Table of Content

15 February 2021, Volume 48 Issue 1
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Gynecological Disease & Related Research Review
Gynecological Disease & Related Research Review
Gynecological Disease & Related Research Original Article
Research on Gynecological Malignancies Review
Obstetric Physiology & Obstetric Disease Review
Obstetric Physiology & Obstetric Disease Review
Obstetric Physiology & Obstetric Disease Original Article
Obstetric Physiology & Obstetric Disease Case Report


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Gynecological Disease & Related Research Review

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Advances in Research on Signaling Pathways Regulation of Endometriosis XIE Tao, ZENG Wei-wei, LU Qi-tian, ZHOU Hua 2021, 48 (1):  1-4.  doi: 10.12280/gjfckx.20200508 Abstract ( 1584 )   HTML ( 232 )   PDF (717KB) ( 8323 )   Endometriosis (EMs) is a common and difficult disease in women of childbearing age with complex pathogenesis. It is extremely invasive, easy to metastasize and relapse, and the therapeutic effect is not satisfactory. The research on the mechanism of its occurrence and development and the search for effective treatment is the focus of gynecological research. In recent years, studies have found that the processes of epithelial-mesenchymal transition, adhesion invasion and angiogenesis of ectopic endometrial cells are important mechanisms in the occurrence and development of EMs. There are many signal pathways in this process, such as transforming growth factor β (TGF-β)/Smad, Notch, nuclear factor κB (NF-κB), Wnt/β-catenin, phosphatidyl inositol 3 kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR). In this paper, the related signal pathways involved in the pathogenesis of EMs were described to provide a new idea for clinical prevention and treatment of EMs. References | Related Articles | Metrics

Gynecological Disease & Related Research Review

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Research Progress of Biomarkers Related to Endometriosis JIANG Mei, YUE Wen-tao 2021, 48 (1):  5-9.  doi: 10.12280/gjfckx.20200561 Abstract ( 1429 )   HTML ( 60 )   PDF (710KB) ( 9206 )   Endometriosis (EMs) is a common gynecologic disease and characterized as a chronic and hormone-dependent disease in which endometrial glands and interstitial tissue are implanted outside the uterine cavity. Despite decades of research, there are no sufficiently sensitive and specific signs and symptoms nor accepted biomarkers for the clinical definitively diagnosis of EMs, which hampers prompt diagnosis and treatment. To identify more effective non-invasive diagnostic biomarkers may provide a new thought for improving the clinical efficacy of EMs patients. Hormones, cytokines, chemokines, tumor-associated carbohydrate antigens, biomarkers related to epigenetic regulation and circulating endometrial cells involved in the chronic inflammation of EMs have been extensively studied in the pathogenesis of EMs, but currently no one can be a specific biomarker for EMs. It is of great significance to find highly sensitive and specific EMs biomarkers or a group of biomarkers as auxiliary methods for the diagnosis and monitoring of EMs. With the development of molecular biology and bioinformatics methods, screening approach using high-throughput technologies is expected to discover specific molecular markers related to this disease. This article reviews the latest research progress of EMs-related biomarkers. References | Related Articles | Metrics

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Research Progress of HOXA10 and Related MiRNA in Endometriosis LI Kun-yu, TANG Xiao-han, LU Mei-song 2021, 48 (1):  10-14.  doi: 10.12280/gjfckx.20200904 Abstract ( 1463 )   HTML ( 29 )   PDF (702KB) ( 8441 )   Endometriosis (EMs) is a widespread gynecological disease in the world, and its specific pathogenesis is still unclear. More and more evidence shows that EMs is an epigenetic disease, which participates in the occurrence and development of EMs through DNA methylation and microRNA (miRNA) regulation. Homologous heterobox gene A10 (HOXA10) is one of the genes targeted by DNA methylation, which not only plays an important role in the female reproductive system, but also its abnormal expression and abnormal methylation pattern are closely related to the onset and infertility of EMs. MiRNA is a highly conserved non-coding regulatory RNA composed of about 22 nucleotides, which can influence endometriosis by regulating various pathophysiological processes such as adhesion, invasion, and angiogenesis of endometrial cells, but its exact mechanism is not completely clear. In recent years, it has been found that there is a correlation between HOXA10 and miRNA expression in EMs patients, and miRNA can abnormally regulate the expression of HOXA10 and promote the occurrence and development of EMs. This article reviews the research progress of HOXA10 and related miRNA in EMs, aim to provide new ideas for elucidating the possible molecular mechanism of endometriosis and its clinical diagnosis and treatment. References | Related Articles | Metrics

