輔助生育中子宮內(nèi)膜異位癥與前置胎盤相關(guān)性的研究
發(fā)布時間：2018-07-24 13:12
【摘要】：背景 子宮內(nèi)膜異位癥(endometriosis)是指具有活性的子宮內(nèi)膜出現(xiàn)在宮腔以外的部位生長繁殖,并在局部生長、浸潤、反復(fù)出血。子宮內(nèi)膜異位癥發(fā)生確切的發(fā)病機制迄今不清,傳統(tǒng)的病因?qū)W理論是Sampon的經(jīng)血逆流種植學(xué)說,其他學(xué)說還有體腔上皮化生學(xué)說、播散學(xué)說、干細胞學(xué)說以及新近形成的“在位內(nèi)膜決定論”等。 子宮內(nèi)膜異位癥最嚴(yán)重及影響最深遠的并發(fā)癥是不孕。研究發(fā)現(xiàn)不孕婦女中子宮內(nèi)膜異位癥的發(fā)生率高達25-40%。子宮內(nèi)膜異位癥可引起不孕的機制尚未完全清楚,輔助生育技術(shù)是治療子宮內(nèi)膜異位癥合并不孕的重要手段。但子官內(nèi)膜異位癥對輔助生育的妊娠結(jié)局也會產(chǎn)生一定的影響,子宮內(nèi)膜異位癥不孕患者其卵子受精率低,胚胎的發(fā)育潛能差,妊娠后的并發(fā)癥卻高。因此,子宮內(nèi)膜異位癥患者的生育能力及對妊娠結(jié)局的影響受到廣泛的關(guān)注。 前置胎盤是指孕28周后,胎盤附著于子宮下段,其下緣甚至達到或覆蓋宮頸內(nèi)口,低于胎先露部。前置胎盤的發(fā)病率國外報道為0.63%,國內(nèi)報道為0.24%-1.57%。傳統(tǒng)的理論認(rèn)為子宮內(nèi)膜病變和各種宮腔操作損傷包括流產(chǎn)、刮宮、引產(chǎn)、放取環(huán)、宮腔鏡操作、剖宮產(chǎn)等等,都有可能引起不同程度的子宮內(nèi)膜炎或內(nèi)膜的萎縮性病變,再次受孕時子宮蛻膜血管缺陷,胎盤血供差,存在慢性缺血缺氧,為攝取足夠的營養(yǎng)而增大胎盤面積就容易發(fā)生前置胎盤。有研究報道合并子宮內(nèi)膜異位癥的孕婦有發(fā)生前置胎盤的明顯傾向性。故本文將探討在輔助生育中子宮內(nèi)膜異位癥患者和前置胎盤發(fā)生的相關(guān)性并分析其可能的原因。 方法 回顧性復(fù)習(xí)2008年1月至2012年12月在浙江大學(xué)附屬婦產(chǎn)科醫(yī)院分娩的產(chǎn)科病歷及輔助生育病歷,對通過輔助生殖技術(shù)(包括體外受精-胚胎移植和卵細胞質(zhì)內(nèi)單精子注射)妊娠并在28周后單胎在本院分娩的并能順利完成電話隨訪得到完整資料者共2060例進行統(tǒng)計分析,其中有110例發(fā)生了前置胎盤。統(tǒng)計這些孕婦年齡、體重指數(shù)、孕次、產(chǎn)次、流產(chǎn)次數(shù)、剖宮產(chǎn)史、子宮內(nèi)膜異位癥、排卵障礙、男性不孕等9個指標(biāo),分析它們與前置胎盤的相關(guān)性。同時對子宮內(nèi)膜異位癥分型與前置胎盤的相關(guān)性做了進一步分析。 結(jié)果 1.各組人群中前置胎盤發(fā)病率：2008年1月至2012年12月在浙江大學(xué)附屬婦產(chǎn)科醫(yī)院住院分娩非輔助生育的總?cè)藬?shù)為60725人次,前置胎盤的發(fā)生率為3.23%。在2060例觀察資料中,前置胎盤的發(fā)生率為5.34%,子宮內(nèi)膜異位癥患者中前置胎盤的發(fā)生率為21.56%。其中內(nèi)異患者與普通人群比較χ2=260.16(P0.005),差異有統(tǒng)計學(xué)意義。 2.子宮內(nèi)膜異位癥組320例患者中前置胎盤發(fā)生率為21.56%,而非子宮內(nèi)膜異位癥組1740例患者中前置胎盤發(fā)生率為2.41%。經(jīng)方差分析,χ2=192.75(P0.005),差異有統(tǒng)計學(xué)意義。 3.110例發(fā)生前置胎盤患者中合并子宮內(nèi)膜異位癥的有69例,前置胎盤組合并子宮內(nèi)膜異位癥達62.7%,而非前置胎盤組合并子宮內(nèi)膜異位癥為12.9%,OR值為19.7,95%CI(0.5-300.6),其P值為0.001,具有統(tǒng)計學(xué)意義。 4.子宮內(nèi)膜異位癥類型及嚴(yán)重程度與前置胎盤的發(fā)生存在正相關(guān),Kendall相關(guān)系數(shù)為0.274,Spearman相關(guān)系數(shù)為0.281,均為P0.001。 結(jié)論 1.子宮內(nèi)膜異位癥不僅造成不孕而且還影響著妊娠結(jié)局,在輔助生殖中子宮內(nèi)膜異位癥與前置胎盤的發(fā)生有一定的相關(guān)性,觀察資料中顯示輔助生育前置胎盤的發(fā)生率為5.34%,高于普通人群3.23%的發(fā)生率,而子宮內(nèi)膜異位癥患者的前置胎盤的發(fā)生率21.56%,遠遠高于前兩者,有顯著性差異。子宮內(nèi)膜異位癥增加了前置胎盤發(fā)生的風(fēng)險。 2.本資料顯示輔助生育組患者中前置胎盤合并內(nèi)膜異位癥達62.7%,而非前置胎盤合并內(nèi)異為12.9%,經(jīng)Logistic回歸分析其OR值為19.7,輔助生育中子官內(nèi)膜異位癥與前置胎盤的發(fā)生存在明顯相關(guān)性。 3.子宮內(nèi)膜異位癥不僅與前置胎盤的發(fā)生存在相關(guān)性,而且子官內(nèi)膜異位癥病變程度與前置胎盤的發(fā)生呈正相關(guān)。接受輔助生育的內(nèi)膜異位癥患者發(fā)生前置胎盤的有110例,其中重型子宮內(nèi)膜異位癥發(fā)生前置胎盤的有48例,輕型發(fā)生前置胎盤的為21例,經(jīng)Spearman非參數(shù)檢驗相關(guān)性分析提示子宮內(nèi)膜異位癥與前置胎盤的發(fā)生有相關(guān)性并與病變程度呈正相關(guān),子宮內(nèi)膜異位癥程度越重發(fā)生前置胎盤的風(fēng)險率越高。
