体外受精-胚胎移植后妊娠早期合并宫腔积血异常产科结局的相关因素分析

Analysis of related factors associated with abnormal obstetric outcomes in the pregnancies achieved by IVF-ET with first-trimester IUHs

目的探讨经体外受精-胚胎移植（IVF/ICSI/F-ET）治疗后早期妊娠合并宫腔积血时导致异常产科结局的相关因素分析。方法收集2010年4月至2012年8月在安徽医科大学第一附属医院经IVF/ICSI/F-ET助孕后获得宫内妊娠且合并宫腔积血患者274例的临床资料,分析宫腔积血的面积、诊断宫腔积血时孕龄、妊娠年龄、单双胎妊娠及不孕原因对产科结局的影响。结果单双胎组及不同积血面积、孕龄、年龄组间的异常产科结局发生率差异无统计学意义,输卵管因素性不孕与男方因素性不孕比较差异有统计学意义（80.77%,126/156 vs.58.06%,36/62,P〈0.01）。输卵管疾病是异常产科结局发生的危险因素（OR 3.32,95%CI 1.71~6.44）。结论 IVF/ICSI/F-ET助孕后妊娠早期合并宫腔积血时,宫腔积血的面积、诊断宫腔积血时孕龄、妊娠年龄、单双胎妊娠对产科结局影响不大;仅不孕原因与异常产科结局有良好的相关性,输卵管因素较男方因素致不孕患者更容易合并异常产科结局。

Objective To investigate related factors associated with abnormal obstetric outcomes in the pregnancies achieved by in vitro fertilization-embryo transfer（IVF/ICSI/F-ET） with first-trimester intrauterine hematomas（IUHs）.Methods A total of 274 patients conceived through IVF/ICSI/F-ET with first-trimester hematomas in the First Affiliated Hospital of Anhui Medical University from April 2010 to August 2012 were studied retrospectively. This study analyzed the influence of the area of hematomas, gestational age at diagnosis, maternal age, single and twin pregnancy and reasons for infertility on obstetric outcomes.Results We compared different groups of single and twin pregnancy, area of hematomas, gestational age, maternal age and reasons for infertility, only the difference in the last one showed statistical significance respectively（P〈 0.01）. The incidence of abnormal obstetric outcomes in tubal infertility group was80.77%（126/156） and that in male infertility group was 58.06%（36/62）. Tubal infertility was a risk factor for abnormal obstetric outcomes（OR 3.32,95% CI 1.71~6.44）.Conclusion The area of hematomas, gestational age, maternal age,single and twin pregnancy may not make a great difference to the obstetric outcomes in the patients conceived through IVF/ICSI/F-ET with first-trimester IUHs,and only the reasons for infertility show a good correlation with the outcomes.The pregnancies after tubal infertility may be at more risk for adverse obstetric outcomes than those after male infertility.