双绒毛膜多胎妊娠不同孕周选择性减胎术后临床结局分析

目的:探讨双绒毛膜多胎妊娠不同孕周选择性减胎术后的临床结局。方法:回顾性分析2012年1月至2018年12月98例双绒毛膜多胎妊娠于四川大学华西第二医院进行选择性减胎术的临床资料,根据实施减胎术孕周分为3组:G1组(孕14~19+6周,19例)、G2组(孕20~27+6周,30例),G3组(≥孕28周,49例),比较不同孕周行选择性减胎术后的临床结局。结果:①98例中行选择性减胎术原因包括染色体异常(25例)、胎儿结构畸形(68例)及其他母胎合并症(5例)等。②G1组母体无相关并发症发生;减胎术后2周G2组母体发生胎膜早破2例,宫内感染2例;G3组发生胎膜早破4例,宫内感染2例。③减胎术后流产发生率为8.2%、早产发生率为50.0%,活产儿存活率94.6%。3组分娩孕周差异无统计学意义(P>0.05)。G1组流产率显著低于G2组(10.5%vs 20.0%,P<0.05);G1组的活产儿出生体质量及存活儿出生体质量也优于G2组(P<0.05);G1组的早产率、足月产率、活产儿出生体质量及存活儿出生体质量均优于G3组(P<0.05)。结论:在孕20周前对双绒毛膜多胎妊娠行选择性减胎术,其妊娠结局较好,合理使用选择性减胎技术,可以有效减灭异常胎儿和多胎妊娠的胎儿数量,减少多胎妊娠的并发症及合并症,改善多胎妊娠母胎结局。     

多胎妊娠早期选择性减胎术17例分析

目的研究多胎妊娠早期选择性减胎术的可行性、安全性及对妊娠的影响.方法17例多胎妊娠孕早期在B超引导下,将穿刺针选择性进入1个或2个胚胎的心管搏动处,反复抽吸或注入少量药物致心搏停止.结果14例经阴道减胎术单次成功,3例经腹部减胎2～3次成功.2例足月剖宫分娩,2例孕32周、孕34周提前剖宫术.5例晚期流产.2例因感染而分别于术后第3、第7天流产.6例继续妊娠.多胎妊娠的减胎术成功率88.2%(15/17).总流产率41.2%(7/17).已分娩的8个新生儿健康.结论在B超引导下,多胎妊娠早期选择性减胎术是安全、有效治疗多胎妊娠的方法.     

妊娠一过性甲状腺功能亢进与妊娠剧吐相关性研究

目的:通过观察妊娠剧吐患者孕期血清甲状腺功能及血清β-h CG水平,探讨妊娠剧吐合并一过性甲状腺功能亢进与血清β-h CG水平的相关性。方法:选取2008年1月至2013年12月因妊娠剧吐于大连医科大学附属第一医院产科住院治疗的129例孕妇,测定血清甲状腺功能,其中65例患者同时行血清β-h CG检测。分析患者血清甲状腺功能情况与β-h CG水平情况及两者相关性。根据患者孕周,分为A(5~(+1)~9周)、B(9~(+1)~12周)、C(12~(+1)~17~(+5)周)3组,分析各组甲状腺激素水平及β-h CG水平。结果:(1)129例妊娠剧吐患者的血清TSH、FT4、FT3水平中位数分别为0.446μIU/ml、19.17pmol/L、34.99pmol/L。A、B、C组患者血清TSH中位数为0.717μIU/ml、0.293μIU/ml和0.315μIU/ml;A组的血清TSH水平明显大于B、C组(P=0.043),但后两组间差异无统计学意义(P=0.086)。A、B、C组患者的血清β-h CG均数分别为(82465.56±45800.90)IU/L、(109338.00±52879.90)IU/L和(121179.67±43666.69)IU/L,3组间差异无统计学意义。(2)血清β-h CG与TSH两者之间存在显著负相关(r=-0.37,P0.01);β-h CG与FT4之间存在显著正相关(r=0.404,P0.01)。当妊娠剧吐患者血清β-h CG水平小于80000IU/L时,10.3%患者的血清TSH受到抑制;β-h CG为80 000~120 000IU/L时,47.4%血清TSH受到抑制;β-h CG大于120 000IU/L时,76.5%血清TSH受到抑制;差异有统计学意义(P=0.001)。结论:妊娠剧吐患者的血清β-h CG和TSH水平呈显著负相关,血清β-h CG和FT4水平呈显著正相关,当β-h CG水平大于120 000IU/L时,76.5%患者出现TSH水平抑制。     