[Abstract]:background
Endometriosis (endometriosis) refers to the growth and reproduction of the active endometrium outside the uterine cavity, and local growth, infiltration, and repeated bleeding. The exact pathogenesis of endometriosis is not clear so far. The traditional etiology theory is Sampon's theory of reflux planting, and other theories and body cavity. Epithelial metaplasia theory, dissemination theory, stem cell theory and the newly formed "eutopic endometriodeterminism" and so on.
The most serious and most far-reaching complication of endometriosis is infertility. Studies have found that the mechanism of endometriosis in infertile women is not completely clear in the incidence of endometriosis as high as 25-40%. endometriosis. Assisted reproductive technology is an important means for the treatment of endometriosis with infertility. Heterotopic has a certain influence on the outcome of pregnancy assisted fertility. Endometriosis infertile patients have low fertilization rate, poor development potential and high complications after pregnancy. Therefore, the fertility of endometriosis patients and the effect on pregnancy outcome are widely concerned.
Placenta previa refers to the attachment of the placenta to the lower uterine segment after 28 weeks of pregnancy. The lower edge of the placenta can even reach or cover the inner mouth of the cervix. The incidence of placenta previa is lower than that of the fetus. The incidence of placenta previa is 0.63%. The domestic report is that endometrial lesions and various intrauterine operation injuries include abortion, curettage, induction, curettage, ring, and uterus. Endoscopic operation, cesarean section and so on, may cause different degrees of endometritis or endometrium atrophy, uterine decidua vascular defects, placental blood supply is poor, chronic ischemic anoxia exists, and the placenta is prone to increase placenta area. There are obvious tendentiousness of placenta previa in pregnant women. Therefore, this article will discuss the correlation of endometriosis and placenta previa in assisted childbirth and analyze the possible reasons.
