Department of Obstetrics and Gynecology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Assist Reprod Genet. 2022 Dec;39(12):2711-2718. doi: 10.1007/s10815-022-02644-4. Epub 2022 Oct 28.
To assess perinatal outcomes and placental findings in in vitro fertilization (IVF) patients with previous recurrent pregnancy loss (RPL).
This was a retrospective cohort of live singleton births following IVF at a single university-affiliated center between 2009 and 2017. Outcomes were compared between patients with previous RPL, defined as two miscarriages (RPL group), and patients without RPL (control group). Placental examination was performed for all deliveries irrelevant of complications, and findings categorized according to the Amsterdam Placental Workshop Consensus.
One hundred seventy-two deliveries of women with previous RPL (RPL group) were compared to 885 controls. Maternal age, 36.2 ± 4.2 vs. 35.4 ± 4.2 years, p = 0.02, and rate of uterine fibroids, 12.7% vs. 7.3%, p = 0.01, were higher in the RPL group. The rate of nulliparity was lower in the RPL group, 63.3% vs. 74.1%, p = 0.003. Unexplained infertility and diminished ovarian reserve were more common in the RPL group and male factor infertility in controls. There was a lower rate of fresh embryo transfer in the RPL group, 50.5% vs. 64.7%, p < 0.001, and reduced endometrial thickness. Similar obstetric outcomes were noted in the groups after adjustment for confounders. Placental examinations were notable for lower placental thickness, β - 0.17 cm, 95%CI - 0.30-(- 0.0), a lower rate of velamentous cord insertion, aOR 0.44, 95%CI 0.20-0.95, and a higher rate of villous infarction, aOR 2.82, 95%CI 1.28-6.20 in the RPL group.
In IVF patients with a history of RPL, subsequent deliveries were associated with a limited number of placental lesions, yet with similar obstetric outcomes.
评估体外受精（IVF）患者中既往复发性妊娠丢失（RPL）的围产期结局和胎盘发现。
这是一项回顾性队列研究，纳入了 2009 年至 2017 年在一家大学附属医院进行的 IVF 后活单胎分娩的患者。将既往有 RPL 史（定义为两次流产）的患者（RPL 组）与无 RPL 史的患者（对照组）进行比较。所有分娩患者均进行胎盘检查，无论是否有并发症，并根据阿姆斯特丹胎盘研讨会共识进行分类。
比较了 172 例既往 RPL 患者（RPL 组）与 885 例对照的分娩情况。RPL 组的产妇年龄为 36.2±4.2 岁，对照组为 35.4±4.2 岁，p=0.02；RPL 组的子宫肌瘤发生率为 12.7%，对照组为 7.3%，p=0.01。RPL 组的初产妇比例较低，为 63.3%，对照组为 74.1%，p=0.003。RPL 组中不明原因不孕和卵巢储备功能减退更为常见，对照组中男性因素不孕更为常见。RPL 组新鲜胚胎移植率较低，为 50.5%，对照组为 64.7%，p<0.001，子宫内膜厚度也较低。在调整混杂因素后，两组的产科结局相似。胎盘检查发现 RPL 组胎盘厚度较低，β=−0.17cm，95%CI−0.30 至（−0.0），脐带帆状附着发生率较低，aOR 0.44，95%CI 0.20 至 0.95，绒毛梗死发生率较高，aOR 2.82，95%CI 1.28 至 6.20。
在有 RPL 病史的 IVF 患者中，随后的分娩与少数胎盘病变相关，但产科结局相似。