辅助生殖技术与多胎妊娠的关系及减胎术

辅助生殖技术(又称助孕技术)的发展在治疗不孕的同时导致多胎妊娠率的提高。本文阐述助孕技术与多胎妊娠的关系,以及如何通过严格控制超促排卵指征、控制移植胚胎数量、冻存胚胎、选择性单胚胎移植、减胎术的应用等方法来获得最佳妊娠率,同时降低助孕术后的多胎妊娠特别是三胎及三胎以上妊娠的发生。     

多胎妊娠妇女孕中期选择性减胎术的临床应用

目的 通过对多胎妊娠妇女于孕中期行选择性减胎术,研究其手术指症、时机、安全性、目标胎儿的选择标准和减灭胎儿数,探讨选择性减胎术在改善多胎妊娠结局中的作用.方法 对37例孕12周+1～25周多胎妊娠孕妇(6例双胎、21例三胎、8例四胎、2例五胎,共117个胎儿)在超声引导下经腹行选择性减胎术,按产科医疗指征,在拟被减的46个胎儿心脏内注射10%氯化钾2～5 ml,见胎心逐渐减慢至停跳视为减胎术成功.术后定期产前检查和监测凝血功能,记录妊娠期并发症及妊娠结局.结果 (1)成功率:共减去胎儿46个,减胎成功率为100%(46/46个胎儿),已有27例孕妇分娩,获24个健康新生儿,妊娠成功率为88.9%(24/27).(2)分娩孕周:＞36周分娩者15例;32～36周7例;28～32周3例;＜28周流产者2例;正在妊娠中10例.平均分娩孕周(34.9±4.1)周,孕28周后分娩率为92.6%(25/27).(3)新生儿平均出生体重:单胎妊娠新生儿平均出生体重为(3014±640)g,双胎妊娠为(2557±573)g,三胎妊娠中除1例两个胎儿存活(出生体重分别为1400及1500 g)外,其余均死亡.(4)安全性:除2例单羊膜囊双胎在减灭1个胎儿后,另1个胎儿随即死亡外,其余多胎妊娠妇女的保留胎儿均未发生胎死宫内.(5)并发症:37例多胎妊娠妇女中仅3例发生子痫前期,减胎术后均无凝血功能障碍发生.(6)阴道流血:有13例孕妇减胎术前发生阴道流血,其中1例在妊娠13周强烈要求减胎,减胎术后于孕22周流产;另12例均在阴道流血停止1周以上后施行减胎.结论 (1)孕中期选择性多胎妊娠减胎术,可以有效减少多胎妊娠胎儿数目、避免异常胎儿出生,降低孕产妇并发症,提高新生儿出生体重.(2)胎儿保留数目以达双胎为好.(3)减胎术前有阴道流血者,避免在流血期间减胎,应选择在流血停止1周以上进行.(4)孕中期多胎妊娠减胎术不会造成孕妇的凝血功能障碍,也不会造成保留胎儿的宫内死亡,安全性好;减胎术后子痫前期的发病率明显下降.     

