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    A Brief Discussion on the Declining Reproductive Intention and Fertility among Chinese Women of Childbearing Age: Causes and Protective Strategies
    YANG Chen-xia, ZHOU Jian-zheng
    Journal of International Obstetrics and Gynecology    2025, 52 (1): 46-51.   DOI: 10.12280/gjfckx.20240968
    Abstract1545)   HTML85)    PDF (824KB)(212)      

    Data from the "Seventh National Population Census" indicates that China has entered a period of extremely low fertility, presenting severe challenges stemming from a low birth rate. While the implementation of the "three-child" policy has granted unprecedented reproductive freedom, it has not effectively stemmed the continuous decline in birth rates. Facing declining reproductive intentions and birth rates, along with population aging, various levels of government and relevant departments are actively researching and implementing supportive policies. This article explores the impact of factors such as the shrinking number of women of childbearing age, reduced willingness to marry and have children, and declining fertility on the declining birth rate under the current policy framework. Based on this analysis, we propose practical countermeasures aimed at protecting female fertility, improving the reproductive intention and scale among women of childbearing age, and ultimately increasing the overall fertility rate. These proposals aim to provide a basis for further optimization of fertility policies to address China′s current demographic challenges.

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    Clinical Analysis of 33 Cases of Diffuse Uterine Leiomyomatosis
    XU Qian, CHENG Jiu-mei
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 583-587.   DOI: 10.12280/gjfckx.20230317
    Abstract847)   HTML42)    PDF (729KB)(1018)      

    Objective: To improve the diagnosis and treatment of diffuse uterine leiomyomatosis (DUL). Methods: 33 cases of DUL admitted between January 2009 and October 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively, including their clinical characteristics, diagnosis and treatment methods and postoperative pregnancy. Results: The average age of onset of the 33 patients was (38.4±6.9) years (24-52 years). Nineteen patients (57.6%) presented with menorrhagia, 7 patients (21.2%) presented with frequent urination or lower abdominal distension, and the remaining 7 patients (21.2%) were asymptomatic and the examination revealed the uterine leiomyoma was progressively enlarged. Ultrasound examination was performed in 33 patients, and 15 patients(45.5%) showed myometrium was full of hypoechoic nodules. 7 patients underwent magnetic resonance imaging (MRI), and 3 cases showed diffuse distribution of round nodules or masses of variable sizes in the myometrium. All 33 patients underwent surgical treatment, 19 underwent transabdominal or laparoscopic hysterectomy, the other 14 with fertility requirements, 11 of them underwent transabdominal myomectomy and 3 underwent hysteroscopic myomectomy. Postoperative pathology and immunohistochemistry were all suggestive of leiomyoma. The average follow-up time after surgery was (67.8±36.3) months in 14 patients with fertility requirements (2 patients lost). Three patients had natural pregnancies, two had successful deliveries (one of which had two deliveries), and the other had cornual pregnancy that was cleared. Conclusions: DUL is a rare benign smooth muscle tumor that occurs in women of reproductive age. The most common clinical symptoms were menorrhagia and infertility. If ultrasound shows myometrium was full of myoma nodules and the patient presents with menorrhagia or infertility except for other reasons, MRI is indicated to help identify the disease early stage. Surgery is the main treatment. Hysterectomy is recommended for patients without fertility requirements, and the choice of fertility-preserving treatment requires further research.

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    Mechanisms of Resistance to PARP Inhibitor and Its Combination Therapy Strategies to Improve Sensitivity in Ovarian Cancer
    LI Bin, LIN Huan-huan, HAN Fei-fei, TIAN Mei-ling, DUAN Ai-hong, KE Xiao-ning
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 563-567.   DOI: 10.12280/gjfckx.20230329
    Abstract827)   HTML54)    PDF (728KB)(1240)      

    Ovarian cancer is the most lethal gynecological malignancy. Poly (ADP-ribose) polymerase inhibitor (PARPi) impairs the repair of DNA single-stranded breaks through enzymatic inhibition and PARP "trapping". The synthetic lethal effect of PARPi in combination with tumor cells with a breast cancer-related gene (BRCA) deficiency or defective in homologous recombination repair (HRR) in ovarian cancer promoting its application in the maintenance therapy of ovarian cancer. However, resistance to PARPi is an obstacle to the long-term use of PARPi. A number of studies have described mechanisms of acquired resistance to PARPi, which include broadly HRR recovery, replication fork protection, reduced PARP "capture", and increased drug efflux. By targeting specific resistance mechanisms, the main combination therapeutic strategies currently being investigated include combining PARPi with anti-angiogenic agents, cell cycle checkpoint protein inhibitors, signalling pathway inhibitors, immunotherapy, epigenetic modifiers, etc. A combination therapy strategy of drugs has the potential to prevent and counteract PARPi resistance, thereby improving PARPis sensitivity and antitumor effects.

