冻融胚胎移植妊娠结局及出生缺陷情况分析

目的:探讨冻融胚胎移植妊娠结局及出生缺陷情况.方法:回顾性研究本中心冻融胚胎移植654周期妊娠结局及出生儿随访观察.结果:654周期中有232例妊娠,临床妊娠187例(28.6%),早期流产31例(16.5%),晚期流产2例(1.1%),异位妊娠8例(4.2%),宫内宫外同时妊娠2例(1.1%).共分娩144例.分娩率23.6%,足月分娩117例(81.1%),早产27例(18.9%),单胎107例(74.3%),单胎早产率9.3%,双胎37例(25.9%),双胎早产率45.9%.获得新生儿180个,男婴89个,女婴91个,其中低体重儿27个(14.9%).新生儿出生缺陷4例,占2.2%,其中1例新生儿死亡.远期随访89例,111个出生儿,年龄1～6岁,新增出生缺陷4例,失访31例(25.8%).总的出生缺陷共8例(4.4%).结论:冻融胚胎移植的早期流产率增加,新生儿畸形发生率与新鲜周期相似,但长期随访出生缺陷率增高,该技术的安全性问题需得到重视,有待进一步随访研究.     

辅助生育技术受孕双胎与自然受孕双胎妊娠结局的分析

目的　探讨辅助生育技术受孕 (助孕 )双胎与自然受孕双胎围产期的结局。方法　选择 10 4例助孕双胎孕妇 (助孕组 )和 173例自然受孕双胎孕妇 (自然受孕组 ) ,比较两组孕妇一般情况、妊娠合并症、分娩情况和新生儿预后等方面的差异。结果　 (1)助孕组孕妇平均年龄 (31 2± 3 7)岁 ,自然受孕组孕妇为 (2 7 8± 3 5 )岁 ,两组比较 ,差异有显著性 (P <0 0 5 )。 (2 )助孕组孕妇早产 70例(6 7 3% ) ,自然受孕组孕妇早产 78例 (45 1% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。助孕组孕妇患妊娠期糖尿病或糖耐量异常 16例 (15 4 % ) ,自然受孕组孕妇仅 4例 (2 3% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。(3)助孕组孕妇剖宫产率为 76 0 % (79/10 4 ) ,明显高于自然受孕组的 6 5 3% (113/173)。(4)两组围产儿死亡率、畸形发生率和新生儿窒息率等比较 ,差异无显著性 (P <0 0 5 )。结论　助孕双胎孕妇年龄较大 ,早产率及妊娠期糖尿病或糖耐量异常发生率高 ;分娩方式以剖宫产为主。助孕双胎孕妇的围产儿结局与自然受孕双胎相似     

不同辅助生殖技术妊娠分娩的1 540例新生儿出生缺陷分析

目的 探讨不同辅助生殖技术妊娠分娩的新生儿出生缺陷的发生情况及影响因素.方法 对1998年10月至2006年12月在郑州大学第一附属医院生殖医学中心接受体外受精(IVF)助孕[IVF、卵母细胞胞质内单精子注射(ICSI)、冻融胚胎移植(Thaw-ET)]妊娠的孕妇分娩的1271例新生儿(体外受精组)及同期接受人工授精妊娠的孕妇所分娩的269例新生儿(人工授精组)的临床资料进行分析,比较两组及不同辅助生殖技术后出生的新生儿情况、出生缺陷及出生缺陷受累系统.结果 体外受精组中,IVF、ICSI、Thaw-ET后出生的低体重(LBW)儿分别为20.0%(134/671)、22.4%(92/410)、18.9%(36/190),也均高于人工授精组的11.5%(31/269),差异有统计学意义(P<0.05);多胎妊娠率分别为23.8%(160/671)、25.4%(104/410)、21.1%(40/190),均高于人工授精组的10.0%(27/269),差异也有统计学意义(P<0.05).ICSI后巨大儿发生率为3.9%(16/410),显著低于人工授精组的8.2%(22/269),两者比较,差异也有统计学意义(P<0.05);两组新生儿各系统出生缺陷比较,差异无统计学意义(P>0.05).结论 不同体外受精助孕后多胎率明显升高,由此造成的相关风险也随之增加,但新生儿的出生缺陷并没有明显增加;减少多胎妊娠是保护出生新生儿健康的关键.     

