OBJECTIVE:To investigate whether prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia compared with placebo. DESIGN:Randomised, double blind, placebo controlled, phase 3 study. SETTING:24 maternity units across China between July 2023 and March 2025. PARTICIPANTS:1732 women with placenta praevia undergoing caesarean delivery. INTERVENTIONS:Participants were randomly (1:1) assigned to receive prophylactic oxytocin and either tranexamic acid (1 g in 10 mL) or placebo (10 mL normal saline) diluted in 40 mL normal saline intravenously over 10 minutes, initiated within five minutes of umbilical cord clamping. MAIN OUTCOME MEASURES:The primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery. Serious adverse events included thromboembolic events, seizures, acute kidney or liver injury, and maternal death. RESULTS:Of 1732 women with placenta praevia who were randomised, 38 were excluded because they withdrew consent or were determined to be ineligible after randomisation. Primary outcome data were available for 99.8% (1691/1694) of the remaining women. Placenta accreta spectrum was diagnosed in 303 participants (17.9%). The primary outcome occurred in 29.7% (251/845) of the tranexamic acid group and 35.1% (297/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01). The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00). CONCLUSIONS:In women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events. TRIAL REGISTRATION:ClinicalTrials.gov NCT05811676.

Preeclampsia (PE) is a placenta-driven hypertensive disorder characterized by oxidative stress, mitochondrial dysfunction, and abnormal autophagy. However, how these stress-response programs are coordinated at the post-transcriptional level remains incompletely understood. We integrated transcriptomic, proteomic, and untargeted metabolomic profiling of placentas from PE patients and normotensive controls, followed by validation in an independent clinical cohort. Mechanistic roles were interrogated using hypoxia-treated HTR-8/SVneo trophoblasts and an L-NAME-induced PE-like mouse model. Autophagy dynamics were assessed using dual-fluorescent autophagic flux reporters, transmission electron microscopy, and molecular markers. Multi-omics analyses converged on oxidative stress-related pathways, oxidative phosphorylation, and autophagy. The m6A reader HNRNPC was selectively upregulated at the protein level in PE placentas and positively correlated with the autophagy-related SNARE protein SEC22B. Clinically, PE placentas exhibited elevated global m6A methylation, increased HNRNPC and SEC22B expression, enhanced autophagic activity, and excessive oxidative stress. In trophoblasts, hypoxia induced ROS and autophagy, while HNRNPC overexpression further amplified intracellular and mitochondrial ROS, enhanced autophagic flux, and promoted apoptosis. In vivo, placental overexpression of HNRNPC aggravated hypertension, proteinuria, placental structural damage, oxidative stress, and autophagy dysregulation in PE-like mice. Our findings implicate a potential HNRNPC-SEC22B-autophagy regulatory network that amplifies placental stress maladaptation in preeclampsia. This study links epitranscriptomic remodeling to redox and autophagy dysregulation, suggesting HNRNPC as a potential mechanistic hub and therapeutic target in PE.

Circular RNAs are associated with important pathophysiological characteristics of gestational diabetes mellitus (GDM). This study preliminarily explored circular polyribonucleotide nucleotidyltransferase 1 (circ-PNPT1) expression in placental tissues and serum of GDM patients and its role in regulating the miR-144-3p/UBE2G1 axis to affect endothelial dysfunction in GDM. Twenty GDM patients and 20 pregnant women with normal glucose tolerance were enrolled. Human umbilical vein endothelial cells (HUVECs) were cultured with high glucose (HG) to establish an in vitro GDM model, then treated with short hairpin-circ-PNPT1 and a lentiviral empty plasmid. Circ-PNPT1 levels, HUVEC viability, endothelial function, and oxidative damage were assessed using RT-qPCR tube formation, CCK-8, flow cytometry, and Transwell assays, respectively. Normally cultured and HG-cultured HUVEC samples underwent small RNA sequencing to analyze differentially expressed miRNAs. The possible miRNAs and mRNAs downstream of circ-PNPT1 were screened using bioinformatics and verified using RT-qPCR, dual luciferase reporter assay, and Ago2-RIP. GDM patients exhibited highly expressed circ-PNPT1 and UBE2G1, and weakly expressed miR-144-3p in placental tissues and serum. In vitro, HG-treated HUVECs displayed highly expressed circ-PNPT1 and cellular dysfunction, as evidenced by reduced cell survival, enhanced apoptosis, decreased cell migration and angiogenesis, an elevated MDA level, and downregulated SOD and GSH-Px levels. Circ-PNPT1 knockdown alleviated HG-induced HUVEC dysfunction. circ-PNPT1 might target and bind miR-144-3p; miR-144-3p might target and bind UBE2G1. Additionally, circ-PNPT1 might act as a competing endogenous RNA for miR-144-3p to regulate UBE2G1 expression in HG-induced HUVECs. Taken together, circ-PNPT1 modulates HG-induced HUVEC dysfunction via the miR-144-3p/UBE2G1 axis.

