Journal of International Obstetrics and Gynecology

Application Progress of Near-Infrared/Indocyanine Green Fluorescence Imaging in Gynecological Surgery

LUO Wei-hong, ZHAI Rui-fang

2023, 50 (3): 241-245. doi: 10.12280/gjfckx.20220950

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Near-infrared fluorescence imaging (NIRF) technology has been widely used in clinical practice, the commonly used near-infrared fluorescent dye in clinical practice at present is indocyanine green (ICG). The near-infrared/ICG fluorescence imaging technology, which combines near-infrared light with ICG, has been widely developed in various fields, and can be used for the detection of metastatic lymph nodes in gynecological malignant tumors and intraoperative navigation. As for the pelvic deep-infiltrating endometriosis, the application of near-infrared/ICG fluorescence imaging technology can more completely clear the lesions, especially for intestinal endometriosis, which can significantly reduce the incidence of intestinal fistula. It can also be used for intraoperative ureteral imaging, which not only reduces the complications caused by the usual methods of ureteral protection (such as preoperative placement of ureteral stents), but also reduces the incidence of iatrogenic ureteral injury. The principle and advantages of near-infrared/ICG fluorescence imaging technology, its development status and clinical application in gynecological surgery, as well as the limitations and application prospects of this technology are reviewed.

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Research Progress of Glucose Metabolism Reprogramming in Endometriosis

LI Shang-jin, ZHANG Bing, CONG Shan-shan, ZHAO Shao-jie

2023, 50 (3): 246-250. doi: 10.12280/gjfckx.20230069

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Endometriosis is a chronic inflammatory disease characterized by pain and infertility as the main clinical manifestations. It seriously affects the physical and mental health of women of reproductive age and requires long-term management. So far, there is no effective way to cure this disease. At present, several studies have confirmed that the existence of glucose metabolism reprogramming in endometriosis, where high glucose intake provides the raw material for energy metabolism. The increased expression level of glycolysis-related enzymes realizes the transformation of cell metabolism from aerobic oxidation to glycolysis, resulting in the accumulation of lactic acid and promoting the progress of endometriosis. The regulation of glucose metabolism reprogramming is not fully understood and is mostly related to the hypoxic microenvironment. This shift in metabolic patterns is crucial for cell survival and disease progression. It can be seen that targeting glucose, lactate transporters, glucose metabolism-related enzymes and regulatory factors can provide useful support for patients with endometriosis.

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Research Progress of Female Genital Tract Inflammation in the Pathogenesis of Endometriosis

WANG Song, ZHANG Wei, SONG Dian-rong

2023, 50 (3): 251-255. doi: 10.12280/gjfckx.20221053

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Endometriosis (EMs) is a common gynecologic disease with an unclear pathogenesis. The inflammatory response can alter the uterine and abdominal microenvironment, among which the occurrence of pelvic inflammatory diseases can lead to ectopic lesions in the formation process of adhesion, invasion and angiogenesis more easily. Chronic endometritis can affect the changes of estrogen receptors in the eutopic endometrial tissue, thus leading to an increase of estrogen production, making the endometrial tissue more biologically active and easier to implant in pelvic organs after escaping pelvic immune surveillance. Female lower genital tract inflammatory diseases can infect upper genital tract, resulting in inflammation of the uterine cavity and abdominal cavity microenvironment, which plays an important role in the occurrence of EMs. At the same time, pelvic inflammatory disease, chronic endometritis and female lower genital tract inflammatory disease are also risk factors to aggravate the severity of EMs.

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The Impact of Intestinal Microbiota Imbalance on the Polycystic Ovary Syndrome

WANG Lei, ZHANG Ning

2023, 50 (3): 256-260. doi: 10.12280/gjfckx.20221082

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Intestinal microbiota is considered as an endocrine organ of the human body. Intestinal microorganisms and their metabolites can participate in human metabolism, immunity, reproduction and other aspects by affecting distant organs and related biological pathways. Intestinal microbiota imbalance plays an important role in the occurrence and development of diseases. Polycystic ovary syndrome (PCOS) has complex pathophysiological processes such as hyperandrogenism, hypothalamic-pituitary-ovarian axis disorders and insulin resistance. Related studies have shown that the intestinal microbiota of PCOS patients and PCOS rodent model is altered, and intestinal microbiota imbalance can lead to disturbances in sex hormone synthesis and insulin secretion and abnormal follicle development by mediating glucocorticoid metabolism, bile acid metabolism and chronic inflammation, suggesting that intestinal microbiota imbalance may play a corresponding role in the development and pathology of PCOS. This review highlights the role of intestinal microbiota imbalance in the pathogenesis of PCOS.

