Uterine necrosis is a rare condition that most commonly occurs during the postpartum period as a severe side effect of conservative interventions for postpartum hemorrhage. The primary treatment for uterine necrosis is a hysterectomy, and conservative management is rarely reported. We present the case of a 30-year-old Chinese woman, unipara, who underwent an emergency cesarean section at 35 weeks of gestation owing to a severe placental abruption. Postpartum hemorrhage occurred during the operation, and uterine artery ligation was employed to control the bleeding. The patient was diagnosed with partial uterine necrosis through contrast-enhanced ultrasound and magnetic resonance imaging 47 days postpartum. The imaging revealed a significantly thinner myometrium with enhancement following intravenous contrast (maximum thickness). The uterine mucosa was diffusely thickened and showed no perfusion. Given the mild clinical symptoms and stable hemodynamic parameters, conservative treatment was administered. Although uterine artery ligation is an effective treatment for postpartum hemorrhage, the possible complication of uterine necrosis that may arise after this procedure requires vigilance. In cases of uterine necrosis, contrast-enhanced ultrasound exhibits diagnostic efficacy comparable to that of magnetic resonance imaging. When hemodynamic stability is maintained, conservative management emerges as a compelling therapeutic option.

Objective: To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers. Methods: This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free beta-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high-and low-density lipoproteins (HDL, LDL) were measured at 11-13+ weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test. Results: GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001). Conclusion: A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.

Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.

Objective:To explore the effect applying the blended teaching mode based on the outcome-based education (OBE) and multi-assessment in the practice teaching of obstetrics.Methods:The experimental control method was used. Ninety five-year program students majoring in clinical medicine of Sun Yat-sen University who practiced in Department of Obstetrics, Third Hospital Affiliated to Sun Yat-sen University from August 2021 to August 2022 were selected as the research objects. They were divided into an experimental group and a control group by the envelope random method, with 45 in each group. There were 27 males and 18 females in the experimental group; they were (22.24±0.57) years old. There were 25 males and 20 females in the control group; they were (22.24±0.88) years old. The control group adopted the traditional offline practice teaching method of teacher teaching and ward practice. The experimental group adopted the blended teaching mode based on OBE concept, offline teaching combined with WeChat Rain classroom online teaching. In the mid-term evaluation of practice, the two groups' students were evaluated by the Mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedure Skills (DOPS), and Clinical Communication Skill Scale. At the end of practice, they were finally evaluated by the comprehensive assessment. The teaching effects of the two groups were compared. The measurement data were analyzed by t test, and the count data by χ 2 test or the Fisher's exact probability method. Results:In the mid-term evaluation of practice, the excellent rate of Mini-CEX in the experimental group was higher than that in the control group[15.6% (7/45) vs. 0; P<0.05]; the score of Clinical Communication Skill Scale in the experimental group was higher than that in the control group [(91.93±3.60) vs. (85.13±3.62); t=-8.938, P<0.001]. In the final evaluation, the score of the comprehensive examination in the experimental group was higher than that in the control group [(82.15±4.14) vs. (80.18±4.46); t=-2.177, P<0.05]. Conclusion:In the practice teaching of obstetrics, the application of the blended teaching mode based on OBE concept and multi-assessment has a good teaching effect on the training of clinical diagnosis and treatment thinking ability and communication ability.