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Research Progress of Endometriosis and Third Trimester Adverse Pregnancy Outcomes XIA Ying, DENG Yan-jie 2021, 48 (1):  15-20.  doi: 10.12280/gjfckx.20200652 Abstract ( 1736 )   HTML ( 24 )   PDF (749KB) ( 8502 )   Endometriosis (EMs) often occurs in women of reproductive age. The main manifestations are pain, infertility and so on. Recent studies have found that a combination of the impact of local immune and inflammatory response on pregnancy, the impact of progesterone resistance in the endometrium, inadequate uterine contractility and thicken of the uterine junctional zone on implantation period can lead to third trimester adverse pregnancy outcomes. Studies have showed that compared to pregnant women with no-EMs, pregnant women with EMs have a significantly higher risk of placenta previa, it may be linked to inadequate uterine contractility. Furthermore, pregnant women with EMs are at higher risk of cesarean delivery, it may be associated with age, pelvic adhesion and increasing rate of late pregnancy complication. Whether the EMs increase the risk of placental abruption, preeclampsia, preterm birth, fetal growth restriction and postpartum hemorrhage in pregnant women is quite controversial. At the same time, during pregnancy we should be vigilant about the occurrence of the endometriosis-related acute complications, such as spontaneous hemoperitoneum in pregnancy. There is no evidence which shows the preventive surgery can reduce the risk of the adverse pregnancy outcomes, but it is essential to add some extra monitoring management of pregnant women with endometriosis who conceived by assisted reproductive technology. References | Related Articles | Metrics

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Research Progress of Infertility Related to Ovarian Endometriosis Cyst FU Li-mei, PING Yi 2021, 48 (1):  21-25.  doi: 10.12280/gjfckx.20200461 Abstract ( 1501 )   HTML ( 28 )   PDF (735KB) ( 8544 )   Ovarian endometriotic cyst (OEC) is the most common form of endometriosis, which can cause pain and infertility. Because of its malignant tumor characteristics such as hyperplasia, invasion, destruction of ovarian function and recurrence after treatment, clinicians pay more and more attention to the treatment of OEC complicated with infertility. At present, the main treatment methods include surgical treatment, drug therapy and assisted reproductive therapy, which sometimes need to complement each other. However, so far, there is controversy about how to effectively improve the pregnancy rate of infertile patients with OEC. This article reviews the mechanism of infertility caused by OEC, the problems existing in laparoscopic cystectomy, the protection of ovarian function during operation,the progress of sclerotherapy, assisted reproductive therapy, the use of GnRH before IVF treatment and the surgical treatment of OEC, in order to provide reference for the clinical treatment of OEC complicated with infertility. References | Related Articles | Metrics

Gynecological Disease & Related Research Original Article

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Meta Analysis of Dienogest Used in Maintenance Treatment of Endometriosis after Conservative Surgery HUANG Ting, HUANG Gao-ting, YANG Guo-min, LIANG Meng-shan, ZHU Yao-kui 2021, 48 (1):  26-34.  doi: 10.12280/gjfckx.20200539 Abstract ( 2601 )   HTML ( 31 )   PDF (1598KB) ( 8581 )   Objective: To compare the effectiveness and safety of dienogest and other treatment in preventing the recurrence of endometriosis (EMs) after laparoscopic excision, so as to provide a reference for clinical drug selection. Methods: Search PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, CNKI, Wanfang data and VIP related literature and trials before April 2020, the retrieved literature was independently screened, quality evaluated and data extracted by two reviewers. The final included data was Meta-analyzed using Revman 5.3. Results: A total of 1 011 articles were retrieved, and 10 articles were finally included, with a total of 1 740 patients. The dienogest group had a lower recurrence rate than the expectant treatment group (OR=0.11, 95%CI: 0.07~0.19, P<0.000 01), and could relieve EMs-related pain. Compared with the GnRHa group, there was no statistically significant difference in recurrence rate (OR=0.49, 95%CI: 0.19~1.24, P=0.13) and pain relief related to EMs (P>0.05), but has a higher rate of vaginal bleeding (RR=13.11, 95%CI: 5.02~34.21, P<0.000 01) and a lower hot flash rate (RR=0.12, 95%CI: 0.06~0.26, P<0.000 01), the difference is statistically significant. The risk of headache (RR=3.49, 95%CI: 0.99~12.25, P=0.05) is higher, but the difference is not statistically significant. Compared with LNG-IUS, there was no statistically significant difference in recurrence rate between these two group (OR=0.46, 95%CI: 0.50~1.04, P=0.06), but the difference in pain relief related to EMs was statistically significant (SMD=-0.46, 95%CI: -0.70~-0.22, P=0.000 1), the risk of vaginal bleeding (OR=0.38, 95%CI: 0.18~0.81, P=0.01), increased vaginal secretion (OR=0.03, 95%CI: 0.00~0.48, P=0.01), and coital discomfort (OR=0.04, 95%CI: 0.00~0.70, P=0.03) in the LNG-IUS group was relatively high, and the difference was statistically significant. Compared with the mifepristone group, the dienogest group can reduce the recurrence rate (OR=0.41, 95%CI: 0.18~0.96, P=0.04), and the pain relief effect is relatively good (OR=21.00, 95%CI: 2.65~166.45, P=0.004), dienogest also has a lower risk of hot flashes (OR=0.11, 95%CI: 0.01~0.89, P=0.04). Conclusions: Dienogest is effective in preventing the recurrence of EMs, and the effect is better than the expected treatment and mifepristone, which is equivalent to GnRHa and LNG-IUS. The pain relief effect is better than the expected treatment, LNG-IUS and mifepristone, equivalent to GnRHa. Although the risk of vaginal bleeding and headache is relatively high, dienogest is safe and well tolerated, and it is expected to become a new option for long-term treatment of EMs after conservative surgery. Figures and Tables | References | Related Articles | Metrics