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The Efficacy Comparison of High-Intensity Focused Ultrasound Ablation and Surgical Excision in the Treatment of Abdominal Wall Endometriosis

WANG Sha, DUAN Hua

2023, 50 (3): 261-265. doi: 10.12280/gjfckx.20221063

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Objective: To compare the clinical effect of high-intensity focused ultrasound (HIFU) ablation and surgery in the treatment of abdominal wall endometriosis (AWE). Methods: The clinical data of 262 AWE patients hospitalized in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2015 to November 2019 were retrospectively analyzed. According to the treatment modality, the patients were divided into HIFU group (n=64) and surgery group (n=198), comparing the operation time, intraoperative bleeding, hospital stay, postoperative lesion size, pain level, clinical efficiency and complications. Results: The median operation time in the HIFU group was 34.5 (22.3, 47.3) min, which was significantly shorter than 40.0 (30.0, 60.0) min in the surgery group (Z=-3.112, P=0.002). The median hospital stay in the HIFU group was 2.0 (2.0, 3.0) days, which was shorter than 7.0 (6.0, 8.3) days in the surgery group (Z=-11.982, P=0.000). There was no significant difference in clinical efficiency between 2 groups (χ²=-1.207, P=0.227). In the HIFU group, ultrasound follow-up was performed 1, 3 and 6 months after treatment. The ablation rates were (88.25±13.09)%, (92.33±9.18)%, (98.67±4.09)%, respectively. By the 12th month after operation, the ablation rates were 100.00%. The volume of lesions before treatment was significantly different from that at 1, 3, 6 and 12 months after treatment (P<0.05). There was significant difference in the degree of periodic pain between the HIFU group and the surgery group at 3, 6 and 12 months after treatment (P<0.05). The rate of adverse reactions was 6.25% (4/64) in the HIFU group and 3.54% (7/198) in the surgery group, and there was no statistically significant difference between 2 groups (χ²=0.340, P=0.560). Conclusions: HIFU ablation for AWE is comparable to surgical resection, but it is superior to surgical resection in terms of shortening procedure time, reducing hospital stay and alleviating postoperative pain, making HIFU ablation one of the safe and effective options available to AWE patients.

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Accessory Cavitated Uterine Malformation: A Case Report and Literature Review

SU Dan, LI Si-jing, HUANG Xiao-wu, XIA En-lan

2023, 50 (3): 266-270. doi: 10.12280/gjfckx.20230008

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Accessory cavitated uterine malformation(ACUM) is a rare form of Müllerian anomaly, usually presents with progressive and aggravating dysmenorrhea from menarche. It should be distinguished from cystic adenomyoma, degenerating cystic leiomyoma and the other form of obstructive Müllerian anomaly. Surgery is its main treatment option. In this study, we present an adolescent female with progressive worsening dysmenorrhea, nausea and vomiting, pain in the left iliac fossa and need to take painkillers. In August 2022, three-dimensional pelvic ultrasound in our hospital showed: basic normal uterine cavity shape, left side wall heterogeneity nodular echo 28 mm×26 mm×20 mm with endometrial echo within 11 mm×10 mm×7 mm, suspected cystic focal uterine adenomyosis or ACUM. Laparoscopic exploration was performed. The appearance of the uterus was normal, the left anterior wall and at the anterior and inferior part of round ligament were slightly full. The uterine wall of slightly full was resected, a pale and tough masses were found and resected completely for examination. ACUM was confirmed by pathology. Symptoms disappeared after follow-up surgery.

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NR5A1 Mutation in 46,XY Disorders of Sex Development Combined with Obesity and Hyperinsulinemia: A Case Report

CHEN Chen, TANG Zhong-yun, LI Min, ZHANG Ying-chun

2023, 50 (3): 271-274. doi: 10.12280/gjfckx.20230049

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46,XY disorders of sex development (DSD) are congenital disorder in which the genetic sex, phenotypic sex, and gonadal sex is inconsistent, and the key to confirming the diagnosis of the disorder is genetic testing. A retrospective analysis of a patient with 46,XY DSD, who was female by gender and was seen for abnormal gonadal development found on physical examination. The patient 46,XY DSD was combined with obesity and hyperinsulinemia, and the causative gene was steroidogenic factor 1 (SF-1 or NR5A1) with mutation locus c.1095_1096insTCGG (p.Q366Sfs*22), which was genetically analyzed, and the mutation due to this locus may be associated with obesity and diabetes mellitus. Perform laparoscopic bilateral cryptorchidism, vulvoplasty and clitoral resection to maintain the female gender of the patient. The detection of the cause from the genetic perspective may provide guidance and basis for the clinical management of 46,XY DSD.

