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15 September 2010, Volume 29 Issue 5
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述评
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述评

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Health Care after Induced Abortion FAN Guang-sheng 2010, 29 (5):  315-319.  Abstract ( 2762 )   PDF (329KB) ( 7329 )   An estimated 26-53 million abortions are still performed annually worldwide by WHO. Unsafe abortions about 2 million are performed in the developing country to occupy 95%. About 10 million abortions are performed annually in China. There are high rate of repeat abortions in the big city such as Beijing，Shanghai and so on. There are some psychological and physiological injures by artificial abortions and some complications. Because the power of bearing recovers quickly in post鄄abortion，and an effective contraceptive method is necessary to be used immediatly after abortion to avoid additional unwanted pregnancy. The characteristics of family planning services after abortion is that the need and objective condition for reproductive womens to offer service，so these services are more acceptable and more effective. The goal of this service is to help each woman decide whether or not need to select methods that are appropriate for their individual and with their partner used effectively. Health care after induced abortion is the service after induced abortion. It has become a vital ingredient of high quality service for reproductive health. Services after induced abortion include community service after induced abortion，contraceptive consultation service， treatment service，family planning services and reproductive health and other general health service. The focal point of this article is family planning services after induced abortion. Related Articles | Metrics

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Study and Current Status of Male Vas Sterilization in China GU Yi-qun 2010, 29 (5):  320-323.  Abstract ( 2411 )   PDF (317KB) ( 7342 )   The methods that are available for male fertility control are namely coitus interrupters， condom and vas sterilization. In the recent 30 years，investigators in China made improvement of vasectomy in order to enhance contraceptive efficacy and reduce complications. The improved vas sterilization was divided into occlusive and non-occlusive methods. It is crucial to develop safe，effective and reversible male contraceptive methods. Among the methods for male contraception that are being investigated，improved surgical approach is close to clinical application. Related Articles | Metrics

热点问题

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Situation fo Repeated Induced Abortion and Post-abortion Care in China CHENG Yi-min;ZHOU You. 2010, 29 (5):  324-326.  Abstract ( 2450 )   PDF (238KB) ( 7222 )   Reproductive health（RH）is a core of human development. More and more scientists pay more attention to RH. Safe abortion is one of five components of reproductive health strategy which put forward in 2004. Chinese experts have done a lot of researches on induced abortion. This paper discusses situation of repeated induced abortion and post-abortion care in China in two parts respectively. First，we conduct literature reviews on repeated induced abortion for last twenty years. We summary the distributions of repeated induced abortion in different sub-populations and analyze major influent factors related repeated induced abortion. Then，we discuss the concepts and five core components of post-abortion care as well as situation post-abortion care in China. We will provide scientific evidences for relevant policy recommendations on reducing repeated abortion and carrying out standardized post-abortion care in China from different perspectives according to the research results of quantitative research and qualitative research. Related Articles | Metrics

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Post-abortion Counseling and Education QIN Jun-pu;ZHANG Di-kai. 2010, 29 (5):  327-328.  Abstract ( 2952 )   PDF (214KB) ( 7273 )   Because of a widespread lack of contraceptive knowledge，the rate of abortion and repeat abortion among Chinese women are both high，which has been an important issue of reproductive health. It is proved that post-abortion care could increase the rate of effective contraceptive use and decrease repeated abortions. As a core part of post-abortion care，post-abortion counseling and education（PACE）has been highly praised for its standardization and efficiency recently. The studies indicated that，PACE increased the rate of effective contraceptive use and decreased the rate of unwanted pregnancies and repeated abortions significantly. Nevertheless，it is still a long way for China to make improvement in post-abortion care. PACE should be enhanced urgently. Related Articles | Metrics

