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目的分析既往自然流产胚胎染色体异常(previous chromosome abnormality miscarriage,PCAM)患者囊胚的染色体异常率及其影响因素。方法回顾性研究比较因PCAM(PCAM组)和因单基因遗传性疾病(对照组)进行植入前胚胎非整倍体遗传学筛查(preimplantation genetic testing for aneuploid,PGT-A)患者的活检囊胚染色体异常率,并分析其与双方年龄、基础促卵泡激素(FSH)、FSH/黄体生成素(LH)、体质量指数(BMI)、既往自然流产次数、新鲜取卵周期数、MⅡ卵子率、受精率、囊胚形成率、活检囊胚数和有无PCAM的关系。结果多重线性回归分析显示,仅女方年龄和有无PCAM对活检囊胚的染色体异常率有影响。女方年龄≤30岁、31~34岁和35~38岁,PCMA组和对照组的囊胚染色体异常率分别为25.29%、27.43%、45.76%和18.22%、19.85%、31.55%(P=0.034、P=0.044、P=0.011);38岁时,PCMA组和对照组的囊胚染色体异常率分别为63.64%和46.15%(P=0.227)。结论 38岁PCAM患者的囊胚染色体异常率超过60%,建议行PGT-A以降低胚胎染色体异常导致的再次流产风险。35~38岁PCAM患者的囊胚染色体异常率明显高于对照组,可考虑行PGT-A。 相似文献
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目的探讨第3日(D3)胚胎质量对冻融囊胚移植周期(frozen-thawed blastocyst transfer,FBT)临床结局的影响。方法回顾性分析2013年3月—2017年2月在本院生殖中心行冻融双囊胚FBT的1 212个周期的临床资料,按移植囊胚所对应D3胚胎的形态学评分将患者分为双优质卵裂胚移植组、单优质卵裂胚组、无优质卵裂胚组;根据移植囊胚所对应D3胚胎卵囊球分为双8-细胞(8C)组、单8C组及非8C组,比较各组FBT的临床结局。结果 D3双优质卵裂胚组的胚胎种植率(44.7%)、临床妊娠率(68.3%)及活产率(54.9%)均显著高于D3无优卵裂胚组(34.4%、55.4%、41.1%;P=0.003、P=0.008、P=0.022);D3中双8C组的胚胎种植率(48.2%)、临床妊娠率(71.4%)及活产率(58.8%)均显著高于非8C组(40.1%、61.3%、45.2%;P=0.002、P=0.005、P=0.002),但多胎妊娠率(27.9%)明显高于D3非8C组(19.6%)。结论 FBT的临床结局与其对应D3胚胎质量密切相关,D3优质卵裂胚尤其8C源囊胚临床结局更佳;选择D3 8C来源的单囊胚或D3非优质卵裂胚来源的双囊胚移植,可在获得高活产率的同时,减少多胎妊娠率。 相似文献
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《生殖与避孕》2014,(9)
目的:探讨辅助生殖和自然妊娠中女性年龄与早期自然流产绒毛染色体数目异常的关系。方法:通过多重连接依赖探针扩增技术(MLPA)对55例自然妊娠(NC)、147例体外受精(IVF)妊娠和85例卵胞质内单精子注射(ICSI)妊娠孕早期自然流产的绒毛组织进行染色体数目检测,比较不同妊娠方式、不同染色体、不同异常染色体个数间女性年龄和非整倍体的关系。结果:NC组和IVF组中非整倍体的孕妇年龄显著高于绒毛染色体正常的孕妇年龄(NC组:35.0±5.0岁vs 31.6±4.1岁,P=0.014;IVF组:35.2±4.5岁vs 32.1±4.6岁,P=0.000),而ICSI组中无统计学差异(34.4±5.1岁vs33.5±4.1岁,P=0.391);NC组和IVF组随孕妇年龄的增长流产儿非整倍体率递增,IVF组有统计学差异(P=0.002),但ICSI组未观察到该现象。15、20、21和22号染色体异常率随孕妇年龄的增长递增,其中20、21号染色体有统计学差异(P0.05);13号染色体异常率在40~47岁亚组中显著增高(P=0.027);16号染色体在各孕母年龄段的异常率相近;性染色体异常率在40~47岁亚组中降低。多重非整倍体组的孕妇年龄显著高于单一非整倍体组(37.4±5.3岁vs 34.9±4.6岁,P=0.039),40~47岁亚组中多重非整倍体发生率显著增高(P0.05)。结论:女性高龄是NC和IVF妊娠非整倍体胎儿的高危因素,而ICSI可能还存在其他机制导致胎儿染色体异常。多重非整倍体及大部分小染色体非整倍体的流产儿多见于高龄孕妇,而性染色体单体流产儿则多见于较年轻孕妇,16-三体不存在母亲年龄效应。 相似文献
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目的:探讨妊娠早期孕妇心理压力与自然流产的关系。方法:选择2019年6月—2021年8月首都医科大学附属复兴医院妊娠早期患者,采用“早孕妇女心理健康状况调查表”,随访至妊娠12周,筛选出自然流产患者108例作为观察组,202例正常早期妊娠孕妇作为对照组。分析妊娠早期自然流产心理压力相关的危险因素,以及情绪调节策略对知觉压力及自然流产的调节作用。结果:观察组孕妇的知觉压力及妊娠期压力源各维度评分均显著高于对照组(P<0.01)。多因素Logistic回归分析显示,担心子代健康(OR=1.188,95%CI:1.006~1.402,P=0.042)、既往自然流产次数多(OR=2.740,95%CI:1.117~6.722,P=0.028)及知觉压力大(OR=1.194,95%CI:1.134~1.257,P<0.001)是自然流产的危险因素。情绪调节策略在知觉压力对自然流产的影响中起调节作用,其中“认知重评×知觉压力”是自然流产的保护因素(B=-0.067,OR=0.935,95%CI:0.915~0.957,P<0.001),“表达抑制×知觉压力”是自然流产的危险因素(... 相似文献
