山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (2): 69-74.doi: 10.6040/j.issn.1671-7554.0.2023.1063
• 临床医学 • 上一篇
赵圣蕊1,2,3,曲慧灵1,2,3,许鑫鑫1,2,张芳芳1,2,颜磊1,2,3
ZHAO Shengrui1,2,3, QU Huiling1,2,3, XU Xinxin1,2, ZHANG Fangfang1,2, YAN Lei1,2,3
摘要: 目的 比较体外受精/卵胞浆内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer, IVF/ICSI-ET)后发生稽留流产时,药物流产和清宫术两种治疗方法的流产效果及其对后续胚胎移植妊娠结局的影响。 方法 研究对象为 2016年1月至2017年1月在山东大学附属生殖医院进行IVF/ICSI-ET治疗、妊娠周数均小于 13 周的稽留流产并于山东大学附属生殖医院行流产治疗的患者,按照随机数字表法分为药物流产组(n=134)和清宫组(n=130)。对患者进行药物流产或者清宫治疗,比较两组患者的流产成功率、流产前后子宫内膜厚度变化和流产后进行第一次胚胎移植的妊娠结局等指标。 结果 行清宫术患者的流产成功率高于行药物流产患者(99.23% vs 85.35%, P<0.001)。清宫组流产当次胚胎移植前人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)日子宫内膜厚度略高于药物流产组[(1.01±0.19)cm vs(1.06±0.20)cm, P=0.040];清宫组的流产前、后两次胚胎移植前的内膜厚度差值高于药物流产组[(-0.01±0.17)cm vs(0.06±0.17)cm, P=0.008]。两组在流产后进行第一次胚胎移植的妊娠结局差异均无统计学意义。 结论 孕13周内的IVF/ICSI后稽留流产,清宫流产疗效高于药物流产,但药物流产可能比清宫更有利于保护子宫内膜;两种治疗方法对后续第一次胚胎移植的妊娠结局无明显影响。
中图分类号:
[1] Magnus MC, Wilcox AJ, Morken NH, et al. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study[J]. BMJ, 2019, 364: l869. doi: 10.1136/bmj.l869. [2] 胡凤贤. 药物流产与人工流产终止早孕效果的临床效果比照观察[J]. 中国医药指南, 2020, 18(1): 159-160. [3] Tamir R, Allouche S, Weissman A, et al. The effect of medical versus surgical treatment of spontaneous miscarriage on subsequent in vitro fertilization cycles[J]. Gynecol Endocrinol, 2016, 32(3): 231-233. [4] Ghosh J, Papadopoulou A, Devall AJ, et al. Methods for managing miscarriage: a network meta-analysis[J]. Cochrane Database Syst Rev, 2021, 6(6): CD012602. doi: 10.1002/14651858.CD012602.pub2. [5] 汪东霞, 王秀中, 唐伟娜. 剖宫产术后早孕人工流产与药物流产治疗效果比较[J]. 中国医药科学, 2019, 9(6): 117-119. WANG Dongxia, WANG Xiuzhong, TANG Weina. Study and comparison of curative effect of induced abortion and medical abortion in early pregnancy after cesarean section[J]. China Medicine and Pharmacy, 2019, 9(6): 117-119. [6] Nagendra D, Gutman SM, Koelper NC, et al. Medical management of early pregnancy loss is cost-effective compared with office uterine aspiration[J]. Am J Obstet Gynecol, 2022, 227(5): 737.e1-737.e11. [7] 卢晓敏. 药物流产与人工流产终止早孕的效果比较[J]. 中国现代药物应用, 2021, 15(14): 94-96. [8] Wang Y, Sun Y, Di W, et al. Association between induced abortion history and later in vitro fertilization outcomes[J]. Int J Gynaecol Obstet, 2018, 141(3): 321-326. [9] Meng J, Zhu M, Shen W, et al. Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study[J]. BMC Pregnancy Childbirth, 2019, 19(1): 409. doi:10.1186/s12884-019-2543-9. [10] 高宏英. 药物流产与人工流产终止早孕效果的临床效果比照观察[J]. 中国医药指南, 2019, 17(36): 139-140. [11] Musik T, Grimm J, Juhasz-Böss I, et al. Treatment options after a diagnosis of early miscarriage: expectant, medical, and surgical[J]. Dtsch Arztebl Int, 2021, 118(46): 789-794. [12] 王春兰. 药物流产与无痛人工流产的临床治疗效果及安全性评价[J]. 中国实用医药, 2019, 14(30): 46-47. [13] 王凤莲. 药物流产与人工流产终止早孕的效果及对阴道出血量的影响[J]. 中国医药指南, 2021, 19(12): 26-27. WANG Fenglian. Effect of drug abortion and induced abortion on termination of early pregnancy and its influence on the amount of vaginal bleeding[J]. Guide of China Medicine, 2021, 19(12): 26-27. [14] Zhang J, Zhou K, Shan D, et al. Medical methods for first trimester abortion[J]. Cochrane Database Syst Rev, 2022, 5(5): CD002855. doi: 10.1002/14651858.CD002855.pub5. [15] 方芳, 许琳玲, 仇茜, 等. 