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目的探讨体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)后异位妊娠高危因素及其处理方法。方法将接受IVF-ET后临床妊娠的2 947例孕妇分为单纯宫外孕组98例、宫内宫外同时妊娠组9例、宫内妊娠组2 840例,对各组一般情况、助孕方式、激素水平等进行比较分析。结果 IVF-ET后异位妊娠发生率为3.63%(107/2 947);常规IVF-ET后异位妊娠率(4.25%)高于卵泡浆内单精子注射后异位妊娠率(2.17%),新鲜周期后异位妊娠率(4.07%)高于复融周期后异位妊娠率(2.57%)(P<0.05);且单纯宫外孕组及宫内宫外同时妊娠组中有输卵管病变及宫外孕病史者均高于宫内妊娠组(P<0.05);人绒毛膜促性腺激素注射日,单纯宫外孕组及宫内宫外同时妊娠组子宫内膜厚度均低于宫内妊娠组(P<0.05);注射日雌二醇、移植后14d人绒毛膜促性腺激素水平单纯宫外孕组低于其他2组(P<0.05)。结论输卵管病变史、受精方式、人绒毛膜促性腺激素注射日雌二醇水平、内膜厚度等均是异位妊娠发生的影响因素;移植后14d人绒毛膜促性腺激素水平的高低有助于异位妊娠早期诊断。
Objective To investigate the risk factors and treatment of ectopic pregnancy after in vitro fertilization and embryo transfer (IVF-ET). Methods A total of 2 947 pregnant women undergoing IVF-ET clinical pregnancy were divided into ectopic pregnancy group (n = 98), intrauterine ectopic pregnancy group (n = 9) and intrauterine pregnancy group (n = 2840) Hormone levels and other comparative analysis. Results The incidence of ectopic pregnancy after IVF-ET was 3.63% (107/2 947). The ectopic pregnancy rate (4.25%) after IVF-ET was higher than that after IVF-ET (2.17% , Ectopic pregnancy rate (4.07%) after fresh cycle was higher than that after eutopic pregnancy (2.57%) (P <0.05); tubal ectopic pregnancy and ectopic pregnancy were found in ectopic pregnancy group and intrauterine ectopic pregnancy group (P <0.05). The thickness of endometrium of uterine pregnancy group and ectopic pregnancy group were lower than those of intrauterine pregnancy group (P <0.05) ). On the day of injection, the level of human chorionic gonadotropin on the 14th day after transplantation was lower than that of the other two groups (P <0.05). Conclusions The history of tubal disease, the way of fertilization, the level of estradiol on the injection day of human chorionic gonadotropin, the thickness of intima are the influencing factors of ectopic pregnancy. The level of human chorionic gonadotropin on the 14th day after transplantation is helpful to Ectopic pregnancy early diagnosis.