宫腔粘连分离术后胚胎移植时机探讨及影响妊娠结局的因素分析

Investigation of embryo transplantation timing after intrauterine adhesion separation and factors analysis influencing pregnancy outcome

目的探讨宫腔粘连分离术后胚胎移植时机,分析影响妊娠结局的因素。方法选择2017年9月至2022年8月于珠海市妇幼保健院行宫腔粘连分离术的444例单胎孕妇作为研究对象,根据有无妊娠不良结局分为正常组(n=350)和妊娠不良组(n=94)。将本研究中纳入的350例正常妊娠结局的研究对象根据不同胚胎移植时机进行分组,即排卵后第4天行冻融胚胎移植为A组(n=182),黄体酮行内膜转化第5天行冻融的胚胎移植为B组(n=168)。通过查阅电子病历收集纳入产妇的基本临床资料及各项研究指标。建立列线图模型进行影响妊娠结局的因素分析,并行内部和外部验证。结果患者体质量指数(BMI)、初潮年龄、妊娠糖尿病、阴道炎、胚胎种植率、流产率、多胎的差异比较有统计学意义(P<0.05),其余指标差异均无统计学意义(P>0.05)。妊娠糖尿病、阴道炎、胚胎种植、流产、多胎是影响妊娠结局的独立危险因素(P<0.05)。基于影响妊娠结局的列线图模型对于妊娠不良发生的预测概率为84.00%,且内部验证和外部评价具有良好的一致性和准确度。结论胚胎移植时机对于宫腔粘连分离术患者的妊娠情况具有重要价值,若发现妊娠糖尿病、阴道炎、胚胎种植、流产史、多胎的情况则很有可能出现妊娠结局不良,临床研究中应及时监测。

Objective To explore the timing of embryo transfer after intrauterine adhesions and analyze the factors affecting pregnancy outcome.Methods A total of 444 singleton pregnant women who underwent intrauterine adhesion separation in Zhuhai Center for Maternal and Child Health Care from September 2017 to August 2022 were selected as the study subjects,and were divided into normal group(n=350)and adverse pregnancy group(n=94)according to the presence of adverse pregnancy outcomes.The 350 normal pregnancy outcomes included in this study were grouped according to different embryo transfer times,namely,freeze-thaw embryos on day 4 after ovulation(n=182)and freeze-thaw embryos on day 5 of progesterone-intimal transformation in group B(n=168).Basic clinical data and various research indicators of the included pregnant women were collected by consulting the electronic medical records.A nomogram model was developed for the analysis of factors affecting pregnancy outcome,with parallel internal and external validation.Results The differences in BMI,age at menarche,Gestational diabetes mellitus,vaginitis,embryo implantation,embryo implantation,abortion,and multiple births were significant(P<0.05),but none of the other indicators were significant(P>0.05).Gestational diabetes mellitus,vaginitis,embryo implantation,abortion,and multiple fetuses were independent risk factors for pregnancy outcome(P<0.05).The nomogram model based on the outcome of pregnancy is 84.00%,and it has good consistency and accuracy between internal validation and external evaluation.Conclusion The timing of embryo transfer is of great value to the pregnancy situation of patients with intrauterine adhesion separation.If gestational diabetes mellitus,vaginitis,embryo implantation,abortion,and multiple fetuses are found,adverse pregnancy outcomes may occur,which should be timely monitored in clinical studies.