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    The Combined Application of PARP Inhibitor and PD-1/PD-L1 Inhibitor in the Treatment of Ovarian Cancer
    GUO Jing-jing, ZHANG Yun-feng, WANG Yue
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 568-572.   DOI: 10.12280/gjfckx.20230289
    Abstract808)   HTML45)    PDF (736KB)(1078)      

    Ovarian cancer is one of the three major gynecological malignancies and the most lethal malignancy of female reproductive system. At present, the main treatment methods for ovarian cancer are primary debulking surgery and platinum-based chemotherapy, but the recurrence rate and drug resistance rate remain high. In recent years, the development of tumor immunotherapy has progressed rapidly, especially the research on programmed death-1(PD-1) and programmed death-ligand 1 (PD-L1), which has been achieved on a variety of tumors. However, many clinical trials have found that PD-1/PD-L1 inhibitors alone are not effective in treating ovarian cancer. The poly (ADP-ribose) polymerase inhibitor (PARPi) is a type of targeted medicine that kills tumor cells through synthetic lethal effect. Recent studies have shown that PARPi has immunomodulatory effects in addition to its own cytotoxic effects, and can have a synergistic effect with PD-1/PD-L1 inhibitors, and the combination of the two can significantly improve patient prognosis. Therefore, this article reviews the research progress on the mechanism of action and clinical application of PD-1/PD-L1 inhibitor combined with PARPi in the treatment of ovarian cancer.

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    Angiomyomas of Vaginal Stump after Total Hysterectomy:A Case Report
    DING Yi, GAO Jun, LI Wen-yan, YE Dan, MA Zhen-qin, HE Rong-xia
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 594-596.   DOI: 10.12280/gjfckx.20230533
    Abstract804)   HTML39)    PDF (2246KB)(1037)      

    Angioleiomyoma is a rare tumor of mesenchymal origin, mostly occurring in the lower extremities, rare in the female reproductive system, and vaginal stump angioleiomyoma is even more rare. This article reports a case of a patient with vaginal stump leiomyoma admitted to the Department of Gynecology of the Second Hospital of Lanzhou University. The patient underwent laparoscopic total hysterectomy in 2015 for uterine fibroids. She had vaginal bleeding for five months. In May 2023, she was admitted to the hospital for open surgery, during which it was found that the mass came from the vaginal stump. Pathology and immunohistochemistry suggested angioleiomyomas. Combined with this case, the literature review of female reproductive system angioleiomyoma mainly uterine angioleiomyoma was carried out to improve clinicians′ understanding and diagnosis and treatment of vascular smooth muscle tumors of the female reproductive system.

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    A Case of Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome First Diagnosed with Multiple Uterine Fibroids and Literature Review
    LI Jia-rong, WANG Guo-jie, DU Jing-xue, JING Qiu-yang, GUO Na, LIU Hui
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 588-593.   DOI: 10.12280/gjfckx.20230213
    Abstract795)   HTML37)    PDF (7905KB)(1018)      

    Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is a rare inherited disorder with germline mutations in the fumarase hydratase (FH) gene. Its early main clinical manifestations are multiple uterine fibroids and skin leiomyoma. The occurrence of HLRCC-related renal malignant tumors is usually late, it is the main factor affecting the prognosis of patients. Therefore, early diagnosis of HLRCC syndrome and early prevention of associated renal cell carcinoma are crucial for the prognosis of patients with HLRCC syndrome. At present, the diagnosis of HLRCC mainly depends on typical clinical manifestations and pathological immunohistochemistry, and the diagnosis method is FH gene detection. A case of HLRCC with multiple uterine fibroids as the primary symptom was reported. After hysterectomy, the tumor cells were negative for FH immunohistochemistry. Ultrasound showed a 2.9 cm×2.6 cm×2.8 cm mass in the left kidney. After nephrectomy, the pathological examination was renal cell carcinoma. The tumor cells were immunohistochemically FH negative and 2-succinylcysteine (2SC) positive. FH gene detection confirmed HLRCC syndrome. The patient was followed up for 6 months without recurrence. This article also reviews the literature related to HLRCC syndrome, aiming to deepen clinicians′ understanding of HLRCC syndrome, intervene early in the course of the disease, and improve the prognosis of patients.