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Research Progress in Relationship and Pathogenesis between Glucose Metabolism and Cervical Cancer

MA Jian-hong, GAO Ya-ting, WAN Zi-hua, LIU Chang

2023, 50 (3): 275-280. doi: 10.12280/gjfckx.20230060

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Cervical cancer is the most common malignant tumor of the reproductive system among women in China. Its incidence is gradually becoming younger, posing a serious threat to women′s life and health. Several studies have shown that energy metabolism is reprogramming in cervical cancer cells, which glycolysis is used to provide biological energy even if oxygen is sufficient. This change is closely related to multiple glycolytic enzymes, transporter proteins, regulatory molecules and specific signaling pathways. Alteration of glucose metabolism promotes malignant processes such as growth, proliferation, migration and invasion through different mechanisms in cervical cancer cells, and affects the sensitivity of the patients to radiotherapy and chemotherapy. Analysis of the expression of proteins related to this metabolic process can predict the prognosis of cervical cancer, and blocking its expression may have anti-cancer effects. Therefore, glycolytic metabolism-related proteins are expected to be potential targets for cervical cancer treatment. This paper reviews the pathological mechanism that glucose metabolism involves in the development and progression of cervical cancer, so as to explore novel therapeutic strategies for energy metabolism, and also provides basis for improving therapeutic prospect and prolonging the survival of the patients.

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Research Progress on DNA Methylation in Predicting Cervical Cancer and Precancerous Lesions

WU Ruo-Lan, QIU Li-hua

2023, 50 (3): 281-285. doi: 10.12280/gjfckx.20230135

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In recent years, with the popularization of early screening, the incidence and mortality rate of cervical cancer in China have decreased. Cytological examination and high-risk human papilloma virus(HPV) test are common screening methods for cervical cancer at present, but they both have their limitations. Cytological examination may lead to missed diagnosis, while high-risk HPV test may lead to over-diagnosis and over-treatment. Therefore, it is necessary to explore a new screening or triage method for cervical cancer. DNA methylation is a common epigenetic modality. With the development of DNA methylation detection technology, DNA methylation has played an increasingly important role in the field of oncology diagnosis and treatment. In recent years, a large amount of DNA methylation genes has been found as markers of cervical cancer, which have a promising application in cervical cancer screening and triage, and have the advantages of prognosis prediction and convenient sampling. DNA methylation is beneficial for the early diagnosis and treatment of cervical cancer. This article reviews the research progress of DNA methylation in cervical cancer and precancerous lesions.

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Correlation of Vaginal Microecology with HPV Positivity and Cervical Lesions

CONG Rong, ZHAI Qing-zhi

2023, 50 (3): 286-289. doi: 10.12280/gjfckx.20230018

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Cervical cancer is one of the most common malignancies of the female reproductive tract worldwide, and its incidence has been increasing year by year in recent years. The etiology of cervical cancer is relatively clear, almost all cases of cervical cancer being associated with human papilloma virus (HPV) infection. In addition, poor lifestyle habits such as multiple sexual partners, young age at first sex and smoking are high risk factors for cervical lesions. In recent years, with the continuous research on vaginal microecology, researchers have discovered that vaginal microecology can regulate HPV infection and play a crucial role in the development of cervical precancerous lesions and invasive cervical cancer, which may serve as a potential biomarker for cervical cancer detection. In-depth study of the intrinsic link between vaginal microecology, cervical lesions and HPV infection is of great significance for the prevention and early treatment of cervical cancer.