双胎妊娠一胎畸形行选择性减胎术对妊娠结局的影响

多胎妊娠是辅助生育技术的主要并发症之一。研究表明 ,为改善多胎妊娠的结局 ,对多胎妊娠行选择性胚胎减灭术 (减胎术 )是安全有效的 ,减胎术多在妊娠 7～ 12周进行[1] 。我们对在我院行辅助生育技术妊娠的 3例孕 18～ 2 6周的双胎妊娠一胎畸形者行减胎术 ,以探讨在妊娠中期施行减胎术的可行性及对妊娠结局的影响。一、资料和方法1 研究对象 :为 1999年 12月～ 2 0 0 0年 10月在我院生殖医学中心接受辅助生育技术妊娠的 3例双胎妊娠一胎畸形的患者。例 1,32岁 ,行第 2周期常规体外受精 胚胎移植(ＩＶＦ ＥＴ) ,在移植前 2ｈ行部分透明带切割…     

选择性减胎术

选择性减胎术是从优生观点实现母婴统一管理的手术,多用于三胎或三胎以上的多胎妊娠,即选择性减少一定数量的胚胎,一般保留2个或3个胚胎,使其健康发育成长,并保护孕妇,减少并发症。 1 选择性减胎术应用的必要性与可能性自从使用人绝经期促性腺激素(hMG)与枸椽酸克罗米芬(CC)促排卵治疗不孕症以来,多胎妊娠发生率呈全球性增高,甚至使人口数量增长失控,且不利优生、优育、优教。不孕症妇女经促排卵药物治疗后受孕,对本人及家庭确是件喜事,但易并发卵巢过度刺激综合征,重症者有卵巢破裂、失血性休克或肾功衰竭的危险。多胎妊娠过程中易合并多种危害母、胎     

IVF/ICSI-ET后单绒毛膜四胎合并单绒毛膜单胎妊娠

目的:报道1例体外受精/单精子胞浆内注射-胚胎移植(IVF/ICSI-ET)后单绒毛膜四胎合并单绒毛膜单胎妊娠。方法:患者为26岁女性,接受IVF/ICSI-ET治疗,取卵后3d移植2枚8-细胞胚胎。结果:孕6周经阴道B超示单绒毛膜四胎合并单绒毛膜单胎妊娠。选择性减胎术在孕7周进行,减灭单绒毛膜四胎。孕40周行剖宫产术娩出单活男婴。结论:高龄、透明带操作、胚胎培养时间和条件、促排卵治疗等多种因素可造成单卵多胎妊娠。选择性减胎术可降低多胎妊娠的不利影响,但应更注重预防其发生。     

辅助生殖技术(ART)助孕获得多胎妊娠行减胎术后妊娠结局观察

目的:探讨辅助生殖技术(ART)获得的多胎妊娠孕早期行经阴道减胎术的有效性和安全性。方法:以经ART助孕获得多胎妊娠行经阴道减胎术的患者123例为减胎组,根据减胎后保留的胎儿数分为双胎组(A组,n=90)和单胎组(B组,n=33)。另以同期经ART助孕获得单胎妊娠(C组,n=36)和双胎妊娠(D组,n=57)的患者为对照组。回顾性分析患者的妊娠结局及妊娠期并发症发生情况。结果:减胎组的减胎成功率为100.0%,妊娠成功率为91.9%。A组胎膜早破发生率、早产发生率、新生儿低出生体质量发生率、新生儿重症监护室(NICU)入住率均高于B组(P<0.05)。结论:多胎妊娠孕早期行经阴道减胎术安全、有效、可行。多胎妊娠实施减胎术中减为单胎更为安全。     

