With the rapid development of high-throughput sequencing technology, the role of long non-coding RNA (lncRNA) HOX transcript antisense RNA (HOTAIR) in gynecological malignant tumors has been gradually revealed. Studies have shown that HOTAIR is generally highly expressed in cervical cancer, ovarian cancer, and endometrial cancer, and is closely related to tumor progression, metastasis, and drug resistance. HOTAIR participates in the processes of tumor proliferation, invasion, metastasis, and drug resistance by regulating signaling pathways such as Wnt/β-catenin, transforming growth factor-β (TGF-β)/epithelial-mesenchymal transition (EMT), Notch, and phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt). In addition, its genetic polymorphisms (such as single nucleotide polymorphisms) are closely related to the susceptibility of gynecological malignant tumors. Its characteristic of regulating microRNA function as a competing endogenous RNA (ceRNA) further highlights its key role in tumor molecular regulation. HOTAIR can not only serve as a potential molecular marker for the diagnosis and prognostic evaluation of gynecological malignant tumors, but may also become an important target for future individualized treatment strategies.

Endometrial cancer (EC) is one of the most common malignant tumors in the female reproductive system, and its incidence is on the rise globally. Glucagon-like peptide-1 receptor agonist (GLP-1RA) as hypoglycemic drug, has gradually attracted attention for their potential role in the treatment of EC. Existing studies have preliminarily demonstrated that GLP-1RA can regulate the physiological activities of EC by activating multiple signaling pathways such as AMP- activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) and cyclic adenosine monophosphate (cAMP)/protein kinase A(PKA). This further affects apoptosis, autophagy, ferroptosis, and cell cycle arrest of EC cells, and shows the potential to overcome cisplatin chemotherapy resistance in a hyperglycemic environment, thereby inhibiting the survival, migration, and invasion abilities of EC cells. In addition, GLP-1RA can upregulate the expression of glucagon-like peptide-1 receptor (GLP-1R), and changes in the expression level of GLP-1R can be detected in both normal tissues and EC tissues. Therefore, GLP-1RA has potential application value in the treatment of EC. This review summarizes the latest research progress of GLP-1RA in the occurrence and development of EC from the perspectives of key targets, physiological mechanisms, and effects, aiming to provide reference for future research.

Ovarian cancer is a gynecological malignant tumor with the highest mortality rate, and its recurrence and drug resistance are closely related to lipid metabolism reprogramming. Studies have shown that abnormal lipid metabolism promotes the synthesis of fatty acid and cholesterol through the abnormal activation of core metabolic enzymes, alters the fluidity of the cell membrane, and drives oncogenic signal transduction. Meanwhile, ascites, exosomes, and immune cells in the tumor microenvironment further enhance tumor metastasis and platinum resistance through lipid transport and metabolic remodeling. Moreover, lipid metabolism interacts with epigenetic modifications and immune checkpoint regulation to reshape the immune response and induce immune escape. These mechanisms work together to maintain the survival, invasion, and drug-resistant phenotypes of cancer cells. Therefore, targeting the key nodes or related pathways of lipid metabolism is not only expected to become molecular markers for the diagnosis and prognosis of ovarian cancer, but also provides a theoretical basis for the combined treatment strategy of metabolic intervention and immune regulation, showing important clinical translational value.

Cervical cancer is one of the most common gynecological malignancies. The phosphoinositide 3-kinase (PI3K) / protein kinase B (Akt) signaling pathway is one of the signal transduction pathways closely related to cervical cancer. Studies have found that quercetin, luteolin, triterpenoids from Inonotus obliquus, tubeimoside Ⅰ, and neferine can inhibit the activation of the PI3K/Akt pathway, reduce the phosphorylation levels of PI3K and Akt, and induce apoptosis in HeLa cells. Wogonin, rotenone, saikosaponin A, lycorine, camptothecin, shikonin, and artemisinin activate pro-apoptotic proteins and autophagic complexes through this pathway, promoting cell autophagy and apoptosis. Paeonol, oxymatrine, and protopanaxadiol inhibit cell migration and invasion by regulating the epithelial-mesenchymal transition mediated by the PI3K/Akt signaling pathway. Arsenic trioxide, paclitaxel, and gambogic acid can block this pathway, reduce the expression of angiogenesis-related proteins, and inhibit tumor angiogenesis. Pterostilbene down-regulates the expression of mammalian target of rapamycin through this pathway, affecting the tumor microenvironment. Traditional Chinese medicine monomers affect the proliferation, apoptosis, autophagy, migration, invasion of HeLa cells and the tumor microenvironment by regulating the PI3K/Akt signaling pathway, providing new therapeutic perspectives and theoretical basis for cervical cancer.

