【作者】 姜蕾；

【导师】 徐素欣； 郝桂敏；

【作者基本信息】 河北医科大学 ， 妇产科学， 2009， 硕士

【摘要】 目的:早期妊娠出血(First-trimester bleeding)是指妊娠三个月内发生的阴道出血。常见原因有流产,异位妊娠等。其中先兆流产是最常见的原因之一,而体外受精-胚胎移植(invitro fertilization-embryo transfer,IVF-ET)早期妊娠出血率明显高于正常妊娠。其原因尚未明了。本研究对通过实施IVF-ET技术妊娠早期出血及未出血妇女的基础血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平以及妊娠30天、45天雌二醇(E2),孕酮(P)水平, B超检查胚胎着床位置,以及子宫位置探讨其出血的原因,以便及早的采取人为的干预,改善IVF-ET的妊娠结局方法:1研究对象:取2008年11月到2009年1月在我科行体外受精-胚胎移植(invitro fertilization-embryo transfer,IVF-ET)及卵细胞浆内单精子注射-胚胎移植(intracytoplasmic sperm injection -embryo transfer ICSI-ET)的妊娠患者39例,年龄在24到35岁,平均年龄29.56±3.14,均为第一胎妊娠,不孕原因均为输卵管因素以及男方因素,并排除习惯性流产,母体生殖道解剖结构异常及子宫内膜病变,妊娠早期无感冒、发热及服药史,无接触放射线或有害化学物质史;无吸烟、酗酒等不良习惯,非近亲结婚配。1.1实验组(早期妊娠出血组):出现妊娠12周内出现阴道出血患者9例,年龄30.11±3.10岁1.2对照组:同期实施IVF/ICSI后妊娠其他患者30例,妊娠12周内未出现阴道出血,年龄29.40±3.18岁.2研究方法和测定内容:2.1内分泌激素测定:化学发光法测定基础血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平,妊娠30天以及45天雌二醇(E2),孕酮(P)水平。2.2胚胎着床位置的测定:B超测定妊娠45天孕囊中心距宫颈内口的距离结果:1实验组与对照组基础FSH、LH、E2的比较①基础FSH分别为(6.65±1.05 mIU/ml vs 7.23±1.60mIU/ml),②基础LH分别为(5.19±0.88mIU/ml vs 4.71±1.05mIU/ml),③基础E2分别为(39.00±6.04pg/ml vs 39.57±13.02 pg/ml)2实验组与对照组妊娠30天E2.P水平的比较①实验组与对照组比较E2 1435.22±733.08 pg/ml VS 2425.77±1055.08pg/ml②实验组与对照组比较P 36.35±5.85 pg/ml VS 38.14±4.80pg/ml3实验组与对照组妊娠45天E2.P水平的比较①实验组与对照组比较E2 1886.89±1087.59 pg/ml VS 2773.37±844.17pg/ml②实验组与对照组比较P 36.89±5.35 pg/ml VS 38.90±3.23pg/ml4实验组与对照组妊娠45天时B超测定胚胎着床位置的比较为34.00±8.26mm VS 43.00±7.21mm实验组前位子宫7例,后位子宫2例,对照组前位子宫25例,后位子宫5例结论:1与对照组患者相比,实验组患者基础血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平无统计学差异2妊娠30天,实验组患者雌二醇(E2)水平低于对照组(P=0.019<0.05)有统计学差异,孕酮(P)水平无统计学差异3妊娠45天,实验组患者雌二醇(E2)水平低于对照组(P=0.017<0.05)有统计学差异,孕酮(P)水平无统计学差异4妊娠45天行阴道B超检查,实验组胚胎着床位置明显低于对照组(P=0.003<0.01),具有统计学差异。5实验组与对照组子宫位置无明显差异。更多还原