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《中国实用妇科与产科杂志》2015,(9)
目的探讨早期自然流产患者高密度脂蛋白(HDL)功能的改变及其与甲状腺自身免疫的关系。方法随访2012年3月至2014年9月青岛市市立医院妊娠妇女至妊娠14周、甲状腺功能正常的早期自然流产者68例(流产组),进一步依据甲状腺过氧化物酶抗体(TPO-Ab)分为TPO-Ab(+)组(23例)和TPO-Ab(-)组(45例);选取同期甲状腺功能正常的未流产者20例为对照组。超高速密度梯度离心法分离HDL。通过检测对氧磷酶-1(PON-1)活性判定HDL的抗氧化功能;通过检测血清淀粉样蛋白A(SAA)含量判定HDL的抗炎状态,并检测HDL介导的巨噬细胞胆固醇流出率。结果流产组TPO-Ab阳性率显著高于未流产组,差异有统计学意义(χ2=28.16,P=0.000)。TPO-Ab(+)组PON-1、胆固醇外流率均低于TPO-Ab(-)组及对照组,差异有统计学意义(均P0.01);TPO-Ab(+)组SAA水平高于TPO-Ab(-)组及对照组,差异有统计学意义(P0.01);TPO-Ab(-)组HDL各项功能指标与对照组差异无统计学意义。TPO-Ab(+)组HDL功能指标与TPO-Ab滴度无相关性(P0.01)。结论甲状腺自身免疫使早期自然流产患者的HDL功能受损;功能异常的HDL可能参与了早期自然流产的发病。 相似文献
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《中国实用妇科与产科杂志》2020,(6)
目的探讨妊娠期甲状腺功能减退症(甲减)与自然流产的关系。方法选取2018年10月至2019年10月于郑州大学第三附属医院就诊的妊娠期甲减患者6336例,其中临床甲减组1825例,亚临床甲减组2190例,单纯低甲状腺素(T4)血症组2321例;选择同期正常健康孕妇2450例作为对照组,分别统计两组血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)阳性率及最终发生自然流产的情况。结果 (1)临床甲减组和亚临床甲减组自然流产的发生率高于对照组(P0.05);临床甲减组早期流产和晚期流产的发生率高于对照组(P0.05),亚临床甲减组仅早期流产的发生率高于对照组(P0.05)。(2)临床甲减组自然流产1次和≥2次的发生率高于对照组(P0.05),而亚临床甲减组自然流产1次的发生率与对照组相比升高(P0.05)。(3)妊娠期临床甲减患者合并TPOAb和TgAb同时阳性或其中1项阳性时,自然流产的发生率与抗体阴性者相比,差异均有统计学意义(P0.001),而亚临床甲减患者仅当合并TPOAb和TgAb同时阳性时,自然流产的发生率与抗体阴性者相比,差异有统计学意义(P0.001)。结论妊娠期临床甲减可导致自然流产,而与流产时期、次数及TPOAb、TgAb无关。妊娠期亚临床甲减与自然流产时期、次数有关,且仅当TPOAb和TgAb同时阳性时可导致自然流产。 相似文献
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目的:探讨授精第3日发育迟缓(5~6-细胞)的胚胎冷冻价值及如何提高其利用价值的可行性方案。方法:回顾性分析进行冷冻复苏移植第3日发育迟缓胚胎的124个周期的临床资料,根据不同的复苏移植方案和培养条件,分为第3日冷冻,复苏移植周期提前1 d解冻者(A组,32个周期)、解冻后培养至囊胚再移植组(B组,62个周期)、当日解冻组(C组,30个周期),再与同期新鲜周期第3日发育迟缓行囊胚培养再冷冻复苏囊胚(复苏囊胚组,D组)的58个周期比较。结果:1各组在女方年龄、不孕年限、排卵日子宫内膜厚度、移植日激素水平等方面无统计学差异(P0.05)。2D组的周期临床妊娠率(55.4%)和种植率(42.2%)都高于其他组(P0.05)。A组和B组的周期取消率(12.5%和35.5%)均高于其他组(P0.05),B组的临床妊娠率(40.0%)高于C组(33.7%)(P0.05),但与A组(39.3%)比较无统计学差异(P0.05)。结论:1授精第3日5~6-细胞胚胎可以通过新鲜周期延长体外培养时间至第6日,获得囊胚后再进行冷冻复苏,可以得到更好的临床结局。2对于胚胎少的患者,可以在患者知情同意下选择5~6-细胞胚胎第3日直接冷冻,复苏周期提前解冻来挑选具有发育潜能的胚胎进行移植。 相似文献
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目的:探讨取卵后第3天(Day3)多个胚胎形态学指标与胚胎着床的关系。方法:选取年龄≤35岁,进行Day3胚胎移植患者,按胚胎移植后全部植入或未植入分为,植入组:30个移植周期,56个胚胎;未植入组:32个移植周期,64个胚胎。分析Day3胚胎卵裂球数目、大小差异、卵裂球核、卵裂球颜色及颗粒、碎片比例和类型、胞质内空泡等与胚胎种植之间的相关性。结果:Day3胚胎发育速度、卵裂球核数量和碎片类型在两组间差异有显著性(P<0.05)。植入组中7~8细胞组最多见(71.4%),尤其是8细胞高达60.7%。卵裂球核指标中,植入组至少一单核组最多见(57.1%)。碎片类型中植入组T1出现率最高,为41.1%。其他形态学指标在两组间无统计学差异(P>0.05)。判别分析表明卵裂球数和碎片类型较卵裂球核、卵裂球大小差异、碎片多少对胚胎植入判别符合率为70.0%。结论:在选择移植胚胎时,胚胎生长速度及碎片类型是考虑的首要因素,其次是胚胎碎片含量。 相似文献