Choriocarcinoma is a highly malignant gestational trophoblastic tumor that is prone to early metastasis. Cesarean scar pregnancy complicated with choriocarcinoma lacks specific clinical symptoms, is extremely rare clinically, and is easily misdiagnosed in the early stage. Early diagnosis and treatment are crucial for the prognosis. A case of cesarean scar pregnancy complicated with choriocarcinoma is reported. The patient was admitted to the hospital due to amenorrhea for 59 days accompanied by vaginal bleeding for 2 days. After hysteroscopic removal of the scar pregnancy tissue, the pathological diagnosis was cesarean scar pregnancy. After the operation, the serum level of β-human chorionic gonadotropin (β-hCG) decreased and then abnormally increased again. Ultrasound showed an abnormal echo mass at the scar site, and gestational trophoblastic disease was suspected. After laparoscopic resection of the cesarean scar pregnancy lesion, the pathological diagnosis was choriocarcinoma. After two courses of chemotherapy with the fluorouracil + actinomycin-D + vincristine (FAV) regimen, the patient's blood β-hCG turned negative. Transvaginal ultrasound showed no abnormal mass. The patient had no recurrence during the 11-month follow-up after the end of chemotherapy.

A case of peritoneal malignant mesothelioma (PMM) is reported. The patient presented due to a palpable abdominal mass. Color Doppler ultrasound indicated a hypoechoic mass in the pelvic cavity. Before the operation, the patient was tentatively diagnosed with a pelvic malignant tumor. Subsequently, a laparoscopic exploration was performed, and the lesions on the surface of the bilateral fallopian tubes and ovaries were resected during the operation. The nature of the mass could not be determined by introperative pathological examination. After the operation, the routine pathological examination, following further consultation, confirmed it as a malignant tumor, suspected to be a malignant mesothelioma, possibly originating from the peritoneum. Then, a cytoreductive surgery was carried out. After the operation, the patient's symptoms were relieved, but the patient refused further treatment. PMM is a clinically rare, highly invasive malignant tumor originating from serosal mesothelial and sub-mesothelial cells. It commonly occurs in the pleura and peritoneum and is closely associated with asbestos exposure. The disease has an insidious onset, lacks typical symptoms, and has low imaging specificity, posing certain difficulties in clinical diagnosis and treatment. Most cases are diagnosed at an advanced stage, with a poor prognosis. The main treatment for PMM is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

A case of a rare non-human papilloma virus (HPV)-related mesonephric adenocarcinoma (MNA) of the cervix is reported, and its clinical diagnosis and treatment characteristics, pathological features, and causes of misdiagnosis are analyzed in depth. The patient was a postmenopausal woman with no obvious clinical symptoms, and the previous cervical HPV and thin-prep cytology test results were both negative. She suddenly had vaginal bleeding 2 years after menopause. Clinical physical examination showed that the cervix looked normal, but the uterus was significantly enlarged. At the initial diagnosis, it was misdiagnosed as endometrial cancer. After the surgery, the diagnosis of cervical malignant tumor was confirmed by histopathological examination, and MNA was diagnosed by immunohistochemical analysis. This case emphasizes the crucial role of multi-disciplinary collaboration in the diagnosis and treatment of non-HPV-related cervical adenocarcinoma. It prompts clinicians to pay more attention to patients with atypical symptoms, comprehensively use means such as medical history collection, laboratory tests, imaging evaluation, and pathological analysis, broaden the diagnostic thinking, and strengthen the multidisciplinary collaboration mechanism, so as to reduce the misdiagnosis rate and promote the precise diagnosis and treatment of non-HPV-related cervical adenocarcinoma.