药物流产与无痛人工流产对育龄期妇女凝血功能、性激素水平及月经功能恢复的影响[J]. 临床和实验医学杂志, 2022, 21(1): 72-76. FANG Fang, XU Linling, QIU Qian, et al. Effects of medical abortion and painless abortion on coagulation function, sex hormone level and menstrual function recovery in women of childbearing age[J]. Journal of Clinical and Experimental Medicine, 2022, 21(1): 72-76. [16] 汤慧敏, 秦真岳, 董智勇, 等. 以雌孕激素序贯疗法为基础的联合药物方案治疗不全流产的疗效分析[J]. 生殖医学杂志, 2023, 32(11): 1687-1692. TANG Huimin, QIN Zhenyue, DONG Zhiyong, et al. Analysis of therapeutic effect of a combined medication regimen based on sequential estrogen and progesterone therapy for incomplete abortion[J]. Journal of Reproductive Medicine, 2023, 32(11): 1687-1692. [17] American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Gynecology, Society of Family Planning. Medication abortion up to 70 days of gestation: ACOG practice bulletin, Number 225[J]. Obstet Gynecol, 2020, 136(4): e31-e47. [18] Karavani G, Alexandroni H, Sheinin D, et al. Endometrial thickness following early miscarriage in IVF patients-is there a preferred management approach?[J]. Reprod Biol Endocrinol, 2021, 19(1): 93. doi: 10.1186/s12958-021-00780-7. [19] 高欣艳, 卢少明, 颜磊. 体外受精-胚胎移植早期稽留流产方式对下次冻胚移植结局的影响[J]. 现代妇产科进展, 2020, 29(12): 925-927. [20] Gan C, Zou Y, Wu S, et al. The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome[J]. Int J Gynaecol Obstet, 2008, 101(3): 231-238. [21] Tzur Y, Samueloff O, Raz Y, et al. Conception rates after medical versus surgical evacuation of early miscarriage[J]. Fertil Steril, 2021, 115(1): 118-124. [22] Sacks D, Baxter B, Campbell BCV, et al. Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke[J]. Int J Stroke, 2018, 13(6): 612-632. [23] 王巧英, 张晓凤. 妊娠期妇女发生早期自然流产的相关因素分析[J]. 中国妇幼保健, 2015, 30(3): 407-409. [24] World Health Organization. Abortion care guideline[M]. Geneva: World Health Organization, 2022. |
[1] | 李军秀,袁莹莹,黄凌燕,赵君利. 子宫内膜CD38表达对胚胎移植前抗炎治疗的临床价值[J]. 山东大学学报 (医学版), 2023, 61(8): 54-60. |
[2] | 刘昶,王倩男,张悦,陈忠绍,褚然,姚舒. 卵巢交界性肿瘤保留生育功能术后肿瘤预后及妊娠结局[J]. 山东大学学报 (医学版), 2023, 61(8): 61-66. |
[3] | 许月明,张杰,姜蕾,尹力,赵畔,许欣,郝桂敏. 扳机日孕酮升高与获卵数对辅助生殖技术新鲜周期妊娠结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 44-50. |
[4] | 张丽霞,田一正,吕尚格,张亚男,颜磊. GnRH-a预处理对子宫内膜异位症患者替代方案冻胚移植结局的影响[J]. 山东大学学报 (医学版), 2023, 61(10): 63-68. |
[5] | 颜磊,陈子江. 子宫腺肌病合并不孕的治疗[J]. 山东大学学报 (医学版), 2022, 60(7): 43-47. |
[6] | 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39. |
[7] | 韩晓婷,高文丽,王婷,赵君利. 扳机日及其后添加重组人促黄体激素对黄体期长方案助孕结局的影响[J]. 山东大学学报 (医学版), 2022, 60(12): 31-38. |
[8] | 陈伟,郭情情,徐金,方园,孙梅,盛燕. 自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析[J]. 山东大学学报 (医学版), 2021, 59(8): 61-66. |
[9] | 邓晓惠,郭玲. 免疫治疗在胚胎反复种植失败中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 32-37. |
[10] | 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37. |
[11] | 张秀清,张敬,蒋琪,李晨,刘畅,李瑞静,冯惠娟,耿玲. 腔内理疗对89例薄型子宫内膜冻融胚胎移植患者妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(5): 62-68. |
[12] | 冯振花,李元美,崔文娟,司蕊,盛燕,赵涵. 79例低促性腺激素性腺功能减退患者体外受精-胚胎移植结局分析[J]. 山东大学学报 (医学版), 2020, 58(1): 43-48. |
[13] | 宋海霞,袁彩霞,范玲玲. 体质量指数对夫精人工授精妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(1): 49-53. |
[14] | 张迎春. 人类辅助生殖技术子代安全性问题[J]. 山东大学学报 (医学版), 2019, 57(10): 52-59. |
[15] | 赵立美,颜磊,申晓畅,孙一卿,何鹏娟,赵兴波. 米非司酮、米索前列醇对滋养细胞TRIM22表达的影响[J]. 山东大学学报 (医学版), 2019, 57(10): 86-92. |
|