体外受精新鲜胚胎移植术后14d血清β-hCG浓度与妊娠结局的关系

目的:探讨体外受精-新鲜胚胎移植术后第14日后血清β-h CG浓度对临床妊娠结局的预测性。方法:对727例移植2枚第3日胚胎后第14日测血清β-h CG浓度7 IU/L的生化妊娠者追踪其临床结局,并回顾性分析正常宫内妊娠、异位妊娠、早期流产与血清β-h CG浓度的关系。结果:本组生化妊娠者,当其血清β-hC G在45 IU/L时,无正常宫内妊娠;46~100 IU/L时生化妊娠流产率为50.00%,正常宫内妊娠的发生率为25.00%,异位妊娠发生率为10.71%,早期流产率为14.29%。生化妊娠流产发生率随着血清β-h CG水平升高而下降,血清β-h CG200 IU/L发生率仅为4.17%。血清β-h CG400 IU/L者异位妊娠发生率(0.19%)与≤400 IU/L(10.20%)相比明显下降(P=0.007);当血清β-h CG500 IU/L时,早期流产率明显低于血清β-h CG500 IU/L(4.66%vs12.88%,P=0.002)。正常宫内妊娠血清β-h CG截断值为379.25 IU/L,ROC曲线下面积为0.868,95%CI=0.828~0.907。异位妊娠者中71.43%妇女存在输卵管性不孕因素,而早期流产者和生化妊娠流产者中存在男方因素性不孕分别占74.00%和68.75%。结论:胚胎移植后第14日血清β-h CG水平是有效预测妊娠的指标。当血清β-h CG≤45 IU/L时继续黄体支持治疗意义不大;血清β-h CG在46.00~379.25 IU/L范围内虽可继续黄体支持保胎,但要警惕异位妊娠及早期流产的发生,尤其是对有输卵管性不孕或男方因素性不孕的患者。     

血清β-hCG监测在单剂量氨甲喋呤治疗异位妊娠中的临床价值

目的:评价动态检测血β-hCG 在单剂量氨甲喋呤(MTX)治疗宫外孕的临床价值。方法:回顾性分析MTX单剂量肌肉注射治疗宫外孕104例。结果:治疗总成功率为79.8%。成功组:用药前血β-hCG　948.7±893.8　mIU/mL,与失败组(1784.5±1157.5　mIU/mL)相比差异显著(P<0.001),用药后血β-hCG在d　2 以及d　7 下降显著。结论:MTX治疗前血β-hCG不是影响治疗效果的唯一危险因素,血β-hCG联合超声检测附件包块、后穹隆积液、是适时手术干预的重要客观指标,是保证治疗效果的关键。     

Can early β-human chorionic gonadotropin predict birth of singletons and twins after in vitro fertilization?

Objective: To assess the predictive value for clinical pregnancy outcome of β-hCG level at 13?d after embryo transfer.

Methods: Retrospective study of IVF clinical pregnancies diagnosed at 6 weeks. We calculated the value of β-hCG level at 13?d after embryo transfer to predict live births.

Results: We analyzed 177 IVF cycles between 2009 and 2014 (50 singleton births, 50 twin births, 27 sets with a vanishing twin, 43 first trimester singleton pregnancy loss and seven first trimester total twin pregnancy loss). Singleton pregnancies with a β-hCG concentration?<85 mIU/mL had an 89% risk of having a first trimester loss whereas a concentration?>386?mU/mL had a 91% chance of a live birth. Twin pregnancies with a concentration?<207 mIU/mL had only a 33% chance of delivering twins and a 55% risk of having a vanishing twin; whereas a level?>768 mIU/mL was associated with a 81% chance of live twin birth and a low risk (19%) of having a vanishing twin. Age, type and duration of infertility, body mass index (BMI) and number of fertilized oocytes did not affect these calculations.

Conclusions: β-hCG level at 13?d after embryo transfer might predict outcomes in clinical singleton and twin pregnancies following IVF.     