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反复自然流产与白细胞介素关系的研究 总被引:11,自引:0,他引:11
目的 探讨反复自然流产患者血清白细胞介素的变化。方法 采用酶联免疫吸附法检测56例反复自然流产妇女血清中IL-6、IL-8、IL-10的水平。流产患者分为两组:早期流产和晚期流产。选择正常早孕妇女及非孕妇女各20例作对照。结果 反复自然流产患者血清IL-6、IL-8含量明显高于对照组(P〈0.01),早期流产组升高明显。IL-6与IL-8之间呈正相关(r=0.78,P〈0.01),与IL-10呈负 相似文献
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Relationship between embryo quality and aneuploidies 总被引:1,自引:0,他引:1
Baltaci V Satiroglu H Kabukçu C Unsal E Aydinuraz B Uner O Aktas Y Cetinkaya E Turhan F Aktan A 《Reproductive biomedicine online》2006,12(1):77-82
Many high-grade embryos selected for transfer according to their morphological evaluation were detected to have chromosomal abnormalities after aneuploidy screening for infertility by preimplantation genetic diagnosis (PGD). The aim of this study was to detect if there is any correlation between embryo quality and genetic status. The chromosomal status of the day three embryos was studied by multicolour fluorescence in-situ hybridization for chromosomes 13, 18, 21, X and Y. PGD was performed on 132 patients for 1107 embryos. The correlation between embryo quality and aneuploidy was analysed. The analysis showed that a large proportion of normal embryos (50.7%, n = 280) were grade I. In addition, a considerably high proportion of aneuploid embryos (36.1%, n = 83) were evaluated as grade I. There was a significant relationship between PGD results and embryo grades (P = 0.001). Of the 69 polyploid embryos, 21.7% were grade I and 37.8% were grade II. Of the 83 haploid embryos, 27.8% were grade I and 34.9% were grade II. Euploidy was positively related to morphological grade of embryo (P = 0.001). It was also possible for chromosomally abnormal embryos to have a good developmental potential, and they could be selected for embryo transfer unless the PGD procedure was applied. 相似文献
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目的 探讨原因不明复发性流产(unexplained recurrent spontaneous abortion,URSA)的发生与记忆滤泡性辅助T(memory Tfh)细胞表达异常是否存在关联.方法 收集15例染色体正常的URSA为流产组,并以15例正常人工流产患者为正常对照组.分离所有患者外周血单个核细胞及蜕膜组织免疫细胞,用流式细胞术(FCM)检测上述细胞中CD4+CXCR5+memory Tfh以及CD4+CXCR5+PD-1 +memory Tfh细胞水平.结果 流产组蜕膜局部CD4+CXCR5+memory Tfh以及CD4+CXCR5+PD-1 +memory Tfh细胞水平显著高于正常对照组(P<0.05).流产组外周血CD4+CXCR5+memory Tfh以及CD4+CXCR5+PD-1 +memory Tfh细胞水平与正常对照组无明显差异(P>0.05).结论 早孕妇女蜕膜局部memory Tfh细胞数量增多可能与URSA发生有关,母-胎界面的免疫异常可能导致URSA的发生. 相似文献
