辅助生殖技术助孕妊娠后患者晚期自然流产危险因素分析

目的 探讨辅助生殖技术 （ART）助孕妊娠后患者发生晚期自然流产的相关因素，阐明引起晚期自然流产的危险因素。 方法 采用回顾性分析研究方法，收集310例行ART助孕后妊娠患者的临床资料，根据患者妊娠结局不同分为足月产组（248例）和晚期流产组（62例）。记录2组患者一般情况、不孕症发病主要原因及相关因素、临床情况和妊娠结局情况，并将单因素回归分析中P<0.05的因素纳入多因素Logistic回归方程，进一步分析患者晚期流产的危险因素。 结果 2组患者既往晚期流产或早产次数、既往宫颈LEEP或锥切史、既往宫腔镜下电切史、多囊卵巢综合征（PCOS）病史、体质量指数（BMI）、周期类型、内膜厚度、是否双胎妊娠和排卵障碍比较差异有统计学意义（P<0.05）。将P<0.05的因素纳入多因素Logistic回归方程， BMI（OR=1.194，95%CI：1.088－1.311，P<0.01）、既往有晚期流产或早产史（OR=5.673，95%CI：1.189－27.069，P=0.029）、宫颈LEEP或锥切史（OR=5.113，95%CI：1.025－25.496，P=0.047）和双胎妊娠（OR=5.129，95%CI：2.377－11.067，P<0.01）是晚期自然流产的危险因素；与新鲜移植周期比较，冻融胚胎移植（FET）周期（OR=0.422，95%CI：0.219－0.814，P=0.010）是晚期流产的保护因素。 结论 既往早产或晚期流产史、宫颈手术、高BMI和双胎妊娠是ART助孕妊娠后晚期自然流产的危险因素，而FET是晚期自然流产的保护因素。

Analysis of risk factors of late spontaneous abortion after assisted reproductive technology-assisted pregnancy

Objective To investigate the factors associated with late spontaneous abortion after pregnancy in the patients assisted by assisted reproductive technology （ART） ， and to illuminate the risk factors for late spontaneous abortion. Methods Using retrospective research method， the clinical data of 310 pregnant patients underwent ART were collected； according to the different pregnancy outcomes of patients， they were divided into term birth group （248 cases） and late abortion group （62 cases）. The general situation， main causes and related factors of infertility， clinical situation and pregnancy outcomes of the patients in two groups were recorded， and the factors with P<0.05 in single factor regression analysis were included in the multivariate Logistic regression equation to further analyze the risk factors of late abortion. Results The differences in number of previous late miscarriages or preterm births， previous history of cervical LEEP or conization， previous history of hysteroscopic electrodesection， history of polycystic ovary syndrome（PCOS）， body mass index （BMI）， cycle type， endometrial thickness，whether twin pregnancies and ovulation disorder of the patients between two groups were statistically significant （P<0.05）.The factors with P<0.05 were included in the multivariate Logistic regression equation，BMI（OR=1.194，95%CI：1.088－1.311， P<0.01），previous history of late abortion or premature delivery（OR=5.673，95%CI：1.189－27.069， P=0.029）， history of cervical LEEP or conization（OR=5.113， 95%CI：1.025－25.496， P=0.047） and twin pregnancy（OR=5.129，95%CI：2.377－11.067，P<0.01） were the risk factors of late spontaneous abortion. Frozen thawed embryo transfer （FET） cycle was the protective factor of late abortion compared with fresh transplantation cycle （OR=0.422， 95% CI：0.219－0.814，P=0.010）. Conclusion Previous history of premature or late abortion， cervical surgery，high BMI and multiple pregnancy are the risk factors of late spontaneous abortion after ART-assisted pregnancy of the patients， while FET is the protective factor of late spontaneous abortion.