Research on Gynecological Malignancies Review

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Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Status and Controversy SUN Fu-qing, SHEN Ming-hong, WANG Sha, DUAN Hua 2021, 48 (1):  35-40.  doi: 10.12280/gjfckx.20200665 Abstract ( 5151 )   HTML ( 58 )   PDF (735KB) ( 10270 )   Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is the neoplasm with pathological features that preclude an equivocal diagnosis of leiomyosarcoma, but that do not fulfill the criteria for leiomyoma or its variants, and raise concerns that the tumor may behave in a malignant fashion. The incidence of STUMP is relatively low. The clinical features and imaging manifestations of STUMP are lack of specificity. In most cases, STUMP grow slowly, and the prognosis is worth expecting. However, the actual course of this disease is difficult to predict, and there is a risk of recurrence and malignant transformation. The diagnosis of STUMP depends solely on histopathological examination, but no consensus has been reached on pathological diagnostic criteria. Immunohistochemical molecular typing and genomic analysis may be helpful for the assessment of prognosis factors, but the evidence is limited and further researches are needed. Although there are no guidelines or consensus governing the treatment of STUMP, total hysterectomy with or without bilateral salpingo-oophorectomy is the standard treatment if fertility is completed, whereas myomectomy alone can be taken into consideration in young patients who desire to preserve childbearing potential. Regular follow-up after surgery is important to detect missed diagnosis and tumor recurrence in time. References | Related Articles | Metrics

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Research Progress on the Role of Long Non-Coding RNA in the Occurrence and Development of Cervical Cancer XIN Yu-qi, TIAN Lei, WANG Xiao-hui 2021, 48 (1):  41-46.  doi: 10.12280/gjfckx.20200425 Abstract ( 1333 )   HTML ( 45 )   PDF (748KB) ( 8434 )   Cervical cancer is one of the common gynecological malignancies. The etiology of the disease has been clear, mainly the persistent infection of human papillomavirus (HPV). In recent years, with the advent of preventive vaccines and the popularization of screening work, early diagnosis and treatment of cervical cancer have achieved some results. However, its incidence and mortality are still high, which seriously threatens the life and health of women. Actively exploring the early diagnosis and treatment of cervical cancer can further improve the prognosis of patients with cervical cancer. Long non-coding RNA (lncRNA) is a kind of RNA without protein coding function, which participates in many biological processes. lncRNA is abnormally expressed in a variety of malignant tumors and plays a role in carcinogenesis or cancer inhibition. More and more studies have found that lncRNA is closely related to cervical cancer and plays an important role in the occurrence, invasion, metastasis and drug resistance of cervical cancer. To explore the role of lncRNA such as metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), HOX antisense intergenic RNA (HOTAIR), antisense non-coding RNA in the INK4 locus (ANRIL), EBIC, CCHE1 in the development of cervical cancer, and to summarize their molecular mechanisms in cervical cancer, so as to provide new ideas for the early diagnosis and targeted therapy of cervical cancer. References | Related Articles | Metrics

