辅助生殖技术后发生宫内外同时妊娠的相关因素分析

目的探讨辅助生殖技术后发生宫内外同时妊娠的高危因素、诊断、治疗及预后。方法对2005年1月～2008年10在广州医学院第三附属医院生殖科进行辅助生殖治疗后发生的7例宫内外同时妊娠病例进行回顾性分析。结果宫内外妊娠的发生率为0.6%,5例为输卵管因素不孕,其中1例有既往异位妊娠史。6例经B超确诊,1例经手术确诊。1例行阴道B超引导下异位孕囊穿刺抽吸胚芽术,1例行输卵管切开取胚术,5例行输卵管切除术,其中3例在异位病灶去除后继续宫内妊娠并分娩活婴。结论既往输卵管盆腔疾病或手术、异位妊娠史是辅助生殖技术后发生宫内外同时妊娠的高危因素。对有高危因素的患者早期加强B超检测有助于早期诊断、早期治疗,将对宫内妊娠的影响减到最小。     

经阴道超声引导下穿刺介入术与单次肌注MTX治疗未破裂异位妊娠的疗效比较

目的:比较经阴道超声引导下穿刺介入术与单次肌注甲氨蝶（Methotrexate,MTX）治疗未破裂异位妊娠的疗效。方法:回顾性收集我院2017年1月至2019年2月收治的94例未破裂异位妊娠患者临床资料,根据治疗方式分为对照组与观察组（n=47）。对照组患者采用单次肌注MTX50 mg进行治疗,观察组采用经阴道超声引导下穿刺介入术治疗。治疗14 d后,比较两组临床疗效、行腹部超声检查妊娠包块直径、记录总住院时间、月经复潮时间、行输卵管碘油造影检查输卵管再通情况。结果:观察组临床总有效率97.87%（46/47）,明显高于对照组87.23%（41/47）（P<0.05）;观察组治疗7 d后妊娠包块直径、总住院时间及月经复潮时间均较对照组低（P<0.05）;观察组输卵管再通情况优于对照组（P<0.05）。结论:经阴道超声引导下穿刺介入术治疗未破裂异位妊娠疗效更佳,可有效减小妊娠包块,改善月经情况,改善输卵管再通情况。     

输卵管积水患者在胚胎解冻周期三种治疗方法的研究

目的探讨输卵管积水患者在胚胎解冻移植(FET)周期中的最佳治疗方案。方法对输卵管积水致不孕而接受体外受精-胚胎移植(IVF-ET)未妊娠而且有冷冻胚胎的患者91例,分为三组:A组,采用积水输卵管切除术30例;B组,采用体外短波治疗加经阴道抽吸输卵管积水31例;C组,仅采取体外短波治疗30例。比较患者FET的胚胎种植率、临床妊娠率、妊娠后的早期流产率和异位妊娠发生率。结果A组的胚胎种植率、临床妊娠率、早期流产率、异位妊娠发生率分别为14.8%,36.7%,18.2%,0。B组的分别为16.3%,38.7%,16.7%,8.3%。C组的分别为11.2%,26.7%,25%,12.5%。A,B组之间胚胎种植率、临床妊娠率、早期流产率的比较差异均无显著性,异位妊娠发生率的比较差异有显著性。A,B组与C组之间临床妊娠率、早期流产率的比较差异有显著性。结论输卵管积水患者在FET前行输卵管切除术或者用体外短波治疗加经阴道抽吸输卵管积水可以改善其FET结局。     

多胎妊娠早期选择性减胎术及心理干预研究

目的探讨多胎妊娠早期选择性减胎术的手术方法和心理干预对结局的影响。方法选择因多胎妊娠行减胎术的患者57例,均在孕7-10周间采用胚胎抽吸法和自制钢丝绞杀加胚胎抽吸法。同时行术前后的心理疏导。结果 57例患者中流产8例,早产5例,足月产26例,18例正在妊娠中,31例分娩出婴儿56个,均为正常新生儿。结论多胎妊娠孕早期经阴道行减胎术安全、有效、操作简单,同时行心理干预可改善母婴预后,获得好的妊娠结局。     