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G. S. ANTHONY Lalor Fellow A. A. CALDER Senior Lecturer M. C. MACNAUGHTON Muirhead Professor 《BJOG : an international journal of obstetrics and gynaecology》1982,89(12):1046-1049
Summary. The Cervical Resistance Index (CRI) was measured in 20 patients with a history of previous spontaneous midtrimester abortion. The mean CRI was 2.44±0.78 in patients with a history suggestive of cervical incompetence and 4.91±0.41 in 102 patients who were parous women with normal menstrual cycles. This new procedure which is used in the non-pregnant state provides an additional method for diagnosis of cervical incompetence. 相似文献
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妇女血清可溶性Fas/FasL与反复自然流产的关系初探 总被引:1,自引:0,他引:1
目的:探讨妇女血清可溶性Fas/FasL(sFas/sFasL)在反复自然流产(RSA)发病中的作用。方法:采用ELISA法检测62例RSA妇女(RSA组)、34例正常妊娠妇女(正常妊娠组)和34例正常非孕妇女(对照组)血清sFas/sFasL水平。结果:RSA组sFas含量(1051.44±420.87pg/ml)高于对照组(529.49±241.01pg/ml),差异有显著性(P<0.05);正常妊娠组sFas含量(520.19±253.82pg/ml)与对照组相比差异无显著性(P>0.05)。RSA组、正常妊娠组、对照组sFasL含量分别为1.29±0.82ng/ml、1.20±0.85ng/ml、1.32±1.01ng/ml,3组间比较,差异无显著性(P>0.05)。结论:反复自然流产的发生可能与血清sFas水平升高有关,而与血清sFasL无明显相关。 相似文献
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目的探讨亚甲基四氢叶酸还原酶(MTHFR)基因C677T突变、凝血因子V(FV)基因G1691A突变和凝血酶原(PT)基因G20210A突变与原因不明复发性早期流产(URESA)的关系。方法应用聚合酶链反应.限制性片段长度多态性(PCR-RFLP)技术分析112例URESA患者(病例组)和100例健康妇女(对照组)MTHFR、FV和PT3种基因多态性。结果(1)MTHFR基因的T/T基因型和T等位基因频率,病例组[分别为38.4%(43/112)和59.8%(134/224)]高于对照组[分别为18.0%(18/100)和43.0%(86/200)],两组分别比较,差异均有统计学意义(P<0.01)。病例组与对照组比较,T/T基因型者发生URESA的相对风险增加(OR=2.8390,95%CI为1.5022~5.3661)。(2)病例组和对照组妇女Fv基因和PT基因均为G/G基因型(即正常带型)。结论MTHFR基因C677T位点多态性与URESA发病密切相关,T/T基因型是其发病的危险因素。FV和PT基因的突变率在中国妇女人群中极低。 相似文献
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抗β2糖蛋白1抗体与习惯性流产 总被引:4,自引:0,他引:4
目的 探讨抗β2 GP1抗体与习惯性流产间的关系。方法 选取122例有习惯性流产史未妊娠妇女为流产组,选取60名未妊娠正常生育育龄妇女为正常对照组,用酶联免疫法检测两组血清中抗β2 GP1抗体。结果 122例不明原因习惯性流产史的患者中,抗β2 GP1IgA、IgG、IgM型抗体阳性率分别为13.1%、9.0%和15.6%。这三型自身抗体阳性率均明显高于正常对照组,差别有显著性(P分别为P=0.009、P=0.011、P=0.003)。结论 对不明原因习惯性流产史的患者作抗β2 GP1抗体检测,将有助于病因的诊断。 相似文献
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Kashanian M Akbarian AR Baradaran H Shabandoust SH 《Gynecologic and obstetric investigation》2006,61(3):167-170