早期补救卵胞浆内单精子注射妊娠结局及新生儿出生结局评估

目的:对常规体外受精(IVF)失败的周期行早期补救性卵胞浆内单精子注射(ICSI)后的妊娠结局及新生儿出生情况进行探讨和分析。方法:常规IVF后6小时未发现明确双极体者判断为完全受精失败,予以早期补救ICSI,纳入早期补救ICSI组(204个周期),随机选择与早期补救ICSI组患者同一日或前一日因男性因素而直接进行ICSI的204例患者纳入ICSI组(204个周期)。回顾性分析两组患者的累计临床妊娠率、流产率、异位妊娠率、累计活产率、分娩孕周及新生儿的单双胎比例、男女性别比例、出生体质量、出生缺陷等指标的差异性。结果:早期补救ICSI组与ICSI组的累计临床妊娠率、流产率、异位妊娠率、累计活产率、新生儿性别比例、新生儿出生体质量等指标的比较差异均无统计学意义(P0. 05)。早期补救ICSI组产妇的分娩孕周较ICSI组略长,双胎比率较ICSI组少,差异有统计学意义(P0. 05)。将分娩孕周分为单胎和双胎分别进行比较,则发现两组间差异无统计学意义(P0. 05)。早期补救ICSI组的活婴中出现1例先天性心脏病出生缺陷,ICSI组的活婴中未发现出生缺陷。结论:早期补救ICSI没有增加胎儿流产及新生儿出生缺陷的风险,双胎率明显下降,怀孕周期略长,可作为常规IVF失败时的一种安全有效的补救方法。     

多囊卵巢综合征患者体外受精/卵胞质内单精子注射-胚胎移植后自然流产相关高危因素的多元回归分析

目的通过了解多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕后自然流产的发生率及其相关危险因素,探讨PCOS患者IVF-ET后流产的相关危险因素,以为临床改善PCOS患者助孕结局提供理论依据。方法回顾性分析因输卵管因素和/或男方因素行IVF/ICSI-ET助孕的PCOS患者共2231例(PCOS组),对照组为条件匹配的因输卵管因素进行助孕治疗的非PCOS患者共2231例,分析其自然流产率和染色体核型异常率。将PCOS组分为自然流产组和持续妊娠组,利用多元回归分析方法探索PCOS自然流产发生的高危因素。结果 PCOS组的自然流产率(24.15%)较对照组高(12.75%),差异有显著统计学意义(P0.001)。在流产的患者中,PCOS组的染色体核型异常率(36.05%,31/86)较对照组低(55.56%,50/90),差异有统计学意义(P=0.009)。在PCOS患者中,自然流产组的年龄、体质量指数(body mass index,BMI)、HOMA指数水平显著高于持续妊娠组(P0.05);经Logistic回归显示,年龄、HOMA指数及BMI与自然流产的发生密切相关;周期类型、移植胚胎质量、移植胚胎数、空腹血糖、空腹胰岛素及基础性激素等组间均无统计学差异(P0.05)。结论与非PCOS患者相比,PCOS患者的流产率高。染色体核型异常不是PCOS患者高流产率的主要因素。年龄、BMI及HOMA指数是PCOS患者在IVF/ICSI-ET助孕后发生自然流产的危险因素。     