Tubal Ectopic Pregnancy with Undetectable Initial Serum β-Human Chorionic Gonadotropin Level

We present a case of a tubal ectopic pregnancy (EP) in a patient with an initially undetectable serum β-human chorionic gonadotropin (β-hCG) level. A 33-year-old woman in a same-sex relationship underwent timed donor intrauterine insemination. Her serum β-hCG level was <5 mIU/mL 14 days after the intrauterine insemination. She reported menstrual bleeding 3 days after her negative pregnancy test and returned to the office 10 days later to begin a new treatment cycle. Her serum levels of estradiol, progesterone, and β-hCG were 119 pg/mL, 6.1 ng/mL and 1157 mIU/mL, respectively. Transvaginal ultrasonography did not show an intrauterine pregnancy. Her β-hCG level increased to 1420 mIU/mL the next day. She was diagnosed with a pregnancy of unknown location and treated with methotrexate. Her β-hCG levels continued to increase despite 3 methotrexate doses, necessitating laparoscopy. The diagnostic laparoscopy demonstrated approximately 100 mL of hemoperitoneum in the posterior cul-de-sac with an intact right fallopian tube that was dilated at its distal end by the EP. A total right salpingectomy was performed. Her β-hCG level was <5 mIU/mL 3 weeks later. The current case supports that although rare, an undetectable serum β-hCG level does not completely rule out the diagnosis of an EP.     

rFSH联合HP-hMG超促排卵方案中血清β-hCG水平与超促排卵结局关系初探

目的:探讨人重组促卵泡素(rFSH)联合高纯尿促性素(HP-hMG)促排卵方案中hCG注射日血清β-hCG水平与促排卵结局的关系。方法:共129个促排周期纳入研究,其中67个长方案周期,62个拮抗剂方案周期。各个方案中,患者根据hCG注射日血清β-hCG水平分为<平均水平组和>平均水平组。结果:长方案和拮抗剂方案组的患者hCG注射日血清平均β-hCG分别为0.9mIU/ml和1.1 mIU/ml。各个方案中,<平均水平组和>平均水平组患者的临床特征、促排卵特征和获卵数、受精率、卵裂率均无统计学差异(P>0.05)。长方案中,血清β-hCG≥0.9mIU/ml的患者较<0.9 mIU/ml的患者获得可用胚胎率更高(62.1%vs 53.6%,P=0.05);拮抗剂方案中,血清β-hCG≥1.1 mIU/ml的患者较<1.1 mIU/ml的患者获得可用胚胎率更高(57.8%vs 46.7%,P=0.06)。结论:在人重组促卵泡素联合高纯尿促性素促排卵方案中注射hCG日血清β-hCG水平与可用胚胎率可能存在正相关关系。     

Significant reduction of twins with single embryo transfer in IVF

Multiple pregnancies in assisted reproduction can be regarded as iatrogenic and avoidable, given that the phenomenon is related to the number of embryos replaced. Prospective studies have shown that transferring one fresh embryo and subsequently one frozen embryo gives similar cumulative pregnancy rates to transferring two fresh embryos. However, the multiple pregnancy rates differ significantly between the two strategies. In Trondheim, elective double embryo transfer (eDET) was introduced in September 1991. Prior to that, multiple pregnancy rates were nearly 35% and the triplet rate was 7%. The triplet rate dropped to below 1%, but the twin rate still remained high. In 2002, it was decided to start elective single embryo transfer (eSET) and currently SET is performed in more than 90% of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. The inclusion criteria are nearly as simple as: 'If you have two good embryos, you get only one embryo at a time'. Multiple pregnancy rates are well below 10% and there are no triplets. In conclusion, triplet rates can be reduced to zero and twin rates to below 10% by eSET. The cumulative pregnancy rate per oocyte recovery is not reduced, including replacement of frozen- thawed embryos.     

