Background: To explore the safety of different termination methods of hydatidiform mole coexisting with a normal fetus in the second trimester of pregnancy. Methods: This is a retrospective cohort study conducted in a referral center for difficult and critical diseases in Obstetrics and Gynecology in Beijing, China. Patients diagnosed hydatidiform mole coexisting with a normal fetus who received termination of pregnancy in the second trimester (12 weeks to 27+6 weeks) were enrolled. The primary end point was the safety of different termination methods, including the volume of blood loss and progression to gestational trophoblastic neoplasm. Results: Different methods of terminating pregnancy in the second trimester of hydatidiform mole coexisting with a normal fetus were feasible, including forceps curettage, combination of mifepristone and misoprostol, intra-amniotic injection of rivanol, and cesarean section. The incidence of massive blood loss (over 300ml) was 50.0%. Molar tissues closer to the lower uterine segment than the fetus (P=0.035), and presence of complications (P=0.015) were the risk factors for massive blood loss during termination of pregnancy. The incidence of progression to gestational trophoblastic neoplasm was 35.7%. Conclusion: Different termination methods might lead to complications including massive blood loss and progression to gestational trophoblastic neoplasm. More medical measures should be taken to prevent and reduce the volume of bleeding among patients with high risk factors.

Growing evidence has unveiled the dynamic nature of human brain networks. However, the dynamic and hierarchical organization that supports information transmission in brain networks remains unexplored across the adult lifespan. In this study, we developed an analytical framework to investigate the spatiotemporal reorganization of dynamic brain networks during adult development and aging. Specifically, using resting-state fMRI data from the Cam-CAN lifespan dataset, we examined the age effects on the topological stability of egocentric structures and the average length of temporal paths. As the egocentric structure reflects the relationships between a node's neighbors, we further explored whether the stability of egocentric structures mediates age effects on information diffusion. The results showed that the topological stability of egocentric structures has an impact on information processing in the spatiotemporal domain. In particular, the age-related changes observed in some functional systems followed different progressive patterns from that of other systems, which might be explained by some compensation mechanisms. Taken together, the present work may provide an additional perspective for understanding the underlying neuro-mechanisms of healthy aging.

Pregnancy with solid pseudopapillary tumor of the pancreas (SPTP) is rare. Because pregnancy hormones may cause tumor progression, the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment. We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP. Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis. Medical termination of pregnancy was performed. The patient has lived with the tumor until now without surgery. We retrieved the published case reports, summarized the clinical characteristics of pregnancy with SPTP, and explored its management during the perinatal period. Most patients with SPTP have a good prognosis with good maternal and fetal outcomes, and it is important to choose an appropriate treatment method and timing. However, pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

To analyze the clinical characteristics of abdominal pregnancy, and to explore the diagnosis and prognosis of different treatment methods. The cases of patients with abdominal pregnancy admitted to Peking Union Medical College Hospital between January 1, 1989 and January 1, 2021, were analyzed retrospectively. The median age of 17 patients was 34 years (22–42 years); the median gestational duration was 57 days (from 41 days to 32 weeks). Among all 17 patients, 15 (88.24%) presented with abdominal pain. The implantation sites of the gestational sac included the bladder peritoneal reflection, anterior wall of the rectum, omentum, serous membrane of the uterus, and inside or on the surface of uterosacral ligament. In all, only 29.41% cases (5/17) were diagnosed before surgery. All 17 patients were treated via surgery. Further, 58.82% (10/17) patients recovered without complications, 29.41% (5/17) developed fever, 5.88% (1/17) underwent reoperation because of intra-abdominal bleeding, and 5.88% (1/17) developed double lower limb venous thrombosis. All 17 patients survived. The preoperative diagnosis rate of abdominal pregnancy is low. Planting sites in the pelvic peritoneum and pelvic organs are more common than the others. Laparoscopic surgery in the first trimester of pregnancy can achieve better therapeutic effects. However, the blood supply of the placenta should be fully evaluated before surgery. When it is expected that attempts to remove the placenta will cause fatal bleeding, the placenta can be left in place, but long-term close follow-up should be paid attention to.