一胎儿结构畸形双胎孕中期减胎术例临床分析

目的 探讨不同绒毛膜性的一胎儿结构畸形双胎胎儿畸形种类差异及不同孕周减胎术妊娠结局。方法 回顾性分析2002—2020年在山东第一医科大学附属省立医院因一胎儿结构畸形行孕中期减胎术的双胎病例,分析双绒毛膜双胎(双绒双胎组)及单绒毛膜双胎(单绒双胎组)胎儿畸形种类及不同减胎孕周的妊娠结局。结果 双绒双胎组颈部畸形占比高,两组其余胎儿畸形种类顺位基本一致。双绒双胎组A(12～13⁺⁶孕周)、B(14～19⁺⁶孕周)、C(20～27⁺⁶孕周)3个亚组流产率、活产率差异无统计学意义,随减胎孕周的增加早产率增加,出生体重降低,差异均有统计学意义,A组早产率低于C组,A组及B组新生儿出生体重高于C组(A、B、C 3组的早产率分别为3.7%、13.9%和25.6%)。单绒双胎组A(12～19⁺⁶孕周)、B(20～27⁺⁶孕周)2个亚组流产率、早产率、活产率差异无统计学意义,A组新生儿分娩孕周及出生体重高于B组[分别为38⁺²(37⁺⁴,40)vs....     

行辅助生殖技术助孕后子宫颈机能不全患者妊娠结局及其晚期流产的高危因素分析

目的:分析辅助生殖技术助孕后子宫颈机能不全(CI)患者妊娠结局及探讨其晚期流产的相关危险因素。方法:回顾性分析2010年5月至2018年12月在中山大学附属第六医院生殖中心行辅助生殖技术助孕妊娠后诊断CI患者(70例)的临床资料,将纳入孕妇分为多囊卵巢综合征(PCOS)组(17例)与非PCOS组(53例)和单胎妊娠组(44例)与双胎妊娠组(26例),比较患者的临床资料及妊娠结局。并采用Logistics回归分析CI患者晚期流产的高危因素。结果:①PCOS组患者平均终止妊娠孕周低于非PCOS组(22.85±7.26周vs 25.71±5.99周,P<0.05)。PCOS组妊娠期糖尿病的发生率明显高于非PCOS患者(41.18%vs 15.09%,P<0.05)。PCOS组患者晚期流产率明显高于于非PCOS组(76.47%vs 41.51%,P<0.05),而足月产率明显低于非PCOS组(5.88%vs 13.21%,P<0.05)。②双胎妊娠组患者平均终止妊娠孕周明显低于单胎妊娠患者(23.86±4.71周vs 25.86±8.02周,P<0.05),双胎妊娠组患者GDM的发生率高于单胎妊娠组(34.62%vs 13.64%,P<0.05),双胎妊娠组晚期流产的发生率高于单胎妊娠组(92.30%vs 31.82%,P<0.05),而足月产的发生率低于单胎妊娠组(3.85%vs 15.91%,P<0.05)。③Logistic回归分析提示仅双胎妊娠是CI患者晚期流产的独立危险因素(OR 1.862,95%CI 1.027~5.097)。结论:行辅助生殖技术助孕时,应尽量选择单胚胎移植。对于PCOS患者,孕前做好子宫颈评估,孕期监测子宫颈长度变化,加强产科管理,有助于改善妊娠结局。     

中国部分地区双胎妊娠孕期贫血6063例临床分析

目的 探讨不同孕周、不同地区、不同程度的双胎妊娠贫血及缺铁性贫血(iron deficiency anemia,IDA)发生率。方法 回顾性分析2020年1月1日至2020年12月31日于中国18个省市32家医院(中国妇幼保健协会双胎妊娠专委会双胎贫血学组成员单位)产前检查并分娩的6063例双胎妊娠孕妇的临床资料,统计孕妇年龄,孕期血清铁蛋白(serum ferritin,SF)和血红蛋白(hemoglobin,Hb)数值,分娩孕周,新生儿体重等数据,计算双胎妊娠不同孕周、不同地区、不同程度的贫血及缺铁性贫血的发生率,分析其存在的差异及可能原因。结果 孕早、中、晚期贫血发生率分别为8.5%(162/1898)、21.5%(608/2821)、29.3%(1142/3904),差异有统计学意义(χ²=318.560,P<0.005)。孕早、中、晚期缺铁性贫血的发生率分别为1.8%(34/1898)、6.6%(186/2821)、8.7%(339/3904),差异有统计学意义(χ²=100.149,P<0.005)。地区发生率：东北地...     