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    Value of Patient-Reported Outcome Scale in Chemotherapy of Ovarian Cancer
    WANG Jian-zhang, RUAN Dan-hua, ZHAO Tian-lang, LIU Rui, ZHANG Xu-yang, ZENG Jing, YIN Ru-tie
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 573-577.   DOI: 10.12280/gjfckx.20230338
    Abstract795)   HTML23)    PDF (714KB)(1090)      

    Ovarian cancer is the most lethal malignancy of the female reproductive system and the standard treatment of advanced ovarian cancer is cytoreductive surgery combined with chemotherapy and targeted therapy. Previously, patients′ adverse effects during and after chemotherapy were mainly assessed by Clinician-Reported Outcome (ClinRO). However, an emerging and reliable method of assessing patient health status Patient-Reported Outcome (PRO), has gained wide spread attention in clinical practice. Nowadays, commonly used PRO scales include PRO-Common Terminology Criteria for Adverse Events (CTCAE), M.D. Anderson Symptom Inventory (MDASI), QLQ-C30, etc., which can capable of multiple aspects of patient health status, detect clinical symptoms, intervene in clinical care and evaluate treatment options, and improve patient prognosis. However, the evaluation effect of some items in current PRO scales has not been effectively verified, and there is a lack of cohort studies for specific patient groups. Further improvement of the PRO scale and related studies is needed to achieve better results.

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    Development of Fetoscopic Laser Coagulation for Twin to Twin Transfusion Syndrome
    LI Yu-bo, LI Jun-nan
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 486-491.   DOI: 10.12280/gjfckx.20230183
    Abstract781)   HTML64)    PDF (771KB)(1005)      

    Fetoscopic laser coagulation (FLC) has been widely used in clinical treatment of patients with twin to twin transfusion syndrome (TTTS) by Ⅱ-Ⅳ stage and has achieved certain results. The perinatal survival rate of TTTS is significantly improved, and the incidence rate of the surviving fetal nervous system is significantly reduced. Meanwhile, it is widely recognized and carried out in the field of minimally invasive fetal medicine because of its advantages such as direct vision operation, small incision, less maternal blood loss, and less interference to pregnancy. However, due to the limitations of FLC technology, which requires a high level of operator skill and special equipment such as their own endoscope and laser, FLC technology can not achieve better results. Pregnant women who receive FLC treatment still face serious perioperative complications, postoperative recurrence, and the risk of reoperation. This article reviews the application and research progress of FLC in TTTS treatment both domestically and internationally, comprehensively elaborates on the development history, operational methods, shortcomings, and future development direction of FLC technology, in order to provide certain reference for the future development of fetal medicine.

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    Research Progress of Laparoscopic Uterine (Leiomyoma) Tissue Extraction Technology
    SHAO Si-qi, WU Zai-gui, CHEN Kai, RUAN Fei
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 578-582.   DOI: 10.12280/gjfckx.20230297
    Abstract770)   HTML31)    PDF (745KB)(1020)      

    The techniques of uterine and uterine leiomyoma specimen tissue morcellation and extraction in gynecological surgery have been developed for decades, including electromechanical morcellation, transvaginal morcellation and small abdominal incision morcellation. In recent years, with the wide spread development of minimally invasive surgery such as laparoscopy, gynecologic surgeons have paid more and more attention to the tumor-free concept and tumor-free technology, and put forward higher requirements for the specimen morcellation and extraction technology. Different techniques have their own advantages and limitations, and there is no significant difference in the incidence of perioperative complications among them, but there are some limitations, such as the higher crushing rate of specimen bags by vaginal morcellation technique and the longer operation time by minilaparotomy morcellation technique. The practicability and safety of various technologies still need high-quality prospective clinical research to verify. When choosing the method of breaking and taking out specimens removal, the operator should strictly follow the principles of treatment and make individualized decisions so that patients can get a better prognosis. This paper reviews the research progress of large uterine (leiomyoma) tissue morcellation and extraction technology for clinical reference.

