探究接受体外受精-胚胎移植妊娠合并绒毛膜下血肿患者的临床特点与妊娠结局。

收集2021年1月至2023年5月于中山大学孙逸仙纪念医院接受体外受精-胚胎移植助孕并诊断为绒毛膜下血肿的79例患者的临床资料，对其进行回顾性分析。以妊娠结局分为妊娠丢失组(13例)和活产组(66例)，比较两组患者的一般情况、血肿与妊娠相关资料及实验室检查情况；以妊娠是否达到12周为时间节点，分为早期流产组(11例)和未发生早期流产组(68例)；79例患者中获得可计算血肿/孕囊体积比详细数据者共71例，以血肿/孕囊体积比分组，分析小血肿(37例)、中血肿(9例)和大血肿(25例)患者的病史资料与妊娠结局。

早期流产组血肿/孕囊体积比大于未发生早期流产组(2.83 vs 0.13，Z＝－3.147)、诊断绒毛膜下血肿孕周早于未发生早期流产组(6.1周vs 8.0周，t＝－2.266)、体质指数低于未发生早期流产组(19.5 vs 21.7，t＝－2.202)，差异均有统计学意义(P<0.05)。按血肿/孕囊体积比分组，大血肿组妊娠丢失率明显高于小、中血肿组(32.0% vs 5.4%、22.2%, χ²＝4.480)，差异具有统计学意义(P<0.05)；既往晚期流产次数和引产次数对绒毛膜下血肿的大小有影响。妊娠丢失组与活产组相比，B淋巴细胞水平较高(19.0% vs 15.7%，t＝2.007)，抗β2糖蛋白抗体IgG型较高(5.1 U/ml vs 2.37 U/ml，Z＝－2.075)，补体C3水平较高(1651.2 mg/L vs 1087.8 mg/L，t＝2.128)，补体C4水平较低(196.0 mg/L vs 231.5 mg/L，Z＝－2.106)，差异均有统计学意义(P<0.05)。妊娠丢失组与活产组凝血指标均在正常范围内。

血肿/孕囊体积比越大、诊断绒毛膜下血肿时孕周越小，早期流产率越高；诊断绒毛膜下血肿孕周<8周早期流产率高，出现大血肿的几率大；有晚期流产史和引产史患者更容易出现中、小血肿；对于妊娠丢失与活产患者存在部分免疫状况差异，临床诊疗中应给予关注。

To investigate the clinical characteristics and pregnancy outcomes of patients who underwent in vitro fertilization-embryo transfer for assisted conception combined with subchorionic hematoma (SCH).

A retrospective analysis was conducted on 79 patients diagnosed with SCH who underwent IVF-ET at Sun Yat-sen Memorial Hospital, Zhongshan University, from January 2021 to May 2023.Grouped by pregnancy outcome, general clinical data, hematoma and pregnancy-related data, and laboratory indexes were compared in the pregnancy loss group (13 cases) and the live birth group (66 cases). The group was divided into an early miscarriage group (11 cases) and a group without early miscarriage (68 cases), using whether or not the pregnancy had reached 12 weeks as the timeline. Among 79 patients, a total of 71 obtained detailed data that can calculate the hematoma/gestational sac volume ratio. The hematoma/gestational sac volume ratio was used as a subgroup to analyze the pregnancy outcomes and past medical history of small hematoma (37 cases), medium hematoma (9 cases) and large hematoma (25 cases) patients.

The hematoma/gestational sac volume ratio was greater in the early miscarriage group than in the group without early miscarriage (2.83 vs 0.13, Z=-3.147), the gestational week of diagnosis of subchorionic hematoma was earlier than in the group without early miscarriage (6.1 vs 8.0 weeks, t=-2.266), and the body mass index was lower than in the group without early miscarriage (19.5 vs 21.7, t=-2.202), and the differences were statistically significant (P<0.05). Grouped by hematoma/gestational sac volume ratio, the pregnancy loss rate was significantly higher in the large hematoma group than in the small and medium hematoma groups (32.0% vs 5.4%, 22.2%, χ²=4.480), and the differences were statistically significant (P<0.05); the number of previous late miscarriages and induced abortions affected the size of SCH. The pregnancy loss group had higher levels of B-lymphocytes (19.0% vs 15.7%, t=2.007), higher anti-β2 glycoprotein antibody IgG type (5.1 U/ml vs 2.37 U/ml, Z=-2.075), higher levels of complement C3(1651.2 mg/L vs 1087.8 mg/L, t=2.128), and lower levels of complement C4(196.0 mg/L vs 231.5 mg/L, Z=-2.106) compared with the live birth group, and the differences were statistically significant (P<0.05). Coagulation indices were within the normal range in the pregnancy loss and live birth groups.

A higher hematoma/sac volume ratio and smaller gestational age at SCH diagnosis are associated with a higher rate of early miscarriage. The early miscarriage rate is higher in the patients with SCH diagnosis <8 weeks, with a greater likelihood of large hematomas occurring. Patients with a history of late miscarriages and induced abortions are more likely to have medium or small hematomas. Partial differences in immune status existed between patients with pregnancy loss and those with live birth, warranting attention in clinical diagnosis and treatment.