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Research Progress of Folic Acid and Its Metabolism in Cervical Cancer LI Yuan-xing, WANG Wei, HAO Min 2021, 48 (1):  47-50.  doi: 10.12280/gjfckx.20200699 Abstract ( 2069 )   HTML ( 28 )   PDF (697KB) ( 8813 )   Folic acid, also known as pteroyl glutamate, has no physiological function, which needs a series of metabolism and transformation in the body to play biological role. It is an essential nutrient involved in the one-carbon metabolism pathway, which plays a critical role in the synthesis and repair of genes and DNA methylation, so it is considered to be related to the occurrence and development of cancer. Folic acid deficiency and metabolic disorders could be a new angle to explain the multifactorial pathogenic theory of cervical cancer. However, the research on the related mechanisms of folic acid and cervical cancer is unclear, and further research is needed to clarify the molecular mechanism of folic acid deficiency and metabolic disorders in the occurrence and development of cervical cancer. Folic acid has made significant progress in the prevention, diagnosis and treatment of cervical cancer in recent years, such as the exploration of folic acid supplementation or fortification on the prevention and treatment of cervical lesions, new cervical screening method based on the biochemical properties of folic acid, and novel targeted drugs modified or functionalized by folic acid. This article reviews the research progress of folic acid and its metabolism in cervical cancer. References | Related Articles | Metrics

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The Prognostic Value of the Ratio of Neutrophils to Lymphocytes and Squamous Cell Carcinoma Antigen in Patients with Cervical Squamous Cell Carcinoma LU Peng, HOU Li-ying, LIU Yan, SUN Shu, LI Pei-ling 2021, 48 (1):  51-55.  doi: 10.12280/gjfckx.20200490 Abstract ( 1468 )   HTML ( 24 )   PDF (821KB) ( 8292 )   Cervical cancer is the second most common gynecological malignancy in the world, causing about 500 000 new diagnoses and 275 000 deaths each year. Nearly one-third of cervical cancer deaths are due to disease recurrence or progression. Squamous cell carcinoma is the most common type of cervical cancer. The treatment of squamous cell cervical cancer includes surgery, chemoradiotherapy and so on. And most of the known prognostic factors of squamous cell cervical cancer are evaluated after operation. Survival studies showed that the ratio of neutrophils to lymphocytes (NLR) in peripheral blood before treatment had a significant influence on the prognosis of patients with squamous cell cervical cancer after radiotherapy. And the serum squamous cell carcinoma antigen (SCC-Ag) level had a predictive effect on the recurrence, survival and lymph node metastasis of patients with squamous cell cervical cancer. NLR and SCC-Ag in peripheral blood can be easily obtained as hematological indexes. Compared with the local state of cancer reflected by International Federation of Gynecology and Obstetrics (FIGO) stage, they can better reflect the general state of patients. Also, they can be dynamically monitored from the beginning of diagnosis, which becomes reference factors for clinicians to provide the best diagnosis and treatment for patients. By elucidating the predictive value of NLR and SCC-Ag in the prognosis of cervical squamous cell carcinoma, it is expected to create a new way to analysis the progression of cervical squamous cell carcinoma. References | Related Articles | Metrics

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Current Status and Progress of Treatment of Recurrent Cervical Cancer JU Yu-ye, ZHANG Fang-fang, WANG Xiao-hui 2021, 48 (1):  56-60.  doi: 10.12280/gjfckx.20200695 Abstract ( 1978 )   HTML ( 51 )   PDF (726KB) ( 8545 )   Cervical cancer is the most common malignant tumor in the female reproductive system. Despite the popularity of cervical cancer screening and the incidence of cervical cancer in the world is lower than before, about 75% of cervical cancer patients still relapse within two years after initial treatment. Recurrent cervical cancer seriously affects the prognosis and survival rate of patients, but there is no standardized treatment for recurrent cervical cancer. With the emergence of tumor immunotherapy, the application of radiotherapy, the continuous improvement of chemotherapy regimen, and the improvement of surgical methods, the treatment scheme of patients with recurrent cervical cancer is increasing, but the high incidence of complications during the treatment can not be ignored. Therefore, further improving the treatment of recurrent cervical cancer and improving the survival rate of patients is still a difficult point in the treatment of recurrent cervical cancer. This article reviews the current situation and progress of the treatment of recurrent cervical cancer, from the aspects of surgical treatments, chemotherapy, immunotherapy, and radiotherapy, aim to provide ideas for the choice of treatment options for patients with recurrent cervical cancer. References | Related Articles | Metrics