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Effect of CD2 Gene on Immune Infiltration in Tumor Microenvironment of Ovarian Cancer

WANG Yi-xuan, ZHANG Shao-hua, WANG Zan-hong

2023, 50 (3): 290-296. doi: 10.12280/gjfckx.20220985

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Objective: To investigate the role of CD2 gene on immune infiltration in ovarian cancer microenvironment. Methods: GEPIA online tool was used to retrieve the expression of CD2 gene in ovarian cancer, GEPIA and Kaplan-Meier plotter databases were used to analyze the value of CD2 gene in evaluating the prognosis of ovarian cancer. Co-expression gene network of CD2 gene in ovarian cancer was constructed by Coexpedia. The key genes were screened out according to the score, and the correlation between CD2 gene and key genes was further analyzed by GEPIA and cBioportal to speculate the expression of related genes in ovarian cancer and their value for prognosis assessment. TIMER was used to analyze the expression of CD2 and related genes in ovarian cancer and the relationship between CD2 and six kinds of immune cells in tumor microenvironment. Results: ①In TCGA, the expression of CD2 gene in tumor tissue of ovarian cancer was higher than that in normal ovarian tissue (P<0.05). ②Both GEPIA and Kaplan-Meier plotter suggested that patients with high expression of CD2 gene had longer overall survival (P<0.05). ③The co-expressed genes of CD2 gene are CD3D, LCK, ITK, CCL5, CD48, GZMK, PTPRC, TRAF31P3, SH2D1A, GZMA, CD247, CD52, IL10RA, CD3E, IKZF1, CD53, CD6, CXCR6 and CD3G. ④In order of the highest score, the top five key genes were screened out, namely CD3D, LCK, ITK, CCL5 and CD48. CD2 was positively correlated with the expression of CD3D, LCK, ITK, CCL5 and CD48 (P<0.05). ⑤TIMER analysis showed that CD2 gene was positively correlated with the infiltration of B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages and dendritic cells in ovarian cancer (P<0.05). COX regression model suggested that the infiltration level of macrophages and neutrophils was positively correlated with the prognosis of patients, the infiltration level of CD4+ T cells was negatively correlated with the prognosis of patients(P<0.05). Conclusions: CD2 gene is highly expressed in ovarian cancer tissues, which may affect the prognosis of patients by affecting the infiltration of immune cells in tumor microenvironment.

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Analysis of 58 Clinical Cases Misdiagnosed as Gynecological Tumors

XU Qian, CHENG Jiu-mei

2023, 50 (3): 297-301. doi: 10.12280/gjfckx.20220843

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Objective: To explore the characteristics of clinical cases misdiagnosed as gynecological tumors and to improve the knowledge and diagnostic ability of pelvic non-genital system tumors. Methods: A retrospective analysis of the case data of 58 patients admitted between August 2009 and March 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University who were misdiagnosed as gynecological tumors, all of which were confirmed to be non-genital tumors by intraoperative exploration and pathology, including 24 cases of retroperitoneal tumors, 15 cases of appendiceal tumors and 19 cases of intestinal or mesenteric tumors. The clinical features, imaging manifestations, surgical methods and pathological diagnosis were analyzed. Results: Twenty-four patients with retroperitoneal tumors were preoperatively misdiagnosed as adnexal masses in 18 cases (75.0%), as uterine fibroids or broad ligament fibroids in 5 cases (20.8%), and as inflammatory pelvic masses in 1 case (4.2%). The clinical manifestations were abdominal pain or lower abdominal cramping in 6 cases (25.0%), frequent urination in 2 cases (8.3%), dyspareunia with sacrococcygeal discomfort in 1 case (4.2%), and no obvious symptoms in 15 cases (62.5%). Ultrasound or pelvic magnetic resonance imaging (MRI) did not suggest the possibility of retroperitoneal masses, and only one patient had pelvic and abdominal CT enhancement that did not exclude the possibility of retroperitoneal masses. In 15 patients with appendiceal tumors, all patients were misdiagnosed as adnexal tumors before surgery. The clinical manifestations were abdominal pain or lower abdominal distension in 6 cases (40.0%), and no obvious symptoms in 9 cases (60.0%). None of the patients had ultrasound suggesting a possible source of the appendiceal mass, and 3 patients had CT or MRI suggesting possible tumors of appendicular origin. 19 patients with intestinal or mesenteric tumors were misdiagnosed as having an adnexal mass in 18 cases (94.7%), a case (5.3%) was misdiagnosed as subserous myoma. The clinical manifestations were abdominal pain or lower abdominal distension in 8 cases (42.1%), and no obvious symptoms in 11 cases (57.9%). A patient had ultrasound suggesting that mesenteric cysts were not excluded, and neither CT nor MRI suggested the possibility of intestinal or mesenteric masses. Conclusions: Retroperitoneal tumors, appendiceal tumors and intestinal or mesenteric tumors are mostly suggested as pelvic masses by preoperative imaging, most of them have no specific clinical symptoms, and it is difficult to differentiate them from gynecological tumors. The gynecologists should pay attention to the above tumors, and carefully indentify patients with adnexal tumors to avoid misdiagnosis.