1998-2007年上海市体外受精-胚胎移植子代出生缺陷情况分析

目的 对1998-2007年上海市体外受精-胚胎移植(IVF-ET)子代出生缺陷情况进行分析,了解影响出生缺陷发生的因素.方法 回顾性分析1998-2007年于上海市7个生殖医学中心(包括上海集爱遗传与不育诊疗中心、上海交通大学医学院附属仁济医院生殖医学中心、上海交通大学医学院附属瑞金医院生殖医学中心、国际和平妇幼保健院生殖医学中心、上海第一妇婴保健院生殖医学中心、上海市第九人民医院及上海长海医院生殖氏学中心)接受辅助生殖技术助孕并妊娠28周后分娩活产新生儿的产妇及其子代的随访资料.共收集产妇6551例及其子代8507例.了解子代的出生缺陷类型及发生率,并分析不同辅助生殖技术、子代性别、产妇年龄、妊娠胚胎数及精子获取方式对出生缺陷发生的影响.结果 8507例子代中,出生缺陷发生率为1.08%(92/8507),其中循环系统畸形的发生率最高,占所有出生缺陷的34%(31/92).IVF后移植新鲜胚胎、IVF后移植冻融胚胎、卵母细胞胞质内单精子注射(ICSI)后移植新鲜胚胎及ICSI后移植冻融胚胎者的出生缺陷率分别为1.21%(34/2799)、1.07%(20/1871)、1.04%(23/2212)和0.92%(15/1625),分别比较,差异均无统计学意义(P>0.05).男性和女性子代出生缺陷的发生率分别为1.12%(49/4371)和1.02%(42/4136),两者比较,差异无统计学意义(P>0.05);子代出生缺陷的发生率随母亲年龄的增加而增长,其中母亲年龄<30岁者为0.84%(41/4884),与>35岁者[1.77%(16/902)]比较,差异有统计学意义(P<0.05);单胎、双胎及三胎妊娠者的子代出生缺陷发生率分别为0.53%(25/4679)、1.59%(57/3576)和3.97%(10/252),分别比较,差异均有统计学意义(P<0.05);采用自然射精、附睾穿刺和他人供精方式出生的子代出生缺陷发生率分别为1.09%(81/7419)、1.21%(7/579)和0.79%(4/509),分别比较,差异均无统计学意义(P>0.05).结论 IVF-ET未增加子代出生缺陷的发生率,不同授精方式、胚胎处理方式及精子获取方式也与子代出生缺陷发生率无关,而高龄产妇和多胎妊娠则明显增加子代出生缺陷的发生率.     

体外受精—胚胎移植后异位妊娠58例分析

目的:探讨体外受精-胚胎移植(IVF-ET)后异位妊娠(EP)的高危因素。方法:对接受体外受精胚胎移植(IVF-ET)助孕后发生异位妊娠病例的助孕指征、助孕方式等进行回顾性分析。结果:2009年1月至2010年12月佛市妇幼保健院行体外受精胚胎移植(IVF-ET)2445个周期,1153个周期临床妊娠,发生率47.16%,异位妊娠58个周期,发生率为5.03%。年龄、促性腺激素总量、取卵数、移植胚胎个数及优质胚胎率与本次助孕后异位妊娠的发生无关(P>0.05)。49例患者助孕指征为输卵管因素和/或盆腔粘连,占84.48%。2种助孕方式(IVF-ET,ICSI)比较,总妊娠率差异无统计学意义(P>0.05),2种助孕方式异位妊娠率比较,差异亦无统计学意义(P>0.05)。结论:输卵管因素是异位妊娠发生的高危因素,与年龄、促性腺激素总量、取卵数、移植胚胎个数、优质胚胎率、助孕方式无关。     

Obstetric outcome of in vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study

Objective: To assess the outcome of pregnancies conceived with the use of IVF that are complicated by severe ovarian hyperstimulation syndrome (OHSS).

Design: A retrospective nationwide multicenter study.

Setting: Sixteen of 19 tertiary care medical centers in Israel.

Patient(s): All patients undergoing IVF who were hospitalized for severe OHSS between January 1987 and December 1996.

Main Outcome Measure(s): Pregnancy rate (PR) and rates of multiple gestation, miscarriage, ectopic pregnancy, obstetric complications, and intervention.