Reactive oxygen species (ROS) can stimulate autophagy and pyroptosis, which have been slightly reported in preeclampsia (PE). Mucolipin TRP Cation Channel 1 (MCOLN1) is a sensor for autophagy to receive ROS. This study aimed to investigate the role of MCOLN1 on ROS-mediated autophagy and pyroptosis in an in vitro model of PE. HTR-8/SVneo cells were treated with different concentrations of rotenone and pre-transfected with plasmids overexpressing or silencing MCOLN1. Thiazolyl blue tetrazolium bromide was used to examine the effects of rotenone and MCOLN1 on trophoblasts. ROS levels were detected by 2',7'-Dichlorodihydrofluorescein Diacetate (DCFH-DA). The levels of MCOLN1, pyroptosis and autophagy-related proteins were determined by western blot, and the mRNA level of MCOLN1 was examined by quantitative real-time polymerase chain reaction. The effect of MCOLN1 on rotenone-treated trophoblast cells was also analyzed using flow cytometry, wound healing, Transwell, and Enzyme-linked immunosorbent assay (ELISA) experiments. Rotenone decreased cell viability and induced ROS levels in a concentration-dependent manner in HTR-8/SVneo. MCOLN1 overexpression partially reversed the inhibition of cell viability, migration and invasion and the promotion of apoptosis by rotenone; but MCOLN1 silencing enhanced the effect of rotenone. Unlike MCOLN1 silencing, MCOLN1 overexpression reduced rotenone-elevated Interleukin (IL)-18, IL-1β, Gasdermin D (GSDMD), nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), pro-caspase 1, caspase 1, but enhanced Beclin 1, Microtubule-associated protein 1 light chain 3 (LC3)II/LC3I levels, and inhibited Sequestosome 1 (P62) expression suppressed by rotenone. MCOLN1 mediates autophagy and pyroptosis balance to alleviate trophoblast dysfunction caused by excess ROS.

OBJECTIVE: To evaluate the association between previous non–cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies. DATA SOURCES: PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov, CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches. METHODS OF STUDY SELECTION: Studies included prospective, retrospective cohort, case–control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery. TABULATION, INTEGRATION, AND RESULTS: Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle–Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity (I 2) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non–cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43–3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77–2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50–90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78–2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10–14.53), abortion (OR 1.65, 95% CI, 1.43–1.92), endometrial ablation (OR 20.26, 95% CI, 17.15–23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86–5.18). CONCLUSION: Prior non–cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42024552210.

OBJECTIVE:To evaluate the association between previous non-cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies. DATA SOURCES:PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov , CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches. METHODS OF STUDY SELECTION:Studies included prospective, retrospective cohort, case-control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery. TABULATION, INTEGRATION, AND RESULTS:Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle-Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity ( I2 ) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non-cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43-3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77-2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50-90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78-2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10-14.53), abortion (OR 1.65, 95% CI, 1.43-1.92), endometrial ablation (OR 20.26, 95% CI, 17.15-23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86-5.18). CONCLUSION:Prior non-cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery. SYSTEMATIC REVIEW REGISTRATION:PROSPERO: CRD42024552210.