Teratoma is a congenital embryogenic tumor, and its occurrence in the placenta is rare. A case of mature teratoma of the placenta is reported here. The patient was a 23-year-old woman. Prenatal ultrasound examination revealed a well-defined, encapsulated mixed-echo mass connected to the fetal surface of the placenta through a band-like structure. Multiple strong-echo spots with posterior acoustic shadows were detected inside, and placental teratoma was considered. Subsequently, regular ultrasound re-examinations were conducted, and no obvious changes were found in the size and echo of the mixed-echo mass. At 40⁺⁵ weeks of gestation, a live female infant was delivered vaginally. The placenta was delivered smoothly. A yellow tissue was observed at the edge of the placenta with the naked eye, and it was confirmed as a mature teratoma of the placenta by postpartum pathology. Through this case report, the characteristics of placental teratoma are summarized to improve the understanding of this disease, with the hope of providing a reference for clinical diagnosis and treatment.

Endometriosis (EMs) is a common chronic gynecological disease. Its core pathology is the ectopic growth of endometrial tissue, but traditional theories struggle to comprehensively explain its complex mechanisms, resulting in challenges of delayed diagnosis and poor treatment outcomes in clinical practice. The application of single-cell sequencing technology provides a new perspective for revealing the cellular and molecular mechanisms of EMs. By analyzing multi-omics information such as the genome and transcriptome of individual cells, this technology overcomes the problem of homogenization of single-cell heterogeneity in traditional sequencing technologies. Studies have found that in the immune microenvironment, the dynamic changes of immune cell subsets in the abdominal cavity and lesions reveal the synergistic effects of immune escape and the inflammatory microenvironment. The fibrosis process involves the deposition of extracellular matrix dominated by myofibroblasts, and the M2 polarization of macrophages exacerbates fibrosis through microenvironmental remodeling or inhibition of epithelial apoptosis. Abnormal angiogenesis is associated with the expansion of tumor-derived endothelial cell and dysregulation of pro-angiogenic factors. Additionally, there is a molecular association between EMs and ovarian cancer, which reveals the mechanisms of infertility caused by impaired oocyte maturation and decreased endometrial receptivity. The emerging spatial transcriptomics technology, which integrates single-cell resolution with spatial location information, further promotes the study of microenvironmental heterogeneity. Despite facing challenges in data complexity and technical processing, single-cell sequencing still has significant potential in high-throughput optimization and multi-omic integration. With technological advancements, this field is expected to break through the bottlenecks in the diagnosis and treatment of EMs and accelerate the transformation from basic research to precise clinical treatment.

Polycystic ovary syndrome (PCOS), as a complex endocrine and metabolic disorder, has a relatively high incidence among women of reproductive age, significantly affecting the reproductive health and quality of life. Traditional treatment regimens are only limited to symptom improvement and cannot reverse the pathological process of PCOS. Therefore, it is difficult to completely cure the disease and effectively prevent long-term complications. Human umbilical cord mesenchymal stem cell (hUC-MSC) and its derived extracellular vesicles have unique immunomodulatory, anti-inflammatory, tissue repair capabilities, and are expected to become a new treatment method for PCOS. Studies have shown that hUC-MSC transplantation and its derived cell-free therapy have positive effects on regulating the immune microenvironment, improving oocyte quality, and alleviating PCOS-related pathological changes through multiple mechanisms, such as regulating the inflammatory response and inflammatory signal transduction, inhibiting programmed cell death of ovarian granulosa cells, and maintaining mitochondrial homeostasis. Furthermore, these also show potential clinical value in improving the reproductive outcomes of PCOS patients and preventing long-term complications, providing a theoretical basis for further in-depth research on the mechanism of action of hUC-MSC and its clinical translation.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disease among women of reproductive age. The imbalance of glucose and lipid metabolic homeostasis in PCOS can interfere with decidualization process of endometrial stromal cell (ESC) and significantly increase the risk of adverse pregnancy outcomes. Studies have found that in terms of glucose metabolism, there are abnormal mechanisms in patients with PCOS, such as abnormal epigenetic regulation, insulin signaling pathway transduction disorders, and the influence of hyperandrogenism on endoplasmic reticulum stress. In terms of lipid metabolism, hyperandrogenism acts on the Wilms tumor 1-very low density lipoprotein receptor (WT1-VLDLR) pathway, leading to abnormal lipid storage, and the disorder of PCOS-related adipokines inhibits ESC decidualization. This review summarizes the mechanisms of abnormal glucose and lipid metabolism during the decidualization of ESC in patients with PCOS, providing a theoretical basis for in-depth research on the metabolic factors of reproductive disorders in PCOS and the further development of treatment strategies targeting metabolic remodeling.