Objective:To investigate the association between body fat percentage (PBF), fat mass index (FMI) and lipid profile in the first trimester with gestational diabetes mellitus (GDM).Methods:The retrospective analysis was performed on 1 578 pregnant women who received prenatal care in the Third Affiliated Hospital of Sun Yat-sen University from May 2020 to May 2021. All subjects were measured by bioelectrical impedance analysis in the first trimester to obtain PBF and fat mass, height and weight, and at the same time plasma fasting blood glucose (FPG), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were measured. 75 g oral glucose tolerance test (OGTT) was conducted between 24 and 28 weeks, FPG, 1 h plasma glucose (1hPG) and 2 h plasma glucose (2hPG) were detected, and the subjects were divided into GDM group (318 cases) and control group (1 260 cases) according to OGTT results. Independent sample t-test, Mann-Whitney U and χ2 test were used for comparison between groups, logistic regression model was used to analyze the association between observation index and GDM. Results:The prevalence of GDM was 20.15% (318/1 578). The age, BMI, PBF, FMI, FPG, TC, TG, LDL-C, 75 g OGTT-FPG, 1hPG and 2hPG, the proportion of gravidity≥3 times in the GDM group were higher than those in the control group ( P<0.05). The risk of GDM in those aged≥25 years increased 183.2% (OR=2.832, 95%CI 1.414-5.672, P<0.05), BMI≥24.0 kg/m 2 was 123.9% (OR=2.239, 95%CI 1.674-2.997, P<0.001), and PBF≥25% was 91.2% (OR=1.912, 95%CI 1.462-2.501, P<0.001). The pregnant women were grouped according to the quartile of FMI, FPG, TC, TG, HDL-C and LDL-C ( Q1, Q2, Q3 and Q4 group). The Q4 group of FMI increased the risk of GDM by 97.7% compared with the Q1 group ( P<0.05); the Q3 group and Q4 group of TC increased the risk of GDM by 63.3% and 55.7% compared with the Q1 group ( P<0.05); the Q4 group of TG increased the risk of GDM by 54.8% compared with the Q1 group ( P<0.05). Conclusions:Age≥25 years, BMI≥24.0 kg/m 2 and PBF≥25% are closely related to the incidence of GDM. The levels of PBF, FMI, TC and TG in the first trimester can provide a reference for early prediction of GDM.

目的:研究在传统教学模式中嵌入情景模拟结合视频反馈的新型教学模式对产科实习教学效果的影响.方法:选取在产科实习的80名实习生,随机分为试验组(n=40)和对照组(n=40).对照组应用传统教学方法;试验组采用新型教学方法.比较两组的实习效果及对实习教学的满意度.结果:试验组平均成绩、病历分析及体格检查成绩均高于对照组(P＜0.05);试验组对产科实习的满意度明显高于对照组(P＜0.01).结论:在传统教学模式中嵌入情景模拟结合视频反馈的新型教学模式可以提高实习生在产科的实习效果及对实习教学的满意度.

Objective To evaluate the effects of different delivery modes on diastasis recti abdominis （DRA） in 6-8 weeks postpartum period. Methods Clinical data of 1354 singleton deliveries who had regular prenatal examination and delivery were collected. According to delivery times and delivery modes, 775 primiparous women [including 546 vaginal delivery （A1 group） and 229 caesarean section （B1 group）] and 579 multipara women [including 357 second vaginal delivery （A2 group） and 222 second caesarean section （B2 group）] were followed-up. The inter-rectus distance was examined by high-frequency ultrasound at three locations on the linea alba （3 cm above the umbilicus, umbilicus, 3 cm below the umbilicus） in 6-8 weeks postpartum. The effects of two delivery modes on DRA in postpartum period were evaluated. Results DRA mainly occurred at umbilicus, followed by at the 3 cm above the umbilicus and 3 cm below the umbilicus. The incidence of DRA in the caesarean section groups was higher than that of the vaginal delivery groups among primiparous or multipara women （92.1% vs. 77.6% and 95.5% vs. 90.8%, both P < 0.05）. The inter-rectus distance at three locations in the caesarean section groups was longer than that in the vaginal delivery groups among primiparous or multipara women （B1 group vs. A1 group and B2 group vs. A2 group, all P < 0.001）. The inter-rectum distance at three locations in B2 group was longer than that in B1 group （all P < 0.001）. Conclusion Caesarean section elevates the incidence of DRA and increases the inter-rectus distance in early postpartum period.