Background Pregnancy-related anemia presents a significant health concern for approximately 500 million women of reproductive age worldwide. To better prevent maternal disorders, it is essential to understand the impact of iron deficiency across different maternal disorders, regions, age groups, and subcategories.Methods Based on the comprehensive maternal disorders data sourced from the 2019 Global Burden of Disease study, an investigation was carried out focusing on Disability-Adjusted Life Years (DALYs) associated with iron deficiency spanning the period from 1990 to 2019. In addition, Estimated Annual Percentage Changes (EAPCs) were computed for the duration of the study.Results Our study indicates decreasing mortality rates and years of life lost due to maternal conditions related to iron deficiency, such as maternal hemorrhage, miscarriage, abortion, hypertensive disorders, and infections. However, mortality rates and years of life lost due to indirect and late maternal deaths, as well as deaths aggravated by HIV/AIDS, have increased in high socio-demographic index (SDI) regions, especially in North America. Moreover, the proportion of maternal deaths aggravated by HIV/AIDS due to iron deficiency is rising globally, especially in Southern Sub-Saharan Africa, Oceania, and Georgia. In addition, in the Maldives, the age-standardized DALYs for maternal disorders attributable to iron deficiency exhibited a notable decreasing trend, encompassing a range of conditions. Furthermore, there was a significant decrease in Disability-Adjusted Life Years rate for miscarriages and preterm births among women aged 15-49, with hypertensive disorders posing the highest burden among women aged 15-39.Conclusion The burden of maternal disorders caused by iron deficiency is decreasing in most regions and subtypes, except for deaths aggravated by HIV/AIDS. By thoroughly understanding the details of how iron deficiency impacts the health of pregnant women, health policymakers, healthcare professionals, and researchers can more effectively pinpoint and address the root causes of inequalities in maternal health.

目的 探讨孕期膳食模式与妊娠糖尿病(GDM)发病的关系,为指导孕妇合理膳食、预防GDM提供依据.方法 选择2021年12月—2022年7月在新疆医科大学第一附属医院产检的孕妇为调查对象,于孕24～28周通过口服葡萄糖耐量试验(OGTT)诊断GDM;采用"中国孕产妇营养与健康科学调查"项目的调查问卷收集基本情况、行OGTT前1个月内的食物摄入频率和每次摄入量;采用因子分析法确定膳食模式;采用多因素logistic回归模型分析膳食模式与GDM患病的关联.结果 纳入449名孕妇,年龄M(QR)为31.00(5.00)岁,孕周M(QR)为35.00(3.00)周.发现7种膳食模式,根据因子载荷较高的食物种类分别命名为薯类-杂粮、禽畜肉类-甜点、奶蛋-水产品、菌类蔬菜-动物内脏、水果-豆类、咸菜-面食、饮料-坚果模式.诊断为GDM 89例,患病率为19.82％.多因素logistic回归分析结果显示,以薯类-杂粮模式为参考,禽畜肉-甜点模式(OR=0.242,95％CI:0.086～0.678)和水果-豆类模式(OR=0.093,95％CI:0.025～0.342)与GDM患病存在统计学关联.结论 相比于薯类-杂粮模式,禽畜肉-甜点模式、水果-豆类模式可能降低GDM的发生风险.

With the development of perinatal medicine in China for more than 30 years, great progress has been made in the fight against infectious diseases associated with pregnancy, including better knowledge, improved clinical treatment, and more effective preventive measures. This article reviews and prospects the prevention and treatment of infectious diseases in pregnancy in China from the four aspects: mother-to-child transmission of acquired immune deficiency syndrome, syphilis, and hepatitis B; toxoplasma, others, rubella virus, cytomegalovirus, and herpes simplex virus infection; influenza and novel coronavirus infection; and sepsis.

目的 了解乌鲁木齐市区孕妇孕期每日饮水量及其影响因素分析,为对孕妇饮水开展有针对性的健康教育工作提供依据.方法 于2021年6月-2022年7月,采用方便抽样的方式抽取新疆医科大学第一附属医院产科自愿参与本课题的559名孕妇作为研究对象,采用标准量具结合问卷调查方式收集孕妇基本情况、身体活动度和饮水摄入量相关的情况,采用Wilcoxon秩和检验、Kruskal-Wallis H秩和检验和多元线性回归对孕妇每日饮水量及其影响因素进行分析.结果 孕妇总饮水量的中位数为1808 mL/d,其中白水饮用量最多(1500 mL/d),其次为液态奶及酸奶和其他饮料(257.12 mL/d和77.62 mL/d).单因素分析显示,孕妇每日总饮水量在不同孕期、文化程度和工作状态上的差异均具有统计学意义(P<0.05).多元线性回归显示,孕期是孕妇每日饮水量、白水和液态奶及酸奶摄入量的最主要影响因素,而孕前体质指数分级是其他饮料摄入量的主要影响因素.结论 乌鲁木齐市区部分孕妇存在饮水量不足的现状,对孕妇进行饮水的健康宣教时需考虑孕期、文化程度、孕前体质指数分级、身体活动强度、产次等因素,改善饮水行为方式.

