阴道B超监测不明原因反复自然流产患者排卵的临床意义

Diagnostic and therapeutic significance of follicular development detected with B ultrasound among unexplained recurrent miscarriage

目的:探讨阴道B超监测不明原因反复自然流产患者排卵的临床意义。方法:采用阴道B超观察96例不明原因反复自然流产患者的卵泡生长模式(观察组),同时进行性激素测定及子宫内膜病理组织学检查。对56例92个周期给予促排卵及黄体支持治疗,观察妊娠结局。选择90例因男性因素不孕的患者作为对照组。结果:观察组卵泡发育不良综合征(FMS)发生率为79.2%(107/135),对照组FMS发生率为29.5%(37/90),二者差异有统计学意义(P<0.05);观察组中有排卵者的黄体中期雌二醇(E2)及孕激素(P)水平均明显低于对照组(P<0.05),子宫内膜分泌不良的发生率亦明显高于对照组(P<0.001);56例92个周期的促排卵及黄体支持治疗后共有48例妊娠,周期妊娠率52.1%(48/92),活产率为33.3%(42/56)。结论:卵泡发育不良是导致反复自然流产的病因之一;B超监测卵泡发育是诊断卵泡发育不良准确而有效的方法;在促排卵或黄体支持治疗中进行卵泡监测可预防再次发生自然流产。

Objective：To investigate the diagnostic and therapeutic significance of follicular development detected with vaginal ultrasound among unexplained recurrent miscarriage by follicular maldevelopment syndrome（FMS）..Methods：The follicular development was detected by vaginal ultrasound and the concentration of sex hormone was determined in 96 patients with history of unexplained recurrent miscarriage..Among them progestogen measurement and endometrial biopsy in luteal phase were performed..92 cycles of ovulation induction or luteal support were done in 56 cases;in these cycles,the follicular development was detected by ultrasound identically and the pregnancy outcomes were analyzed.90 infertile women with normal ovulation were selected as control group.Results：The incidence of FMS was 79.2%（107/135）in patients of unexplained recurrent miscarriage,which was higher than that in the control group（29.5%（37/90））.The concentrations of serum E2 and progestogen（P）of ovulatory patients were lower in study group than those in control group（P0.05）,however,the occurrence rate of endometrium hyposecretion was much higher in study group than that in control group（P0.001）.The pregnancy rate of induced ovulation cycles were 52.1%（48/ 92）,live birth rates were 33.3%（42/56） in 92 cycles ovulation induction and luteal support of 56 case..Conclusion：FMS is one of the reasons which causing spontaneous abortion.Follicular development detection with vaginal ultrasound is the important way to diagnose FSM.During treatment,follicular development detection with ultrasound can help to decrease the incidence of second spontaneous abortion..