异位妊娠误诊21例临床分析

异位妊娠是妇科常见急腹症,近年来发病率呈上升趋势[1-2]。1998年12月至2005年12月我们共收治异位妊娠破裂166例,误诊21例,误诊率12.65%,其中门诊误诊16例,术前误诊5例。本组病例均经手术和病理检查证实。现分析报告如下。1资料与方法1.1临床资料本组年龄17~40岁。初次妊娠6例,有流产史而未生育3例,有分娩史而无流产史1例,有流产史又有分娩史1例,置宫内节育器3例,输卵管结扎1例,有剖宫产史1例,不孕史2例,阑尾炎术后1例,异位妊娠破裂术后1例,卵巢肿瘤切除术后1例。有停经、不规则阴道流血、腹痛者8例(38.1%),无停经,有不规则阴道流血、腹痛或…     

辅助生育技术后宫内宫外同时妊娠的临床分析

目的探讨辅助生育技术后宫内宫外同时妊娠的病因、临床特点、处理及宫内胚胎的预后。方法对本院1996年6月至2007年10月收治的8例宫内宫外同时妊娠病例进行回顾性分析。结果8例宫内宫外同时妊娠患者中,5例有输卵管炎,6例为辅助受孕,2例自然妊娠,4例腹腔内出血大于1000ml。结论既往输卵管或盆腔疾患、宫外孕、输卵管手术是辅助生育技术后HP发生的常见原因。输卵管炎与辅助生育是宫内宫外同时妊娠的主要病因。误诊可造成腹腔内大出血。加强B超监测有助于早诊断、早治疗。异位妊娠的终止可能影响宫内妊娠的预后。     

经阴道彩色多普勒像在早期诊断输卵管妊娠中的临床价值

目的探讨经阴道彩色多普勒血流显像(TV-CDFI)在早期诊断输卵管妊娠中的价值.方法对30例临床疑诊异位妊娠的病人行TV-CDFI检查并与手术病理结果对照分析.结果经阴道彩色多普勒超声诊断异位妊娠29例,宫内、外同时妊娠1例,均经病理证实,符合率100%.结论经阴道彩色多普勒超声检查对早期输卵管妊娠诊断与鉴别诊断有重要的临床价值.     

一高龄妇女双侧输卵管同时妊娠后再行IVF-ET获双胎妊娠

病例:患者38岁,因继发性不孕10年,经碘油造影(HGS)确诊为双侧输卵管伞端梗阻.于2000年在外院进行体外受精一胚胎移植(IVF-ET).停经后42d出现腹痛,伴阴道流血,被诊断为宫外孕,剖腹探查为:右侧妊娠破裂行后侧输卵管切除术.左侧输卵管扭曲充血,与卵巢粘连,有3.2×2.5×1.5cm紫蓝色囊性包块,分离粘连,行左侧输卵管切除.病理报告:双侧输卵管见蜕膜组织及绒毛.患者于2003年到我所就诊:检查衣原体阳性,经治愈后.2003年11月在本所行IVF-ET,采用本实验室FSH HMG HCG方案促排卵,当优势卵有2个直径16mm,肌注绒毛膜促性腺HCG1000U,36h阴道B超引导下穿刺取卵5个,其丈夫排卵后按常规方法行体外受精,获受精卵3个,2d后移植3个4-细胞胚胎,给黄体酮及HCG支持,移植后14d,尿HCG( ),30d经B超检查:宫内见两个孕囊及原胎胎心博动,为临床妊娠.随访已分娩二活婴,胎儿各重2750g和2980g,现婴儿正常.     

