根据超声和多普勒测量资料分析孕前护理阶段子宫因素不孕妇女的子宫内膜状态

O. Makarchuk, O. Ostrovska, Okolokh Onieka Gibson, I. Orishchak, A. R. Cheredarchuk
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引用次数: 0

摘要

近年来,子宫因素不孕的病例数不断增长。不幸的是,对科学工作的分析的特点是缺乏关于改进诊断算法的数据和强调先入为主阶段的重要性的权宜之计。本研究的目的是发展超声标准子宫内膜准备着床在孕前护理阶段与子宫因素不孕妇女。第一组包括80名子宫因素不孕的妇女,第二组(40名妇女)包括首次进入试管婴儿计划的患者。对照组由30名生育能力正常的妇女组成。在月经周期的第4 -6天(根据国际子宫内膜肿瘤分析(IETA) -超声描述子宫内膜变化的共识)和月经周期的第20 -24天,在Voluson 760上对子宫内膜、子宫肌层和卵巢组织的结构进行研究。为了评估慢性子宫内膜炎的间接征象,采用了由V.N. Demidov等人制定的超声标准。超声诊断在形态学和免疫组织化学检查中得到证实。子宫因素性不孕症女性最常见的月经失调是痛经(33.3%)、痛经减退(22.2%)和痛经减退(64.4%)。子宫内膜变薄在子宫因子生殖障碍组中更为常见;三分之一(33.8%)的患者子宫内膜回声异常;41.3%的病例诊断为m回声不均匀,以高回声区为主。每五分之一的患者出现基底层高回声包涵体、多线状结构和回声增强,47.5%的患者出现子宫轮廓低回声。子宫内膜异位症患者与IVF失败和早期生殖丧失相关的优势比最显著(OR - 5.85;95% CI: 1.32-13.32), synnechiae (OR - 2.27;95% CI: 0.96-10.16)和息肉(OR - 2.48;95% ci: 0.84-11.36)。可以区分子宫内膜植入功能准备的以下标准:子宫内膜厚度大于8mm,符合月经周期的回声结构阶段,m回声均匀性,无高回声和低回声包体,骨盆血管池血流动力学充分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endometrial state in women with uterine factor of infertility at the stage of preconceptional care according to sonography and doplerometry data
In recent years, the number of cases of uterine factors infertility is constantly growing. Unfortunately, the analysis of scientific works is characterized by the lack of data on the improvement of the diagnostic algorithm and the expediency of accentuating the significance of the preconceptional stage. The purpose of this study was to develop sonographic criteria for endometrial readiness for implantation at the stage of preconceptional care in women with uterine factor infertility. The first group included 80 women with uterine factor infertility, the second group (40 women) consisted of patients who entered the IVF program for the first time. The control group consisted of 30 women with normal fertility. Studies of the structure of the endometrium, myometrium and ovarian tissue were performed on a Voluson 760, on the 4th-6th days of the menstrual cycle (according to the International Endometrial Tumor Analysis (IETA) – consensus of ultrasound description of endometrial changes) and on the 20th-24th days of the cycle. To assess the indirect signs of chronic endometritis the echographic criteria developed by V.N. Demidov et al. were used. The sonographic diagnosis was verified during morphological and immunohistochemical examination. The most common menstrual disorders in women with uterine factor infertility were algodysmenorrhea – 33.3%, algohypomenorrhea –22.2%, hypoopsomenorrhea – 64.4%. Thinning of the endometrium was significantly more often observed in the group with uterine factor of reproductive disorders; one third of patients (33.8%) had dyschronosis of the endometrial echotexture; heterogeneity of M-echo with a predominance of hyperechoic areas was diagnosed in 41.3% of cases. Hyperechogenic inclusions in the basal layer, multiple structures of a linear nature and increased echogenicity were revealed in every fifth patients and hypoechoic uterine contour – in 47.5% of cases. The most significant odds ratio associated with IVF failures and early reproductive loss was found in patients with endometriosis (OR – 5.85; 95% CI: 1.32-13.32), synechiae (OR – 2.27; 95% CI: 0.96-10.16) and polyps (OR – 2.48; 95% CI: 0.84-11.36). It was possible to distinguish the following criteria of functional readiness of the endometrium for implantation: endometrial thickness was more than 8 mm, compliance with the echostructure phase of the menstrual cycle, homogeneity of M-echo, absence of hyper-and hypoechoic inclusions, and full hemodynamics in the vascular pool of the pelvis.
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