IVF-ET术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局分析

目的 分析体外受精-胚胎移植(1VF-ET)术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局.方法 回顾性分析2014年3月至2019年6月于我院诊治的IVF-ET周期宫内妊娠合并输卵管妊娠患者50例的临床资料.分析其临床特征、超声表现、治疗方式及妊娠结局等.结果 (1)本研究50例患者中10例(20.0％)无明显症状,16...

Analysis of the diagnosis&treatment and pregnancy outcomes of intrauterine pregnancy combined with fallopian tube pregnancy after IVF-ET

Objective:To analyze the diagnosis,treatment and pregnancy outcomes of intrauterine pregnancy combined with tubal pregnancy after IVF-ET.Methods:The clinical data of 50 patients with intrauterine pregnancy combined with tubal pregnancy after IVF-ET who were diagnosed and treated in our hospital from March 2014 to June 2019 were retrospectively analyzed.The clinical characteristics,ultrasound characteristics,treatment methods and pregnancy outcomes were analyzed.Results:(1)Among the 50 patients,10 patients(20.0%)had no obvious symptoms,16 patients(32.0%)of vaginal bleeding,13 patients(26.0%)of lower abdominal pain or bloating,and 11 patients(22.0%)of vaginal bleeding with lower abdominal pain or bloating.(2)Treatment exploration revealed that 12 patients had intrauterine pregnancy with tubal interstitial pregnancy,34 patients of intrauterine pregnancy with tubal ampullary pregnancy,and 4 patients of intrauterine pregnancy with tubal isthmus pregnancy.(3)All 50 patients were initially diagnosed by vaginal ultrasound.The ultrasound findings of ectopic pregnancy included 1 case of gestational sac,5 cases of yolk sac,6 cases of germ,16 cases of cardiac pulsation,and 22 cases of mixed mass in the appendage area.(4)In 39 patients with laparoscopic surgery,31 cases of intrauterine pregnancy survived.The follow-up results were as follows:2 cases of premature birth,24 cases of full-term live birth,5 cases of continued pregnancy,8 cases of termination of pregnancy(7 cases of miscarriage,1 case of deformity induced labor).Among the 7 cases of laparotomy,3 cases of intrauterine pregnancy were full-term live births,4 cases were aborted.Among 4 cases of intrauterine pregnancy after interventional therapy,1 case was premature delivery,2 cases were full-term live births,and 1 case was aborted.The overall survival rate of intrauterine pregnancy after treatment was 74.0%(37/50).Full-term and premature babies were followed up,and they were in good health and no congenital abnormalities were found.(5)The pregnancy outcomes of ectopic pregnancy in different tubal sites(interstitial group,ampulla group,isthmus group)were compared.There was no significant difference in intrauterine pregnancy survival rate,preterm birth rate,gestational weeks of termination of pregnancy,neonatal birth weight and 1-minute Apgar score of newborn and incidence of complications(P>0.05).(6)Except for 1 patient with induced abortion due to fetal malformation,the remaining patients were divided into abortion group(n=12)and intrauterine pregnancy survival group(n=37)according to whether or not miscarriage after treatment,and the correlations between pregnancy outcome and clinical characteristics was analyzed in the two groups.The results showed that ultrasound performance and gestational age at the time of treatment were significantly correlated to pregnancy outcome(P<0.05).However,the patient’s age,BMI index,gravidity,parity,history of pelvic disease,history of fallopian tube surgery,type of embryo transfer,clinical symptoms,average diameter of ectopic mass,ectopic pregnancy site and treatment method did not influence the pregnancy outcome(P>0.05).Conclusions:Vaginal ultrasound is greatly significant in the diagnosis of intrauterine pregnancy combined with tubal pregnancy.Early examination in early pregnancy can eliminate the influence of combined ectopic pregnancy on intrauterine pregnancy.Early diagnosis and treatment can help to obtain a good pregnancy outcome.