子宫内膜异位症与晚期不良妊娠结局的研究进展

doi:10.12280/gjfckx.20200652

摘要/Abstract

摘要：

子宫内膜异位症（endometriosis,EMs）常见于生育年龄女性,主要临床表现是疼痛和不孕等。近年研究认为,EMs增加晚期不良妊娠结局的相关因素包括EMs局部免疫和炎性反应对妊娠过程的持续影响,以及在位子宫内膜孕酮抵抗、子宫异常收缩和子宫结合带增厚对胚胎着床的影响。研究发现与非EMs孕妇相比,EMs孕妇的前置胎盘风险增加,可能与EMs的子宫异常收缩有关;另外EMs孕妇的剖宫产风险增加,可能与EMs孕妇的年龄较大、盆腔粘连及妊娠晚期并发症增加有关;对于EMs是否增加孕妇的胎盘早剥、子痫前期、早产、胎儿生长受限及产后出血的风险还存在争议;EMs孕妇要警惕妊娠期急性并发症自发性腹腔出血。目前未发现使用预防性手术可以降低不良妊娠结局风险,但对EMs的人类辅助生殖技术妊娠者可适当增加额外的产前管理项目。

关键词: 子宫内膜异位症, 前置胎盘, 胎盘早剥, 子痫前期, 早产, 胎儿生长迟缓, 剖宫产术, 产后出血, 妊娠结局, 生殖技术, 辅助

Abstract:

Endometriosis (EMs) often occurs in women of reproductive age. The main manifestations are pain, infertility and so on. Recent studies have found that a combination of the impact of local immune and inflammatory response on pregnancy, the impact of progesterone resistance in the endometrium, inadequate uterine contractility and thicken of the uterine junctional zone on implantation period can lead to third trimester adverse pregnancy outcomes. Studies have showed that compared to pregnant women with no-EMs, pregnant women with EMs have a significantly higher risk of placenta previa, it may be linked to inadequate uterine contractility. Furthermore, pregnant women with EMs are at higher risk of cesarean delivery, it may be associated with age, pelvic adhesion and increasing rate of late pregnancy complication. Whether the EMs increase the risk of placental abruption, preeclampsia, preterm birth, fetal growth restriction and postpartum hemorrhage in pregnant women is quite controversial. At the same time, during pregnancy we should be vigilant about the occurrence of the endometriosis-related acute complications, such as spontaneous hemoperitoneum in pregnancy. There is no evidence which shows the preventive surgery can reduce the risk of the adverse pregnancy outcomes, but it is essential to add some extra monitoring management of pregnant women with endometriosis who conceived by assisted reproductive technology.

Key words: Endometriosis, Placenta previa, Abruptio placentae, Pre-eclampsia, Premature birth, Fetal growth retardation, Cesarean section, Postpartum hemorrhage, Pregnancy outcomes, Reproductive technology, assisted

夏颖, 邓燕杰. 子宫内膜异位症与晚期不良妊娠结局的研究进展[J]. 国际妇产科学杂志, 2021, 48(1): 15-20.

XIA Ying, DENG Yan-jie. Research Progress of Endometriosis and Third Trimester Adverse Pregnancy Outcomes[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 15-20.

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