82例IVF-ET前行腹腔镜下宫颈环扎患者妊娠结局的回顾性分析

Retrospective analysis of pregnancy outcome of 82 patients undergoing laparoscopic cervical cerclage before IVF-ET

目的分析孕前腹腔镜下宫颈环扎(LTCC)患者行体外受精-胚胎移植(IVF-ET)的妊娠结局,比较该类患者卵裂期胚胎移植和囊胚移植对妊娠结局的影响。方法收集2017年1月至2019年3月因不孕症合并宫颈机能不全(CI)在本中心行孕前LTCC术后实施IVF-ET的82例患者资料,根据移植胚胎种类不同分为卵裂期胚胎组(n=20)和囊胚组(n=62)。统计患者术后妊娠结局,比较两组间活产率、HCG阳性率、临床妊娠率、胚胎种植率、异位妊娠率、流产率、早产率、分娩孕周和子代出生情况(包括新生儿出生体重、性别比例和出生缺陷)差异。结果82例CI患者前次平均妊娠终止时间为20.68±3.44周,行LTCC术后,移植卵裂期胚胎和囊胚平均分娩孕周分别为37.70±1.42周和38.11±1.07周。卵裂期胚胎组和囊胚组移植后活产率分别为50%和45.16%,两组间差异无统计学意义(P>0.05)。囊胚组的HCG阳性率(74.19%vs.50%)和流产率(33.33%vs.0.00%)均显著高于卵裂期胚胎组(P<0.05),两组间临床妊娠率、胚胎种植率、异位妊娠率、早产率和平均分娩孕周差异均无统计学意义(P>0.05)。两组新生儿出生体重、性别比例及出生缺陷的差异均无统计学意义(P>0.05)。结论不孕症合并宫颈机能不全者孕前行LTCC术有较好的妊娠结局,且移植卵裂期胚胎和囊胚最终活产率相似。

Objective:To investigate the effects of the pre-pregnant laparoscopic cervical cerclage(LTCC)on patients with cervical incompetence(CI),and to compare the pregnancy outcomes between cleavage-stage embryo transfers and blastocyst transfers respectively.Methods:The data of infertile patients who was diagnosed with cervical incompetence before IVF-ET from January 2017 to March 2019 were analyzed retrospectively.According to the different types of embryos transferred,they were divided into cleavage stage embryo group(n=20)and blastocyst group(n=62).The postoperative pregnancy outcomes of patients were compared between the two groups for live birth rate,HCG positive rate,clinical pregnancy rate,embryo implantation rate,ectopic pregnancy rate,miscarriage rate,premature birth rate,gestational week of delivery,and offspring births status(including newborn births weight,sex ratio and birth defects).Results:Eighty two patients were included.The average termination time of previous pregnancy was(20.68±3.44)gestational week.After pre-pregnant LTCC,the average delivery time of cleavage-stage embryo transfer and blastocyst transfer were(37.70±1.42)weeks and(38.11±1.07)weeks respectively.The live birth rate of cleavage-stage embryo transfer and blastocyst transfer was 50%and 45.16%respectively,and there was no significant difference(P>0.05).The HCG positive rate(74.19%vs.50%)and abortion rate(33.33%vs.0.00%)of blastocyst transfer were significantly higher than cleavage-stage embryo transfer(P<0.05).There were no significant differences in clinical pregnancy rate,implantation rate,ectopic pregnancy rate,preterm birth rate and average delivery week between the two groups(P>0.05).In addition,there were no significant differences in neonate weight,sex ratio and birth defects rate between the two groups(P>0.05).Conclusions:Pre-pregnant LTCC improves reproductive outcomes of patients with cervical incompetence,and final live birth rate were similar between cleavage-stage embryo transfer and blastocyst transfer.