Method
A retrospective review of the obstetric and assisted reproductive medical records from January 2008 to December 2012 at the Department of Obstetrics and Gynecology, affiliated to Zhejiang University, was reviewed, and a complete telephone follow-up was completed through assisted reproductive technology (including in vitro fertilization - embryo transfer and intracytoplasmic sperm injection) and the single fetus was delivered in our hospital after 28 weeks. A total of 2060 cases were statistically analyzed, including 110 cases of placenta previa. Statistics of these pregnant women's age, body mass index, pregnancy times, birth times, abortion times, cesarean section history, endometriosis, ovulation disorder, male infertility and other 9 indicators, analysis of their correlation with the placenta previa, and endometriosis classification and prepositional The correlation of placenta has been further analyzed.
Result
1. the incidence of placenta previa in all groups: the total number of non assisted childbirth in the affiliated obstetrics and Gynecology Hospital of Zhejiang University from January 2008 to December 2012 was 60725. The incidence of placenta previa was 3.23%. in 2060 cases, the incidence of placenta previa was 5.34%, placenta previa in endometriosis patients. The birth rate was 21.56%. Among them, 2=260.16 (P 0.005) was significantly different between endometriosis patients and the general population.
2. the incidence of placenta previa in 320 patients with endometriosis group was 21.56%, but the incidence of placenta previa in 1740 patients of non endometriosis group was 2.41%. via variance analysis and X 2=192.75 (P0.005), the difference was statistically significant.
There were 69 cases of endometriosis in 3.110 patients with placenta previa. Placenta previa combined with endometriosis was 62.7%, but not placenta previa combined with endometriosis 12.9%, OR value was 19.7,95%CI (0.5-300.6), and the value of P was 0.001, which had statistical significance.
4. the type and severity of endometriosis were positively correlated with the occurrence of placenta previa. The correlation coefficient of Kendall was 0.274, and the correlation coefficient of Spearman was 0.281, all P0.001..
conclusion
1. endometriosis not only causes infertility but also affects pregnancy outcomes. There is a certain correlation between endometriosis and placenta previa in assisted reproduction. The incidence of placenta previa is 5.34% in the observation data, which is higher than the incidence of 3.23% in the general population, and the prepositional previa of endometriosis patients. The incidence of placenta is 21.56%, which is much higher than that of the former two. There is a significant difference. Endometriosis increases the risk of placenta previa.
2. the data showed that the placenta previa combined with endometriosis in the assisted reproductive group was 62.7%, while the non placenta previa combined with internal differentiation was 12.9%, and the OR value was 19.7 by Logistic regression analysis. There was a significant correlation between the assisted reproductive neutrons endometriosis and the placenta previa.
3. endometriosis is not only associated with the occurrence of placenta previa, but also a positive correlation between the degree of endometriosis and the occurrence of placenta previa. There are 110 cases of placenta previa in patients with endometriosis receiving assisted fertility. There are 48 cases of placenta previa in severe endometriosis and light prepositional previa. In 21 cases of placenta, the correlation analysis between endometriosis and placenta previa was found to be correlated with the incidence of placenta previa by Spearman nonparametric test. The higher the risk rate of placenta previa was the more severe endometriosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71
本文編號：2141492
[Abstract]:background
Endometriosis (endometriosis) refers to the growth and reproduction of the active endometrium outside the uterine cavity, and local growth, infiltration, and repeated bleeding. The exact pathogenesis of endometriosis is not clear so far. The traditional etiology theory is Sampon's theory of reflux planting, and other theories and body cavity. Epithelial metaplasia theory, dissemination theory, stem cell theory and the newly formed "eutopic endometriodeterminism" and so on.
The most serious and most far-reaching complication of endometriosis is infertility. Studies have found that the mechanism of endometriosis in infertile women is not completely clear in the incidence of endometriosis as high as 25-40%. endometriosis. Assisted reproductive technology is an important means for the treatment of endometriosis with infertility. Heterotopic has a certain influence on the outcome of pregnancy assisted fertility. Endometriosis infertile patients have low fertilization rate, poor development potential and high complications after pregnancy. Therefore, the fertility of endometriosis patients and the effect on pregnancy outcome are widely concerned.