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    A Case of Ovarian Torsion and Necrosis after Ovarian Suspension Surgery
    PENG Hao-chen, SHAO Ya-wen, CAO Xiao-cui, SUN Jian-hao, WU Zhen-zhen
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 559-562.   DOI: 10.12280/gjfckx.20230345
    Abstract755)   HTML39)    PDF (3808KB)(1097)      

    Ovarian suspension surgery can preserve ovarian function and improve quality of life in young patients with cervical cancer. In view of the fact that there is no unified standard surgical method at home and abroad, postoperative ovarian torsion, ovarian cyst and other related complications occasionally occur. A retrospective analysis was performed on a patient with stage cervical cancer admitted to Gansu Provincial Maternity and Child-Care Hospital in 2018. She underwent laparoscopic radical hysterectomy + bilateral ovary suspension surgery. She was re-admitted 3 years after the operation due to lower abdominal pain. The imaging assessment was recurrence and metastasis of cervical cancer. After discussion by multi-disciplinary team (MDT), laparotomy was performed to clarify the nature of the tumor. Postoperative pathological diagnosis was a case of ovarian torsion and necrosis. The selection of ovarian suspension location, intraoperative precautions, and postoperative complications were further analyzed in the light of the literature, in order to provide reference and experience in diagnosis and treatment for standardized surgical operations, early identification, and reasonable treatment of related complications.

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    A Case of Recurrent Cervical Cancer Treated with Cadonilimab Monotherapy and Combination Chemotherapy
    SHI Rui, FENG Shu-xian, MA Wei, ZHANG Zong-cui
    Journal of International Obstetrics and Gynecology    2023, 50 (6): 665-667.   DOI: 10.12280/gjfckx.20230672
    Abstract740)   HTML29)    PDF (1637KB)(664)      

    The incidence rate of cervical cancer is the highest among gynecological malignancies. At present, surgery is still an effective treatment for early-stage cervical cancer, but cervical cancer has a high recurrence rate and distant metastasis, poor prognosis in advanced stages, and limited treatment options. This article focuses on a case with recurrence of cervical cancer despite radical hysterectomy and combined chemotherapy and radiotherapy, who developed vesicovaginal fistula and rectovaginal fistula with severe infection, and achieved a survival benefit by treatment with cadonilimab monotherapy and combination chemotherapy. It aims to provide new ideas for the treatment of recurrent cervical cancer.

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    Effects of Vitamin E on the Health of Perimenopausal and Postmenopausal Women
    LIU Xiang, AO Kai, GAO Yi-wei, WU Qiong, MU Yu-lan
    Journal of International Obstetrics and Gynecology    2024, 51 (1): 93-98.   DOI: 10.12280/gjfckx.20230715
    Abstract720)   HTML27)    PDF (867KB)(382)      

    With the increase of age, ovarian function gradually declines from the flourishing period, until the failure, women will gradually enter the old age from the reproductive period. This will not only affect the menstrual cycle and fertility, but also be accompanied by a series of physical and psychological changes, which can significantly impact daily life and work. Studies have found that the development of ovarian follicles and the occurrence and development of urogenital dysfunction, osteoporosis, neurocognitive dysfunction, cardiovascular diseases and other diseases before and after menopause may be closely related to oxidative stress. Vitamin E has antioxidant properties and the ability to stabilize cells, and has been proven to play an important role in the prevention and treatment of metabolic syndrome, osteoporosis, cardiovascular and cerebrovascular diseases, neurological disorder and other diseases. Moreover, it has been found that vitamin E also has estrogen-like effects to a certain extent. Therefore, vitamin E supplementation has potential benefits for the health of perimenopausal and postmenopausal women. This article comprehensively expounds the effects of vitamin E on ovarian follicle development and estrogen during perimenopause, and the preventive and therapeutic roles in menopause syndrome, so as to provide reference for considering vitamin E as an adjuvant or alternative therapy to improve the physical and mental health of perimenopause and postmenopausal women.