Background: Maternal subclinical hypothyroidism (SCH) has been associated with adverse pregnancy outcomes. This study aimed to explore whether SCH in the first trimester contributed to the development of gestational diabetes mellitus (GDM). Materials and Methods: A total of 8,777 pregnant women who first visited before 13 weeks and 6 days of gestation and accepted routine prenatal service at the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to September 2018 were recruited in this study. Thyroid functions (thyroid stimulating hormone [TSH], free T4, and thyroid peroxidase antibody [TPOAb]) were measured before 13 weeks and 6 days of gestation and data of 7,536 subjects with TSH ≥0.1 mIU/L were analyzed. A 2-hour 75-g oral glucose tolerance test was performed between 24 and 28 gestational weeks. Chi-square test and multivariate logistic regression analysis were applied to evaluate the relationship between SCH and GDM. Results: The prevalence of SCH in this population was 7.53%. After stratifying the relationship between SCH and GDM according to TSH concentrations (slightly elevated TSH: ≥2.5, <4.0 mIU/L; moderately elevated TSH: ≥4.0, <10.0 mIU/L) and TPOAb status, a moderately elevated TSH combined with positive TPOAb (23.9% vs. normal 13.0%, chi-square = 6.317, p = 0.012) was found to increase the incidence of GDM. Furthermore, after adjusting for confounders (maternal age, educational levels, parity, and pregestational body mass index [preBMI]), the SCH group still exhibited a higher risk of GDM (relative risk [RR] 1.867, 95% confidence interval [CI] 1.018-3.424). Conclusion: Our findings indicated that SCH during early pregnancy, in the presence of moderately elevated TSH levels and positive TPOAb, might lead to an increased risk of GDM.

目的 探讨阴道助产对初产妇产后早期盆底功能的影响.方法 收集345例阴道分娩初产妇的临床资料,根据分娩方式分为自然分娩组170例、胎头吸引器助产组130例、产钳助产组45例,在产妇产后6～12周进行盆底肌力和盆底三维超声检查.比较3组产妇的盆底肌力异常率、膀胱颈移动度增大率、膀胱膨出率、肛提肌裂孔面积增大率、肛提肌损伤率及肛门括约肌损伤率.结果 3组产妇的年龄、BMI、孕期增重、孕周、新生儿出生体质量比较差异均无统计学意义(P均>0.05).产钳助产组盆底肌力的异常率高于自然分娩组(P<0.017),其余两两比较差异均无统计学意义(P均>0.017).产钳助产组的肛提肌损伤发生率高于自然分娩组及吸引器助产组(P均<0.017),吸引器助产组的肛提肌损伤发生率高于自然分娩组(P<0.001).3组产妇的膀胱颈移动度增大、膀胱膨出、肛提肌裂孔面积增大及肛门括约肌损伤发生率比较差异均无统计学意义(P均>0.05).盆底超声提示盆底肌肉损伤的52例产妇中,产后盆底肌力筛查示正常9例,2种检查方法的一致性检测结果为Kappa=0.061,P=0.029.结论 与自然分娩的产妇相比,产钳助产对盆底肌力的损伤最大,接受产钳助产者的肛提肌损伤发生率最高;2种产后盆底肌力检查方法相互独立,盆底超声能清晰显示盆底肌损伤状况,在产后盆底筛查中起重要作用.

患者38岁,孕4产2,因"孕27+3周,双下肢水肿3周,发现血压升高1 d"于2019年6月24日急诊收入中山大学附属第三医院产科.患者末次月经不详,根据超声推算预产期2019年9月18日.孕期未进行规律产科检查,未监测血压.