剖宫产疤痕部位妊娠13例临床分析

目的:探讨剖宫产切口疤痕妊娠(CSP)的诊断、治疗方法及预后情况。方法:对近10年收治的13例剖宫产切口疤痕妊娠患者进行回顾性分析。结果:既往有人工流产刮宫史者10例,主要表现为停经(77%,10/13)及不规则阴道流血(77%,10/13),血β-hCG介于81~133 576 mIU/ml之间,其中入院后血β-hCG≥6 000 mIU/ml者为9例。B超均提示剖宫产切口疤痕妊娠可能。12例患者采用保守治疗成功,1例患者经手术切除妊娠组织成功。结论:B超和血β-hCG水平对剖宫产切口疤痕妊娠诊断帮助较大,多数可保守治疗获得成功,但需充分备血及做好手术切除子宫的准备。     

Three-dimensional computed tomographic angiography in the diagnosis and conservative management of cesarean scar pregnancy with prominent neovascularization

ObjectiveCesarean scar pregnancy (CSP) is a rare potentially life-threatening form of ectopic gestation. However, optimal management has not yet been established. Furthermore, there are limited reports on the diagnostic value of three-dimensional computed tomographic angiography (3D-CTA) for the conservative management of this disorder.Case reportA 33-year-old woman (gravida 3, para 2), with two previous deliveries by low segmental transverse cesarean section, was referred after 5 weeks of amenorrhea. Her serum beta-human chorionic gonadotropin (β-hCG) value was 2921 mIU/mL. Cesarean scar pregnancy was diagnosed by ultrasonography and magnetic resonance imaging. On 3D-CTA, a prominent uteroplacental neovascularized mass was identified. It was supplied by the left uterine artery and a thick draining left ovarian vein. After three cycles of systemic methotrexate (MTX) administration, the serum β-hCG value decreased to 142 mIU/mL. However, the gestational sac enlarged and peritrophoblastic blood flow persisted. In contrast to the ultrasonographic findings, marked reduction of uteroplacental neovascularization at the CSP site with regression of the draining ovarian vein was evident on 3D-CTA. The gestational products were thereafter successfully resected by hysteroscopic surgery without hemorrhagic complications. Fifty-seven days after the initial MTX administration, serum β-hCG reached a normal level.ConclusionThis case emphasizes that, when selecting the method of intervention, 3D-CTA is potentially useful for evaluating uteroplacental neovascularization in a hemodynamically stable CSP.     

Five cases of dizygotic triplet pregnancy following assisted reproductive techniques

Of 816 patients who became clinically pregnant by assisted reproductive techniques between September 2000 and August 2004, we experienced 10 cases (1.2%) of monozygotic twinning, and in five of these 10 cases, implantation of another embryo resulted in dizygotic triplets. Here, we report these five cases of dizygotic triplets. Fresh embryo transfer was performed in all five cases. Intracytoplasmic sperm injection or assisted hatching was not carried out in these cases. Blastocyst transfer was performed in three cases. Three embryos were transferred in case 1 (40-year-old female). While only two embryos were transferred in the other four cases so as to avoid triplet pregnancy, triplet pregnancies were confirmed. Triplet pregnancy was maintained in three cases, but in the other two cases, monochorionic twinning resulted in miscarriage during the first trimester. For the three patients who delivered the triplets, while the postnatal growth has been normal for all nine babies, the mothers were hospitalized for a long period of time, and an emergency cesarean section was performed on two patients. Because triplet pregnancy could not be completely prevented even when only two embryos were transferred, physicians should be sure to obtain informed consent in similar cases. (Reprod Med Biol 2005; 4 : 59–64)     

宫颈妊娠17例临床分析

目的:探讨宫颈妊娠的临床特点及近10年来我院的治疗方法及效果。方法:对我院近10年间总共收治的17例宫颈妊娠患者进行回顾性分析。结果:有停经史者16例,无痛性阴道流血的患者共15例,血β-hCG在167￣89915mIU/ml之间,其中入院血β-hCG≥3000mIU/ml者11例。16例患者采用保守治疗成功。结论:保守治疗宫颈妊娠成功率高,且保留患者日后生育能力,是目前治疗宫颈妊娠较常用且有效的方法。