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A Study on Need and Obstacle of Immediate Postplacental Insertion among Internal Migrant Women in Shanghai HUANG Yong-mei;ZHUANG Chan-juan;ZHU Hao-ping;MAO Mei-li;CHEN Qiu-ju;CHENG Li- nan 2010, 29 (5):  329-332.  Abstract ( 3337 )   PDF (258KB) ( 7423 )   Objectives: To learn about the need of immediate postplacental insertion （IPPI）among internal migrant women and health providers’attitude about IPPI and explore the possibility of providing IPPI at hospitals where provide delivery services at affordable prices for impoverished migrant women. Methods: Questionnaire surveys were carried out among 841 internal migrant women and 343 health providers，and 16 health providers were chosen to participate in group interviews. EpiData 3.1 was used for data management and SAS6. 12 was performed for quantitative data analysis. Qualitative data was analyzed by qualitative methods. Results: Out of 841 internal migrant women，37.0 percent were willing to accept IPPI. Unconditional multivariate logistic regression showed that women with elder age and cesarean section were associated with increased possibility of IPPI. Main causes of declining IPPI included ignorance，willingness to use other contraceptive methods，and concerns about side effects. Only 7.3 percent of interviewed health providers agreed with IPPI. Reasons of health providers disagree with IPPI included that reproductive system has not yet resumed，IUD easy to fall off，and higher risk for surgery among lactation，etc. Conclusions: Over one third migrant women are willing to accept IPPI. Hospitals providing delivery service for impoverished migrant women are appropriate place for IPPI. Moreover，it is necessary to provide technological and theory training for health providers to change their service awareness and attitude. Related Articles | Metrics

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A Survey on Ectopic Pregnancy with IUD in Situ in Shanghai TONG Chuan－liang;LIU Xiao－ai;GE Hui－ ling;KANG Jian－zhong;WU Yu;CAO Chang－sheng 2010, 29 (5):  333-335.  Abstract ( 2894 )   PDF (270KB) ( 7276 )   Objective：To understand the current situation of ectopic pregnancy with intrauterine device (IUD) in situ and their characteristics in Shanghai, with an aim to provide a scientific basis to make strategies for their prevention. Methods：A census survey was carried out for investigating all cases of ectopic pregnancy with IUD in situ, who were diagnosed from September to November 2006 in all ninety鄄three public hospitals in Shanghai. Results：A total of 337 cases of ectopic pregnancy in situ were investigated; among which 172 cases of Shanghai and nationality（缘1.0%）, 165 cases of non-Shanghai nationality（49.0%）; The mean age was （33.1 依5.0）years old, of which Shanghai nationality were older than those non鄄Shanghai nationality[（34.4依4.8）years old vs（31.7依4.8）years old, P<0.01]. 70% of subjects used circular ring IUD，the mean retention time of the IUDs in vivo was 6 years, and the difference of retention time of IUDs between Shanghai nationality and non鄄Shanghai nationality was statistically significant (8 years vs 4 years respectively, P=0.001). The difference of ratios between Shanghai nationality and non鄄Shanghai nationality within the same insertion pattern was not statistically different. Conclusions：In order to minimize the risk level, awareness of ectopic pregnancy with IUD in situ should be emphasized among futile鄄aged women with IUD insertion, especially for those with cesarean section history and condom use during the ovulatory period is suggested for those women. It is suggested to Shanghai Municipal Government that free of charge services or some amount of subsidy should be provided to ectopic pregnancies with IUD in situ who meet the requirements Related Articles | Metrics

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Removal of Complicated Intrauterine Contraceptive Device in 47 Cases under Hysteroscopy CHEN Xiu- juan;LI Hong;CAI Liang-zhi. 2010, 29 (5):  336-337.  Abstract ( 2443 )   PDF (181KB) ( 7208 )   Objective：To probe into the clinical value of hysteroscopy in removal of complicated IUD. Methods：A retrospective analysis was carried out in 47 cases from January 2006 to December 2009 in our hospital with complications associated with IUD and removed IUD under hysteroscopy. Results：In 47 cases, IUDs of 42 cases were removed under Hysteroscopy including 17 cases of IUD embedded in the myometrium, 8 cases of broken IUD, 4 cases of ectopic IUD, 16 cases of IUD fractured with incarceration, 2 cases of ring fracture with incarceration and 6 cases of intrauterine adhesions. In 4 ectopic IUD cases, 2 cases were removed by laparotomy and 2 cases removed under laparoscopy, respectively. Conclusions：Hysteroscopy used in removal of complicated IUD can provide direct observation intrauterine ring, and have the advantages of safety and effectiveness, clear diagnosis, high success rate and less trauma. Those cases that had been failed to be removed IUD conventionally or had uterine space鄄occupying lesions, uterine abnormalities, intrauterine adhesions, ectopic ring, incarcerated, cracked and atrophy in postmenopausal uterus, which should be removed IUD under hysteroscop and Type鄄B ultrasonic should be combined with if necessary. Related Articles | Metrics

