Effectiveness, safety, and acceptability of postplacental insertion of GyneFix postpartum intrauterine device among women undergoing cesarean section: A multicenter prospective cohort study in China.

OBJECTIVES: To assess the effectiveness, safety, and acceptability of postplacental insertion of GyneFix postpartum intrauterine device (PPIUD) in women undergoing cesarean section (C-section). STUDY DESIGN: We conducted a prospective cohort study at 14 hospitals in four eastern coastal provinces of China between September 2017 and November 2020. A total of 470 women who underwent C-section and consented to the postplacental insertion of GyneFix PPIUD were enrolled, and 400 completed the 12-month follow-up. Participants were interviewed in the wards after delivery and followed up at 42 days, and months 3, 6, and 12 after delivery. We used Pearl Index (PI) to measure the rate of contraceptive failure, life-table method to measure the rate of PPIUD discontinuation, including IUD expulsion, and Cox regression model to explore the risk factors associated with discontinuation of the device. RESULTS: Nine pregnancies were detected during the first year after GyneFix PPIUD insertion: seven were due to device expulsion and two occurred with PPIUD in situ. The PIs for overall 1-year pregnancy rate and pregnancies with IUD in situ were 2.3 (95% CI: 1.1-4.4) and 0.5 (95% CI: 0.1-1.9), respectively. The 6- and 12-month cumulative expulsion rates for PPIUD expulsion were 6.3% and 7.6%, respectively. The overall 1-year continuation rate was 86.6% (95% CI: 83.3-89.8). We did not identify any patient with insertion failure, uterine perforation, pelvic infection, or excess bleeding due to GyneFix PPIUD insertion. Women's age, education, occupation, previous history of C-section, parity, and breastfeeding were not associated with removal of GyneFix PPIUD in the first year of use. CONCLUSIONS: Postplacental insertion of GyneFix PPIUD is effective, safe, and acceptable for women undergoing C-section. Expulsion is the most common reason for GyneFix PPIUD discontinuation and pregnancy. The expulsion rate for GyneFix PPIUD is lower than that for framed IUDs, but more evidence is needed for a firm verdict.

Care willingness and demand of residents under 60 years of age in western China: a cross-sectional study.

OBJECTIVES: The objective was to examine care willingness and demand of residents under 60 years of age after retirement. SETTING: The staged cluster sampling method was used between August and October 2018 in Dujiangyan, Sichuan Province, China. PARTICIPANTS: 2282 participants under 60 years of age were surveyed in 2018 by the staged cluster sampling method in China. PRIMARY AND SECONDARY OUTCOME MEASURES: The results of care willingness and demand were assessed by multiple comparisons of χ2 test and multivariable logistic regression. RESULTS: The respondents who preferred institution-based care, home-based care and community-based care accounted for 39.5%, 38.3% and 20.2% respectively, whereas only 2.1% preferred home-based self-care. The main reasons for the respondents to choose institution-based care included better medical care (31.9%), better daily care (27.0%), burden reduction for children (26.3%), better accommodation (22.8%), satisfied living environment (21.6%) and low consumption (12.3%). The factors that affected care willingness and demand included age, ethnicity, educational attainment, marital status, occupation and the current type of residence. CONCLUSIONS: The results revealed the care willingness and demand of residents under 60 years of age after retirement and relevant decision factors. This study provides a certain theoretical and practical significance for the development of the care willingness mode and promotes the cognition of policy-makers and researchers, and also provides the basis for decision-making.

Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai.

BACKGROUND: Rural-to-urban migrant women in Shanghai have poor reproductive health; the incidence of postpartum unintended pregnancy and contraceptive practices has not been adequately studied in this population. STUDY DESIGN: This retrospective study examined the incidence of postpartum unintended pregnancy and associated factors among migrant women and included a medical records reviews, telephone interviews and in-depth face-to-face interviews. RESULTS: The incidence of unintended pregnancy during the first and second years postpartum was 12.8 and 12.9 per 100 women-years, respectively. Eighty-six percent resulted from nonuse of contraception, and 88% ended in induced abortions. Median times of sexual activity resumption and contraception initiation were 2 months and 7.5 months postpartum, respectively. Approximately 17% of women did not adopt effective contraceptive methods until undergoing induced abortion. CONCLUSIONS: Concentrated efforts, including contraception counseling prior to discharge and early postpartum visits, are required to increase early use of effective contraception among rural-to-urban migrant women in Shanghai and to reduce their high level of postpartum unintended pregnancy.