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Molecular Characteristics and Clinical Analysis of 20 Cases of Uterine Serous Carcinoma

WU Lin-lin, YU Jing-yao, HU Yan-ping

2023, 50 (3): 302-305. doi: 10.12280/gjfckx.20221075

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Objective: To summarize the clinicopathological characteristics of uterine serous carcinoma (USC), and to investigate its molecular classification and human epidermal growth factor receptor 2 (HER2) expression. Methods: The clinical data of 20 USC patients were collected. HE, immunohistochemistry, Sanger sequencing and FISH were used to detect in USC patients, and the molecular typing and HER2 expression were analyzed. Results: USC accounted for 8% of endometrial cancers, with FIGO stage Ⅰ in 5 cases (25%), stage Ⅱ in 1 case (5%), stage Ⅲ in 9 cases (45%), and stage Ⅳ in 5 cases (25%). Three histological structures of papilla, glandular and solid were seen in the carcinoma tissue. The nipple is wide or small, the cells are easy to fall off, the edge is not smooth and the glandular lumen is mostly fissured. The cytoplasm was clear or eosinophilic and vascular invasion was observed in 13 cases (65%). The positive rates of ER, PR, Vimentin, WT1 and P16 were 40%, 25%, 10%, 35% and 100%, respectively, and the positive rates of Ki-67 were 30%-80%. POLE mutation was not detected in 20 UCS patients, MLH1, PMS2, MSH2 and MSH6 were all positive. There were 16 cases (75%) with P53 missense mutation and 4 cases (25%) with nonsense mutation. HER2 3+ was labeled by immunohistochemistry in 5 cases (25%), and amplified signal was detected by FISH in 4 cases. Conclusions: The incidence of USC was low and the pathological morphology of USC was diverse. Immunohistochemical staining was helpful for its diagnosis. The molecular typing of USC was abnormal P53, and HER2 was expected to be a therapeutic target.

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Endometrial Angiosarcoma: A Case Report and Literature Review

LIN Zhi-ming, XU Fei-xue

2023, 50 (3): 306-308. doi: 10.12280/gjfckx.20220810

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Endometrial angiosarcoma is a rare interstitial sarcoma in clinic. Its clinical symptoms are atypical and diagnosis is relatively difficult. The diagnosis is mainly based on tissue biopsy. There is no standard treatment. The diagnosis and treatment of one case of endometrial angiosarcoma was reported. The patient was treated for abnormal vaginal bleeding for more than 1 month, during which the blood loss was more than the usual menstrual volume. After admission, specialized physical examination, gynecological ultrasound and pelvic magnetic resonance imaging were performed, and endometrial sarcoma was considered based on the diagnostic endometrial curettage pathological section of other hospital. Extensive hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy were performed. Postoperative pathology showed endometrial angiosarcoma with clinical stage ⅢC1. The patient did not undergo adjuvant treatment after the operation, and was reviewed 5 months after the operation to consider recurrence and metastasis. The postoperative recurrence time of endometrial angiosarcoma is short and there is a risk of distant metastasis. Postoperative adjuvant chemoradiotherapy, immunotherapy and targeted therapy after surgery can improve the survival rate of patients.

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Misdiagnosis of Ovarian Non-Gestational Choriocarcinoma in Adolescents: A Case Report and Literature Review

GUAN Hong-fei, SHI Li-li, LI Su-rong, CHENG Hua

2023, 50 (3): 309-312. doi: 10.12280/gjfckx.20220768

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Ovarian non-gestational choriocarcinoma is a rare malignant tumor originating from ovarian germ cell. The increase of human chorionic gonadotropin(hCG) can prompt this disease. Adolescents often see doctors for irregular vaginal bleeding and abdominal pain, imaging findings are cystic mass in adnexal region with abundant blood supply. Standardized treatment is beneficial to the retention of children′s reproductive function and the improvement of their quality of life. This paper aims to make a retrospective analysis of a misdiagnosed case and review the literature, analyze and summarize the clinical features, pathological basis, CT imaging manifestations and treatment of this disease, in order to improve the understanding of the disease among radiologists, improve preoperative imaging diagnosis.