Pelvic floor dysfunction (PFD) is a common health problem among women, severely affecting the quality of life of postpartum and elderly women. With the improvement of people's health awareness and the development of population aging, the early detection and intervention of PFD have become a global public-health priority. Pelvic floor electrophysiological examination, with its advantages of non-invasiveness and dynamic monitoring, has been widely used in the diagnosis and treatment of PFD. This technology can objectively quantify pelvic floor electromyographic signals and has high sensitivity for the screening of early asymptomatic PFD. In the evaluation of treatment efficacy, it can accurately reflect the rehabilitation effect. Additionally, it also provides support for the research on the mechanisms of PFD, such as distinguishing the differences in electromyographic characteristics among different patients. However, this technology still has some problems, including insufficient standardization, limited evaluation of deep muscle groups, and lack of multidisciplinary collaboration. In the future, it is necessary to promote technological innovation, strengthen multidisciplinary integration, and establish an interdisciplinary collaboration system to achieve precise prevention and control of PFD.

Some patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome have underdeveloped uterus. Among them, adenomyosis in a rudimentary uterus without functional endometrium rarely caused pelvic pain. We reported a case of MRKH syndrome complicated with adenomyosis. The 49-year-old patient presented with periodic abdominal pain and a pelvic solid mass. Laparoscopic exploration suggested bilateral rudimentary uterus with adenomyosis in the left uterus. Bilateral rudimentary hysterectomy was performed, and the diagnosis was confirmed by histopathological examination. The patient was discharged smoothly after the operation, and follow-up showed relief of abdominal pain without recurrence. Meanwhile, a literature review was conducted to discuss the diagnosis and treatment of MRKH syndrome complicated with adenomyosis.

Postmenopausal women face a significant increase in health risks such as cardiovascular diseases,osteoporotic fractures, and obesity due to decline in estrogen level. As a healthy dietary pattern, the Mediterranean diet can improve these adverse outcomes through multiple mechanisms. The polyphenols and monounsaturated fatty acids rich in it can improve lipid metabolism, reduce oxidative stress and chronic inflammation to protect the cardiovascular system. The high dietary fiber and specific bioactive components help enhance satiety, promote fat metabolism, and improve insulin sensitivity for weight management. It can also protect bone health by regulating the "gut-bone axis", providing sufficient calcium, vitamin D, vitamin K, and through the anti-inflammatory and antioxidant effects of polyphenols. However, the promotion of this dietary pattern in non-Mediterranean regions faces challenges in cultural adaptation, mainly due to the differences in the usage habits of extra virgin olive oil. It is necessary to explore local alternative solutions based on local oils with similar nutritional characteristics and develop individualized strategies combined with behavioral interventions to provide effective and feasible nutritional intervention approaches for the health management of postmenopausal women in China.

Strontium is one of the essential trace elements in the human body. The strontium content in pregnancy women may have a certain impact on pregnancy outcomes, especially in terms of fetal growth and development and pregnancy-related complications. Research has shown that abnormal strontium content in pregnant women may participate in the pathological processes of pregnancy-related diseases by interfering with redox homeostasis. Oxidative stress is one of the pathogenic mechanisms of diseases such as pre-eclampsia, gestational diabetes mellitus, and fetal growth restriction. In recent years, studies have found that strontium can participate in the regulation of oxidative stress responses by regulating the activity of antioxidant enzymes and inhibiting lipid peroxidation, suggesting that it may play a certain role in maintaining oxidative balance during pregnancy. Therefore, maintaining an appropriate strontium level in pregnant women is potentially of great significance for reducing the risk of pregnancy complications such as pre-eclampsia and gestational diabetes mellitus, promoting normal fetal growth and development, and thus ensuring the health of both the mother and the infant.