Termination of second-trimester pregnancy by mifepristone combined with misoprostol versus intra-amniotic injection of ethacridine lactate (Rivanol®): a systematic review of Chinese trials.

BACKGROUND: Mifepristone combined with misoprostol for second-trimester abortion (MM) and intra-amniotic injection of ethacridine lactate (EL; Rivanol®) are the common methods for termination of second-trimester pregnancy in China. The systematic review of relevant literature was conducted to evaluate the effectiveness and safety on termination of second-trimester pregnancy using MM, introduced in 1988 in China, versus the Chinese routinely used method since 1970 -- EL. The review was conducted to evaluate mifepristone combined with the misoprostol versus intra-amniotic injection of ethacridine lactate in China for termination of second-trimester pregnancy with respect to efficacy, side effects, complications and so on. STUDY DESIGN: The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, POPLINE, TOXLINE, World Health Organization-Department of Reproductive Health and Research, Chinese Biomedical Literature Database, Chinese Journal Full-text Database and Chinese Science & Technology Journal Database were systematically searched. Reference lists for English and Chinese-language reports (published from 1966 to 2008) were searched. All randomized controlled trials (RCTs) on second-trimester abortion by combination of mifepristone and misoprostol versus ethacridine lactate, which conducted in China, were analyzed. Trial quality was assessed, and data extraction was made independently by two reviewers. RESULTS: Fifteen original RCTs using MM versus EL were included. Three trials used oral misoprostol, six trials used vaginal misoprostol, and six trials used oral plus vaginal misoprostol. Failure rate of abortion was 2.0% to 5.9% in the MM group and 7.4% to 20.7% in the EL group. The incidence of postabortion curettage was similar in the two groups. The time of labor and hospitalization for abortion in the MM group were shorter compared with EL group. The blood loss within 2 h of abortion in the MM group was significantly less than that in the EL group, but the blood loss within 24 h of abortion was the same in both groups. More gastrointestinal side effects occurred with the MM regimen, whereas cervical injury occurred more often in the EL group. CONCLUSIONS: Compared with the intra-amniotic injection of ethacridine lactate, mifepristone/misoprostol has a higher success rate and shorter time of labor with more gastrointestinal side effects for termination of second-trimester pregnancy.

Mifepristone in combination with prostaglandins for termination of 10-16 weeks' gestation: a systematic review.

OBJECTIVES: Medical regimens using mifepristone in combination with prostaglandins have been widely available for women undergoing termination of pregnancy (TOP) at 10-16 weeks' gestation in China. We undertook a systematic review to compare different regimens of mifepristone with prostaglandins for TOP at 10-16 weeks' gestation. METHODS: We searched multiple electronic databases for English and Chinese language reports (1990-2007) including MEDLINE, the Cochrane Library and the Chinese Biomedical Literature Database. Included were trials comparing mifepristone with prostaglandins (misoprostol, gemeprost or carboprost (PG05)) to each other for women at 10-16 weeks' gestation. Outcomes were successful abortion rates, induction-to-expulsion time, blood loss and side effects. Data were processed with RevMan 5 software. RESULTS: Nineteen trials comparing mifepristone with prostaglandin (misoprostol and PG05) were found of which 14 contributed to meta-analyses (4206 women). The quality of reports was poor. The effectiveness of vaginal mifepristone/misoprostol was super than mifepristone/PG05 (RR 1.14, 95%CI 1.05-1.22) as was induction-to-expulsion time, blood loss and side effects. When comparing misoprostol/mifepristone 150mg to misoprostol/mifepristone 200mg, no difference in TOP success rates were found (RR 0.98, 95%CI 0.96-1.01). Misoprostol vaginally compared to orally significantly increased the TOP success rate (RR 1.12, 95%CI 1.01-1.24). Gastrointestinal symptoms and fever occurred more often in misoprostol oral group (RR 1.67, 95%CI 1.46-1.91). CONCLUSIONS: Medical regimens of mifepristone/prostaglandins were effective and safe for TOP at 10-16 weeks' gestation. Misoprostol was super than PG05, and misoprostol vaginally was found to have better effectiveness than misoprostol orally. Further research should evaluate the relative effectiveness of medical methods compared to surgery.

[Mechanism of hypoxia inducing factor-1α in low endometrial receptivity].