患者35岁，妊1产0，因"孕24+2周无明显诱因出现阴道流液3个多小时，随后出现不规律下腹阵痛不适"于2020年10月30日01：20就诊四川省人民医院(我院)急诊并收入院。患者因"多囊卵巢综合征"在我院行体外受精－胚胎移植(in vitro fertilization and embryo transfer，IVF-ET)术后双胎妊娠，孕早期彩色多普勒超声(彩超)确诊为双胎妊娠双绒毛膜双羊膜囊(双绒双羊)，按双胎妊娠常规产检，孕16周行胎儿四维超声及胎儿心脏超声结果未见明显异常，孕16+3周自选无创DNA检测，提示13、18、21-三体低风险。否认其他疾病，否认家族遗传病史。

Objective To explore the association between inter-pregnancy intervals and placenta previa and placenta accreta spectrum among women who had prior cesarean deliveries with respect to maternal age at first cesarean delivery. Methods This retrospective study included clinical data from 9981 singleton pregnant women with a history of cesarean delivery at 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. The study population was divided into four groups (<2, 2-5, 5-10, >= 10 years of the interval) according to the inter-pregnancy interval. The rate of placenta previa and placenta accreta spectrum among the four groups was compared, and multivariate logistic regression was used to analyze the relationship between inter-pregnancy interval and placenta previa and placenta accreta spectrum with respect to maternal age at first cesarean delivery. Results Compared to women aged 30-34 years old at first cesarean delivery, the risk of placenta previa (aRR, 1.48; 95% CI, 1.16-1.88) and placenta accreta spectrum (aRR, 1.74; 95% CI, 1.28-2.35) were higher among women aged 18-24. Multivariate regression results showed that women at 18-24 with <2 years intervals exhibited a 5.05-fold increased risk for placenta previa compared with those with 2-5-year intervals (aRR, 5.05; 95% CI, 1.13-22.51). In addition, women aged 18-24 with less than 2 years intervals had an 8.44 times greater risk of developing PAS than women aged 30-34 with 2 to 5 years intervals (aRR, 8.44; 95% CI, 1.82-39.26). Conclusions The findings of this study suggested that short inter-pregnancy intervals were associated with increased risks for placenta previa, and placenta accreta spectrum for women under 25 years at first cesarean delivery, which may be partly attributed to obstetrical outcomes.

Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods: This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31%vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87%vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03%vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32%vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01%vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27%vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 %vs. 231/869,26.58%) was significantly increased in the PA group (P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) gvs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40%vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01%vs. 210/869, 24.17%) also increased significantly (P < 0.05). Weight (odds ratio (OR)= 1.03, 95% confidence interval (CI): 1.01-1.05)), parity (OR= 1.18, 95%CI: 1.03-1.34), number of miscarriages (OR= 1.31, 95%CI: 1.17-1.47), number of previous cesarean sections (OR= 2.57, 95%CI: 2.02-3.26), history of premature rupture of membrane (OR= 1.61, 95%CI: 1.32-1.96), previous cesarean-section transverse incisions (OR= 1.38, 95%CI: 1.12-1.69), history of placenta previa (OR= 2.44,95%CI: 1.50-3.96), and the combination of prenatal hemorrhage (OR= 9.95,95%CI: 8.42-11.75) and placenta previa (OR= 91.74, 95%CI: 74.11-113.56) were all independent risk factors for PA.Conclusion: There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