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Cervical Inflammatory Myofibroblastic Tumor: A Case Report and Literature Review

MA Rui, ZHANG Xiang-xi, LI Jing-wen, CHEN Yu-huan, YANG Xiao-hong

2023, 50 (3): 313-317. doi: 10.12280/gjfckx.20220743

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Cervical inflammatory myofibroblastic tumor (IMT) is a type of mesenchymal tumor with moderate malignant potential, unknown etiology, rare clinical manifestations, lack of specificity, its diagnosis depends on pathological morphology and immunohistochemical findings. One patient with cervical IMT was reported and the literature was reviewed to improve understanding of this tumor. The patient was admitted to the hospital due to the discovery of uterine fibroids for 5 years and irregular vaginal bleeding for more than half a month, and was clearly diagnosed as cervical IMT by segmented curettage+cervical biopsy before surgery, complete hysterectomy+bilateral adnexectomy+bilateral ovarian arteriovenous high ligation, and postoperative pathological examination confirmed the preoperative diagnosis. Laboratory tests and imaging examinations are not specific for cervical IMT, because it is similar to malignant tumors and not easy to identify, easily to misdiagnose and missed diagnosis, surgical resection is an effective treatment, it is recommended to completely resect the lesion, and complete hysterectomy, and regular follow-up after surgery.

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Early Endometrioid Carcinoma with CTNNB1 Mutation: A Case Report and Literature Review

YANG Ming, CHEN Ming-zhu, TIAN Shu-yi, LIU Xiao-yan, ZHANG Li-hui

2023, 50 (3): 318-321. doi: 10.12280/gjfckx.20220640

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The incidence of endometrial carcinoma has been increasing in recent years, and the age of onset is tends to younger. Most endometrial carcinomas are low-grade, early-stage endometrioid carcinomas (EECs) with a good prognosis. However, some patients with low-grade, early-stage EECs are prone to recurrence and have a poor prognosis. Early identification of these high-risk patients with EECs can help determine which patients need additional adjuvant therapy and closer follow-up. In recent years, CTNNB1 mutation has been considered as a potential risk factor for recurrence, which has independent prognostic value. But so far, there are no clear guidelines on whether adjuvant therapy is needed for low-grade and early-stage EECs patients with CTNNB1 mutation. Combined with a patient with an ⅠA stage, low-grade patient with CTNNB1 gene mutation in our hospital, this gene mutation is mainly discussed in order to improve clinicians′ further understanding of the prognosis and follow-up treatment of patients with such mutation.

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Application of Metabonomics in the Study of Missed Abortion

XIA Li-na, SHAN Li, ZHAO Huan, CHU Guang-hua, WANG Yan-xia

2023, 50 (3): 322-326. doi: 10.12280/gjfckx.20221051

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Metabolomics is a technology which understands the changes of all endogenous metabolites in the organism at a certain time through comprehensive and quantitative detection of endogenous small molecular compounds in the biological system, screening out significant biomarkers, and providing new ideas for early prediction, diagnosis and exploration of pathogenesis of diseases. Missed abortion is a common gynecological disease, and its pathogenesis has not been fully elucidated. At present, metabonomics technology has been applied to the study of missed abortion, and biomarkers that may be associated with missed abortion have been found, involving a variety of pathways such as tricarboxylic acid cycle, oxidative stress and signal transduction, making a breakthrough. This article briefly introduces the metabonomics technology and its application in the study of missed abortion, and to further discusses the explore of differential metabolites in serum and changes in related metabolic pathways on missed abortion.

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Research Progress of Inflammasome NLRP3 in Pre-Eclampsia

LI Shu-ming, GUAN Hong-qiong

2023, 50 (3): 327-331. doi: 10.12280/gjfckx.20221032

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Pre-eclampsia(PE) is a pregnancy complication characterized by placental and systemic inflammation. It is classified as hypertensive disorder during pregnancy and may develop into eclampsia. It is an important factor affecting the outcome and prognosis of maternal and fetal pregnancy, and seriously affects the health of mother and infant. However, its related pathophysiological mechanism is still under further study, and currently clinical examination of blood pressure and proteinuria is still an important way to identify and diagnose PE, and timely termination of pregnancy is an important treatment measure. Systemic inflammation is the key to the pathogenesis of PE. Studies have shown that the inflammasome NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) is the "traffic hub" that triggers the cascade inflammatory response, and the "trigger" that promotes the production of inflammatory factors and causes the inflammatory response of PE. The activation or inhibition of NLRP3 is related to the onset and severity of PE. Therefore, it is of great significance to find the cause of the change of NLRP3 activity for understanding the pathogenesis and targeted therapy of PE.