OBJECTIVE: To study the mechanism of hypoxia inducing factor-1α (HIF-1α) pathway in establishment of hypoxia inducing low endometrial receptivity. METHODS: RL95-2 cell lines, the ideal model of study ER, were cultured in hypoxia condition induced by CoCl2, and the expression of mRNA and protein of HIF-1α and tumor necrosis factor like weak inducer of apoptosis (TWEAK) were measured by reverse transcription-PCR and western blot. The apoptosis rate was analyzed by flow cytometry. Then the mechanism confirmed by comparing the two factors in endometrium and the ultra-appearance of inflammatory reaction and apoptosis between recurrent spontaneous abortion women and control women. RESULTS: (1) On different time point (0, 12, 24, 48 hour), mRNA expression of HIF-1α were 0.272 ± 0.010, 0.354 ± 0.020, 0.591 ± 0.020, 0.890 ± 0.020, while the expression of TWEAK were 0.104 ± 0.010, 0.510 ± 0.020, 1.021 ± 0.020, 1.237 ± 0.040, respectively, the expression level between 12, 24, 48 and 0 hour all showed significant differences (P < 0.05). (2) Protein expression of HIF-1α were 0.853 ± 0.010, 0.931 ± 0.030, 1.124 ± 0.010, 1.317 ± 0.020 respectively, while was 0.042 ± 0.010, 0.091 ± 0.010, 0.131 ± 0.020, 0.205 ± 0.030 in TWEAK expression, the different level were statistically significant (P < 0.05). (3) With longer culture under hypoxia, the cell apoptosis rate increased obviously. The apoptosis rate of each time point were (3.2 ± 1.4)%, (16.2 ± 3.2)%, (26.3 ± 3.5)%, (31.8 ± 3.5)%, the differences between 12, 24, 48 and 0 hour had significance (P < 0.05). (4) The positive rate of HIF-1α stained in epithelium cells and stroma cells of test group were 32.3%, 8.4% and 16.7%, 7.3% in control group. The positive rate of TWEAK were 28.3%, 3.9% in recurrent spontaneous abortion group and 11.6%, 2.7% in control group (P < 0.05). The ultra-appearance of inflammatory cell infiltrated and apoptosis were obvious in test group. CONCLUSIONS: Cell inflammation reaction and apoptosis induced by HIF-1α pathway may participate the mechanism of hypoxia inducing low endometrial receptivity. HIF-1α might become a novel target for improving poor endometrial receptivity.

[Effect of maternal antepartum psychological therapy upon early infant temperament].

OBJECTIVE: To find out whether there was any change in early infant temperament after mothers had received group psychological therapy on depression and anxiety during pregnancy period. METHODS: A total of 800 subjects meeting the inclusion criteria, without the exclusion criteria and willing to sign the informed consent were recruited randomly from Shanghai International Peace Maternity & Child Health Hospital in their l6th-20th weeks of pregnancy. They were randomized into the therapy group and the control group by the doll randomization table. Women in the therapy group would have a group psychological therapy for 6 times, 1.5 hours each time, while the control group not. The group psychological therapy included therapist introduction and participatory discussion. The therapy concerned the antepartum and postpartum depression, the risk factors concerned with antepartum and postpartum depression, antepartum and postpartum anxiety, psychological defense theory, reflex training and spouse lesson. Mothers reported their babies' infant temperament by filling the early infant temperament questionnaire (EITQ) within 3 months post-delivery. RESULTS: The percent of easy infant temperament type was 87.9% in the psychological therapy group and 81.7% in the hard group. And there was significant difference between two groups (chi2 = 4.530, upsilon=1, P = 0.033). And there were significant differences in the dimensions of approach-withdrawal and threshold of responsiveness in infant temperament between two groups. CONCLUSION: The maternal antepartum psychological therapy can increase the ratio of easy infant temperament. And it has effects upon the temperament dimensions of approach-withdrawal and threshold of responsiveness.

[Efficacy and safety of drospirenone-ethinylestradiol on contraception in healthy Chinese women: a multicenter randomized controlled trial].