目的 分析妊娠期脂代谢异常与子痫前期发生的关系.方法 回顾性选取2019年1月至2020年1月于新疆医科大学第一附属医院产检并分娩的53例子痫前期产妇作为观察组,并选取同期医院产检并分娩的53例正常产妇作为对照组.记录两组产妇妊娠早、中、晚期的脂代谢指标,分析其与子痫前期发生的关系.结果 两组早、中、晚期的甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平比较,差异具有统计学意义(P＜0.001);进一步两两比较发现,两组晚期TG、HDL-C、LDL-C分别与两组早期及中期比较,差异具有统计学意义(P＜0.001),两组中期TC与观察组早期及对照组晚期比较,差异具有统计学意义(P＜0.001),但观察组中期与晚期TC及对照组早期与中期TC比较,差异无统计学意义(P＞0.05).经Logistic回归分析结果显示,不同妊娠期脂代谢水平与子痫前期的发生有关,妊娠早、中、晚期TG、TC、LDL-C升高及HDL-C降低可能是子痫前期发生的风险因子(P＜0.05);绘制受试者工作特征(ROC)曲线结果显示,妊娠早、中、晚期TG、TC、HDL-C、LDL-C水平预测子痫前期发生风险的AUC均＞0.80.结论 妊娠期血脂代谢水平异常与子痫前期的发生有关,可能是产妇发生子痫前期的风险因子.

目的:探究既往人工流产次数对于剖宫产术后再次妊娠母婴围产结局的影响.方法:回顾分析广州医科大学附属第三医院等国内7省10家三级医院妇产科于2017年1月至2017年12月收治的剖宫产术后再次妊娠28周后分娩的孕妇,收集孕产妇的一般资料和本次妊娠情况,分析既往人工流产史对于剖宫产后再次妊娠的妊娠合并症及新生儿不良结局的影响.结果:共纳入9468例孕妇,其中无流产史者5305例,有人工流产史者4163例,并根据人工流产次数分为人工流产1次组(2482例),人工流产2次组(1165例),人工流产≥3次组(516例).4组孕妇的年龄、孕前体重、孕期增重、分娩孕周、产前出血、前置胎盘、胎盘植入、产后出血、新生儿转入NICU之间比较,差异有统计学意义(P<0.05).二元logistic回归分析显示,与无流产史组相比,人工流产次数是剖宫产术后再次妊娠发生前置胎盘的独立危险因素(aOR1:1.44,95％CI为1.19～1.76;aOR2:2.18,95％CI为1.73～2.73,aOR3:3.65,95％CI为2.78～4.78);同时,人工流产史是产后出血的独立危险因素(aOR1:1.48,95％CI为1.10～1.98;aOR2:1.62,95％CI为1.12～2.36;aOR3:3.29,95％CI为2.20～4.93).人工流产≥2次是胎盘植入的独立危险因素(aOR2:1.87,95％CI为1.39～2.50;aOR3:4.22,95％CI为3.08～5.77).结论:既往人工流产次数是瘢痕子宫再次妊娠孕妇发生前置胎盘、产后出血的独立危险因素.人工流产次数增加,可能会增加剖宫产后再次妊娠孕妇发生胎盘植入的风险.

双语教学是培养具有扎实专业知识及良好外语交流能力的复合型医学人才的重要途径.双语师资建设直接影响到双语教学效果,现就新疆医科大学第一临床医学院参与妇产科双语教学的15名专业教师及143名七年制临床学生围绕着双语教师的专业水平、英语语言能力、双语教学实践能力进行问卷调查与分析,提出妇产科双语教学高质量可持续发展的理论依据,以提高妇产科学双语教学效果,进一步达到培养复合型医学人才的需要.

目的 探讨孕妇体重指数(BMI)、炎症相关指标及D-二聚体与子痫前期的相关性.方法 选取子痫前期孕妇为病例组共80例,选取同期进行孕检的正常孕妇作为对照组共83例,计算两组孕妇BMI,同时检测两组孕妇血清中的C反应蛋白(CRP)、D-二聚体、白细胞介素6(IL-6)、白细胞(WBC)的表达水平,登记孕周,并应用Logistic回归、ROC曲线进行分析.结果 病例组孕妇BMI、血清CRP水平、D-二聚体水平高于对照组,孕周小于对照组,差异有统计学意义(P<0.05);病例组的血清IL-6水平和WBC计数与对照组相比的差异无统计学意义(P>0.05);孕期BMI、血清CRP水平预测子痫前期发生风险的曲线下面积(AUC)分别是0.725、0.632.结论 孕妇BMI、血清CRP水平、D-二聚体是子痫前期发病的危险因素,且BMI及血清CRP水平对子痫前期的发病有预测价值,可以为早期预测及治疗子痫前期提供依据.