The influence of gestational nutrition on the maternal gut microbiota and fetal development is a hot-topic in clinical research. Increasing attention has been paid to the impact of the maternal internal environment on fetal development and the long-term health of offspring. Traditionally, it was believed that fetal development was mainly dominated by genetic programs. However, studies have shown that the fetus has complex perception and learning abilities, and the maternal nutritional and metabolic status is a key factor determining the health of offspring. Based on the "thrifty phenotype hypothesis", intrauterine malnutrition in the fetus can increase the risk of metabolic diseases in adulthood through metabolic reprogramming. Gestational nutrition has a profound impact on fetal developmental programming and the long-term health of offspring by reshaping the gut microbiota and its metabolite profile. This review summarizes the dynamic changes in gut microbiota during pregnancy, the hormonal and immune regulatory mechanisms, and the effects of different dietary patterns on the gut microbiota and the health of mothers and infants.

Objective: To explore the risk factors for pre-eclampsia(PE) complicating elderly pregnant women, and construct and validate a nomogram risk prediction model. Methods: The clinical data of 1 287 elderly pregnant women admitted to the Suqian First Hospital, Jiangsu Province from January 2017 to August 2024 were retrospectively analyzed. The pregnant women were randomly divided into a training set (n=858) and a validation set (n=429) at a ratio of 2∶1. According to the pregnant women in the training set were further divided into a complication group (n=94) and a non-complication group (n=764). The clinical data of the two groups were compared. Binary logistic regression analysis was used to screen the influence factors for PE complicating elderly pregnant women, and a nomogram model was constructed based on the results. The Bootstrap method was used for internal validation of the model. The concordance index (C-index) was calculated, and calibration curve, receiver operating characteristic (ROC) curve, and decision curve were drawn to evaluate the predictive performance of the model. The validation set data were used for further internal validation of the model. Results: Binary logistic regression analysis showed that a high pre-pregnancy body mass index (BMI), a family history of hypertension, a previous history of PE, a history of spontaneous abortion, gestational diabetes mellitus, high serum uric acid, and malnutrition were all risk factors for PE complicating elderly pregnant women (all P<0.05), while a high platelet count and regular prenatal check-ups were protective factors (both P<0.05). A nomogram risk prediction model for PE complicating elderly pregnant women was constructed based on the results of the multivariate analysis. After internal validation, the C-indices of the training set and the validation set were 0.841 and 0.823 respectively, and the calibration curves were closed to the ideal curves. The ROC curves showed that in the training set, the sensitivity, specificity, area under the curve (AUC), and optimal cut-off value were 87.10%, 81.88%, 0.859 and 316 points respectively; in the validation set, they were 83.87%, 82.61%, 0.842 and 310 points respectively. Decision curve analysis showed that when the threshold probability of the training set were between 0.03-0.74 and 0.77-0.82, and that of the validation set were between 0.02-0.70, 0.73-0.76 and 0.83-1.00, a higher net benefit could be obtained. Conclusions: Pre-pregnancy BMI, family history of hypertension, previous history of PE, history of spontaneous abortion, gestational diabetes mellitus, platelet count, serum uric acid, malnutrition, and regular prenatal check-ups are all influencing factors for PE complicating elderly pregnant women. The nomogram risk prediction model for PE complicating elderly pregnant women constructed based on these factors has high predictive performance and can guide the early clinical screening of high-risk pregnant women for timely intervention.