三种输卵管疏通术治疗输卵管梗阻性不孕疗效分析

目的：分析三种输卵管疏通术治疗输卵管梗阻性不孕的治疗效果.方法：2005年9月～2009年9月,我院分别采用不同输卵管疏通术治疗输卵管梗阻性不孕193例.其中宫腔镜引导下输卵管插管110例（A组）,输卵管介入30例（B组）,宫-腹腔镜联合疏通输卵管53例（C组）.比较3组治疗后妊娠结局;对其中术后1 a以上未孕的113例病人行子宫输卵管碘油造影及经宫腔镜输卵管插管通液,观察输卵管梗阻部位与疏通效果之间的关系,并分析输卵管疏通后不孕的原因.结果：193例病人治疗后宫内妊娠67例、异位妊娠13例、未孕113例,其宫内妊娠率、异位妊娠率、不孕率分别是34.7%、6.7%、58.6%;3组比较,C组术后宫内妊娠率最高,明显优于B组（P＜0.05）.疏通术后输卵管再梗阻发生率为48.7%（94/193）,经宫腔镜实施再疏通成功率为56.8%（71/125）,近端再疏通成功率显著优于远端（P＜0.05）.结论：重视对输卵管梗阻性不孕患者的术前诊断,选择正确的疏通方法,加强抗感染,可提高治疗的成功率.     

体外受精-胚胎移植后异位妊娠10例临床分析

目的探讨体外受精-胚胎移值后异位妊娠的发生率、高危因素及早期诊治方法.方法对我中心2000年6月至2004年9月接受体外受精-胚胎移植后妊娠的141例临床资料进行回顾性分析.结果141例临床妊娠中宫内妊娠131例,异位妊娠10例(包括宫内外同时妊娠2例),异位妊娠发生率为7.1%.其中输卵管病变发生异位妊娠8例,非输卵管病变发生异位妊娠2例.结论异位妊娠的发生与输卵管病变及其他高危因素有关,妊娠早期测定β-人绒毛膜促性激素(β-HCG)和B超检查,有利于异位妊娠的早期诊断和治疗.     

Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations.

Assisted reproduction technologies and ovulation induction for treatment of infertility continue to cause high order multiple gestations. Increased perinatal morbidity and mortality, as well as maternal morbidity, may complicate these pregnancies. Selective fetal reduction, an acceptable therapeutic approach in these cases, is usually performed at or after the ninth week of gestation, with KCl injected in the vicinity of the fetal heart, and is associated with a total pregnancy loss rate of 11.7%. We report our experience with 90 women who underwent early (mean 7.5 weeks gestation, range 7. 0-8.0 weeks) transvaginal selective embryo aspiration. The mean number of viable embryos before and after reduction was 3.5 and 2.1 respectively. Six (6.7%) pregnancies were lost before 24 gestational weeks. One miscarriage occurred at the tenth gestational week. The other five pregnancies were aborted at 17.3-21.6 weeks gestation. Additional interventions were performed in three of these pregnancies: genetic amniocentesis in two cases and cervical suture in one case. In the subset of 39 patients with>/=4 embryos, only one (2.6%) pregnancy loss was recorded. This loss rate is significantly lower (P < 0.05) than the 15.3% loss rate in patients with >/=4 fetuses calculated from other work. Four (4.4%) other pregnancies were complicated by premature delivery (25-28 weeks gestation). Mean gestational age of delivered pregnancies in our series was 35.7 weeks. In conclusion, early transvaginal embryo aspiration is a simple and relatively safe method for multiple pregnancy reduction. The overall pregnancy loss rate associated with early embryo aspiration is similar to that of procedures performed at later gestational age, but is significantly lower when the initial number of embryos is four or greater.     

Successful pregnancy in an infertile patient with conservatively treated endometrial adenocarcinoma after transfer of embryos obtained by intracytoplasmic sperm injection.