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Advance in Hormonal Male Contraception LI Hong-jun;GU Yi-qun. 2010, 29 (5):  340-342.  Abstract ( 2455 )   PDF (564KB) ( 7466 )   The ideal male contraceptive agent would be highly effctive，safe，accessible，inexpen原 sive，long鄄acting yet rapidly reversible，and culturally acceptable. Unfortunately，such an ideal has been elu原 sive，hormonal male contraception could be a suitable candidate，and might become a reality in the near fu原 ture. In this review article，the mechanisms and advances of hormonal male contraception were introduced， and the common methods of hormonal contraceptive agent for male were sumarrized，including testosterone alone，testosterone鄄progestagen combination，testosterone鄄GnRH ananlog combination，hormonal immunol contraceptive agent，especially Chinese pioneer research in this area bring us a step closer to making this great leap forward. Related Articles | Metrics

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Contraception for Women at Premenopause Period XU Jin-xun;CHENG Li-nan. 2010, 29 (5):  343-345.  Abstract ( 3153 )   PDF (234KB) ( 7271 )   To avoid unwanted pregnancy，the majority of women at pre-menopause need an effective method of contraception until they have reached their menopause. As to methodology，no contraceptive measure is contraindication by advanced reproductive age alone. As some physiology changes at premenopausal period，including menstrual cycles，it may be some complicated for women over 40 to choose a family planning method suitable for them. This review mainly elaborates the adaptability，risks，and non- contraceptive benifits of the most used contraceptive measures for women at pre鄄menopause，as well as the suggestion of the time to discontinue contraception for the older women. Related Articles | Metrics

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Use of Combined Oral Contraceptives Post-abortion CHEN Xiu-ying;HUANG Li-li. 2010, 29 (5):  346-348.  Abstract ( 1995 )   PDF (254KB) ( 7272 )   Induced abortion is a kind of remedial measure after contraceptive failure. However， induced abortion is hazardous to the women’s physical and mental health，particularly repeat abortion. Because of ovulation recovery quickly after abortion and women resumption of sexual life early，the incidence of repeat abortion increased. So the contraception issue after abortion is widely concerned. At present, some researchers considered that administration the combined oral contraceptive immediately after abortion is a safe and effective contraceptive measure. There are a great variety of combined oral contraceptive pills, with fewer side effects, higher safety. Related Articles | Metrics

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Hereditary Factor of Unexplained Recurrent Spontaneous Abortion Lu Xing-yu;CAI Xia. 2010, 29 (5):  349-352.  Abstract ( 2453 )   PDF (239KB) ( 7249 )   Unexplained recurrent spontaneous abortion （哉砸杂粤）is a complex disease controlled by various genes. The occurrence of URSA is estimted as 50% of recurrent spontaneous abortion（RSA）. 砸ecently, many studys indicate that there are compact association between URSA and gene polymorphisms. There are association between URSA and human leucocyte antigen （匀蕴粤）of immune system and 糟藻造枣葬糟贼燥则早藻灶藻 责燥造赠皂燥则责澡蚤泽皂泽, 蚤灶澡藻则蚤贼藻凿贼澡则燥皂遭燥责澡蚤造蚤葬糟燥则则藻造葬贼藻凿早藻灶藻责造葬泽皂蚤灶燥早藻灶葬糟贼蚤增葬贼燥则蚤灶澡蚤遭蚤贼燥则（孕粤陨原员），灾枣葬糟贼燥则， m藻贼澡赠造藻灶藻贼藻贼则葬澡赠凿则燥枣燥造葬贼藻则藻凿怎糟贼葬泽藻（酝栽匀云砸）葬灶凿葬责燥造蚤责燥责则燥贼藻蚤灶，责则燥早藻泽贼藻则燥灶藻则藻糟藻责贼燥则（孕砸）and insulin鄄like growth factor gene polymorphisms. It’s pathogenesis is illuminated at the gene level，which will guide clinical prevention, therapy and prognosis. Today, the survey on URSA is becoming hot spot increasingly. This text will overview these correlated surveys in recent years. Related Articles | Metrics