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    Advances in the Study of Fetal Intracranial Hemorrhage
    MA Shuai, XU Ying, WANG Min, LI Jie
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 481-485.   DOI: 10.12280/gjfckx.20230234
    Abstract707)   HTML118)    PDF (739KB)(1021)      

    Fetal intracranial hemorrhage (FICH) is a rare clinical event of brain injury, mostly occurring in the middle and late stages of pregnancy. Because of the particularity of fetal brain structure, its pathogenesis may be related to the development of germinal layer, coagulation function and the autoregulation function of fetal intracranial vessels. FICH is often discovered by chance during routine pregnancy examinations, with atypical clinical manifestations and some patients progressing rapidly. There is no gold standard for FICH diagnosis, and the imaging manifestations are complex and varied. The diagnosis mainly relies on prenatal ultrasound and magnetic resonance imaging to assist, which needs to be distinguished from fetal intracranial tumors, Galen′s venous tumors, arachnoid cysts, and intracranial calcification. Depending on the location and extent of the hemorrhage, it can lead to varying degrees of neurological dysfunction and even death, with significant differences in prognosis. Summarize the research progress of FICH, aiming to deepen the understanding of the disease among clinical doctors, effectively improve clinical diagnosis and treatment capabilities, and reduce the birth rate of children with severe neurological sequelae while reducing the number of blindly induced abortions.

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    Study on the Role of Placental Mitochondrial Function in the Pathogenesis of Pregnancy Complications
    JI En-ting, XU Ya-xuan, ZHANG Chun-ren, HU Min, MA Hong-xia
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 497-501.   DOI: 10.12280/gjfckx.20230425
    Abstract703)   HTML58)    PDF (700KB)(1071)      

    As the foundation for maintaining normal pregnancy and an important medium for maternal-fetal communication, the placenta can cause various pregnancy complications such as miscarriage, preeclampsia, gestational diabetes, and premature birth when it is in a state of fibrosis, hypoxia, chronic inflammation, insufficient blood supply, and other conditions. These complications can seriously affect women′s health and fetal outcomes. Mitochondria, as the hub of energy metabolism, can increase the level of inflammatory factors in placental tissue, disrupt the balance between oxidation and antioxidation, and resulting in placental functional damage when their dynamics, biosynthesis, oxidative phosphorylation, and other processes are abnormal, thereby promoting the occurrence and development of various pregnancy complications. This article reviews the current research on the impact of placental mitochondrial dysfunction on a variety of pregnancy complications and to explore the potential mechanisms involved.

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    Role of Anti- Müllerian Hormone in Pathogenesis, Diagnosis and Treatment of Polycystic Ovary Syndrome
    GAO Ya, LU Di, SONG Dian-rong
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 540-544.   DOI: 10.12280/gjfckx.20230141
    Abstract702)   HTML27)    PDF (718KB)(1125)      

    Polycystic ovary syndrome (PCOS) is a relatively common female reproductive endocrine and metabolic disorder with complex etiology and pathogenesis. Recent studies have found that anti-Müllerian hormone (AMH) is an important factor affecting the pathophysiology of PCOS. AMH is closely related to follicular development, hyperandrogenism, hypothalamic-pituitary-ovarian axis and heredity. AMH can inhibit primordial follicle recruitment and small sinus follicle growth, and prevent premature ovarian failure. AMH also exacerbates follicular growth and development disorders by interacting with androgens. In addition, AMH can activate the discharge of gonadotropin-releasing hormone (GnRH) neurons and increases the secretion of luteinizing hormone (LH), which in turn leads to the increase of androgen production. Moreover, high AMH status in pregnant women with PCOS can lead to masculinization of female offspring and PCOS-like reproductive and neuroendocrine phenotypes in adulthood. At the same time, AMH may also be a new indicator for the diagnosis of PCOS, and the determination of AMH level can also reflect and predict the therapeutic effect of PCOS patients.