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New Research Progress of CircRNA in Ovarian Cancer LIU Yan, LU Peng, HOU Li-ying, LI Pei-ling 2021, 48 (1):  61-65.  doi: 10.12280/gjfckx.20200530 Abstract ( 1319 )   HTML ( 24 )   PDF (745KB) ( 8411 )   Circular RNAs (circRNA) are hotspot members of non-coding RNA networks, which have a variety of characteristics and pathophysiological functions. CircRNA plays roles in epigenetic, transcriptional, and post-transcriptional regulation. At present, the number of validated endogenous circRNA involved in ovarian cancer continues increasing and many circRNA expressions are related to the occurrence, invasion and metastasis of ovarian cancer. In addition, the abnormal expression of circRNA is also closely related to the stage, volume of tumor, differentiation and metastasis of ovarian cancer. Because of their high stability, highly conserved, and tissue-specific expression patterns, circRNA may become potential markers of ovarian cancer for the diagnosis. This article reviews the current research reports of circRNA related to ovarian cancer, proposes its impact on the occurrence of ovarian cancer and its potential value as a diagnostic and prognostic biomarker and as a therapeutic target for ovarian cancer, and explores circRNA′s impacts of chemotherapy resistance for ovarian cancer. Finally, the clinical potential and future research directions of circRNA related to ovarian cancer are discussed. References | Related Articles | Metrics

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Advances in the Inguinal Sentinel Lymph Nodes Biopsy for Vulvar Carcinoma LU Yan, YAO De-sheng 2021, 48 (1):  66-70.  doi: 10.12280/gjfckx.20200314 Abstract ( 1983 )   HTML ( 23 )   PDF (706KB) ( 8172 )   The main metastasis method of vulvar cancer is lymph node metastasis. The 5-year survival rate of patients with lymph node metastasis is only 25%~41%, which seriously affects the prognosis of patients. However, due to the large scope and trauma of inguinal lymph node dissection, it also brings high postoperative complications such as lymphedema, lymphocysts, delayed wound healing, etc., especially the long-term lower extremity lymphedema, which is the most serious long-term complication, affecting the postoperative follow-up treatment, quality of life and even the prognosis of patients. The inguinal sentinel lymph node is the first stop of lymph node metastasis in vulvar cancer, and it is the most meaningful lymph node in pathology. If there is no metastasis in the sentinel lymph node, it can be considered that the posterior lymph node has no metastasis. Sentinel lymph node biopsy can thereby reduce surgical trauma, reduce the scope of surgery, reduce the risk of postoperative complications, and improve the quality of life. References | Related Articles | Metrics

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Advances in Fertility Preservation in Women with BRCA Mutations LIU Xiao-shi, DI Wen 2021, 48 (1):  71-74.  doi: 10.12280/gjfckx.20200287 Abstract ( 1405 )   HTML ( 383 )   PDF (704KB) ( 8418 )   Deleterious mutations in BRCA1 or BRCA2 genes have long been recognized as independent risk factors, mostly for breast and ovarian cancer. Any treatment for the turmor, such as bilateral salpingectomy, inevitably results in damage or loss of fertility. With the general postponement of women′s childbearing age and the younger age of cancer onset, fertility perservation has become a problem that often needs to be faced when making tumor treatment decisions. At the same time, some research evidence suggests that this genetic state may also be associated with ovarian dysfunction, especially the reduction of ovarian reserve. In this paper, we reviewed the fertility problems that BRCA1/2 gene mutation carriers may face and the existing fertility preservation techniques. Figures and Tables | References | Related Articles | Metrics

Obstetric Physiology & Obstetric Disease Review

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Research Progress of Copy Number Variation Sequencing in Prenatal Diagnosis LI Feng-jin, YAO Xin-yu, ZHANG Yu-ping 2021, 48 (1):  75-78.  doi: 10.12280/gjfckx.20200527 Abstract ( 2494 )   HTML ( 72 )   PDF (711KB) ( 9621 )   It′s reported that congenital heart disease, polydactyly (toe), cleft lip, congenital hydrocephalus and clubfoot rank among the top five in birth defects. Chromosomal microdeletions and microduplications are related to these diseases. Prenatal diagnosis is the main mean to prevent birth defects, which is to use advanced technology to diagnose fetal congenital diseases before birth. Research has shown that copy number variation sequencing (CNV-seq) can diagnose prenatal chromosomal microdeletions and microduplications. It increased the detection rate of chromosomal abnormalities to 2.8%. CNV-seq is a whole genome sequencing technology developed based on high-throughput sequencing. It has a wide range of detection and high resolution, it covers genome-wide microdeletion and microduplication abnormalities. It has been gradually applied to the detection of fetal congenital diseases and abortion tissues. It can also be used to identify chromosomal abnormalities of unknown origin. The paper reviews the research progress of CNV-seq in prenatal diagnosis. References | Related Articles | Metrics

