有剖宫产史高龄女性不同胚胎移植方案和妊娠结局回顾性分析  

Retrospective analysis of embryo transfer strategy and pregnancy outcome in elderly women with cesarean section history

作　　者：王婷 师娟子 刘珊 田莉 WANG Ting;SHI Juanzi;LIU Shan;TIAN Li(Center for Assisted Reproduction Technology,Northwest Women’s&Children’s Hospital,Xi’an 710004,China)

机构地区：[1]西北妇女儿童医院辅助生殖中心,陕西西安710004

出　　处：《陕西医学杂志》2023年第4期418-422,432,共6页Shaanxi Medical Journal

基　　金：陕西省科技厅社会发展领域项目(2020SF-305)。

摘　　要：目的:分析高龄有剖宫产史女性接受辅助生殖技术助孕不同移植方案的助孕结局。方法:回顾性分析进行体外受精-胚胎移植(IVF-ET)治疗的2098例既往有孕28周以上分娩史,且年龄≥35岁的高龄女性及其伴侣的临床资料,根据既往分娩方式分为剖宫产史组(909例)及阴道产史组(1180例),比较两组患者IVF-ET治疗中新鲜周期不同移植策略时的活产结局。结果:虽然剖宫产史组患者较阴道产史组年轻(38.16岁与38.69岁),根据移植个数及第3/5天胚胎进行亚组分析后发现,移植1枚第3天胚胎时两组活产率比较没有统计学差异,而移植1枚囊胚时临床妊娠率相当,但剖宫产组早期流产率升高,因此活产率低于阴道产史组,有统计学差异(P=0.236、0.01);移植2枚第3天胚胎剖宫产史组活产率显著低于阴道产史组(P=0.023);而移植2枚第5天囊胚时,剖宫产史组活产率与阴道产史组比较无统计学差异(P=0.847),但剖宫产史组平均分娩孕周未达足月,低出生体重儿占比较阴道产史组高,有统计学差异(P=0.015)。结论:剖宫产史影响高龄女性IVF/ICSI助孕的活产率,移植策略建议首选单囊胚移植;而移植2枚囊胚时,剖宫产史会增加新生儿低出生体重风险,则需谨慎对待。Objective:To analyze the pregnancy outcomes of elderly women with cesarean section who received assisted reproductive technology and different transplantation strategies.Methods:The clinical data of 2098 elderly women with a history of delivery of more than 28 weeks of pregnancy and age≥35 years and their partners who underwent in vitro fertilization embryo transfer(IVF-ET)in the reproductive center were analyzed retrospectively.According to the previous mode of delivery,they were divided into cesarean section group(909 cases)and vaginal delivery group(1180 cases).The live birth outcomes of the two groups with different transplantation strategies in the fresh cycle of IVF-ET were compared.Results:Although the caesarean section group was younger than the vaginal birth group(38.16 years vs 38.69 years old),based on the number of transfers and the 3rd/5th day embryos,it was found that there was no significant difference in the live birth rate between the two groups when transferring a day 3 embryo,while the clinical pregnancy rate was comparable at the time of transfer of 1 blastocyst,but the early miscarriage rate in the caesarean section group was increased,so the live birth rate was lower than that in the vaginal delivery group,and there was a significant difference(P=0.236,P=0.01);the live birth rate in the 3rd day embryo cesarean section group was significantly lower than that in the vaginal delivery group(P=0.023),while when transferring two day 5 blastocysts,there was no significant difference between the caesarean section group and the vaginal delivery group(P=0.847),but the average delivery week of delivery in the caesarean section group was not full term,and the proportion of low-birth weight infants was higher than that in the vaginal delivery group(P=0.015).Conclusion:The history of cesarean section affects the live rate of IVF/ICSI assisted pregnancy in elderly women.It is suggested that single blastocyst transplantation shall be the first choice for transplantation strategy.When two blastocysts are t

关 键 词：前次剖宫产 活产 出生体重 高龄 剖宫产瘢痕缺损 胚胎移植 

分 类 号：R719.8[医药卫生—妇产科学]