Objective: To analyze the changing trends of the disease burden of ectopic pregnancy in China from 1990 to 2021, predict its future epidemic trends, and provide a basis for optimizing prevention and control strategies. Methods: Based on the data from Global Burden of Disease (GBD) 2021, data such as the incidence rate, prevalence rate, and disability-adjusted life year (DALY) rate of ectopic pregnancy were extracted. Joinpoint regression analysis was used to analyze the time trends, The age-period-cohort model was used to analyze the age, period, and cohort effects, and the autoregressive integrated moving average (ARIMA) model was used to predict the disease burden from 2022 to 2036. Results: In 2021, the number of new cases of ectopic pregnancy in China was 1.525 9 million, a decrease of 32.03% compared with 1990; the number of prevalent cases was 12 600, a decrease of 31.89% compared with 1990; and DALY caused by ectopic pregnancy was 5 900 person-years, a decrease of 63.58% compared with 1990. The average annual percentage changes (AAPC) of the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALY rate (ASDR) were -2.82%, -1.07%, and -1.07%, respectively, with statistically significant differences (all P<0.001), showing an overall downward trend. However, the ASIR and ASPR showed a phased rebound from 2010 to 2014 (annual percentage changes were 6.45% and 6.43%). The age effect showed that from 1990 to 2021, the DALY rate of ectopic pregnancy in China first increased and then decreased with age. The period effects showed a downward trend from 1992 to 2022, with the relative risk (RR) value decreasing by 0.83. The cohort effect showed that the RR value was relatively high from 1935 to 1950, and there was no significant change from 1955 to 2005. The prediction results of the ARIMA model showed that from 2022 to 2036, the ASIR and ASPR of ectopic pregnancy would show an upward trend, while the ASDR would show a downward trend. The ASDR would decrease from 0.46 per 100 000 in 2021 to 0.12 per 100 000 in 2036, the ASPR would increase from 0.91 per 100 000 to 1.08 per 100 000, an increase of about 18.68%, and the ASIR would increase from 110.95 per 100 000 to 130.62 per 100 000, an increase of 17.73%. Conclusions: From 1990 to 2021, the disease burden of ectopic pregnancy in China showed an overall downward trend, with a phased rebound from 2010 to 2014. It is predicted that the ASIR and ASPR may increase in the future. Currently, the disease burden is mainly concentrated among women of child-bearing age aged 30-34, suggesting that contraceptive guidance (such as long-acting reversible contraceptive measures) and reproductive health management for high-risk age group (30-34 years old) should be emphasized and screening. Primary-level diagnosis and treatment capabilities for high-risk birth cohorts should be strengthened to cope with the possible rebound of the disease burden in the future.

The etiology of refractory postpartum hemorrhage vary greatly. A small number of cases are actually diagnosed as atypical amniotic fluid embolism. Since it is difficult to identify clinically and the condition is critical, the routine treatment for postpartum hemorrhage is often ineffective, seriously threatening the lives of the mother and the fetus. A case is reported in which a patient underwent sequential induction of labor with oxytocin and dinoprostone suppositories due to premature rupture of membranes at term. After the onset of labor, the labor progressed rapidly, fetal distress occurred, and severe postpartum hemorrhage occurred after vaginal assisted delivery. Multidisciplinary emergency treatment was promptly carried out, and the outcomes of the mother and the fetus were good. After the onset of labor, the patient's platelet count decreased, and unexplained severe coagulation dysfunction occurred shortly after delivery. It was considered to be disseminated intravascular coagulation (DIC)-type amniotic fluid embolism. A retrospective analysis of the diagnosis and treatment process of this patient reveals that it is very necessary to standardize the induction of labor measures for pregnant women with high-risk factors for amniotic fluid embolism. Abnormal signs after the onset of labor should be closely observed, amniotic fluid embolism should be identified in a timely manner, and emergency treatment measures should be taken promptly to ensure the safety of the mother and the infant.