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Connexin 43 and Premature Rupture of Membranes Related Problems NAN Lian-ling, MU Wan-ru, ZHANG Hong, LI Jie, YANG Chen-chen, TANG Ling, BAI Yu-fang 2021, 48 (1):  79-83.  doi: 10.12280/gjfckx.20200558 Abstract ( 1367 )   HTML ( 21 )   PDF (698KB) ( 8419 )   Premature rupture of membranes (PROM) is one of the most common causes of preterm delivery in obstetrics, which can induce poor prognosis, such as neonatal respiratory distress syndrome, chorioamnionitis, placental abruption, septicemia and so on. Gap junction communication is the most common way of information exchange and material exchange between cells. Its function is mainly realized by gap junction proteins. Connexin43 (Cx43) is the most common and important protein in the gap junction family, Cx43 can connect cells to form a complete transmission channel between cells, which plays an important role in intercellular gap junction, the exchange of information and materials between cells, and fetal membrane integrity. It is closely related to the levels of type I and III collagen in fetal membranes, which can cause weakening of the fetal membranes by affecting the amount of type I and III collagen and the cross-linking method, lead to premature rupture of the fetal membranes. The decrease of Cx43 can lead to the occurrence and expansion of fetal membrane microfissures and lead to premature rupture of fetal membranes. This article reviews the correlation between Cx43 and premature rupture of membranes in order to have a better understanding of the mechanism, prevention and treatment of premature rupture of membranes. References | Related Articles | Metrics

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Progress in Diagnosis and Treatment of Late Postpartum Hemorrhage Caused by Uterine Arteriovenous Fistula YIN Ya-dong, LIU Lan 2021, 48 (1):  84-88.  doi: 10.12280/gjfckx.20200541 Abstract ( 1602 )   HTML ( 22 )   PDF (756KB) ( 8797 )   Uterine arteriovenous fistula (UVAF) is a kind of rare abnormal uterine vascular disease, which is one of the causes of late postpartum hemorrhage in women. In recent years, with the opening of the two-child policy and the increase of the rate of artificial abortion, the incidence rate of UAVF has also increased, which seriously affects the quality of life of women and increases the difficulty and risk of the second pregnancy. Due to the diversity of etiology and clinical manifestations of UAVF, it is often difficult to identify early and make appropriate treatment in clinical work, which leads to the occurrence of adverse events. At present, the diagnosis of UAVF mainly depends on imaging methods, among which angiography is the gold standard. Conservative treatment, interventional therapy and surgical treatment are the main treatment methods of UVAF, among which uterine artery embolization is the most commonly used, but the adverse effects of re-pregnancy are increasing year by year. According to the patient′s clinical symptoms and fertility wishes, choosing a reasonable diagnosis and treatment program can improve the prognosis and reduce the risk of re-pregnancy. References | Related Articles | Metrics

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Research between Folic Acid and Adverse Pregnancy HU Hao-mei, YANG Hua 2021, 48 (1):  89-94.  doi: 10.12280/gjfckx.20200467 Abstract ( 1362 )   HTML ( 27 )   PDF (971KB) ( 8335 )   Adverse pregnancy mainly includes early recurrent abortion, abnormal fetal development and so on. Adverse pregnancy imposes a heavy burden on families and society. Reducing birth defects is an important task for obstetricians and gynecologists. The cause of adverse fertility is complex, which is the result of the combination of genetic and environmental factors. Folic acid is a hot research topic that leads to adverse pregnancy. Folic acid deficiency or utilization disorder is a well-established cause of fetal neural tube defects. Folic acid deficiency may also be associated with recurrent abortion, male sterility, and other birth defects such as cleft lip and palate, congenital heart disease and Down syndrome. Although there are many relevant studies, the specific pathogenesis is still unclear. In recent years, many studies have elucidated the correlation between folic acid deficiency and adverse fertility from the aspects of gene and histone modified epigenetics. Based on the relevant literature in recent years, the paper reviews folic acid transport absorption, folic acid metabolism and related enzyme polymorphism, folic acid deficiency leading to various adverse fertility and its pathogenesis, to lay a theoretical foundation for further research on the relationship between them. References | Related Articles | Metrics

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Research Progress on the Formation Factors of Cesarean Scar Diverticula HAN Qiao, ZHOU Xing-chen, WANG Xi-peng 2021, 48 (1):  95-98.  doi: 10.12280/gjfckx.20200559 Abstract ( 1762 )   HTML ( 23 )   PDF (693KB) ( 8627 )   Cesarean scar diverticula (CSD) is a new gynecological disease secondary to cesarean section. It refers to the poor healing of myometrium of uterine incision after cesarean section. A cystic defect protruding to the serosa layer in the isthmus of uterus and communicating with the uterine cavity leads to serious complications such as abnormal uterine bleeding, chronic pelvic pain, scar pregnancy, placenta implantation, and even uterine rupture in pregnancy again. At present, the formation factors of CSD have not been fully elucidated, which may be related to cesarean section incision position, surgical suture, infection, pregnancy complications or complications. This paper reviews the formation factors of CSD to provide theoretical basis for reducing the occurrence of CSD. References | Related Articles | Metrics

