安徽医科大学：《生殖医学基础与临床》课程教学资源（PPT课件讲稿）辅助生殖技术并发 The prevention and treatment of complications related to ART（主讲：许孝凤）

The prevention and treatment of complications related to ART Reproductive Medicine Center Xu Xiaofeng 2016.Dec.1 1

The prevention and treatment of complications related to ART Reproductive Medicine Center Xu Xiaofeng 2016.Dec.1 1

2 官颈钳 cervical clamp 后穹窿 posterior fornix 52 输卵管 子官 膀胱 女性尿道 外生殖墨 直肠 阴道 女性盆腔侧面解剖图+

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取卵示意圆 2 3

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Contents ·OHSS Infection and Bleeding ·Ectopic pregnancy ·Multiple pregnancy 。Damage Other ovarian torsion,POl... 4

Contents • OHSS • Infection and Bleeding • Ectopic pregnancy • Multiple pregnancy • Damage • Other : ovarian torsion, POI … 4

OHSS Feature:enlarged ovarian and increased permeability of capillary 。Pathology: Body fluid exudation Hydrothorax and ascites Hypovolemia,hemoconcentration,electrolyte disturbance, and thrombus Liver and kidney function is damaged 5

OHSS • Feature： enlarged ovarian and increased permeability of capillary • Pathology： Body fluid exudation Hydrothorax and ascites Hypovolemia, hemoconcentration, electrolyte disturbance, and thrombus Liver and kidney function is damaged 5

Pathogenesis Renin-angiotensin-aldosterone system Vascular endothelial growth factor ·Prostaglandin Vascular permeability factor 6

Pathogenesis • Renin-angiotensin-aldosterone system • Vascular endothelial growth factor • Prostaglandin • Vascular permeability factor 6

Renin-angiotensin-aldosterone System HCG made prorenin increase Prorenin transformed to renin Activation of the renin -angiotensin-aldosterone system Angiotensin ll affected the angiogenesis and increased the permeability of capillaries 7

Renin-angiotensin-aldosterone System • HCG made prorenin increase . Prorenin transformed to renin • Activation of the renin - angiotensin- aldosterone system • Angiotensin II affected the angiogenesis and increased the permeability of capillaries 7

Vascular Endothelial Growth Factor VEGF is the one of the major factors High level of estrogen and HCG induced the synthesis of VEGF High level of VEGF promoted the proliferation of vascular endothelial cell and increased the permeability of capillary 8

Vascular Endothelial Growth Factor • VEGF is the one of the major factors • High level of estrogen and HCG induced the synthesis of VEGF • High level of VEGF promoted the proliferation of vascular endothelial cell and increased the permeability of capillary 8

Prostaglandin High level of estrogen and HCG activiated arachidonic acid.Arachidonic acid transformed to epoxidase Promoted prostaglandin secretion ·Histamine increased Increased the permeability of capillary Hydrothorax and ascite 9

Prostaglandin • High level of estrogen and HCG activiated arachidonic acid. Arachidonic acid transformed to epoxidase • Promoted prostaglandin secretion • Histamine increased • Increased the permeability of capillary • Hydrothorax and ascite 9

Vascular Permeability Factor mRNA expression of vascular permeability factor increase in granular cell is related to COH Cytokines increased,including TNF,IL-1 and IL-2 Some of mediators of inflammation increased. including histamine and serotonin,which damaged the capillary and reduced angiotelectasis 10

Vascular Permeability Factor • mRNA expression of vascular permeability factor increase in granular cell is related to COH • Cytokines increased, including TNF, IL-1 and IL-2 • Some of mediators of inflammation increased, including histamine and serotonin,which damaged the capillary and reduced angiotelectasis 10