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    The Efficacy and Reproductive Outcome of Auto-Cross-Linked Hyaluronic Acid Gel for the Prevention of Recurrence of Mild to Moderate Intrauterine Adhesions
    GUO Yan, XIA En-lan, XIAO Yu, HUANG Xiao-wu, LIU Yu-huan, YANG Ling-ling, LI Tian-zhao
    Journal of International Obstetrics and Gynecology    2024, 51 (1): 110-113.   DOI: 10.12280/gjfckx.20230717
    Abstract688)   HTML26)    PDF (516KB)(339)      

    Objective: To investigate the efficacy of auto-cross-linked hyaluronic acid (ACP) gel in preventing adhesion recurrence after transcervical resection adhesion (TCRA) in patients with mild to moderate intrauterine adhesion (IUA) and its effect on reproductive outcomes. Methods: 188 patients with mild to moderate IUA who underwent TCRA in Fuxing Hospital of Capital Medical University from May 2020 to March 2021 were collected, and the recurrence rate of postoperative IUA, American Fertility Association (AFS) score, menstrual improvement and reproductive outcomes were observed in a single-center prospective randomized controlled manner, and the efficacy of ACP gel in preventing recurrence of IUA and its effect on reproductive outcomes were analyzed. The study group (84 cases) was received intrauterine injection of ACP gel + balloon stent at the end of surgery, and the control group (87 cases) only received balloon stent at the end of surgery. Results: 171 cases underwent the second and third hysteroscopies at 4 and 8 weeks after surgery, respectively. The recurrence rate of IUA in the study group was slightly lower than that in the control group, but the difference was not statistically significant (20.2% vs. 23.0%, 9.5% vs. 11.5%, both P>0.05). There was no significant difference in AFS scores between the two groups (P>0.05). There was no significant difference in menstrual improvement between the two groups at 12 weeks after surgery (P=0.630). More than one year after TCRA operation, there was no significant difference in pregnancy rate and live birth rate between the two groups (both P>0.05). Conclusions: In patients with mild to moderate IUA, compared with balloon stent alone after TCRA, balloon stent combined with intrauterine injection of ACP gel did not reduce the recurrence rate and adhesion severity of IUA, nor could it promote the improvement of menstrual pattern and postoperative reproductive outcome.

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    Fetal Limb Body Wall Complex:A Case Report and Literature Review
    HU Meng-shuang, MEI Jing
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 519-522.   DOI: 10.12280/gjfckx.20230370
    Abstract685)   HTML63)    PDF (4782KB)(1013)      

    Limb body wall complex (LBWC) is a complex multiple fetal malformation. The prognosis of LBWC is very poor. Early detection by ultrasound doctor is crucial for timely clinical management and termination of pregnancy. A 32-year-old female patient, 23 weeks plus 4 days gestation, underwent fetal ultrasound screening in our hospital. It was found that the fetal spine was curved at the sacrococcygeal region, the abdominal wall muscle layer and the skin continuity were interrupted, the abdominal organs were bulked out, a dark liquid area about 9 mm depth was visible in the abdominal cavity, both feet were in the position of pronation, the left foot showed 6 toes, the umbilical cord was too short, about 49 mm in length, and the extrembryonic body cavity was visible. LBWC may be considered for ultrasound diagnosis. The clinical diagnosis was LBWC after induction of labor. By reporting the case and reviewing the literature, LBWC was analyzed and introduced, so as to improve the basic doctors′ understanding of the disease.

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    Research Progress in Abdominal Endometriosis
    QIU Ling-bing, LI Jin-bo, CHEN Shu-qin
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 545-549.   DOI: 10.12280/gjfckx.20230034
    Abstract679)   HTML37)    PDF (698KB)(976)      

    Abdominal wall endometriosis (AWE) is the most common form of external pelvic endometriosis, which is mainly manifested as gradual enlargement of mass in the abdominal wall, accompanied by progressive and aggravated periodic pain. The pathogenesis of AWE is still unclear, and the formation of the focus is affected by a number of factors, including hormones, gestational weeks of cesarean section, body mass index. Clinically AWE can be diagnosed on the basis of history, symptoms, signs and imaging examination. In recent years, although high-intensity focused ultrasound has been used to treat AWE, but surgical excision is still the preferred treatment. Preoperative classification of AWE helps in the selection of treatment. Currently, according to the depth of tissue invaded by the base of AWE lesion, it can be divided into subcutaneous type, sheath type and peritoneal type. In addition, intraoperative navigation, abdominal wall reconstruction and other technologies also provide more possibilities for accurate personalized medical treatment. With the development of minimally invasive laparoscopic technology, laparoscopy has also been used in the treatment of AWE, but its long-term safety and efficacy remain to be explored.