Cushing syndrome (CS) is a rare endocrine disorder characterized by hypercortisolism. CS complicating pregnancy is even rarer. Affected by the physiological increase of cortisol levels during pregnancy, the diagnosis and management of this disease are particularly complex. A case of a pregnant patient with adrenocorticotropic hormone (ACTH)-independent CS presenting with hip pain as the first symptom is reported. The patient had obvious metabolic disorders and typical signs of CS. Laboratory tests indicated hypercortisolism, and an adrenal ultrasound revealed an adenoma in the right adrenal gland. A multidisciplinary team collaborated to develop an individualized plan. The patient underwent a cesarean section at 30⁺³ weeks of gestation, and a right adrenalectomy was performed 6 weeks after delivery. The symptoms improved significantly after the operation, and the follow-up indicated favorable outcomes for both the mother and the infant. This case suggests that if there are abnormal weight gain, metabolic disorders, or skin changes during pregnancy, the possibility of potential endocrine diseases should be alerted and evaluated as early as possible. Multidisciplinary collaboration and psychological intervention are the keys to optimizing the pregnancy outcomes of CS patients.

A case of severe adverse reaction after a single-dose methotrexate combined with mifepristone for ectopic pregnancy is reported. After receiving drug treatment for ectopic pregnancy at an outside hospital, the patient developed high fever, oral ulcers, rashes, diarrhea, and bone marrow suppression. Due to the failure of timely recognition and treatment, the condition progressed to severe complications such as grade Ⅳ oral mucositis, grade Ⅳ bone marrow suppression, septic shock, and multiple organ dysfunction. After being transferred to our hospital, the patient finally improved after active treatments including calcium folinate rescue, anti-infection, granulocyte stimulating factor therapy, total parenteral nutrition, and blood product transfusions. Currently, all guidelines for the drug treatment of ectopic pregnancy recommend a single-dose of methotrexate, and multiple-doses if necessary. The combined use of methotrexate and mifepristone is not recommended. Medical staff should be aware of the adverse reactions of the drugs and strengthens monitoring. Once the aforementioned adverse reactions occur, early recognition and standardized treatment can prevent the occurrence of severe complications.

In clinical practice, the treatment success rate of preterm premature rupture of membrane (PPROM) in twin pregnancy is very low. Once it is complicated with cervical insufficiency, the treatment becomes even more difficult. A case of a pregnant woman with dichorionic diamniotic twins who experienced PPROM in one fetus at 16⁺⁶ weeks of gestation is reported. After anti-infection and uterine contraction inhibition treatment, selective fetal reduction was performed when the condition was stable, enabling the fetus with intact membranes to continue to survive. Nine days after the operation (at 19⁺¹ weeks of gestation), cervical insufficiency occurred, and an emergency cervical cerclage was carried out, successfully prolonging the pregnancy. At term, the pregnant woman planned a vaginal delivery, but fetal heart rate deceleration occurred during the process, and a cesarean section was then performed, resulting in the smooth delivery of a healthy newborn. This case suggests that for twin pregnancies complicated with PPROM and cervical insufficiency, selective fetal reduction combined with emergency cervical cerclage may be an effective treatment method under specific circumstances, providing a reference for the clinical diagnosis and treatment of related diseases.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease that commonly occurs in the second and third trimesters of pregnancy. Its main manifestations are skin pruritus and elevated serum total bile acid levels, which can lead to adverse pregnancy outcomes. The 2024 guideline of the Society of Obstetricians and Gynaecologists of Canada (SOGC) states that the diagnostic criterion for ICP is non-fasting serum bile acid>19 μmol/L. Serum bile acid levels should be monitored every 2-4 weeks. The timing of delivery is determined individually based on the highest bile acid level during pregnancy and combined with high-risk factors. Ursodeoxycholic acid (UDCA) is the first-line treatment for ICP. The 2022 guideline of the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK stipulates that the diagnostic criterion for ICP is random bile acid≥19 μmol/L accompanied by pruritus without skin lesions, and it does not recommend the routine use of UDCA to reduce the risk of adverse perinatal outcomes in ICP. The 2024 Chinese guideline recommends using a fasting serum bile acid level≥10 μmol/L or a post-meal serum bile acid level≥19 μmol/L as the diagnostic criterion for ICP, and there are also slight differences in the auxiliary examinations, treatment regimens, frequency of prenatal monitoring, and timing of delivery for ICP. By interpreting the 2024 SOGC guideline and conducting a comparative analysis of the three guidelines, we hope to provide more evidence for clinicians in the diagnosis and treatment of ICP.