Result(s): A total of 163 patients who had severe OHSS after IVF treatment were identified, of whom 142 (87.1%) had undergone ET. The clinical PR was 73.2%; 42.3% were singletons, 33.6% were twins, 17.3% were triplets, and 6.7% were quadruplets. The miscarriage rate was 29.8%, whereas the incidence of ectopic pregnancy was 1.9%. Forty-four percent of all births were premature, and 62.1% of all newborns had low birth weight. The most common antenatal complications were pregnancy-induced hypertension (13.2%), gestational diabetes (5.9%), and placental abruption (4.4%). The rate of cesarean section was 44.1%.

Conclusion(s): Among patients who have severe OHSS after IVF treatment, the pregnancy rate and the rates of multiple gestation, miscarriage, prematurity, low birth weight, pregnancy-induced hypertension, gestational diabetes, and placental abruption are significantly higher than those reported previously for pregnancies conceived with the use of assisted reproductive techniques.     

Pregnancy outcome, health of children, and family adjustment after donor insemination

We evaluated the pregnancies of 427 women who conceived through artificial insemination by donor (AID) at our clinic over a 12-year period. Initial phone contact was followed by a questionnaire. Outcome was known for 594 of the 606 pregnancies, with a total of 502 live-born children including 15 sets of twins. The spontaneous abortion rate was 16.5%, with no difference between fresh- and frozen-semen pregnancies. Significant correlations were found between spontaneous abortion rate and maternal age (P less than .001) and spontaneous abortion rate and cycle of conception (P less than .025). Follow-up was completed on 481 children, among whom the following were found: one chromosomal anomaly, 22 major congenital anomalies, four children with possibly syndromic conditions, and 38 with minor congenital anomalies. Of the school-aged children, 5.8% had recognized learning disabilities and 10.5% were considered gifted by their schools. We also investigated the psychological impact of AID on each family. The majority of couples (71.7%) informed their obstetricians of the AID. Half of the couples did not tell any family or friends. Many couples did not (47%) or probably did not (14%) plan to tell their children of their origins. The divorce rate among those with AID children was 7.2%, which was significantly less (P less than .01) than that in a matched population. Psychological counseling specifically related to AID was sought by 2.8% of the couples. We conclude that AID children are at similar risk for congenital anomalies as normally conceived children, but they experience lower rates of family dissolution.     

Reproductive performance in the next pregnancy for nulliparous women with history of first trimester spontaneous abortion

Objective

To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy.

Method

A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy.

Results

Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months.

Conclusions

Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.     

辅助生殖技术单卵双胎相关因素分析及含单绒毛膜双胎三胎妊娠减除单绒毛膜双胎之一的临床结局比较

目的探讨辅助生殖技术(ART)治疗后行多胎妊娠减胎术中单卵双胎(MZT)的发生和三胎妊娠行单绒毛膜双胎中一胎减胎术保留双胎者的临床结局。方法回顾性分析ART治疗后行经阴道多胎妊娠减胎术的196例患者的临床资料,分析比较MZT在不同分组中的发生情况,同时比较其中伴单绒毛膜双胎的三胎妊娠减单绒毛膜双胎之一者(A组)与不伴单绒毛膜双胎的三胎妊娠减胎后保留双胎者(B组)的临床结局。结果 (1)196例患者中MZT所占比率为44.39%(87/196)。MZT占比率在体外受精(IVF)组(0.85%)、卵胞质内单精子显微注射(ICSI)组(0.66%)、冻融胚胎移植(FET)组(0.78%)和人工授精(AIH/AID)组(0.16%)间比较差异有统计学意义(P=0.001);在辅助孵化(AH)组(1.48%)和无AH组(0.44%)间比较差异亦有统计学意义(P=0.000)。MZT占比率在高龄(≥35岁)和非高龄患者中(P=0.330)及卵裂期胚胎移植组和囊胚期胚胎移植组组间(P=0.950)比较差异无统计学意义。(2)A组和B组患者的平均年龄、平均孕周、新生儿的平均胎龄、平均胎儿出生体质量、流产率、早期流产率、晚期流产率、早产率、足月产率、活产率、低出生体质量儿发生率、新生儿出生缺陷率和妊娠并发症率比较,差异均无统计学意义(P0.05)。结论 ART行多胎妊娠减胎术的患者中MZT所占几率很高,为减少MZT的发生,尽量选择单胚胎移植;A组和B组患者临床结局无统计学差异,单绒毛膜双胎中一胎减胎术可能是安全而可行的。     