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Research Progress of Cystic Fibrosis Transmembrane Conductance Regulator Gene and Male Infertility LUO Fang-ye;CAI Xia. 2010, 29 (5):  353-356.  Abstract ( 2546 )   PDF (248KB) ( 7295 )   Cystic fibrosis（CF）is a very common and deadly euchromosome recessive genetic disease among white people. It is a kind of genetic disease caused by cystic fibrosis transmembrane conductance regulator’s (CFTR) genic mutation. Cystic fibrosis transmembrane conductance regulator’s genic mutation often shows with congenital bilateral absence of the vas deferens (CBAVD)，congenital unilateral absence of the vas deferens (CUAVD) and the low quality of sperm in male infertility. Intracytoplasmic sperm injection technique gives those patients the chance of producing generations but it can also inherit their generations with mutation gene preimplantation genetic diagnosis （PGD）and genetic risk analysis can avoid a embryo with genetic mutation to plant in uterus and improve the quality of fertility. Related Articles | Metrics

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New Advancement of VCT Carried in China and Related Factors LI Na;WU Jun-qing. 2010, 29 (5):  357-361.  Abstract ( 2775 )   PDF (320KB) ( 7324 )   In order to strengthen AIDS prevention and control，HIV/AIDS Voluntary Counseling and Testing (VCT) was introduced，which encourages people who engaged in high鄄risk behavior to take voluntary rather than mandatory HIV testing. It mainly provides services of counseling，supports and referral before and after testing. VCT can not only discover and treat PLWHA（people Living with HIV/AIDS），but also provide psychological support to them. In these review，the latest development of VCT in China and the related factors are stated. As an entry point of conducting intervention，treatment and care for PLWHA，VCT is highlighted for attention in China. Since 2003，the VCT service for free has been throughout every province. And data from CDC in the year of 2008 showed that there were more than 6000 VCT sites in China. The study also showed that the main factors influencing the expansion and use of VCT service include policy，social and family supportive environment，quality of service，accessibility of service and the KAP of service target. To promote the VCT services，it needs support from policy，social and family，as well the capacity building of the service providers. Related Articles | Metrics

讲座

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The Principle and Skills of Sexual and Reproductive Health Integrated Counseling WU Jun-qing;LI Yu- yan. 2010, 29 (5):  362-363.  Abstract ( 2058 )   PDF (210KB) ( 7241 )   Since the year of 2004, a national project about integrated sexual and reproductive health (SRH) counseling was conducted in China. Firstly, the integrated SRH training was implemented in 5 provinces of China. And the training curriculums named Sexual and Reproductive Health Integrated Counseling Skills Trainer’s Manual and Participant’s Handbook were published. People-oriented, Neutral Value, Talking about Sex frankly and Integrated Counseling are the main attitudes of the SRH counseling. Rapport-building, exploration, decision-making, implementing the decision by clients themselves are the four steps of the counseling. And asking questions, listening, paraphrasing, using language that clients can understand and using visual aids to explain reproductive anatomy and physiology are the five counseling skills of the SRH counseling. Related Articles | Metrics

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Diagnosis and Treatment of Postabortal Infections HUANG Zi-rong; 2010, 29 (5):  364-365.  Abstract ( 3003 )   PDF (189KB) ( 7351 )   Postabortal infections affect the women’s reproductive health significantly. It is caused by sexually transmitted infection，overgrown vaginal flora and iatrogenic infection. Family planning surgery is the major way of iatrogenic infections. General preventive guidelines for postabortal infections include the following：understanding the case history carefully and following the operative indications strictly before the operation，performing surgical operations with appropriate techniques，stopping the blood and repairing the tissue injury immediately during the surgery，and presumptive treatment with appropriate antibiotics. Postabortal infections are often caused by the various vaginal flora，therefore broad鄄spectrum antibiotics or in combination should be chosen. Appropriate dose of antibiotic should be applied in order to prevent chronic pelvic inflammatory disease. Supportive therapy at the time of antibiotic treatment may be useful for the treatment efficacy. Related Articles | Metrics

