体外受精-胚胎移植术后宫内宫外同时妊娠15例临床分析

目的探讨体外受精-胚胎移植(IVF-ET)后宫内宫外同时妊娠的发病率、危险因素、早期诊断及最佳治疗方式。方法对2001年10月至2006年10月在我院生殖中心行IVF-ET后获宫内宫外同时妊娠(HP)15例进行回顾性分析。结果同期IVF-ET后临床妊娠1,230例,HP15例,发生率1.2%。15例均为输卵管因素不育,其中1例合并男性因素;7例有盆腔手术史,3例宫外孕史;14例为宫内合并输卵管妊娠,1例为双侧输卵管切除术后合并间质部妊娠。15例患者均于确诊后手术治疗,其中10例在异位妊娠破裂前确诊,5例于破裂后确诊。术后9例宫内妊娠继续至足月分娩,4例胚胎停止发育,2例继续妊娠。结论输卵管病变或(和)盆腔手术史是IVF-ET术后HP发生的主要危险因素。IVF术前术中适当处理、早期诊断、及时治疗异位妊娠,有助于挽救宫内妊娠。

Heterotopic pregnancy after in vitro fertilization and embryo transfer: a clinical analysis of 15 cases

Objective:To investigate the incidence,high risk factors,clinical characteristics and treatment methods of heterotopic pregnancy(HP) after in vitro fertilization and embryo transfer(IVF-ET).Method:Fifteen cases of HP after IVF-ET were analyzed retrospectively.Results:There were 15 cases with HP out of 1,230 clinical pregnant women after IVF-ET,and the occurrence rate was 1.2%.All 15 patients had the IVF-ET treatment due to the tubal problems.7 of them had previous pelvic surgeries and 3 had a history of ectopic pregnancy.14 were found to be intrauterine pregnancy complicated with tubal gestation and 1 with cornual gestation after bilateral salpingectomy.Operation was performed for all 15 cases,with the intrauterine gestation preserved in 11 cases and aborted after operation in other 4 cases.Conclusion:HPs increase with the development of assisted reproductive technology.Tubal diseases are the major high risk factors.Early diagnosis and prompt treatment can maintain the intrauterine pregnancy.