,24.0%)(P<0.05);60.8% of women had no fertility plan in repeated abortion group,which was significantly higher than that of non-repeated abortion group(50.0%)(P<0.05).Conclusions:The repeated abortion rate is high in the women who had birth.The proportion of older women and no re-fertility plan is higher.Condom is the main method of contraception before induced abortion.The main reason for failure of contraception is no contraception method used.LARC implementation rate after induced abortion is higher.