【目的】分析高海拔地区藏族孕产妇妊娠晚期全血细胞计数（CBC）、糖化血红蛋白（GHbA1c）及甲状腺功能的相关性。【方法】回顾性分析2021年1月1日至2021年12月31日在西藏自治区昌都市察雅县人民医院住院分娩的妊娠≥28周藏族单胎妊娠孕产妇临床资料，共纳入研究对象374例。研究对象均在入院时分娩前完成CBC、GHbA1c及总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、促甲状腺激素（TSH）的检测。根据研究对象长期居住地的海拔高度将其分为三组：A组海拔高度＜3 500 m;B组海拔高度3 500～4 000 m;C组海拔高度＞4 000 m。分析高海拔地区藏族孕产妇妊娠晚期经海拔校正前后的贫血率，不同海拔高度妊娠晚期CBC、GHbA1c及甲状腺功能水平及其相关性。【结果】（1）该地区妊娠晚期实测血红蛋白（HB）水平为120.0（108.0～130.0）g/L，贫血率27.8%（104/374），海拔校正后HB水平为93.0（80.0～104.0）g/L，贫血率为84.3%（315/374）；（2）三组对比，实测HB水平随海拔升高有上升趋势，但差异无统计学意义（P＞0.05），实测贫血率比较差异无统计学意义（P＞0.05）；经海拔校正后HB水平随海拔升高呈下降趋势，贫血率随海拔升高呈上升趋势，差异有统计学意义（P＜0.001）；（3）三组对比，红细胞计数（RBC）、平均红细胞血红蛋白浓度（MCHC）随海拔升高呈上升趋势，TSH随海拔升高呈下降趋势，差异有统计学意义（P＜0.05）；（4）实测HB、MCHC水平与TT4呈正相关，GHbA1c与TT4呈负相关，与血小板计数（PLT）呈正相关，相关性分析有统计学意义（P＜0.05）。【结论】高海拔地区藏族孕产妇妊娠晚期实测HB水平随海拔升高上升趋势不明显，海拔校正后贫血率大增。随海拔升高TSH呈下降趋势，海拔高度可能对妊娠晚期甲状腺相关激素有影响。妊娠晚期实测贫血与低T4水平相关，低T4水平、高PLT与GHbA1c升高有关，妊娠晚期实测HB、PLT及T4水平有望成为GDM的预测因子。

例1 患者31 岁,孕2产0,因"停经39 +3周,下腹阵痛6 h"于2014年8月8 日收入中山大学附属第三医院产科.患者孕期定期产前检查,妊娠期血常规提示血红蛋白波动在100～110 g/L,其余各项检查均正常,否认既往高血压、糖尿病、心脏病、癫痫等病史.入院诊断:(1 )妊娠39 +3周,先兆临产;(2)轻度贫血.入院后患者生命体征平稳顺利进入产程,第一产程14小时零5 分钟,患者无不适,第二产程指导用力15 min后患者突然出现抽搐,呼之不应,口吐白沫,呼吸困难和低氧血症.立即启动多学科[神经内科、神经外科、心血管内科、麻醉科、新生儿科、重症监护病房(intensive care unit,ICU)]急会诊,怀疑羊水栓塞,按照羊水栓塞抢救并气管插管,抢救期间血压最高148/86 mmHg,检测尿蛋白(-),胎心率100～110 次/min,钳产助产娩出一足月女婴,出生体重4000 g,Apgar评分9-10-10分,因代谢性酸中毒转新生儿科.分娩后患者行头颅CT平扫(图1 A)、计算机断层扫描动脉造影(computed tomography angiography,CTA)及计算机断层扫描静脉造影(computed tomography venography, CTV)检查,左侧大脑中动脉M1 段可见一球状突起,大小约24 mm ×22 mm,左侧大脑中动脉M1段动脉瘤破裂伴广泛蛛网膜下腔出血,双侧侧脑室后角及第四脑室积血(图1B,C).产后24 h阴道出血约300 ml.产后患者处于轻度昏迷,呼吸机辅助呼吸,格拉斯哥昏迷指数评分(Glasgow Coma Scale,GCS)为7分(唤醒能睁眼、伴呻吟、对外界刺激四肢可屈曲有反应),Hunt-Hess分级属于Ⅳ级.因患者浅昏迷伴肺部感染、广泛的蛛网膜下腔出血和脑水肿,动脉瘤2. 5 cm开颅手术难度较大,死亡率极高,全院大会诊和与患者家属沟通后,家属考虑手术风险,强烈要求保守治疗.

