辅助生育技术受孕，更容易出现绒毛膜下血肿吗？

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OBJECTIVE

研究目的

To evaluate the association of subchorionic hematoma in early first trimester with early pregnancy loss in patients who conceived through assisted reproductive techniques versus spontaneous conception.

评估辅助生育技术受孕和自然受孕患者中，妊娠早期绒毛膜下血肿（SCH）与早期妊娠丢失的关系。

MATERIALS AND METHODS

研究对象及方法

A retrospective cohort study on 591 pregnancies resulting from frozen embryo transfer (FET), ovulation induction with intrauterine insemination (IUI) or timed intercourse (TIC), and spontaneous conception between 2015-2021 at Texas Children’s Family Fertility Center. Patients were included after an obstetric ultrasound showing the presence of fetal heartbeat at 6 weeks gestation and if delivery results were available. Those without documented pregnancy outcomes or without first trimester ultrasounds were excluded. The primary outcome was early pregnancy loss (EPL), defined as ultrasound confirmed spontaneous abortion at less than 20 weeks gestation. Demographics including age, BMI, diagnoses, obstetrical outcomes were collected. Presence, and largest dimensions of a SCH were recorded, along with presence/absence of vaginal bleeding. Baseline characteristics were compared using chi square and t-test statistics. Log-binomial regression test was used to adjust for baseline characteristics that were statistically significant.

得克萨斯州儿童家庭生育中心进行了一项回顾性队列研究，研究对象为该中心2015年至2021年间591例通过冻胚移植（FET），诱导排卵后人工授精（IUI）或指导适时同房（TIC）受孕和自然受孕的患者。纳入研究的患者均在孕6周超声检查可探及胎心搏动且有分娩结局记录。未有妊娠结局或无早孕期超声检查结果的患者被除外。主要结局为早期妊娠丢失（EPL），即孕20周前由超声明确的自然流产。人口统计学数据包括年龄、体重指数(BMI)、诊断、产科结局。此外还包括SCH出现的时间、最大径线及是否出现阴道流血。基线特征比较采用卡方检验和t－检验。对数二项式回归检验用于调整具有统计学差异的基线特征。

RESULTS

研究结果

At our institution, 576 patients met study criteria (215 patients with SCH and 361 without). There was no significant difference in early pregnancy loss outcome for patients who were diagnosed with SCH (crude RR 0.658, 95% CI 0.40-1.07). The early pregnancy loss rates were 9% (live birth rate of 91%) for patients with SCH vs 14% (live birth rate of 86%) for those without SCH. The prevalence of SCH was 56% in pregnancies conceived by embryo transfer, 13% by IUI, 8.4% by TIC, and 23% by spontaneous conception. There was a significant difference in the rate of SCH depending on method of conception (FET 35% without vs 56% with SCH, IUI 21 % vs 3%, TIC 6.7 vs 8.4% or spontaneous conception 38 vs 23%, p<0.001). After adjusting for the conception method, there was no significantly increased risk of EPL (aRR 0.635, 95% CI 0.39-1.04). There was no difference in age (mean 34.8 vs 34.8 yr, p=0.863), body mass index (median 25.3 vs 25.3, p=0.560), delivery type of Cesarean or vaginal (p=0.213), presence of preterm delivery (11 vs 12%, p=0.682), presence of uterine factor diagnosis (31% vs 29%, p=0.58), endometriosis (9.1% vs 8.8%, p=0.166), or medical diagnosis (70% vs 76%, p=0.093) between patients with or without SCH. In a subgroup analysis of patients with SCH (n=215), there was no association between vaginal bleeding, size, or number of SCH with EPL (p=0.106) regardless of conception when controlling for age, BMI, and medical diagnosis.

在我们中心，576例患者被纳入研究（215例患者有SCH，361例无SCH）。SCH组患者的EPL并无显著差异（crude RR 0.658，95%CI 0.40-1.07）。SCH组的EPL率为9%（活产率为91%），无SCH组为14%（活产率为86%）。SCH的患病率在胚胎移植组中为56%，IUI组为13%，TIC组为8.4%，自然受孕组为23%。其比例在不同受孕方式间有明显差异（FET组：35%无SCH vs 6%出现SCH，IUI组：21% vs 3%，TIC：6.7% vs 8.4%，自然受孕组：38% vs 23%，p<0.001）。在调整生育方式后，EPL的风险并未显著增加（aRR 0.635,95%CI 0.39-1.04）。有无SCH的两组患者在年龄（平均34.8 vs 34.8，p=0.863）、BMI（中位数25.3 vs 25.3，p=0.560）、剖宫产或阴道分娩（p=0.213）、早产（11 vs 12%，p=0.628）、子宫因素（31% vs 29%，p=0.58），子宫内膜异位症（9.1% vs 8.8%，p=0.166）或其他诊断（70% vs 76%，p=0.093）方面均无明显差异。对215例SCH患者进行亚组分析，在调整患者年龄、BMI及医学诊断后，无论其受孕方式，是否出现阴道流血或SCH的数量与EPL均无相关性。

CONCLUSIONS

研究结论

High rates of SCH were found in pregnancies resulting from embryo transfer compared to ovulation induction or spontaneous conception when assessed at early gestational age. However, there was no increased incidence of EPL in this group.

与诱导排卵受孕和自然受孕相比，胚胎移植术后在妊娠早期SCH的比例较高，但这并不增加EPL的发生率。

IMPACT STATEMENT

影响声明

Subchorionic hematoma is highly prevalent following embryo transfer in patients undergoing fertility treatment and is not associated with increased risk of early pregnancy loss.

在接受生育治疗的患者中，SCH在胚胎移植术后更为常见，但这并不增加EPL的风险。

本文来源：

FIRST TRIMESTER SUBCHORIONIC HEMATOMA AND EARLY PREGNANCY LOSS IN PATIENTS UNDERGOING FERTILITY TREATMENT Dadoun, Simon Eliahou et al.Fertility and Sterility, Volume 120, Issue 4, e169 - e170