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Progress in Treatment of Infertility Associated with Cesarean Scar Defect

WANG Zhuo-min, HU Qian-yu, SUN Tao, XU Jian

2023, 50 (3): 332-336. doi: 10.12280/gjfckx.20221059

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Cesarean scar defect (CSD) is one of the common complications after cesarean section. The clinical manifestations include abnormal uterine bleeding, pelvic pain and secondary infertility. With the evolution of fertility policy and the increase of cesarean section rate, the infertility associated with it is gradually gaining attention. There is no consensus on the treatment options of infertility secondary to CSD currently. In patients combined with small amounts of uterine cavity effusion, the prolonged GnRHa down-regulation protocol can be used to assist reproduction. While in patients with abnormal uterine bleeding or obvious endometrial cavity fluid, surgery should be considered as first-line treatment. However, there is still a lack of uniformity in the choice of surgical approach and surgical plans are usually determined based on the residual myometrial thickness on the scar. In addition, treatment options such as intrauterine ozone infusion, traditional Chinese medicine conditioning and physiotherapy, and stem cell transplantation may also have potential benefits in the treatment of secondary infertility in CSD.

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Research Progress on the Regulatory Mechanism of Autophagy on Ovarian Microenvironment

ZHANG Yu-lin, FENG Xiao-ling

2023, 50 (3): 337-342. doi: 10.12280/gjfckx.20220856

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Autophagy is a cell survival pathway that assists in reproductive development, immune regulation, degradation metabolism and cell aging, and plays a key role in maintaining homeostasis. Recent studies have pointed out that autophagy not only participates in the growth, development and atresia of follicles, but also regulates the function of ovarian stroma and corpus luteum to a certain extent. It also abnormally regulates ovarian microenvironmental status, inducing various pathologies such as ovarian polycystic-like changes, ovarian aging and ovarian tumor. At the same time, the immune imbalance caused by the degeneration of the ovarian microenvironment will also react on the autophagosomes, resulting in a vicious cycle of microecology. The role of autophagy in the ovary is reviewed to lay the foundation for the clinical treatment of autophagy-related reproductive disorders and ovarian diseases.

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The Incidence and Influencing Factors of Pregnancy Complications in Chinese Women

YANG Cai-xia, LI Jing, ZHANG Yan, ZHOU Yuan-zhong, LI Yu-yan, CHE Yan

2023, 50 (3): 343-348. doi: 10.12280/gjfckx.20221046

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Objective: To investigate the incidence and influencing factors of pregnancy complications in China. Methods: We recruited and interviewed women who had a live birth between 13 and 24 months after childbirth at 60 hospitals in 15 provinces (regions and cities) in the estern, central and western regions of China. Information on women′s demographic characteristics, occurrences of pregnancy complications, previous pregnancy and disease history, etc. was collected. We performed unordered multicategorical logistic regression to identify the influencing factors of pregnancy complications. Results: A total of 18 045 maternal cases were interviewed. The incidence of pregnancy complications was 25.04%. 8.98% women had internal diseases and/or surgical operations during pregnancy, 7.99% experienced abnormal fetus and/or appendages, 6.79% suffered pregnancy complications only, and 1.29% had abnormal labor and/or puerperium. The risk of pregnancy complications in Chinese women is associated with the age of pregnant women, the number of abortions, the number of deliveries and delivery method. Moreover, the probability of pregnancy complications varied between geographical regions in China. Conclusions: The incidence of maternal pregnancy complications in pregnant women in China is relatively high. Strengthening contraceptive services, reducing induced abortions, increasing the frequency of prenatal examinations for high-risk pregnancy patients, and strengthening pregnancy health care are recommended. It is recommended that those with severe pregnancy complications seek medical treatment/referral to tertiary hospitals, which can help reduce the risk of pregnancy complications and the severity of complications.