OBJECTIVE: To determine the pregnancy outcome following a previous spontaneous abortion (miscarriage). METHOD: A prospective cohort study was done on 300 gravida-2 patients: 200 patients (case group) whose previous pregnancy was spontaneously aborted (early abortion), and 100 patients (control group) whose previous pregnancy went to term and a live fetus was delivered. All the patients were followed until delivery, and then the pregnancy outcomes, neonatal complications and delivery routes were determined and compared between the 2 groups. Pregnancy outcomes included: maternal complications (e.g. placenta previa, placental abruption, premature rupture of the membranes, preeclampsia and eclampsia, abortion, breech presentation, preterm labor, intrauterine fetal death); neonatal complications (low birth weight, gross congenital malformations, low Apgar score at 1 min), and delivery routes (cesarean delivery or instrumental delivery, e.g. forceps or vacuum). Statistical analysis was performed using the Statistical Package for Social Science. RESULTS: Statistical analysis showed that the pregnancy complications following a previous spontaneous miscarriage were no different from those of the control group, except for abortion (16.5 vs. 11%, p < 0.003, RR = 1.15, CI 95% = 0.95-1.39), fetal deaths (1.5 vs. 0%, p < 0.004, RR = 1.51, CI 95% = 1.39-1.63), and vaginal bleeding during the first trimester (19 vs. 1%, p < 0.001, RR = 1.57, CI 95% = 1.41-1.75), which were more than those of the control group. Also, the rate of cesarean delivery (28.14 vs. 13.48%) was increased (p = 0.026, RR = 1.25, CI 95% = 1.07-1.47). Neonatal complications were not statistically significantly different in comparison with the control group. CONCLUSION: A prior spontaneous miscarriage is a risk for the next pregnancy, and the risk of abortion and intrauterine fetal death will increase. Therefore, careful prenatal care is mandatory. 相似文献
20.
We have carried out a retrospective clinical investigation of 45 women in the first and second trimester of pregnancy aiming to demonstrate the role of genital HSV infection in the genesis of spontaneous abortion (miscarriage). Latent HSV infection was diagnosed using the microneutralization test; asymptomatic HSV vaginal or cervical shedding was diagnosed with indirect immunofluorescence and cytological-Papanicolau staining. The results showed that the highest incidence of latent HSV type 2 infection (64%) occurred in women who had one or more spontaneous abortions, whereas this type of infection was found in only 5% of pregnant women of the control group. The incidence of asymptomatic cervical HSV type 2 infection was also considerably higher in patients with a history of spontaneous abortions. Our results indicate a possible aetiological connection between HSV and spontaneous abortion. 相似文献