【Abstract】 Purpose:Early pregnancy bleeding (First-trimester bleeding) are referring to happen within three months of pregnancy vaginal bleeding. In vitro fertilization - embryo culture (invitro fertilization-embryo transfer, IVF-ET) high abortion rate, early pregnancy bleeding pregnancy rate is much higher than normal. Unknown reasons.Through this experiment, human assisted reproductive technology (Assisted Reproductive Technology ART), as well as after a natural pregnancy bleeding during early pregnancy in patients with basic serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) level and 30 of pregnancy days of estradiol (E2), progesterone (P) level of 45 days of pregnancy estradiol (E2), progesterone (P) levels and implantation location of B-ultrasound, uterine hemorrhage location to explore the reasons for so early take man-made interventions to improve the IVF-ET Pregnancy Outcome。Methods:1 study: From November 2008 to January 2009 at my Branch in vitro fertilization - embryo transfer (invitro fertilization-embryo transfer, IVF-ET) with intracytoplasmic sperm injection - embryo transfer (intracytoplasmic sperm injection-embryo transfer ICSI-ET) of 39 cases of pregnancy, age at 24-35 years old, the average age of 29.56±3.14, are the first pregnancy, tubal factor infertility as well as the former are male factors, exclusion of habitual abortion, maternal reproductive tract abnormalities and anatomical structures within the uterus membrane lesions, early pregnancy without a cold, fever history, no medication history, then no radiation or the history of harmful chemical substances; no smoking, drinking and other bad habits, with non-consanguineous marriage.1.1 Experimental group (early pregnancy bleeding group): 12 weeks of pregnancy there appeared nine cases of patients with vaginal bleeding, age 30.11±3.10 years old1.2 Control group: the same period in IVF / ICSI pregnancy 30 cases of other patients, 12 weeks of pregnancy does not appear vaginal bleeding, age 29.40±3.18 years old,All patients are first child, pregnancy, rule out the possibility of habitual abortion, maternal reproductive tract anatomy and abnormal endometrial lesions, early pregnancy without a cold, fever history, no medication history, then no radiation or the history of harmful chemical substances; no smoking , alcohol and other bad habits, with non-consanguineous marriage.2 Research Methods and Determination of Content:2.1 Determination of embryo implantation Location: B super-center distance measured progesterone capsule away from the mouth of the cervix2.2 Determination of endocrine hormone: basic Chemiluminescence Determination of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and 30 days of pregnancy 45 days of estradiol (E2), progesterone (P).Results:1 experimental group and control group basic FSH, LH, E2 Comparison①basic FSH, respectively (6.65±1.05 mIU / ml vs 7.23±1.60mIU/ml),②basic LH, respectively (5.19±0.88mIU/ml vs 4.71±1.05mIU/ml),③basic E2, respect ively (39.00±6.04pg/ml vs 39.57±13.02 pg / ml)2 the experimental group and control group 30 days of pregnancy compared E2.P level①experimental group E2 1435.22±733.08 pg / ml VS 2425.77±1055.08pg/ml②experimental group P 36.35±5.85 pg / ml VS 38.14±4.80pg/ml3 the experimental group and control group 45 days of pregnancy compared E2.P level①experimental group E2 1886.89±1087.59 pg / ml VS 2773.37±844.17pg/ml②experimental group P 36.89±5.35 pg / ml VS 38.90±3.23pg/ml 4 with the control group 45 days of pregnancy embryo implantation B-Determination of the location of the experimental group compared 34.00±8.26mm VS 43.00±7.21mmExperimental group, three cases of anterior implantation, the posterior wall of six cases of implantation, the anterior wall of the control group 13 cases of implantation, the posterior wall of 17 cases of implantationExperimental group, 7 cases of uterine anterior, posterior uterine Example 2, the control group 25 cases of anterior uterus, 5 cases of posterior uterineConclusion:1 patients compared with the control group, experimental group of patients with basic serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) level was no significant difference2 pregnant 30 days, experimental group of patients with estradiol (E2) level was lower than the control group (P <0.05), progesterone (P) level of no significant difference 3 of pregnancy 45 days, experimental group of patients with estradiol (E2) level was lower than the control group (P <0.05), progesterone (P) level of no significant difference4 lines 45 days of pregnancy vaginal ultrasonography B, the experimental group is lower than on the embryo implantationControl group (P <0.05), the experimental group and control group, no significant difference between the location of the uterus. Implantation in the uterine wall position was no significant differenceSo the diagnosis of bleeding of early pregnancy early only estradiol (E2), embryo implantation Location prediction has significance更多还原