目的 探讨中孕期合并肺动脉高压(PAH)患者的临床特点和诊疗方案.方法 回顾性分析北京协和医院2000年1月至2021年3月收治的12例中孕期合并PAH的患者病历资料,按照肺动脉收缩压高低分为轻度、中度、重度三组,结合其原发病分析其临床特点、诊断、治疗和妊娠结局.结果 患者平均年龄29岁(17～41岁),经产妇3例、初产妇9例.12例患者中5例合并免疫系统疾病、2例合并先天性心脏病、2例既往心肌炎史、1例合并肾功能不全、1例合并高血压病,1例无原发疾病.3例孕前诊断PAH(2例孕前为重度PAH、1例为中度PAH),1例孕早期诊断中度PAH,其余8例于中孕期出现临床症状后诊断.12例患者中重度6例、中度5例,轻度1例.8例经剖宫产终止妊娠,3例选择药物引产,1例轻度者继续妊娠中.共3例PA H孕妇死亡(重度组2例、中度组1例).结论 中孕期合并PAH患者中死亡率高(3/12),属于极高危孕妇;肺动脉高压越重,孕妇死亡风险越高;中重度PAH合并妊娠患者建议及时终止妊娠以改善妊娠结局.

Background Mild cognitive impairment (MCI) is an intermediate stage between normal aging and dementia. Studies on MCI progression are important for Alzheimer’s disease (AD) prevention. 18F fluoro-deoxy-glucose positron emission tomography (FDG-PET) has been proven to be a powerful tool for measuring cerebral glucose metabolism. In this study, we proposed a classification framework for MCI prediction with both baseline and multiple follow-up FDG-PET scans as well as cognitive scores of 33 progressive MCI (pMCI) patients and 46 stable MCI (sMCI) patients from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Method First, PET images were normalized using the Yakushev normalization procedure and registered to the Brainnetome Atlas (BNA). The average metabolic intensities of brain regions were defined as static features. Dynamic features were the intensity variation between baseline and the other three time points and change ratios with the intensity obtained at baseline considered as reference. Mini-mental State Examination (MMSE) scores and Alzheimer’s disease Assessment Scale-Cognitive section (ADAS-cog) scores of each time point were collected as cognitive features. And F-score was applied for feature selection. Finally, support vector machine (SVM) with radial basis function (RBF) kernel was used for the three above features. Results Dynamic features showed the best classification performance in accuracy of 88.61% than static features (accuracy of 78.48%). And the combination of cognitive features and dynamic features improved the classification performance in specificity of 95.65% and Area Under Curve (AUC) of 0.9308. Conclusion Our results reported that dynamic features are more representative in longitudinal research for MCI prediction work. And dynamic features and cognitive scores complementarily enhance the classification performance in specificity and AUC. These findings may predict the disease course and clinical changes in individuals with mild cognitive impairment.

BACKGROUND The aim of the study is to determine the effects of blood lead levels (BLLs) on spontaneous abortion. METHODS A well-matched case-control study was performed at Peking Union Medical College Hospital from 2016 - 2018. Spontaneous abortion cases requiring suction and curettage within 12 weeks gestational age composed the case group. Control group includes pregnancies showing fetal cardiac activity with simultaneous requests for induced abortions matched to case group in age, gravidity, parity, and gestational age. RESULTS Three hundred patients with 150 per group were included. Age, gravidity, parity, gestational age and the number of lead exposures, smokers, alcoholic beverage drinkers, and coffee drinkers were not significantly different between the two groups. The mean BLLs were 27.17 μg/L and 17.28 μg/L for the case and control group, respectively (p = 0.000). The odds ratios for spontaneous abortion comparing 5 - 9, 10 - 14, 15 - 24, 25 - 39, and ≥ 40 μg/L with a reference category of < 5 μg/L blood lead were 1.58 (0.23 - 10.90), 3.13 (2.11 - 9.08), 4.63 (1.45 - 14.83), 6.33 (1.95 - 20.56), and 22.56 (4.91 - 103.66), respectively, demonstrating a significant trend (P1 = 0.64, P2 = 0.02, P3 = 0.01, P4 = 0.02, and P5 = 0.00). CONCLUSIONS Lead contamination and its effect on spontaneous abortion cannot be ignored. During early pregnancy, when BLL is above 10 μg/L, the chance of spontaneous abortion increases compared to BLLs below 5 μg/L. The higher the BLL is, the greater the risk of spontaneous abortion will be.

