早期B超监测体外授精-胚胎移植结局的价值

Predictive value of early B-mode ultrasonographic monitoring for outcome of women who received IVF-ET

目的探讨移植胚胎后第3周进行阴道B超监测对体外授精一胚胎移植结局的预测价值。方法于体外授精-胚胎移植后12～14天确诊生化妊娠，于19～21天开始进行阴道B超监测。统计2009年1—12月接受体外授精－胚胎移植助孕后并获得妊娠的患者资料（包括卵胞浆内单精子显微注射和冻融胚胎移植），分析阴道B超监测结果与妊娠结局的关系。结果①异位妊娠组于移植后3周及4周均未能探及宫内孕囊；②继续妊娠组于移植后3周的宫内孕囊阳性率、宫内卵黄囊阳性率均分别显著高于流产组，差异均有统计学意义（Х^2分别为57．402、36．304，均P=0．000）；③继续妊娠组于移植后4周宫内胚胎原始心管搏动阳性率也显著高于流产组（，=241．902，P=0．000）。结论将体外授精-胚胎移植后的阴道B超监测提前至第3周进行可较好地预测妊娠结局；于移植后第3周监测到宫内孕囊及卵黄囊，4周监测到胚芽及胚胎原始心管搏动预示有较好的妊娠结局；易于宫外孕的早期发现及处理；利于预测流产的发生及其处理，值得在临床推广应用。

Objective To evaluate predictive value of transvaginal B-ultrasonographic monitoring starting from the third week after IVT-ET for outcomes of the woman. Methods The clinical data of women who received ART（IVF-ET or ICSI-ET or FET） and their biochemical pregnancy were determined at 12-14 days after embryo transfer（ET） in our center in a period from January to december, 2009 were retrospectively analyzed. Transvaginal B-ultrasonographic monitoring started from 19th-21th day after IVT-ET for the women to predict pregnancy outcomes of the woman. Relationship between B ultrasonographic monitoring results and pregnancy outcomes was analyzed. Results ①For women in ectopic pregnancy group, no intrauterine gestational sac was found at 3rd and 4th weekend after ET; ②The positive rates of intrauterine gestational sac and yolk sac at 3rd weekend after ET in women in ongoing pregnancy group were significantly higher than those of women in abortion group （99.38% vs 76.47%, X2 = 57. 402, P = 0.000 ; 76.56% vs 35.29%, X^2 = 36. 304 ; P = 0.000 ） ; ③The positive rate of embryonic primitive cardiac tube in women in the ongoing pregnancy group at the 4th weekend after ET was also significantly higher than that in women in the abortion group （99. 38% vs 27.45% , X^2 = 241. 902, P = 0. 000）. Condution Transvaginal B-ultrasonographic monitoring earlier than the third week after IVT-ET can predict pregnancy outcomes of the woman effectively. The findings of intrauterine pregnancy sac and yolk at the third week after ET and embyo bud and primitive cardiac tube at the 4th week after ET by transvaginal uhrasonography both predict better pregnancy outcomes of the woman. It is helpful to early identify and early treat ectopic pregnancy, and to predict and treat abortion, so it is worthy to be popularized in clinical practice.