Early pregnancy wastage after gamete manipulation

Summary. The outcome of 1034 pregnancies in women who conceived after referral for infertility management in seven treatment groups is detailed. The mean early pregnancy wastage (before 20 weeks gestation) was 27% and ranged from 18% after AID (artificial insemination by donor semen) to 33% after IVF-ET (in-vitro fertilization and embryo transfer). These differences were not due to maternal age which was similar in all groups (means between 29.7 and 32.7 years). Excluding the AID group, there was a high rate of ectopic pregnancy which was significantly higher after GIFT (gamete intrafallopian transfer) and was only partly related to underlying tubal disease. Blighted ova was the main category of early pregnancy loss and was highest after AIH (artificial insemination by husband's semen). There was a higher rate of biochemical pregnancies after GIFT, PROST (pronuclear stage tubal transfer) and IVF-ET. Our findings confirm a high pregnancy wastage rate in subfertile women and highlight deficiencies in the sperm separation, gamete handling and IVF/embryo culture techniques.     

体外受精-胚胎移植中多胎减胎后双胎妊娠结局的分析

目的:探讨IVF-ET中多胎妊娠减胎术对双胎妊娠结局的影响。方法:回顾性地分析IVF-ET治疗后直接双胎妊娠124例(A组)和IVF多胎妊娠减为双胎妊娠43例(B组),比较二组孕期流产率、早产率、胎儿出生体重、胎儿畸形率、新生儿死亡率、胎盘粘连和产后出血等。结果:早期流产率A组8.1%,B组25.6%;晚期流产率A组16.9%,B组9.3%;总流产率A组25%,B组34.9%;A、B组间流产率有显著差异(P<0.01)。A、B组平均孕周(36.6±2.2周vs36.0±2.9周)、第一胎胎儿出生体重(2678.0±510.3gvs2542.5±454.8g)和第二胎胎儿出生体重(2393.4±496.8gvs2297.5±501.0g)间无统计学差异;A、B组间在母体并发症发生率、胎儿畸形率、新生儿死亡率之间也无统计学差异(P>0.05)。结论:IVF-ET中多胎减为双胎妊娠与IVF-ET中直接双胎妊娠相比,早期流产率明显增加。     

Fertility after ectopic pregnancy

In the period July 1983 to March 1985, 264 women had surgery for ectopic pregnancy at Grady Memorial Hospital; 76 had postoperative hysterosalpingograms. Of these, 55 (76.4%) women were followed up for 3 to 41 months (mean, 23.8) to determine subsequent fertility. During the follow-up period, 30 pregnancies occurred among the 55 patients; 24 were intrauterine and 6 were repeat ectopic pregnancies. In the surgical group of 39 patients with salpingectomy, 60.8% of those desiring pregnancy achieved an intrauterine pregnancy. Of the 12 patients with salpingostomy, the three who desired pregnancy achieved it (100%). In the tubal abortion group, the two women desiring pregnancy conceived (100%). There were six repeat ectopic pregnancies (10.9%). Of the ectopic pregnancies, one occurred in the salpingectomy group (2.6%), four in the salpingostomy group (33.3%), and one in the tubal abortion group (25%). Five of the six ectopic gestations were found in the contralateral fallopian tube. Hysterosalpingographic evidence of contralateral tubal patency was a good prognostic indicator for subsequent intrauterine pregnancy. By contrast, one half of study patients with findings suggesting tubal occlusion still achieved an intrauterine pregnancy.     

