剖宫产术后瘢痕子宫对再生育患者IVF-ET助孕结局影响的研究
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摘要
目的:研究拟再生育不孕症人群中剖宫产术后瘢痕子宫对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法:回顾性分析2011年12月至2017年7月就诊于厦门市妇幼保健院生殖医学科拟生育二孩接受IVF-ET助孕治疗的285例继发输卵管因素不孕症患者资料,按照生育第一孩的分娩方式将109例瘢痕子宫患者纳入研究组,将176例非瘢痕子宫患者纳入对照组;按照患者年龄分为高龄组(≥35岁)和低龄组(<35岁);再将研究组按照胚胎移植距剖宫产术的时间分为≥10年组(50例)和<10年组(59例),比较各组的妊娠结局。结果:两组患者年龄、不孕年限、移植胚胎数比较,差异无统计学意义(P>0. 05)。研究组的临床妊娠率(42. 20%)、着床率(27. 40%)显著低于对照组(54. 55%、36. 14%),差异有统计学意义(P<0. 05),两组间生化妊娠率、异位妊娠率及流产率比较,差异无统计学意义(P>0. 05)。在<35岁的低龄组中,研究组的临床妊娠率(41. 51%)和着床率(28. 51%)显著低于对照组(68. 11%、46. 04%),差异有统计学意义(P<0. 05),两组生化妊娠率、异位妊娠率和流产率比较,差异无统计学意义(P>0. 05);在≥35岁的高龄组中,研究组与对照组的生化妊娠率、临床妊娠率、着床率、异位妊娠率以及流产率比较,差异无统计学意义(P>0. 05)。研究组中瘢痕子宫<10年组的生化妊娠率(13. 56%)显著高于≥10年组(0%),差异有统计学意义(P<0. 05)。结论:剖宫产术后瘢痕子宫是影响再生育人群IVF-ET妊娠结局的重要因素,降低了IVF-ET的临床妊娠率和着床率,其对IVF-ET临床妊娠率和着床率的影响与患者的年龄和剖宫产术距再孕的时间有关。
Objective: To explore the influence of scarred uterus after cesarean section on pregnancy outcomes in IVF-ET of secondary infertility patients.Methods: Retrospectively analyzed the clinical data of 285 cycles of tubal factor infertility patients who desired to have a second child in vitro fertilization cycles in Maternal and Child Health Hospital of Xiamen City from Dec.2011 to Jul.2017.All patients were assigned into 2 groups according to the delivery way of the first child,scar uterus after cesarean section group( research group 109 cycles) and the nonscar uterus group( control group 176 cycles). Next,patients were grouped accoding to age and interval time between embryo transfer and cesarean section.The influence of scarred uterus on IVF-ET pregnancy outcome was analyzed.Results: There were no significant differences between the two groups in patient age,duration of infertility and the number of transferred embryos( P > 0. 05). However,the clinical pregnancy rate( 42. 20%),implantation rate( 27. 40%) in the research group was significantly lower than the control group( 54. 55%,36. 46%)( P<0. 05).The biochemical pregnancy rate,ectopic gestation rate,abortion rate was no significant differences between the two groups( P > 0. 05). In patients age ≥35 group,the biochemical pregnancy rate,clinical pregnancy rate,implantation rate,ectopic gestation rate and abortion rate were no significant differences between the research and control groups( P>0. 05).However,in age <35 group,the clinical pregnancy rate( 41. 51%),implantation rate( 28. 51%) in the research group were significantly lower than the control group( 68. 11%,46. 04%)( P<0. 05); the biochemical pregnancy rate,ectopic gestation rate,abortion rate were no significant differences between the two groups( P>0. 05).Moreover,biochemical pregnancy rate in cesarean section scar less than 10 year group was significantly higher than ≥10 years group( P<0. 05).Conclusions: Scarred uterus after cesarean section is an important factor affecting the pregnancy outcomes of IVF/ICSI-ET.It reduced the clinical pregnancy rate and implantation rate in IVF-ET.