目的 探讨形成性评价在产科住院医师规范化培训(简称住培)教学病例讨论中的应用价值.方法 选择2014年7月至2019年12月期间在中山大学附属第三医院产科接受培训的住院医师共83人,其中参加教学病例讨论应用形成性评价的57人作为研究组,参加传统病例讨论的26人作为对照组.通过对住院医师及带教老师的问卷调查,了解两组住院医师参加病例讨论后的学习心得,同时了解住院医师和带教老师对病例讨论中应用形成性评价的体会.结果 研究组在提高病史汇报的全面性及提炼能力、治疗计划的正确性、疾病新进展的掌握、语言表达能力、临床思维能力以及学习的主观能动性方面,均优于对照组(均P<0.05),研究组住院医师和带教老师均肯定了在病例讨论中应用形成性评价的可行性、有效性.结论 形成性评价可以更好地激发住院医师的学习积极性,培养其岗位胜任力,同时促进带教老师规范带教过程,及时改进教学方法,值得在住培的病例讨论教学活动中进一步推广.

Objective:To explore the effects of gestational diabetes mellitus (GDM) on the perinatal outcomes in twin pregnancies, and analyze the risk factors of twin pregnancies complicated with GDM.Methods:Retrospective analysis was performed on 757 patients of twin pregnancies who had delivered in the Third Affiliated Hospital of Sun Yat-sen University during January 2015 to June 2020. According to the results of 75 g oral glucose tolerance test (OGTT), 196 cases were in the GDM group, and 561 cases were inthe non-GDM group. The clinical characteristics of the subjects were recorded, the perinatal outcomes of the two groups were compared by using t test, Mann-Whitney U test, χ 2 test or Fisher exact probability method;the risk factors related to GDM were analyzed by multivariate-logistic stepwise regression. Results:Compared with the non-GDM group, 75 g OGTT-fasting plasma glucose (FPG), 1 h plasma glucose (PG), 2 h PG in GDM group were higher, gestational weeks and birth weight of newborn in GDM group were lower, the rate of preterm birth(<37 weeks) was higher. The incidence of neonatal respiratory distress syndrome, infection and anemia in the GDM group was higher than that in the non-GDM group (all P<0.05). There were statistically significant differences in age, pre-pregnancy body mess index (pre-BMI), gravidity, parity, proportion of in vitro fertilization and embryo transfer (IVF-ET), chorionicity, polycystic ovary syndrome (PCOS) history and family history of diabetes (all P<0.05). Risk factors were analyzed by multivariate-logistic stepwise regression, age ≥35 years (OR=2.335), pre-BMI ≥24.0 kg/m 2 (OR=2.356), PCOS history (OR=1.932) and family history of diabetes (OR=3.127) were independent risk factors for GDM in twin pregnancies (all P<0.05). Conclusions:GDM increased the incidence of preterm birth less than 37 weeks, neonatal respiratory distress syndrome, infection and anemia in twin pregnancies. Age ≥35 years, pre-BMI ≥24.0 kg/m 2, PCOS history and family history of diabetes were independent risk factors for GDM in twin pregnancies.

Objective:To explore whether thyroid stimulating hormone (TSH) treat-to-target during early pregnancy had an impact on the incidence of gestational diabetes mellitus (GDM) in women with hypothyroidism.Methods:A retrospective analysis was performed on naturally conceived singleton pregnant women who had accepted routinely prenatal services at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2018. The gestational weeks of the first obstetric examination were before 13 weeks and 6 days of gestation. Data of 6 978 subjects were analyzed, including 186 cases in the hypothyroidism group and 6 792 cases in the normal group. In the hypothyroidism group, according to whether TSH levels were<2.5 mU/L in the first prenatal examination, 124 cases were in the under control group and 62 cases in the non-control group. Basic information was collected at first visit, and laboratory tests were performed with fasting samples, including thyroid function [TSH, free thyroxine (FT4), thyroid peroxidase antibody (TPOAb)] and fasting plasma glucose (FPG). The 75-gram oral glucose tolerance test (OGTT) was performed at 24 to 28 weeks. The incidence of GDM and the impact of TSH levels on it between the hypothyroidism group and the normal group were explored by using χ2 test. The risk factors of GDM were analyzed by logistic regression. Results:The incidence of GDM in the hypothyroidism group was higher than that in the under-control group [21.5% (40/186) vs. 13.7% (929/6 792), P=0.002]. The incidences of GDM in the under-control group [20.2% (25/124)] and the non-control group [24.2% (15/62)] were higher than that of the control group (all P<0.05). Multivariate logistic regression analysis for risk factors of incidence of GDM was performed, and finally age, pregestational body mass index, history of hypothyroidism, FPG, positive TPOAb, and triglyceride were considered to be independent risk factors for incidence of GDM ( P<0.05). Whether TSH met the standard was ruled out from the equation. Conclusion:Compared with women with normal thyroid function, women with hypothyroidism still are at higher risk of developing GDM, whether TSH levels are under control or not.