OBJECTIVE: To evaluate the contraception efficacy, mode of bleeding, side effects and other positive effects of drospirenone-ethinylestradiol (Yasmin) in healthy Chinese women. METHODS: This was a multicenter, randomized, control study of 768 healthy Chinese women who consulted about contraception. The subjects were randomized into Yasmin group (30 microg ethinylestradiol plus 3 mg drospirenone, 573 cases) or desogestrel group (30 microg ethinylestradiol plus 150 microg desogestrel, 195 cases) with the ratio of 3:1. Each individual was treated for 13 cycles. Further visits were required at cycle 4, cycle 7, cycle 10 and cycle 13 of treatment Weight, height, body mass index were evaluated at each visit. The menstrual distress questionnaire (MDQ) was given to the women at baseline, visit 3 (cycle 7) and visit 5 (after cycle 13). RESULTS: The values of basal features were similar between two groups (P > 0.05). The Pearl index (method failure) of Yasmin was 0. 208/hundred women year which was lower than that of desogestrel (0. 601/hundred women year). The mode of bleeding was similar between two groups after trial without showing any significant difference. According to MDQ subscale, the improvement of water retention and increasing appetite during inter-menstrual period and water retention and general well-being during menstrual period in the Yasmin group (-0.297, -0.057, 0.033, 0.150 respectively) was more obvious than that in the desogestrel group (-0.108, 0.023, 0.231, -0.023 respectively) with a significant difference (P < 0.05). Some other values which improved in both two groups, especially the improvement of breast tenderness and pain and skin abnormality in Yasmin group (18.0%, 89/494; 12.6%, 62/494) was more distinct than that in desogestrel group (11.3%, 19/168; 5.4%, 9/168). The mean weight increased in desogestrel group (0.57 kg) while it decreased in Yasmin group (-0.28 kg) with a significant difference (P < 0.01). CONCLUSIONS: Both Yasmin and desogestrel have good efficacy on contraception and similar modes of menstrual bleeding. Yasmin is better than desogestrel in terms of weight control and premenstrual syndrome of oral contraceptive.

Expressions of steroid receptors and Ki67 in first-trimester decidua and chorionic villi exposed to levonorgestrel used for emergency contraception.

Levonorgestrel (1.5 mg) is commonly used for emergency contraception to prevent an unwanted pregnancy after an unprotected intercourse. We found that postovulatory administration of 1.5 mg of levonorgestrel to women with a subsequent or existing early pregnancy did not affect the immunohistochemical expressions of estrogen receptors (ER(alpha), ER(beta)), P receptors (PR(B), PR(A+B)), androgen receptor (AR), or proliferation index Ki67 in the first-trimester decidua and chorionic villi.

Effects of ovarian stimulation on endometrial integrin beta3 and leukemia inhibitory factor expression in the peri-implantation phase.

OBJECTIVE: To investigate the effects of ovarian stimulation on endometrial receptivity in the peri-implantation phase. DESIGN: Comparison of integrin beta3 and leukemia inhibitory factor (LIF) expression in endometrial biopsies from moderate responders and high responders with temporally matched natural cycles. SETTING: Clinical and experimental research. PATIENT(S): Patients with cancelled embryo transfer were evaluated. Moderate responders were defined as E2 5,000-15,000 pmol/L on the day of hCG administration (group B, n = 7). High responders were defined as E2 >15,000 pmol/L on the day of hCG administration (group C, n = 8). Healthy and fertile volunteers were used as natural controls (group A, n = 10). INTERVENTION(S): Endometrial biopsy on the day of LH+7/hCG+7. MAIN OUTCOME MEASURE(S): Immunohistochemistry of integrin beta3 and LIF and imaging analysis. RESULT(S): Endometrial integrin beta3 and LIF expressions in the peri-implantation phase were significantly lower in stimulated cycles (including both moderate and high responders) compared to natural controls. Expression of LIF in glandular epithelium in high responders was lower than that in moderate responders. CONCLUSION(S): These data demonstrated that suggested markers of endometrial receptivity were reduced in stimulated cycles compared with natural cycles, and more so in high response cycles compared with moderate response cycles.

[Factors in relation to repeated abortions among unmarried young people in Shanghai].