Objective: To explore the influence of scarred uterus after cesarean section on pregnancy outcomes in IVF-ET of secondary infertility patients.Methods: Retrospectively analyzed the clinical data of 285 cycles of tubal factor infertility patients who desired to have a second child in vitro fertilization cycles in Maternal and Child Health Hospital of Xiamen City from Dec.2011 to Jul.2017.All patients were assigned into 2 groups according to the delivery way of the first child,scar uterus after cesarean section group( research group 109 cycles) and the nonscar uterus group( control group 176 cycles). Next,patients were grouped accoding to age and interval time between embryo transfer and cesarean section.The influence of scarred uterus on IVF-ET pregnancy outcome was analyzed.Results: There were no significant differences between the two groups in patient age,duration of infertility and the number of transferred embryos( P > 0. 05). However,the clinical pregnancy rate( 42. 20%),implantation rate( 27. 40%) in the research group was significantly lower than the control group( 54. 55%,36. 46%)( P<0. 05).The biochemical pregnancy rate,ectopic gestation rate,abortion rate was no significant differences between the two groups( P > 0. 05). In patients age ≥35 group,the biochemical pregnancy rate,clinical pregnancy rate,implantation rate,ectopic gestation rate and abortion rate were no significant differences between the research and control groups( P>0. 05).However,in age <35 group,the clinical pregnancy rate( 41. 51%),implantation rate( 28. 51%) in the research group were significantly lower than the control group( 68. 11%,46. 04%)( P<0. 05); the biochemical pregnancy rate,ectopic gestation rate,abortion rate were no significant differences between the two groups( P>0. 05).Moreover,biochemical pregnancy rate in cesarean section scar less than 10 year group was significantly higher than ≥10 years group( P<0. 05).Conclusions: Scarred uterus after cesarean section is an important factor affecting the pregnancy outcomes of IVF/ICSI-ET.It reduced the clinical pregnancy rate and implantation rate in IVF-ET.
引文
[1] Yasmin S,Sadaf J,Fatima N.Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment[J].J Coll Physicians Surg Pak,2011,21(9):522-526.
[2]陈诚,常青.瘢痕子宫剖宫产围手术期处理[J].中国计划生育和妇产科,2012,4(4):19-22.
[3] Fogelberg M,Baranov A,Herbst A,et al.Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section[J]. J Matern Fetal Neonatal Med,2017,30(17):2058-2061.
[4] Allornuvor GF,Xue M,Zhu X,et al.The definition,aetiology,presentation,diagnosis and management of previous caesarean scar defects[J].J Obstet Gynaecol,2013,33(8):759-763.
[5]朱振萍,向思阳,王琳.瘢痕子宫再次妊娠严重并发症的危险因素及预防[J].浙江临床医学,2013,15(1):102-103.
[6] Tower AM,Frishman GN. Cesarean scar defects:an underrecognized cause of abnormal uterine bleeding and other gynecologic complications[J].J Minim Invasive Gynecol,2013,20(5):562-572.
[7]王雅琴,高玥,徐望明,等.剖宫产手术史对体外受精-胚胎移植患者临床结局的影响[J].中华生殖与避孕杂志,2017,37(7):556-560.
[8] Morris H. Surgical pathology of the lower uterine segment caesarean section scar:is the scar a source of clinical symptoms[J].Int J Gynecol Pathol,1995,14(1):16-20.
[9] Gleicher N,Kushnir VA,Albertini DF,et al.Improvements in IVF in women of advanced age[J].J Endocrinol,2016,230(1):F1-6.
[10] Fitzpatrick KE,Kurinczuk JJ,Alfirevic Z,et al.Uterine rupture by intended mode of delivery in the UK:a national case-control study[J].PLoS Med,2012,9(3):e1001184.
[11]刘桂军,朱丹.超声测量妊娠晚期子宫前壁下段厚度及其临床意义[J].中国妇幼保健,2011,26(23):3672-3673.
[2]陈诚,常青.瘢痕子宫剖宫产围手术期处理[J].中国计划生育和妇产科,2012,4(4):19-22.
[3] Fogelberg M,Baranov A,Herbst A,et al.Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section[J]. J Matern Fetal Neonatal Med,2017,30(17):2058-2061.
[4] Allornuvor GF,Xue M,Zhu X,et al.The definition,aetiology,presentation,diagnosis and management of previous caesarean scar defects[J].J Obstet Gynaecol,2013,33(8):759-763.
[5]朱振萍,向思阳,王琳.瘢痕子宫再次妊娠严重并发症的危险因素及预防[J].浙江临床医学,2013,15(1):102-103.
[6] Tower AM,Frishman GN. Cesarean scar defects:an underrecognized cause of abnormal uterine bleeding and other gynecologic complications[J].J Minim Invasive Gynecol,2013,20(5):562-572.
[7]王雅琴,高玥,徐望明,等.剖宫产手术史对体外受精-胚胎移植患者临床结局的影响[J].中华生殖与避孕杂志,2017,37(7):556-560.
[8] Morris H. Surgical pathology of the lower uterine segment caesarean section scar:is the scar a source of clinical symptoms[J].Int J Gynecol Pathol,1995,14(1):16-20.
[9] Gleicher N,Kushnir VA,Albertini DF,et al.Improvements in IVF in women of advanced age[J].J Endocrinol,2016,230(1):F1-6.
[10] Fitzpatrick KE,Kurinczuk JJ,Alfirevic Z,et al.Uterine rupture by intended mode of delivery in the UK:a national case-control study[J].PLoS Med,2012,9(3):e1001184.
[11]刘桂军,朱丹.超声测量妊娠晚期子宫前壁下段厚度及其临床意义[J].中国妇幼保健,2011,26(23):3672-3673.