Kurume University, Department of Obstetrics and Gynecology, School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan.
Kurume University, Department of Obstetrics and Gynecology, School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan.
Eur J Obstet Gynecol Reprod Biol. 2024 May;296:194-199. doi: 10.1016/j.ejogrb.2024.02.040. Epub 2024 Feb 28.
Assisted reproductive technology (ART), especially frozen-thawed embryo transfer (FET) in a hormone replacement cycle (HRC), is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies achieved after FET in an HRC.
We performed a case-control study in two tertiary perinatal centres in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centres between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed on the basis of the FIGO classification for the clinical diagnosis of PAS or retained products of conception after delivery at ≥24 weeks of gestation. We excluded women with fresh embryo transfer, FET with a spontaneous ovulatory cycle, a donor oocyte cycle, and missing details of the ART treatment. Finally, among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case-control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of caesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos, and endometrial thickness at the initiation of progestin administration.
PAS was associated with ≥2 previous uterine surgeries (adjusted odds ratio, 3.57; 95 % confidence interval, 1.60-7.97) and the stage of embryo transfer (blastocysts: adjusted odds ratio, 2.89; 95 % confidence interval, 1.15-7.26). In patients with <2 previous uterine surgeries, PAS was associated with an endometrial thickness of <7.0 mm (adjusted odds ratio, 5.18; 95 % confidence interval, 1.10-24.44).
Multiple uterine surgeries and the transfer of blastocysts are risk factors for PAS in pregnancies conceived after FET in an HRC. In women with <2 previous uterine surgeries, a thin endometrium before FET is also a risk factor for PAS in these pregnancies.
辅助生殖技术(ART),尤其是激素替代周期(HRC)中的冻融胚胎移植(FET),是胎盘部位滋养细胞疾病谱(PAS)的一个危险因素。本研究旨在明确与母体背景和 ART 技术相关的、在 HRC 中 FET 后妊娠中 PAS 的危险因素。
我们在日本的两家三级围产医学中心进行了病例对照研究。在 2010 年至 2021 年间,共有 14028 名在≥24 孕周分娩或分娩后转至这两家三级围产医学中心的患者中,972 名患者通过 ART 受孕,13056 名患者未通过 ART 受孕。根据 PAS 的 FIGO 分类,对 PAS 或≥24 孕周分娩后残留妊娠物进行临床诊断。我们排除了新鲜胚胎移植、FET 自发性排卵周期、供卵周期以及 ART 治疗细节缺失的患者。最后,在 HRC 中接受 FET 后受孕的患者中,纳入了 62 名 PAS 患者和 340 名无 PAS 患者进行本研究。采用多变量 logistic 回归模型进行病例对照比较,并对产妇分娩时的年龄、产次、子宫内膜异位症或子宫腺肌病、既往剖宫产、子宫肌瘤切除术、子宫内膜息肉切除术或刮宫术、前置胎盘、移植胚胎的阶段以及孕激素治疗开始时的子宫内膜厚度进行调整。
PAS 与≥2 次既往子宫手术(调整后的优势比,3.57;95%置信区间,1.60-7.97)和胚胎移植阶段(囊胚:调整后的优势比,2.89;95%置信区间,1.15-7.26)相关。在既往子宫手术次数<2 的患者中,PAS 与子宫内膜厚度<7.0mm(调整后的优势比,5.18;95%置信区间,1.10-24.44)相关。
多次子宫手术和囊胚移植是 HRC 中 FET 后妊娠 PAS 的危险因素。在既往子宫手术次数<2 的患者中,FET 前的薄子宫内膜也是这些妊娠 PAS 的危险因素。