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Research Progress of Vaginal Trial Delivery after Cesarean Section XING Yu, CHEN Xuan 2021, 48 (1):  99-104.  doi: 10.12280/gjfckx.20200450 Abstract ( 1690 )   HTML ( 22 )   PDF (795KB) ( 8267 )   With the change of birth policy, the number of pregnant women who are pregnant again after cesarean section is increasing. How to choose the mode of delivery has aroused wide thinking and discussion in obstetrics. In the past, this kind of pregnant women were recommended to select repeated cesarean section as the termination method. Although it can avoid the risk of uterine rupture, the secondary damage of the mother and the high risk of postpartum hemorrhage caused by it cannot be ignored. In recent years, vaginal trial delivery after cesarean section have been gradually promoted, showing higher value in maternal and child prognosis. The safety and success rate of vaginal trial delivery after cesarean section can be significantly improved by changing the perinatal health care mode, improving the awareness and acceptance of vaginal trial delivery after cesarean section, accurately evaluating the feasibility conditions of pregnant women before delivery, strictly controlling the indications and contraindications, and taking reasonable auxiliary intervention during delivery. In order to promote the work of vaginal trial delivery after cesarean section, this paper analyzes the relevant literature and summarizes the research progress. References | Related Articles | Metrics

Obstetric Physiology & Obstetric Disease Original Article

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Relationship between Gestational Diabetes Mellitus with Premature Rupture of Membranes and Vaginal Microbial Infection and Pregnancy Outcome JIA Yi-xin, SONG Zhi-hui, GAO Chun-yan, GAO Ran 2021, 48 (1):  105-109.  doi: 10.12280/gjfckx.20200497 Abstract ( 1749 )   HTML ( 48 )   PDF (883KB) ( 8444 )   Objective: To explore the relationship between gestational diabetes mellitus with premature rupture of membranes and vaginal microbial infection and pregnancy outcome. Methods: From June 2019 to June 2020, pregnant women with gestational diabetes mellitus and PPROM in our hospital were selected as the study group (n=64) and normal pregnant women in our hospital at the same time as the control group (n=50). Vaginal secretions were collected for the detection of group B streptococcus (GBS), bacterial vaginosis (BV) and Candida (CM). Cervical secretions were used for the detection of Ureaplasma urealyticum (UU) and Chlamydia (CT). The vaginal microbial infection and pregnancy outcomes were recorded. Results: There was significant difference in GBS, UU and CT infection between the two groups (P<0.05), but there was no significant difference in BV and CM infection (P>0.05). GDM combined with PPROM was positively correlated with GBS, UU and CT infection (r=0.293, 0.202, 0.189, respectively), and GBS infection was most significantly related. The incidence of chorioamnionitis was significantly higher in GBS and CT infection groups (r=0.375, 0.277), neonatal pneumonia was significantly higher in GBS, CT and BV infection groups (r=0.248, 0.239, 0.245), and the incidence of pathological jaundice in UU and CT infection groups was significantly higher (r=0.489, 0.292). Conclusions: It is of great significance to carry out vaginal microbiological detection in women with gestational diabetes mellitus, and the infection of GBS may lead to the occurrence of PPROM, and further lead to adverse pregnancy outcomes, such as chorioamnionitis and neonatal pneumonia. Figures and Tables | References | Related Articles | Metrics