A rare case of successful pregnancy in a woman with early-stage endometrial adenocarcinoma conservatively treated is presented. The patient, having polycystic ovaries, was initially diagnosed with hyperplasia of the endometrium and treated with several cycles of ovulation induction following intrauterine insemination. Then dilatation and curettage were carried out when hysteroscopy was performed. The histology report identified a well-differentiated adenocarcinoma of the endometrium. After repeated endometrial curettage, in-vitro fertilization and embryo transfer were introduced for immediate treatment of the patient's infertility in order to avoid the risk of recurrence of neoplastic endometrial lesions by oestrogens. A single pregnancy was achieved after transfer of the embryos obtained after intracytoplasmic sperm injection. This was performed due to the poor semen characteristics (asthenozoospermia). The patient delivered a healthy normal male infant at term. A transvaginal ultrasound examination 2 months after delivery showed a smooth, linear endometrium. Moreover, the histology report after endometrial biopsy was free of any malignancies. The patient now desires another pregnancy. We conclude that conservative treatment of early-stage endometrial adenocarcinoma in young women wishing to preserve fertility should be considered in carefully selected cases. Assisted reproductive technologies may be helpful for immediate achievement of pregnancy in such patients.     

Heterotopic triplet pregnancy: report of a case with bilateral tubal pregnancy and an intrauterine pregnancy

The first report of an ectopic pregnancy following IVF was published in 1976, and since then heterotopic pregnancies (HPs) have been reported at an increasing rate. Although cases of the co-existence of a bilateral tubal and an intrauterine pregnancy following IVF-embryo transfer have been reported, a case of heterotopic triplet pregnancy caused by unilateral tubal embryo transfer has not yet been published in the literature. Here we report on a 38-year-old women (gravida 3, para 1) with a history of infertility who presented to our infertility clinic for evaluation. Hysterosalpingography revealed bilaterally patent Fallopian tubes and stricture of the cervical canal. She conceived after receiving HMG combined with pure FSH, followed by IVF-tubal embryo transfer. Four embryos were replaced into the right tube. Approximately 5 weeks after tubal embryo transfer, the patient presented with lower abdominal tenderness and shock due to internal bleeding. She underwent an emergency laparotomy under the impression of HP. Bilateral tubal pregnancy with right tubal rupture was noted during the operation. The post-operative course was uneventful. Early intervention and thorough inspection of the peritoneal cavity in patients with haemodynamic instability can prevent jeopardizing the life of the mother as well as the ongoing pregnancy.     

The place of methotrexate in the management of interstitial pregnancy

Six patients with interstitial pregnancies were treated with systemic or local injections of methotrexate, 15 mg i.m. daily for 5 days, or 1 mg/kg for 1 day. One dose of folinic acid rescue (50 mg) was administered on the first day of the treatment course. Diagnosis of interstitial pregnancy was established either by laparoscopy or transvaginal ultrasound. Out of six patients, five had serial measurements of serum human chorionic gonadotrophin (HCG), progesterone (P) and 17 beta-oestradiol (E2) until either the ectopic pregnancy resolved or surgery was performed. For one patient operated on day 1 after medical treatment, no serial serum measurements were performed. Serum HCG became undetectable under medical treatment in only four of the six patients. Out of these four patients, three had an initial level of HCG less than 1000 mIU/ml. Two patients underwent surgery (salpingectomy) because either the level of serum HCG did not decrease after the course of methotrexate therapy or it was required the next day to stop haemorrhage. In these patients, the initial level of HCG at the time of diagnosis, was 5300 and 43,000 mIU/ml, respectively. In the four patients who received conservative medical treatment only, the next menstrual period occurred 20-46 days after the onset of methotrexate and was preceded by luteal activity. A control hysterosalpingography performed 2 months later showed that in the four patients who received medical treatment only, the Fallopian tube was patent, and three became pregnant within 1 year of the methotrexate therapy. One of two patients who failed to respond to medical treatment and required surgical treatment, became pregnant 6 months later.(ABSTRACT TRUNCATED AT 250 WORDS)     

Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra

The presence of hydrosalpinges has been shown to be deleterious in infertility treatment. Pregnancy rates after in-vitro fertilization (IVF) with embryo transfer decline considerably. This study concerns a patient who developed bilateral hydrosalpinges during controlled ovarian stimulation in preparation for IVF treatment. Transvaginal aspiration of the tubal fluid was unsuccessful as the tubes refilled within 2 days. Additionally, on the day of embryo transfer a serometra developed which could not be seen on the day of oocyte retrieval. The uterine cavity was evacuated via an embryo transfer catheter and three embryos were transferred. The serometra reappeared 3 days after embryo transfer. A pregnancy could not be achieved. The accumulation of fluid in the uterine cavity during an IVF/embryo transfer cycle is a rare complication of hydrosalpinges. However, the retrograde flow of tubal fluid may disturb intrauterine embryo development. This study suggests that the aspiration of hydrosalpinges and intrauterine fluid accumulation during an IVF cycle is not beneficial, as the underlying pathology is not cured. Cancellation of the treatment cycle or cryopreservation of oocytes in the pronucleate stage and transfer of the cryopreserved oocytes after surgical correction of the tubes may be better options.      

Monozygotic twin delivery following reduction from quadramniotic-dichorionic gestation established after ICSI and embryo transfer: Case report

We report the delivery of healthy monozygous (MZ) twins in a 31 year-old nulligravida following gonadotrophin ovulation induction, ICSI, assisted hatching and fresh embryo transfer. Although a sonogram on day 35 confirmed that two of four transferred embryos had implanted, a second transvaginal sonogram 1 week later showed each gestational sac had two conceptuses-all four were associated with distinct amniotic compartments. Cardiac activity was observed in all four embryos. At 12 weeks and 5 days gestation, chorionic villus sampling was performed on fetuses 1 and 2 which were euploid for chromosomes 13, 18, 21, X and Y via fluorescence in-situ hybridization analysis. Subsequent KCl injection into sacs 3 and 4 resulted in asystole for these fetuses, while cardiac activity in sacs 1 and 2 remained unchanged after reduction. A twin vaginal delivery occurred at 36 weeks gestation, resulting in the birth of two male infants and one placenta. This case represents the first known report of human quadruplet pregnancy consisting of two MZ twin sets conceived by assisted reproductive techniques. Our report reviews proposed mechanisms for explaining twinning, with special emphasis on zona pellucida micromanipulation and subsequent MZ twin induction.     

A method to prevent arrest of embryo development by ultrasound coupling gels after transvaginal ultrasoundguided oocyte retrieval

Two commonly used sterile ultrasound coupling gels were foundto affect development in vitro of 8-cell mouse embryos adversely.Suggestions made previously by other investigators to preventthese deleterious effects in percutaneous aspiration of humanovaries under ultrasound guidance, appeared not to be applicablein transvaginal ultrasound-guided oocyte retrieval, especiallyin nulliparous patients. We report a new method, developed inour IVF programme, which allows optimal visualization of thepelvic organs without the risk of impairing embryo developmentafter ultrasound-guided vaginal oocyte retrieval.     

The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth.     

双胎妊娠-胎宫内死亡20例临床分析

目的探讨双胎妊娠-胎宫内死亡的原因、临床处理及预后。方法回顾性分析1994年3月至2008年2月北京大学第三医院双胎妊娠-胎宫内死亡的病例共20例。结果双胎-胎宫内死亡的发生率为3．2％,其中双卵双胎17例,单卵双胎3例。28w前发现-胎宫内死亡者6例,平均期待治疗95．8天,平均分娩孕周为34．4w（32^＋4-39w）;28w后发现-胎宫内死亡者14例,平均期待治疗10．1天,平均分娩孕周为34．6w（29^＋4-39^＋2w）;仅2例新生儿发生轻度窒息。无一例孕妇发生凝血功能障碍。追踪新生儿6月至14年,1例新生儿因合并隐性脊柱裂及早产原因早期死亡,1例患儿3岁时发生运动障碍性脑瘫（分娩孕周为29^＋6w）,4例失访,其余均健康存活。结论双胎妊娠-胎宫内死亡后可采取期待治疗,严密监测存活胎儿宫内状况,尽量延长孕周,可提高存活胎儿的生存质量。