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    Research Progress of Estrogen Adjuvant Therapy after Transcervical Resection of Adhesions
    LIU Hui-xing, BIN Li, ZHU Xue-hong, LIN Zhong, LU Li-miao
    Journal of International Obstetrics and Gynecology    2023, 50 (6): 618-622.   DOI: 10.12280/gjfckx.20230474
    Abstract674)   HTML50)    PDF (713KB)(684)      

    Intrauterine adhesions can cause a series of symptoms such as amenorrhea, secondary infertility and recurrent abortion in women. There is still a high recurrence rate after hysteroscopic transcervical resection of adhesions, which seriously affects women′s fertility and mental health. Estrogen adjuvant therapy can effectively reduce the recurrence rate after transcervical resection of adhesions by promoting the repair of residual endometrial hyperplasia and reducing the expression of endometrial fibrosis factors, but a unified medication regimen has not yet been formed. The commonly used clinical regimen is estradiol valerate tablets 2-4 mg/d or equivalent hormone plus progesterone sequential oral administration for 2-3 menstrual cycles. The efficacy of high-dose estrogen therapy is still not very clear, or individualized estrogen therapy can be formulated by detecting the expression level of estrogen receptor in the endometrium to achieve the best efficacy. Oral estrogen is the most classic treatment for intrauterine adhesions. However, recent studies have shown that transdermal and transvaginal administration of estrogen have higher bioavailability, fewer adverse reactions, and comparable efficacy. At present, there are still significant variation in the usage and dosage of estrogen in a large number of clinical studies. Therefore, more large-scale and high-quality studies are still needed to explore the best medication regimen of estrogen.

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    Study on the Extended Screening Model for Carriers of Genetic Deafness Susceptibility Genes in Pregnancy
    XIE Xiao-yuan, FENG Shu-ren, LIU Hui-kun, WANG Lei-shen, LIU Xia
    Journal of International Obstetrics and Gynecology    2023, 50 (5): 514-518.   DOI: 10.12280/gjfckx.20230397
    Abstract659)   HTML34)    PDF (730KB)(1012)      

    Objective: To explore the applicability of the extended screening model to carry out screening of deafness susceptibility genes in pregnancy in Tianjin. Methods: Combined with the distribution of deafness gene mutation sites in Tianjin resident population obtained under the model of newborn hearing and gene screening, the susceptibility genes of 1 427 pregnant women and some of the spouses of pregnant women were tested for extended genetic deafness susceptibility genes. A total of 208 mutation sites in 24 genes related to deafness, including GJB2 and GJB3, were screened and analyzed by high-throughput sequencing. Positive results identified by high-throughput sequencing were further confirmed by Sanger sequencing. After verifying that the pregnant women were carriers of the disease-causing mutations on genes from the nuclear genome, their spouses were also analyzed via the same test scheme as described above, in addition to full-length analysis of the same gene identified in the female. Results: Among 1 427 pregnant women tested, 100 individuals with at least one pathogenic mutations of deafness genes were found by extended deafness gene screening, including 45 individuals with GJB2 gene mutations, 41 carriers of heterozygous mutations in the SLC26A4 gene, 2 carriers of heterozygous mutations in the TMPRSS3 gene, 1 carrier of LRTOMT gene mutation, and 11 individuals with homogeneous mutations on the mitochondrial gene MT-RNR1. Spouses of the above individuals with genomic deafness gene mutations were screened following the same procedures, and 6 deafness gene mutation carriers were detected, with 5 of them carrying mutations on the same gene as their spouses. Nine out of the 100 individuals detected by the extended screening scheme would have been missed using the original screening scheme, which only tests for 20 hotspot mutations from 4 target genes. Conclusions: Genetic screening for deafness related mutations in pregnant or pre-pregnant couples allows for earlier detection of potential birth defects, which can serve as a supplement to the newborn hearing concurrent gene screening program for hearing impairment. With advances in sequencing technology and decrease of sequencing costs, the application of extended screening scheme can help to identify additional carriers of deafness gene mutations missed by the original testing scheme.

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