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Relationship Between Pregnancy-associated Plasma Protein A and Hepatitis B Virus Infection and Missed Abortion WANG Ming-zhen;YU Xiao-hui;HUAI Zhong-mei;YAN Qun. 2010, 29 (5):  369-371.  Abstract ( 3578 )   PDF (248KB) ( 7451 )   Objectives：To explore the impacts of PAPP鄄A (Pregnancy鄄associated plasma protein A) and HBV (Hepatitis B virus) on missed abortion. Methods: The serum and tissues of villus and decidua of the missed abortion patients (experimental group) and the normal pregnancies that have artificial abortion(control group) were collected. The serum level of PAPP鄄A was detected by double antibody Sandwich enzyme鄄linked immunosorbent technology (Sandwich ELISA); The HBV鄄DNA level in tissues of villus and decidua was tested by using the quantitative polymerase chain reaction (PCR), and the relationship between the level of PAPP鄄A and HBV鄄DNA load was analyzed. Results: The levels of PAPP鄄A of the experimental group (whether or not infected with Hepatitis B) were all lower than that of the control group. For the subjects with HBsAg positive, the DNA seropositive rate of the experimental group (74.36%) was higher than that of the control group (15%， P＜0.01). For the subjects with HBV鄄DNA positive, the serum DNA load and the DNA load in the tissue of villus and decidua being higher than 1.0伊102 of the experimental group was higher than that of the control group （P＜0.01, P＜0.05). HBV鄄DNA load in villus tissue showed positive correlation to the virus load in the peripheral blood （P＜0.05）. Conclusions：The decreasing of serum PAPP鄄A level in early trimester of pregnancy can predict the probability of missed abortion. The higher serum HBV鄄DNA load of the pregnancy women was one of the factors that caused intrauterine embryo HBV鄄infection in early pregnancy and the missed abortion. Related Articles | Metrics

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The Diagnostic and Therapeutic Developments of Salpingemphraxis SONG Juan;LIU Wei-hui;WU Li- ying. 2010, 29 (5):  374-376.  Abstract ( 2930 )   PDF (253KB) ( 7303 )   Salpingemphraxis is the first main type for infertilitas feminis. Meanwhile the incidence of salpingempraxis is increasing year by year. Accordingly，the diagnostic and therapeutic methods are also pushed to be improved. In terms of the complicated causes for salpingemphraxis，the concept of its diagnosis has been greatly changed，from blind and arbitrary to direct and exact. Although the therapeutic modes have been modified for several times，minimal invasion is the permanent pursuit. This can be detailed as following， from traditional medication and open surgery to microsurgery and interventional therapy，further to endoscopic techniques. Because the reasons for salpingempraxis are very complex，single therapeutic manner hardly gets satisfying effect. Thus how to select proper therapeutic methods puzzles accoucheurs. By summarizing recent progresses in the diagnosis and therapy of salpingemphraxis，this paper intends to provide some suggestions. Related Articles | Metrics

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Female Vaginal Micro-ecological Environment and Reproductive Tract Infections LIN Nong;ZHANG ei-jia. 2010, 29 (5):  377-379.  Abstract ( 2540 )   PDF (246KB) ( 7312 )   The normal vaginal micro鄄ecological of women is an important indicator of their reproductive health and a variety of factors can affect the micro-cological imbalance，followed by endogenous vaginal micro-rganisms diseases and alien microbial invasion lead to all kinds of vaginal inflammation，and cause the endometritis in severe cases and even the pelvic inflammatory diseases. As a result，adverse pregnancy outcomes and infertility occur，which seriously affect the quality of work and life. Among the common gynecological infectious diseases in clinic，many have an obvious imbalance in the vaginal microbial systems，which is of concern in recent years. To understand and show much concern for the balance of the vaginal microenvironment has the great significance on the treatment for infections of reproductive system， which is the new treatment concept from the previous concept of killing micro-rganisms to increase the probiotics and restore normal vaginal micro-cological environment，thus enhancing cure rate and reducing the recurrence and reinfection. Related Articles | Metrics