OBJECTIVE: To study the factors related to repeated abortions among unmarried young people, and to standardize the services as informed choice counseling and post abortion, and to reduce the repeated abortion rate. METHODS: A cross-sectional survey using anonymous questionnaire was conducted among unmarried young women who requested termination of early pregnancy in 10 hospitals in Shanghai. RESULTS: 2343 subjects responded to the questionnaires. Results showed that the repeated abortion rate was 38.5%, repeated abortion rate within 1 year was 23.5%, and the high risk factors of abortion accounted for 40.2% . Subjects who were older than 19, unemployed, with poor education background, cohabitating and boyfriends being elder were more likely to have repeated abortions (OR > 1). Subjects who did not change boyfriend or use no contraception were more likely to have repeated abortions 1 year after abortion (OR > 1). CONCLUSION: No reliable contraception used after abortion seemed to be the main reason for repeated unwanted pregnancy. Being socially disadvantaged women such as unemployed or with poor education background, meanwhile cohabitating with boyfriends or boyfriends being elder etc. they should be viewed as the key population for intervention. Male involvement and reliable contraceptive methods use among young people should be emphasized as key steps for intervention. 1 year after abortion fell into the key period for intervention. Reinforcement on factors including: training for service providers to improve their skills, setting up standard technical process and monitoring systems to carry out the basic principle of 'Informed Choice', and widely launching post-coital contraception programs including emergency contraception, luteal phase contraception and menstrual induction should be stressed.

Effects of ovarian high response on implantation and pregnancy outcome during controlled ovarian hyperstimulation (with GnRH agonist and rFSH).

BACKGROUND: The study was aimed at investigating the effects of ovarian high response during controlled ovarian hyperstimulation (COH) on implantation and pregnancy outcome in fresh IVF/ICSI cycles, and subsequent frozen-thawed embryo transfer (FET) cycles. METHODS: An analysis of 1,196 cycles using a long protocol with GnRHa and rFSH was performed. A serum oestrial level (peak E(2)) was obtained on the day of hCG administration, and patients were grouped by peak E(2) percentile distribution into 3 groups. Normal responder was set as cut-off concentrations between percentile (P)25 and P75 (Group A: 1,199-3,047 pg/ml, 595 cycles). Moderate high responders were classified as peak E(2) between P75-P90 (Group B: 3,048-4,127 pg/ml, 180 cycles). For the high response group, the E(2) cut-off concentration was set as P90 and above (Group C: >or=4,128 pg/ml, 119 cycles). Oocyte/embryo parameters and clinical outcomes were compared among the 3 groups in fresh cycles and subsequent FET cycles. RESULTS: Comparisons between groups revealed no difference in the quality of oocyte retrieved and in fertilisation rates. Group C showed decreased trends in implantation and pregnancy rates compared with Group A, but statistical significance was reached only for the difference in implantation rates. Implantation and pregnancy rates in FET cycles were similar among the 3 groups. CONCLUSIONS: High serum estrogen levels were detrimental to implantation, but not to the quality of oocytes, which may be due to an adverse effect on endometrial receptivity in COH cycles.

[Effects of mifepristone of different doses on emergency contraception, a randomized double-blind study].

OBJECTIVE: To compare the effects of mifepristone of different doses on emergency contraception. METHODS: 3,052 healthy women with regular menstrual cycle who visited the 10 family planning institutes and hospitals in Beijing, Shanghai, Shangdong, Sichuan, Tianjin, Guangdong, and Liaoning for emergency contraception within the period of 120 hours after a single act of unprotected sex were given a single dose of 10 mg or 25 mg mifepristone randomly and double-blindly. They were asked to record the vaginal hemorrhage that would occur and not to have unprotected sex until the next menstrual onset when they were followed up. The trial for a specific subject ended when she menstruated. If the menstruation was irregular or a specific subject failed to menstruate on time a blood or urine human chorionic gonadotropin (hCG) test was made. If the hCG test was negative, an appointment was made to follow up once one week later. If the hCG test was positive ultrasound examination was made to detect pregnancy. If the subject still failed to menstruate and the hCG test was still negative follow-up for this subject could be finished. RESULTS: Twenty-two of the 3,052 subjects were lost to follow up. Among the remaining 3,030 women 1,516 were in the 10 mg group and 1 514 in the 25 mg group. Seventeen pregnancies occurred in each group, with a pregnancy rate of 1.1% for both groups. The relative risk of pregnancy of treatment of 25 mg mifepristone in comparison with treatment of 10 mg mifepristone was 1.0 (95% CI: 0.51-1.95). Both doses prevented about 85% approximately 86% of the anticipated pregnancy if no measure had been adopted. The pregnancy rate nearly doubled in the women who had unprotected sex after treatment of mifepristone. The efficacy of mifepristone decreased along with the delay of mifepristone administration. Side effects were uncommon and mild. Delay of 7 days or more in the onset of next menstruation occurred in 9%-10% of the women. CONCLUSION: Mifepristone of the dose of 10 mg is safe and effective for emergency contraception. Earlier administration is preferable, although the method can be used effectively up to five days after the unprotected sex.