[目的]探讨产后腹直肌分离的相关危险因素.[方法]回顾性分析2019年6月至2020年10月在中山大学附属第三医院岭南医院产检并分娩,且产后3个月内使用高频超声探头测量腹直肌的孕妇共2394例,根据腹直肌是否分离,分为非DRA组321例和DRA组2073例.收集两组孕期的一般临床特点和分娩结局,包括:年龄、身高、产次、体质量指数、是否合并糖尿病、分娩孕周、分娩方式和新生儿出生体质量等.对比分析两组之间的临床特点差异,通过Logistic回归分析方法分析DRA发生的危险因素.[结果]①产后3个月内DRA以脐部分离为主,发生率为86.6％.其中轻度DRA发生率32.1％,中度DRA发生率48.2％,重度DRA发生率6.3％.②与非DRA组相比较,DRA组的产妇年龄、孕前BMI、分娩前BMI和新生儿出生体质量更大(P<0.001),DRA组中多产和剖宫产的比例更高(48.2％vs.26.8％和41.3％vs.19.6％,P<0.001).③高龄、多产和剖宫产均为产后DRA发生的独立危险因素[OR=4.137,95％CI为(2.655,6.448);OR=2.892,95％CI为(2.198,3.805)和OR=3.217,95％CI为(2.379,4.350),P<0.05].[结论]高龄、多产和剖宫产均为产妇产后DRA发生的独立危险因素.

Abstract Background Preeclampsia (PE) is a frequently occurring pregnancy disorder in the placenta, which results in various maternal and fetal complications. The current study aims to evaluate the role of extracellular vesicles (EVs)-encapsulated microRNA (miR)-101 in biological processes of trophoblasts in PE and its underlying mechanism. Methods Human umbilical cord mesenchymal stem cell (HUCMSC) and HUCMSC-derived EVs were isolated and cultured, after which EV characterization was carried out using PKH67 staining. In silico analyses were adopted to predict the downstream target genes of miR-101, and dual luciferase reporter gene assay was applied to validate the binding affinity. Furthermore, loss- and gain-of-function approaches were adopted to determine the role of miR-101 and bromodomain-containing protein 4 (BRD4) in trophoblast proliferation and invasion using EDU staining and transwell assay. In addition, a rat model of PE was established to verify the function of EV-encapsulated miR-101 in vivo. Results Placental tissues obtained from PE patients presented with downregulated miR-101 expression and upregulated BRD4 and CXCL11 expression. EV-encapsulated miR-101 from HUCMSCs could be delivered into the trophoblast HTR-8/SVneo cells, thus enhancing proliferation and migration of trophoblasts. Mechanically, miR-101 targeted and negatively regulated BRD4 expression. BRD4 knockdown promoted the proliferation and migration of trophoblasts by suppressing NF-κB/CXCL11 axis. EV-encapsulated miR-101 from HUCMSCs also reduced blood pressure and 24 h urine protein in vivo, thereby ameliorating PE. Conclusion In summary, EV-encapsulated miR-101 promoted proliferation and migration of placental trophoblasts through the inhibition of BRD4 expression via NF-κB/CXCL11 inactivation.