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Relationship between Psychological Pressure in Early Pregnancy Period and Spontaneous Abortion

YAN Jing, LI Xiao-yu, ZHANG Jing

2023, 50 (3): 349-353. doi: 10.12280/gjfckx.20220959

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Objective: To investigate the relationship between psychological pressure and spontaneous abortion in pregnant women in early pregnancy. Methods: Patients with early pregnancy in Fu Xing Hospital affiliated to Capital Medical University from June 2019 to August 2021 were enrolled. The "early pregnancy women psychological health survey" questionnaire was used, follow up until 12 weeks of pregnancy, and 108 cases of spontaneous abortion were selected as the observation group and 202 cases of normal early pregnancy were selected as the control group. The risk factors related to psychological stress of spontaneous abortion during early pregnancy and the moderating effect of emotion regulation strategy on perceived stress and spontaneous abortion were analyzed. Results: The scores of perceived stress and stress sources during pregnancy in the observation group were significantly higher than those in the control group (P<0.01). Multi-factor logistic regression analysis showed that concern about the health of offspring (OR=1.188, 95%CI: 1.006-1.402, P=0.042), number of previous spontaneous abortion (OR=2.740, 95%CI: 1.117-6.722, P=0.028) and perceived stress (OR=1.194, 95%CI: 1.134-1.257, P<0.001) were risk factors of spontaneous abortion. Emotion regulation strategy moderated the relationship between perceived stress and spontaneous abortion. Cognitive reappraisal multiplied by perceived stress was significantly negatively correlated with spontaneous abortion (B=-0.067, OR=0.935, 95%CI: 0.915-0.957, P<0.001), while expressive suppression multiplied by perceived stress was significantly positively correlated with spontaneous abortion (B=0.004, OR=1.004, 95%CI: 1.001-1.007, P=0.010). Conclusions: High psychological stress level during pregnancy is a risk factor for spontaneous abortion, and the psychological stress mainly comes from the number of previous spontaneous abortion. Under high level of perceived stress, the frequent use of cognitive reappraisal and reducing the use of expressive suppression can reduce the occurrence of spontaneous abortion.

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Late Pregnancy Complicated with Rupture of Blood Vessels on the Surface of Uterine Myoma: A Case Report and Literature Review

LENG Qin, YU Wei-wei, WEI Wei

2023, 50 (3): 354-356. doi: 10.12280/gjfckx.20220978

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Spontaneous rupture of blood vessels on the surface of uterine myoma is rare in clinical practice, especially in pregnancy. Reported a case of admission to our hospital with acute abdominal pain in the third pregnancy trimester, who performed cesarean section due to suspected fetal distress during treatment, and spontaneous rupture and hemorrhage were found on the surface of the subserous myoma during the operation, the myoma was completely removed and the wound was sutured to stop bleeding, and the cause of abdominal pain on admission was finally identified. Clinicians should be reminded to consider whether there exists the diagnosis of haemorrhage from spontaneous rupture of a uterine myoma and acute abdominal pain during pregnancy. This paper reviews the literature at home and abroad to summarize its etiology and characteristics in order to improve the clinical recognition of the rupture of blood vessels on the surface of uterine myoma.

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Spontaneous Hemoperitoneum in Pregnancy：A Case Report and Literature Review

QU Lin, YIN Yin, LIU Le-nan, ZHOU Xin

2023, 50 (3): 357-360. doi: 10.12280/gjfckx.20220924

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Spontaneous hemoperitoneum in pregnancy(SHiP) is a very rare and serious complication of pregnancy. Closely associated with endometriosis, and lack of specificity in clinic, it will increase the morbidity of the fetus and the mother. A SHiP case was reported that both mother and fetus were safe after operation. A 30-year-old primigravida was hospitalized with persistent lower abdominal pain lasting for half an hour at 39⁺² weeks. She suffered from endometriosis and received laparoscopic surgery for rupture of ovarian endometrioma four months prior to the current pregnancy. An emergency cesarean section due to suspected fetal distress and possible placental abruption was performed and a healthy female neonatal was delivered with Apgar score of 10 at 1 min, and no placental signs of abruption. During the operation, 1 200 mL of intraperitoneal hemorrhage was seen. A new active bleeding venous vessel was seen in the middle and lower segment of the right posterior wall of the uterus. The bleeding was treated and healed by suturing. SHiP requires early detection, rapid diagnosis and appropriate intervention to improve maternal and fetal outcomes in clinical practice.

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