Placenta previa refers to the attachment of the placenta to the lower uterine segment after 28 weeks of pregnancy. The lower edge of the placenta can even reach or cover the inner mouth of the cervix. The incidence of placenta previa is lower than that of the fetus. The incidence of placenta previa is 0.63%. The domestic report is that endometrial lesions and various intrauterine operation injuries include abortion, curettage, induction, curettage, ring, and uterus. Endoscopic operation, cesarean section and so on, may cause different degrees of endometritis or endometrium atrophy, uterine decidua vascular defects, placental blood supply is poor, chronic ischemic anoxia exists, and the placenta is prone to increase placenta area. There are obvious tendentiousness of placenta previa in pregnant women. Therefore, this article will discuss the correlation of endometriosis and placenta previa in assisted childbirth and analyze the possible reasons.
Method
A retrospective review of the obstetric and assisted reproductive medical records from January 2008 to December 2012 at the Department of Obstetrics and Gynecology, affiliated to Zhejiang University, was reviewed, and a complete telephone follow-up was completed through assisted reproductive technology (including in vitro fertilization - embryo transfer and intracytoplasmic sperm injection) and the single fetus was delivered in our hospital after 28 weeks. A total of 2060 cases were statistically analyzed, including 110 cases of placenta previa. Statistics of these pregnant women's age, body mass index, pregnancy times, birth times, abortion times, cesarean section history, endometriosis, ovulation disorder, male infertility and other 9 indicators, analysis of their correlation with the placenta previa, and endometriosis classification and prepositional The correlation of placenta has been further analyzed.
Result
1. the incidence of placenta previa in all groups: the total number of non assisted childbirth in the affiliated obstetrics and Gynecology Hospital of Zhejiang University from January 2008 to December 2012 was 60725. The incidence of placenta previa was 3.23%. in 2060 cases, the incidence of placenta previa was 5.34%, placenta previa in endometriosis patients. The birth rate was 21.56%. Among them, 2=260.16 (P 0.005) was significantly different between endometriosis patients and the general population.
2. the incidence of placenta previa in 320 patients with endometriosis group was 21.56%, but the incidence of placenta previa in 1740 patients of non endometriosis group was 2.41%. via variance analysis and X 2=192.75 (P0.005), the difference was statistically significant.
There were 69 cases of endometriosis in 3.110 patients with placenta previa. Placenta previa combined with endometriosis was 62.7%, but not placenta previa combined with endometriosis 12.9%, OR value was 19.7,95%CI (0.5-300.6), and the value of P was 0.001, which had statistical significance.
4. the type and severity of endometriosis were positively correlated with the occurrence of placenta previa. The correlation coefficient of Kendall was 0.274, and the correlation coefficient of Spearman was 0.281, all P0.001..
conclusion
1. endometriosis not only causes infertility but also affects pregnancy outcomes. There is a certain correlation between endometriosis and placenta previa in assisted reproduction. The incidence of placenta previa is 5.34% in the observation data, which is higher than the incidence of 3.23% in the general population, and the prepositional previa of endometriosis patients. The incidence of placenta is 21.56%, which is much higher than that of the former two. There is a significant difference. Endometriosis increases the risk of placenta previa.
2. the data showed that the placenta previa combined with endometriosis in the assisted reproductive group was 62.7%, while the non placenta previa combined with internal differentiation was 12.9%, and the OR value was 19.7 by Logistic regression analysis. There was a significant correlation between the assisted reproductive neutrons endometriosis and the placenta previa.
3. endometriosis is not only associated with the occurrence of placenta previa, but also a positive correlation between the degree of endometriosis and the occurrence of placenta previa. There are 110 cases of placenta previa in patients with endometriosis receiving assisted fertility. There are 48 cases of placenta previa in severe endometriosis and light prepositional previa. In 21 cases of placenta, the correlation analysis between endometriosis and placenta previa was found to be correlated with the incidence of placenta previa by Spearman nonparametric test. The higher the risk rate of placenta previa was the more severe endometriosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71
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