目的 探讨子痫前期(preeclampsia,PE)孕妇血清维生素D水平与维生素D受体(vitamin D receptor,VDR)基因多态性的相关性,分析VDR与子痫前期的关系.方法 选取2018年2月 ～2019年4月新疆医科大学第一附属医院收治的子痫前期孕妇100例为PE组,另选取同期健康孕妇100例为对照组;比较两组孕妇一般资料及VDR基因位点BsmI、ApaI、ForI、TaqI表达多态性差异;再根据孕妇血清1,25(OH)2D3是否低于30ng/ml进行亚组分析.结果 PE组孕妇血清1,25(OH)2D3、血钙及白蛋白水平低于对照组,甘油三酯水平高于对照组,差异有统计学意义(P<0.05);在低1,25(OH)2D3水平孕妇中,PE组VDR基因位点中BsmI GG基因型、G等位基因频率及ForI CC基因型、C等位基因频率高于对照组,差异有统计学意义(P<0.05);在正常1,25(OH)2D3水平孕妇中,PE组与对照组各VDR基因位点的基因型及等位基因频率情况差异无统计学意义(P>0.05).结论 子痫前期孕妇体内维生素D水平较低,低维生素D水平且BsmI位点GG基因型及ForI位点CC基因型比例较高的孕妇易发生子痫前期.

目的 探讨新疆地区汉族、维吾尔族及哈萨克族孕妇维生素D受体(VDR)基因多态性与子痫前期(PE)风险的相关性.方法 选取2017年6月至2019年6月于新疆医科大学第一附属医院行产前检查并确诊PE的新疆地区汉族、维吾尔族及哈萨克族124例患者纳入PE组,按民族分为汉族PE组(n=41)、维吾尔族PE组(n=42)及哈萨克族PE组(n=41);选取同期行产前检查的三民族127名健康孕妇纳入健康组,按民族分为汉族健康组(n=42)、维吾尔族健康组(n=44)和哈萨克族健康组(n=41).抽取样本全血提取外周血单核细胞(PBMC)中的DNA,通过和基因测序对VDR的单核苷酸多态性(SNP)位点FokI(A>G,r2228570)进行基因型及等位基因的分型,评估各组间该位点的基因型分布及其与PE的相关性.结果 PE组各民族FokI基因GG型占比及其等位基因G频率均显著高于同民族健康组(P<0.05).汉族健康组FokI基因GG型占比及其等位基因G频率显著低于维吾尔族及哈萨克族健康组(P<0.05).汉族PE组FokI基因GG型占比及其等位基因G频率低于维吾尔族PE组及哈萨克族PE组,维吾尔族PE组该等位基因低于哈萨克族PE组(P<0.05).三民族健康组及PE组FokI位点GG分型的甘油三酯(TG)及肌肝(Cr)水平均显著高于AG及AA分型(P<0.05).汉族健康组及PE组FokI位点GG分型的TG及Cr水平分别低于维吾尔族及哈萨克族健康组及PE组同型患者(P<0.05).结论 VDR中FokI SNP表达为GG型与新疆地区汉族、维吾尔族及哈萨克族孕妇发生PE具有相关性,但其等位基因G在其中的作用及具体影响机制还有待进一步研究确定.

To determine the factors predicting the probability of severe postpartum hemorrhage (SPPH) in women undergoing repeat cesarean delivery (RCD). This multicenter, retrospective cohort study involved women who underwent RCD from January 2017 to December 2017, in 11 public tertiary hospitals within 7 provinces of China. The all-variables model and the multivariable logistic regression model (pre-operative, operative and simple model) were developed to estimate the probability of SPPH in development data and external validated in validation data. Discrimination and calibration were evaluated and clinical impact was determined by decision curve analysis. The study consisted of 11,074 women undergoing RCD. 278 (2.5%) women experienced SPPH. The pre-operative simple model including 9 pre-operative features, the operative simple model including 4 pre-operative and 2 intraoperative features and simple model including only 4 closely related pre-operative features showed AUC 0.888, 0.864 and 0.858 in development data and 0.921, 0.928 and 0.925 in validation data, respectively. Nomograms were developed based on predictive models for SPPH. Predictive tools based on clinical characteristics can be used to estimate the probability of SPPH in patients undergoing RCD and help to allow better preparation and management of these patients by using a multidisciplinary approach of cesarean delivery for obstetrician.