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Effect of COVID-19 Epidemic on Pregnant Women′s Anxiety during Rregnancy YAN Dan-dan, YUAN Jing-ping, YAN Hong-lin, LIU Tian, WANG Feng, TIAN Kun-ming 2021, 48 (1):  110-114.  doi: 10.12280/gjfckx.20200651 Abstract ( 1756 )   HTML ( 26 )   PDF (764KB) ( 8457 )   Objective: To explore the influencing factors of anxiety and depression in pregnant women under the COVID-19 epidemic. Methods: A cross-sectional survey of the mental health status of pregnant women was carried out in Hubei, Hunan, Jiangxi, Henan, Guangdong, Guizhou, and Shanxi provinces from January 23 to April 8, 2020. A questionnaire survey was adopted to obtain 1 793 valid questionnaires. The survey mainly includes basic information of pregnant women during pregnancy (age, height, weight, parity, education level, occupation, and monthly household income), exercise volume assessment, and self-rating anxiety scale (SAS) scores. The trend χ2 test was used to explore the difference between the detection rates of anxiety in high, medium and low risk areas and early, middle and late pregnancy. The logistic regression analysis was used to access the influencing factors of anxiety in pregnancy women during the COVID-19 epidemic. Results: The detection rate of anxiety symptoms in pregnancy women during the COVID-19 epidemic was 34.47% (618/1 793), which was significantly higher than that before (χ2=596.234, P=0.000). The detection rates of anxiety symptoms in high, medium and low risk areas were 34.71% (455/1 311), 31.79% (55/173) and 34.95% (108/309), respectively (χ2=0.011, P=0.916). The detection rates of anxiety symptoms in early, middle, and late pregnancy were 41.38% (36/87), 38.01% (176/463), and 32.66% (406/1243), respectively (χ2=6.122, P=0.013). Compared with the third trimester of pregnancy, the risk of anxiety symptoms is higher in early and middle pregnancy, with OR (95%CI) values of 1.706 (1.058~2.749) and 1.461 (1.151~1.855), respectively. Compared with pregnant women with high school education and below, pregnant women with master degree and above have a higher risk of anxiety symptoms (OR=1.861, 95%CI: 1.102~3.144). Compared with pregnant women who use electronic products less than 2 hours per day, those use electronic products for 5~6 hours and 7 h per day have a higher risk of anxiety symptoms, with OR (95%CI) values of 1.725 (1.188~2.505) and 2.000 (1.376~2.908), respectively. Compared with pregnant women who have enough sleep every day, those sleep less than 6 hours has a higher risk of anxiety symptoms, with an OR (95%CI) value of 2.603 (1.706~3.970). Compared with pregnant women who exercise 4~7 times per week, pregnant women who do not exercise or rarely exercise has a higher risk of anxiety symptoms, with an OR (95%CI) of 1.612 (1.166~2.230). Conclusions: The detection rate of anxiety symptoms in pregnant women during the epidemic period is higher than that before the epidemic. Mental health intervention services should focus on the anxiety and depression in pregnant women during COVID-19 epidemic, and timely counseling and intervention should be conducted for pregnant women with anxiety and depression to prevent the occurrence of post-traumatic stress disorder. At the same time, relevant departments should manage the public opinion to eliminate the psychological damage caused by false reports. Figures and Tables | References | Related Articles | Metrics

Obstetric Physiology & Obstetric Disease Case Report

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Case Report of A Successful Delivery by Twin Pregnancy with Twice Vaginal Cervical Cerclages and Literature Review ZHANG Shi-ping, ZHANG Hong, SUN Mei-guo 2021, 48 (1):  115-117.  doi: 10.12280/gjfckx.20200643 Abstract ( 1897 )   HTML ( 21 )   PDF (635KB) ( 8424 )   Cervical insufficiency is one of the main causes of recurrent late abortions and premature births. Preterm birth can increase the rate of perinatal morbidity and mortality, which brings severe psychological and economic burden to pregnant women and their families. At present, cervical cerclage is recommended to be used in single pregnancy at home and abroad. However, there are few reports on its application in twin pregnancy, and the indications are not clear. In this paper, a case about the parturition of two healthy babies after twice cervical cerclages in twin pregnancy is reported and relevant literature are reviewed to explore the application of cervical ligation in twin pregnancy. References | Related Articles | Metrics

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Transient Diabetes Insipidus after Hysterectomy Caused by Disseminated Intravascular Coagulation after Postpartum Hemorrhage: A Case Report XU Hui, YANG Hui-Min, SUN Qing 2021, 48 (1):  118-120.  doi: 10.12280/gjfckx.20200560 Abstract ( 1407 )   HTML ( 21 )   PDF (1040KB) ( 8439 )   The present study reported on a special case of cesarean section due to relative cephalopelvic disproportion. Due to severe postpartum hemorrhage and disseminated intravascular coagulation, hysterectomy was performed, posterior pituitary dysfunction was found and transient diabetes insipidus was presented, which is very rare in clinical practice. Clinical analysis and literature review were conducted on this case. The aim of this study was to improve the understanding of the Sheehan syndrome such as transient diabetes insipidus after postpartum hemorrhage and provide reference for clinical workers. Sheehan syndrome is due to postpartum hemorrhage caused by ischemic pituitary necrosis, usually diagnosed a few years after delivery. However, transient diabetes insipidus caused by hypopituitarism soon after postpartum is not common in clinical practice, which should be paid attention to by clinical workers. When evaluating patients with polyuria and polydipsia after severe postpartum hemorrhage, we should always keep in mind the possibility of central diabetes insipidus, explore its causes and treatment methods, so as to carry out appropriate treatment quickly. Figures and Tables | References | Related Articles | Metrics