辅助生殖技术助孕妊娠后患者晚期自然流产危险因素分析

doi:10.13481/j.1671-587X.20220525

Abstract

Abstract:

Objective To investigate the factors associated with late spontaneous abortion after pregnancy in the patients assisted by assisted reproductive technology （ART）， and to illuminate the risk factors for late spontaneous abortion. Methods Using retrospective research method， the clinical data of 310 pregnant patients underwent ART were collected； according to the different pregnancy outcomes of patients， they were divided into term birth group （248 cases） and late abortion group （62 cases）. The general situation， main causes and related factors of infertility， clinical situation and pregnancy outcomes of the patients in two groups were recorded， and the factors with P<0.05 in single factor regression analysis were included in the multivariate Logistic regression equation to further analyze the risk factors of late abortion. Results The differences in number of previous late miscarriages or preterm births， previous history of cervical LEEP or conization， previous history of hysteroscopic electrodesection， history of polycystic ovary syndrome（PCOS）， body mass index （BMI）， cycle type， endometrial thickness，whether twin pregnancies and ovulation disorder of the patients between two groups were statistically significant （P<0.05）.The factors with P<0.05 were included in the multivariate Logistic regression equation，BMI（OR=1.194，95%CI：1.088－1.311， P<0.01），previous history of late abortion or premature delivery（OR=5.673，95%CI：1.189－27.069， P=0.029）， history of cervical LEEP or conization（OR=5.113， 95%CI：1.025－25.496， P=0.047） and twin pregnancy（OR=5.129，95%CI：2.377－11.067，P<0.01） were the risk factors of late spontaneous abortion. Frozen thawed embryo transfer （FET） cycle was the protective factor of late abortion compared with fresh transplantation cycle （OR=0.422， 95% CI：0.219－0.814，P=0.010）. Conclusion Previous history of premature or late abortion， cervical surgery，high BMI and multiple pregnancy are the risk factors of late spontaneous abortion after ART-assisted pregnancy of the patients， while FET is the protective factor of late spontaneous abortion.

Key words: Late spontaneous abortion, Twin pregnancy, Cervical insufficiency, Body mass index, Assisted reproductive technology

CLC Number:

Hong GAO,Xiaohong YAN,Li LIN,Lulu REN,Youzhu LI. Analysis of risk factors of late spontaneous abortion after assisted reproductive technology-assisted pregnancy[J].Journal of Jilin University(Medicine Edition), 2022, 48(5): 1298-1304.

Figures/Tables 5

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References 27

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Group	n	Age(year)		Duration of infertility(year)	BMI (kg·m^－2)	FSH[λ_B/(IU·L^－1)]		LH [λ_B/(IU·L^－1)]
Group	n	Female	Male	Duration of infertility(year)	BMI (kg·m^－2)	FSH[λ_B/(IU·L^－1)]		LH [λ_B/(IU·L^－1)]
Term birth	248	30.96±4.06	32.34±4.61	3（2,5）	21.76±3.13	7.11±2.35		5.11±2.73
Late abortion	62	31.44±4.37	32.94±4.40	2 (1,4)	23.78±3.17	6.75±2.28		4.72±2.56
t/χ²/Z		－0.813	－0.852	1.817	－4.538	1.008		1.023
P		0.417	0.395	0.069	<0.01	0.278		0.307
Group	n	E2 [ρ_B/(μg·L^－1)]	Previous pregnancy[n(η/%)]	Previous artificial abortion [n(η/%)]	Previous preterm birth or late abortion [n(η/%)]		Previous term birth [n(η/%)]
Term birth	248	50.45±21.65	125(50.4)	50(20.2)	3(1.2)		57(23.0)
Late abortion	62	47.07±13.23	36(58.1)	17(27.4)	5(8.1)		18(29.0)
t/χ²/Z		1.560	1.166	1.542	6.744		0.989
P		0.271	0.280	0.214	0.009		0.320

Group	n	Tubal factor	Endometriosis	Ovulation disorder	Male factor	Bilateral factor	Ambiguous factor	LEEP or conization of cervix	Hysteroscopic electrotomy	PCOS
Term birth	248	86（34.7）	44（17.7）	15（6.0）	29（11.7）	47（19.0）	27（10.9）	4（1.6）	19（7.7）	37（14.9）
Late abortion	62	23（37.1）	8（12.9）	12（19.4）	3（4.8）	13（21.0）	3（4.8）	4（6.5）	10（16.1）	18（29.0）
χ²		0.127	0.832	11.045	1.832	0.129	1.442	4.619	4.194	6.769
P		0.721	0.362	0.001	0.176	0.719	0.230	0.032	0.041	0.009

Group	n	FET cycles	Endometrial thickness (l/mm)	Blastocyst transfered cycles	Two embryos transferred cycles	Twin pregnancy cycles
Term birth	248	123（49.6）	11.08±2.40	100（40.3）	142（57.3）	22（8.9）
Late abortion	62	42（67.7）	10.27±1.99	26（41.9）	43（69.4）	19（30.6）
t/χ²		6.560	2.738	0.053	3.016	20.491
P		0.010	0.007	0.817	0.082	<0.01

Variable	Assignment
Late spontaneous abortion	No=0；Yes=1
Previous preterm birth or late abortion	No=0；Yes=1
Ovulation disorder	No=0；Yes=1
PCOS	No=0；Yes=1
LEEP or conization of cervix	No=0；Yes=1
Hysteroscopic electrotomy	No=0；Yes=1
Cycle types	No=0；Yes=1
Twin pregnancy	No=0；Yes=1

Feature	Group	B value	Standard error of B value	OR 95%CI	Wald chisquare value	P value
BMI		0.177	0.048	1.194 1.088－1.311	13.908	<0.01
Previous preterm birth or late abortion	No^*
	Yes	1.736	0.797	5.673 1.189－27.069	4.739	0.029
Ovulation disorder	No^*
	Yes	－0.929	0.475	0.395 0.156－1.002	3.825	0.051
LEEP or conization of cervix	No^*
	Yes	1.632	0.820	5.113 1.025－25.496	5.113	0.047
Cycle types	Fresh cycle^*
	FET cycle	－0.862	0.335	0.422 0.219－0.814	6.620	0.010
Twin pregnancy	No^*
	Yes	1.635	0.392	5.129 2.377－11.067	17.355	<0.01

Analysis of risk factors of late spontaneous abortion after assisted reproductive technology-assisted pregnancy

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