目的:接受试管婴儿(IVF)的女性,既往有剖腹产(CS)的活产率低于既往有阴道分娩的女性。然而,确切的潜在机制需要澄清。以前的CS会影响子宫收缩性的模式吗?。
方法:前瞻性评估在药物子宫内膜准备周期中接受冷冻胚泡胚胎移植的患者。20例患者被纳入组:A/未产。B/先前的阴道分娩。C/没有利基的先前CS,而15例患者被纳入D组(CS和利基)。患者使用雌二醇化合物和800mg阴道孕酮。在记录子宫收缩力/分钟的转移日进行3D扫描。
结果:基线特征(年龄,BMI,吸烟,子宫内膜厚度)相似。平均子宫收缩频率/分钟组间相似(A组1.15、1.01、0.92和1.21,B,C,D,分别)。与对照组相比,有超声表现的患者的收缩数量略有增加,未达到统计学意义(p=0.48)。在比较先前剖腹产的患者(无论是否存在利基)与没有剖腹产的患者时,没有观察到差异。未分娩(p=0.78)或先前的阴道分娩(p=0.80)。实现临床妊娠的患者和未实现临床妊娠的患者之间的子宫收缩频率相似(1.19vs.1.02UC/min,分别为p=0.219)。
结论:我们的研究发现,在有或没有剖腹产或超声诊断的小生境的患者之间,子宫收缩频率没有显着差异。需要进一步研究以了解影响峡部突出症患者植入的生理机制。
OBJECTIVE: Women undergoing IVF who have had a previous c-section (CS) have a lower live birth rate than those with a previous vaginal delivery. However, the precise underlying mechanisms need clarification. Does a previous CS affect the pattern of uterine contractility?.
METHODS: Prospective evaluation in patients undergoing frozen blastocyst embryo transfer in medicated endometrial preparation cycles. Twenty patients were included in groups: A/nulliparous. B/previous vaginal delivery. C/ previous CS without a
niche, whereas fifteen patients were recruited in group D (CS and a
niche). Patients employed estradiol compounds and 800 mg vaginal progesterone. A 3D-scan was performed the transfer-day where uterine contractility/minute was recorded.
RESULTS: Baseline characteristics (age, BMI, smoking, endometrial thickness) were similar. Mean frequency of uterine contractions/minute was similar between groups (1.15, 1.01, 0.92, and 1.21 for groups A, B, C, and D, respectively). There was a slight increase in the number of contractions in patients with a sonographic
niche versus controls, not reaching statistical significance (p=0.48). No differences were observed when comparing patients with a previous C-section (regardless of the presence of a
niche) to those without a C-section, either nulliparous (p=0.78) or with a previous vaginal delivery (p=0.80). The frequency of uterine contractions was similar between patients who achieved a clinical pregnancy and those who did not (1.19 vs. 1.02 UC/min, p=0.219, respectively).
CONCLUSIONS: Our study found no significant difference in the frequency of uterine contractility between patients with or without a previous C-section or sonographic diagnosed
niche. Further investigation is necessary to understand the physiological mechanisms affecting implantation in patients with isthmocele.