Huggins G R, Cullins V E
Department of Obstetrics and Gynecology, Francis Scott Key Medical Center, Baltimore, Maryland 21224.
Fertil Steril. 1990 Oct;54(4):559-73. doi: 10.1016/s0015-0282(16)53808-4.
There is a very small correlation, if any, between the prior use of OCs and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an OC containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take OCs, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The incidence of postoperative infection after first trimester therapeutic abortion in this country is low. However, increasing numbers of women are undergoing repeated pregnancy terminations, and their risk for subsequent pelvic infections may be multiplied with each succeeding abortion. The incidence of prematurity due to cervical incompetence or surgical infertility after first trimester pregnancy terminations is not increased significantly. Asherman's syndrome may occur after septic therapeutic abortion. The pregnancy rate after treatment of this syndrome is low. The return of menses and the achievement of a pregnancy may be slightly delayed after OCs are discontinued, but the fertility rate is within the normal range by 1 year. The incidence of postpill amenorrhea of greater than 6 months' duration is probably less than 1%. The occurrence of the syndrome does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of OCs may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for patients with spontaneous return of menses. The criteria for defining PID or for categorizing its severity are diverse. The incidence of PID is higher among IUD users than among patients taking OCs or using a barrier method. The excess risk of PID among IUD users, with the exception of the first few months after insertion, is related to sexually transmitted diseases and not the IUD. Women with no risk factors for sexually transmitted diseases have little increased risk of PID or infertility associated with IUD use. There appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users. All present methods of contraception entail some risk to the patient. The risk of imparied future fertility with the use of any method appears to be low.(ABSTRACT TRUNCATED AT 400 WORDS)
口服避孕药（OC）的既往使用与先天性畸形（包括唐氏综合征）之间即便存在关联，也非常微弱。关于孕期早期服用含1毫克孕激素的OC的母亲所生女性胎儿男性化的近期报道极少。然而，疑似怀孕且希望继续妊娠的患者不应继续服用OC，也不应采用孕激素撤药妊娠试验。此类女性所生婴儿出现先天性异常的情况仍令人担忧。该国孕早期治疗性流产术后感染发生率较低。然而，越来越多的女性正在经历反复终止妊娠，且每次后续流产时她们发生盆腔感染的风险可能会成倍增加。孕早期终止妊娠后因宫颈机能不全或手术性不孕导致的早产发生率并未显著增加。感染性治疗性流产后可能发生Asherman综合征。该综合征治疗后的妊娠率较低。停用OC后月经恢复及妊娠可能会稍有延迟，但1年后生育率在正常范围内。服药后闭经持续超过6个月的发生率可能低于1%。该综合征的发生似乎与用药时长或避孕药类型无关。既往月经正常以及服用OC前月经异常的患者都可能发生该综合征。雌激素和促性腺激素水平正常的患者在用克罗米芬治疗后通常会恢复月经和排卵。妊娠成功率远低于月经自然恢复的患者。定义盆腔炎（PID）或对其严重程度进行分类的标准多种多样。宫内节育器（IUD）使用者中PID的发生率高于服用OC或采用屏障避孕法的患者。IUD使用者中PID的额外风险（插入后的头几个月除外）与性传播疾病有关，而非与IUD有关。无性传播疾病风险因素的女性使用IUD时发生PID或不孕的风险几乎没有增加。杀精剂使用者中先天性异常、性别比例改变或早期妊娠丢失的风险似乎并未增加。目前所有的避孕方法都给患者带来一定风险。使用任何方法对未来生育能力造成损害的风险似乎都较低。（摘要截选至400词）