Reproductive outcome after methotrexate treatment of tubal pregnancies

OBJECTIVE: To evaluate reproductive outcome after ectopic pregnancy (EP) treated with methotrexate (MTX) and to assess the relative contribution of various risk factors to future fertility. DESIGN: Telephone follow-up interviews in a cohort of patients treated for EP. SETTING: University hospital. PATIENT(S): A cohort of 158 patients treated with MTX for tubal pregnancies between April 1991 and March 1999. INTERVENTION(S): Assessment of fertility outcomes. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rates for intrauterine and ectopic pregnancies. RESULT(S): Thirty-two patients (20.2%) were lost to follow-up. Of 126 patients, 93 (73.8%) sought to become pregnant, and of these 93 women, 76 (81.7%) did. Sixty-four pregnancies were spontaneous, and 12 resulted from in vitro fertilization (IVF). No pregnancies occurred in the group not trying to become pregnant. Of the 64 spontaneous pregnancies, 52 (81.2%) were intrauterine, with 12 (18.7%) resulting in miscarriages, and 12 (18.7%) were recurrent ectopic pregnancies. The cumulative intrauterine pregnancy rate was 57.5% after 1 year and 66.9% after 2 years. The cumulative ectopic pregnancy rate was 15.4% after 1 year and 23.7% after 2 years. After adjusting for factors associated with fertility with a Cox regression, only one factor was associated with poor reproductive performance: previous history of infertility. CONCLUSION(S): Within 1 year of seeking to become pregnant, more than half the women previously treated medically for EP conceived and had ongoing pregnancies. Our analysis indicates that fertility depends more on the patients' previous medical history than on her treatment for EP.     

子宫肌瘤子宫动脉栓塞术后妊娠情况及影响因素分析

目的:探讨子宫肌瘤患者行子宫动脉栓塞术(UAE)后的妊娠结局,以及肌瘤位置对妊娠率和结局的影响。方法:对行子宫动脉栓塞术的84例有生育要求和497例无生育要求的子宫肌瘤患者进行随访,了解其术后妊娠和产科并发症的发生情况。结果:(1)截止2011年4月,本研究中有50例患者60次妊娠。其中有妊娠要求组共30例39次妊娠,无妊娠要求组共20例21次妊娠。(2)有妊娠要求组妊娠结局为分娩26次(自然分娩9次,剖宫产17次),人工流产4次,自然流产5次,异位妊娠1次,宫内死胎3次(同1人);无妊娠要求组均行人工流产;(2)分娩的26例患者中,发现产科并发症7例26.92%(7/26),其中子痫前期1例3.85%(1/26)、胎盘前置状态1例3.85%(1/26)、早产4例15.38%(4/26)、中央性前置胎盘1例3.85%(1/26);(4)有妊娠要求的单发性肌瘤组(黏膜下、肌壁间、浆膜下、不明)和多发性肌瘤组的妊娠率分别为25.00%、59.09%、62.50%、14.29%和27.58%;单发浆膜下肌瘤组无产科并发症发生,黏膜下子宫肌瘤患者的产科并发症发生率高达75%。结论:子宫肌瘤患者在UAE后可正常妊娠,但自然流产率、胎盘异常等的发生率明显增高,特别是黏膜下和多发性子宫肌瘤患者。     

Ectopic pregnancy: A case-control study of aetiological risk factors

Summary Aetiological risk factors for ectopic pregnancies were evaluated in a prospective study of 86 consecutive patients with ectopic pregnancy and two age- and parity-matched control groups of women in normal early pregnancy; those with planned pregnancy (65 pairs) and those having legal abortion (51 pairs). Compared with women with planned pregnancy, the patients with ectopic pregnancy more often had an IUD in situ, they had less frequently used hormonal contraception, and they had had more legal abortions, curettages, previous ectopic pregnancies, gynaecological operations and salpingo-oophoritis. Compared with women having legal abortion, the patients with ectopic pregnancy had favoured IUD-usage, or they had been without any contraception, and they had an increased frequency of previous ectopic pregnancies. The frequency of fertility problems was also increased in patients with ectopic pregnancy. Our results show that gynaecological plevic operations, endometrial curettage and evacuation, gynaecological infections, and usage of IUD are important risk factors for ectopic pregnancy, and that infertility seems to be a sign of this risk. In addition, the clinical characteristics of the patients with ectopic pregnancy were similar to those of the patients having legal abortion.