自然妊娠与体外受精-胚胎移植受孕子宫腺肌病患者母儿结局对比分析  

Analysis of maternal and fetal outcomes in patients with adenomyosis conceived naturally or by IVF-ET

作　　者：卢潇菲 王伊玲 卢欣蕾 昌晓红[1] 祝洪澜[1] LU Xiao-fei;WANG Yi-ling;LU Xin-lei;CHANG Xiao-hong;ZHU Hong-lan(Department of Obstetrics and Gynecology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院妇产科,北京100044

出　　处：《中国实用妇科与产科杂志》2025年第3期338-342,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市自然科学基金(7222206);北京大学人民医院研究与发展基金(科研)(RDL2022-47)。

摘　　要：目的探讨自然妊娠与体外受精-胚胎移植(IVF-ET)受孕的子宫腺肌病患者的母儿结局。方法收集2015年1月至2023年12月就诊于北京大学人民医院且有妊娠结局的151例子宫腺肌病患者的临床资料,根据妊娠方式分为自然妊娠组与IVF-ET组,回顾性分析两组患者的妊娠结局。结果151例患者中自然妊娠组90例,IVF-ET组61例,两组间难免流产(14例)发生率差异无统计学意义(8.9%vs.9.8%,P=0.844);余137例患者的妊娠结局均为活产,其中自然妊娠组82例,IVF-ET组55例。IVF-ET组妊娠期高血压疾病的发生率显著高于自然妊娠组(30.9%vs.15.9%,P=0.037),且孕期因先兆流产或者先兆早产接受住院保胎治疗的发生率也显著高于自然妊娠组(25.5%vs.9.8%,P=0.014)。IVF-ET组产后出血量中位数为500mL,显著高于自然妊娠组的400mL(P=0.001)。进一步按照分娩方式对比两组产后出血量:IVF-ET组剖宫产产妇产后出血量中位数为500mL,显著高于自然妊娠组的剖宫产产后出血量422.5mL(P=0.006);IVF-ET组与自然妊娠组经阴道分娩的产后出血量中位数分别为530mL、380mL,两组差异无统计学意义(P=0.153)。多因素logistic回归分析显示,IVF-ET为子宫腺肌病患者发生妊娠期高血压疾病的独立危险因素(OR=4.029,95%CI 1.365~11.890,P=0.012)。结论与自然妊娠的子宫腺肌病患者相比,通过IVF-ET受孕者孕期更易发生妊娠期高血压疾病、先兆流产或者先兆早产接受住院治疗、产后出血量增多;IVF-ET为子宫腺肌病患者发生妊娠期高血压疾病的独立危险因素;孕期需加强对IVF-ET受孕的子宫腺肌病患者的监测,分娩过程中加强对产后出血的预防,以改善母儿结局。Objective To analyze the maternal and fetal outcomes of patients with adenomyosis conceived naturally or through in vitro fertilization and embryo transfe(r IVF-ET).Methods We collected clinical data from 151 patients with adenomyosis who had pregnancy outcomes and were admitted to Peking University People's Hospital from January 2015 to December 2023.Based on the mode of conception we divided the patients into two groups:natural pregnancy group and IVF-ET group and analyzed the pregnancy outcomes of the two groups retrospectively.Results Among the 151 patients,there were 90 in the natural pregnancy group and 61 in the IVF-ET group.There was no statistically significant difference in the incidence of inevitable miscarriage(14 cases)between the two groups(8.9%,9.8%;P=0.844).The remaining 137 patients gave live births,82 patients were in the natural pregnancy group and 55 patients were in the IVFET group.The incidence of hypertensive disorders of pregnancy in IVF-ET group was significantly higher than that of natural pregnancy group(30.9%,15.9%;P=0.037),and the incidence of hospitalization maintenance for threatened abortion or threatened premature labor of the IVF-ET group was also significantly higher than that of natural pregnancy group(25.5%,9.8%;P=0.014).Compared with natural pregnancy group,the median of postpartum blood loss in IVF-ET group was significantly higher(400mL,500mL,P=0.001).Further comparison of postpartum blood loss between the two groups according to the mode of delivery:the median postpartum blood loss for cesarean section patients in the IVF-ET group was 500mL,significantly higher than that of the natural pregnancy group,which was 422.5mL(P=0.006);the median postpartum blood loss for vaginal delivery in the IVF-ET group and the natural pregnancy group were 530mL and 380mL,respectively,with no statistically significant difference(P=0.153).In multivariate logistic regression showed that IVF-ET was an independent risk factor for hypertensive disorders of pregnancy in patients with adenomyosis(OR

关 键 词：子宫腺肌病 体外授精-胚胎移植 妊娠期高血压 母儿结局 

分 类 号：R711.71[医药卫生—妇产科学]