Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 167

Pelvic irradiation increases the risk of pregnancy‐related complications, including spontaneous miscarriages, preterm labor and delivery, low birth weight infants and placental abnormalities (placenta accreta and percreta). This is probably brought about by reduced uterine volume, impaired uterine distensibility due to myometrial fibrosis, uterine vasculature damage and endometrial injury. The degree of uterine damage depends on the total radiation dose, site of irradiation and patient age at time of treatment. The prepubertal uterus is more vulnerable than the adult uterus to the effects of pelvic irradiation, with doses of 14–30 Gy likely to cause uterine dysfunction. The reduction in uterine volume is significantly higher in patients with direct uterine radiation. A study reported that following whole abdominal irradiation (20–30 Gy) in childhood, all pregnancies occurring in women with preserved ovarian function resulted in mid‐trimester miscarriage [7]. In a study of 16 pregnancies in 13 whole‐body irradiation recipients (10–15.75 Gy), none of the six patients who had received irradiation prepubertally had a live birth (five spontaneous miscarriages and one elective termination) [8].