[目的]探讨系统性红斑狼疮(SLE)合并妊娠孕妇孕期病情变化以及对妊娠结局的影响,分析不良妊娠结局的相关危险因素.[方法]回顾性分析2013年1月1日至2018年12月31日在中山大学附属第三医院产检并分娩,且病例资料完整的合并SLE孕妇,共89例孕妇,95次妊娠,分析孕期SLE病情活动情况及妊娠结局,找出不良妊娠结局的相关危险因素.[结果]①根据SLE疾病活动指数(SLEDAI)评价病情变化,将其分为疾病活动组及稳定组,其中孕期出现病情活动39例(活动组,A组),病情稳定56例(稳定组,B组),狼疮活动率为41.05％,其中妊娠期初发病例和孕前病情不清非计划妊娠的患者中为100％(17/17),在孕前病情稳定计划妊娠的患者中为28.21％(22/78),差异有统计学意义(P<0.05);②不良妊娠结局:其中胎儿丢失、早产、胎儿宫内生长受限(IUGR)、子痫前期、活动性狼疮肾炎在活动组发生率分别为20.51％、35.90％、43.59％、17.95％、41.02％,稳定组分别为1.8％、14.29％、17.86％、3.57％、0,两组相比差异有统计学意义(P<0.05),胎儿窘迫、新生儿窒息、新生儿狼疮在活动组发生率分别为10.26％、7.69％、2.56％,稳定组分别为1.79％、1.79％、0,两组相比差异无统计学意义(P>0.05);③孕前SLE病情不清非计划妊娠、此次妊娠发生活动性狼疮肾炎、aPL阳性、抗SSA阳性均为不良妊娠结局的危险因素(P<0.05).[结论]SLE患者妊娠时机的选择对孕期疾病活动情况至关重要,孕期SLE病情活动增加胎儿丢失、早产、IUGR、子痫前期、活动性狼疮肾炎的发生率;孕前SLE病情不清非计划妊娠、此次妊娠发生活动性狼疮肾炎、aPL阳性、抗SSA阳性与不良妊娠结局密切相关.

This study aims to evaluate the relationship between subclinical hypothyroidism (SCH) during the first trimester and gestational diabetes mellitus (GDM) that was happened later on in our cohort. A total of 6530 pregnant women who first visited before 13+6 gestational weeks and accepted routinely prenatal services in the third affiliated hospital of Sun Yat-Sen University from January 2015 to September 2018 were finally met the inclusion criteria and recruited. Thyroid functions were performed at the first visit and a 2h 75-g OGTTwas performed between 24-28 weeks. The glucose levels of OGTT were shown no differences between SCH and euthyroid women [0 hour: 4.17 mmol/L (3.99-4.38) vs. 4.16 mmol/L (3.97-4.39), P = 0.730; 1 hour: 7.61 mmol/L (6.64-8.66) vs. 7.68 mmol/L (664-8.75), P = 0.449; 2 hour: 6.66 mmol/L (5.85-7.68) vs. 6.75 mmol/L (5.93-7.74), P = 0.142]. The incidence of GDM was no change as the TSH level increased in either TPOAb negative or positive SCH women (all P > 0.05). After using the multivariate logistic regression analysis adjusted for confounders (maternal age, educational levels and preBMI), elevated TSH and TPOAb status also had no effect on the incidence of GDM (Table 1). These results suggested maternal SCH in the first trimester was not related to GDM, regardless of the TPOAb status or the TSH levels. Disclosure P. Li: None. S. Lin: None. J. Fan: None. Funding Science and Technology Planning Project of Guangdong Province (2017A020215026); Medical Scientific Research Foundation of Guangdong Province (A2017314)

复发性流产是指与同一性伴侣连续发生3次及3次以上的自然流产 [1],在育龄女性中发病率达1％～5％[2],是一种常见的妊娠并发症.对于流产的次数一直存在争议,虽然复发性流产定义为3次及3次以上的自然流产,但多数学者认为连续发生2次流产即应重视和评估,因为其再次发生流产的机会与3次者相近.2008年美国生殖协会将复发性流产的定义为2次及2次以上的连续自然流产 [3].所以出现2次及2次以上的连续自然流产时必须警惕发生流产的可能原因,当流产次数达3次及3次以上,建议进行全面的病因学检查 [4].