Background Uterine artery embolization (UAE) followed by suction and curettage is a common conservative treatment for caesarean scar pregnancy (CSP), but the advantages of suction and curettage alone are underestimated due to the lack of standards for selecting appropriate cases for which this approach would be applicable. We sought to identify indicators with which to assess the need for UAE during suction and curettage. Methods The prospective cohort consisted of 105 women diagnosed with CSP in Peking Union Medical College Hospital between January 2016 and September 2018 who were followed up until 60 days after surgery. The main outcome was the therapy used, and secondary outcomes included recovery, bleeding, surgery time, length of hospital stay, and total cost. Results We found that β-human chorionic gonadotropin (β-hCG) levels were significantly lower ( P < 0.05), foetal cardiac activity was significantly lower ( P < 0.05), the myometrial layer was significantly thicker ( P < 0.05), expenditures were lower and lengths of hospital stay were shorter in patients who received suction and curettage alone (the non-UAE group) than in those who received UAE followed by suction and curettage (the UAE+ group). In addition, for CSP patients, UAE might be less necessary when the myometrial thickness is ≥2 mm and the gestational sacmeasures ≤5 cm, and suction and curettage alone may be safer for these patients. Conclusion Suction and curettage alone is a more suitable option than UAE followed by suction and curettage because the former carries a lower cost, shorter length of hospital stay, and lower risk of adverse events. Regarding risk factors, patients with a lower uterine segment thickness ≥ 2 mm and a gestational mass diameter ≤ 5 cm have an increased probability of being successfully treated with suction and curettage alone.

35岁患者，盆腹腔巨大肿物进行性增大6年、停经16周余，为终止妊娠入院。入院后经详细检查及多学科会诊，诊断为宫内孕16周余，合并结节性硬化症相关的肾血管平滑肌脂肪瘤及中度肺动脉高压。患者瘤体巨大，肾功能轻度受损，已错过手术的最佳时机，手术风险极大，选择药物姑息治疗。充分准备后予以序贯使用米非司酮及米索前列醇在手术室药物引产，引产成功，子宫复旧好。产后2个月月经复潮，口服依维莫司片治疗原发病（结节性硬化症），腹部较前稍缩小，可平卧入睡，生活自理。妊娠合并巨大肾血管平滑肌脂肪瘤者文献中鲜有报道，现结合文献，报道其临床特点。

Purpose: To analyse the management of patients with placenta accreta spectrum (PAS) disorders who underwent 2nd trimester pregnancy terminations. Method: The records of patients with PAS disorders who underwent 2nd trimester pregnancy terminations were collected and analysed. Results: Twenty-eight patients were included; 8 (28.6%) patients received prenatal diagnoses and 20 (71.4%) patients received postnatal diagnoses. In the prenatal diagnosis group, scheduling hysterotomy and placenta removal were performed in 5 patients with complete placenta previa and previous caesarean delivery without hysterectomy or postpartum haemorrhage, and medical termination was performed in 3 patients, 2 of whom retained the placenta in situ. In the postnatal diagnosis group, the placenta remained in situ in 11 patients, and in 13 (46.4%) patients overall, adjuvant treatments were applied to the patients, and the abnormally implanted placenta was passed 43.5 (range: 7-102) days after termination. A complication associated with the placenta left in situ included intrauterine infection in one case. Uterus preservation was achieved in all the patients. Conclusions: For patients with PAS disorders with complete placenta previa and previous caesarean delivery, hysterotomy is a safe choice for terminating a 2nd trimester pregnancy. When it is impossible to manually remove the placenta, leaving the placenta in situ with the administration of adjuvant treatment is a good choice for uterus preservation. (C) 2019 Elsevier B.V. All rights reserved.

宫内节育器 ( intrauterine device, IUD ) 是一种放置于子宫腔内、 可人工安装及摘取并通过机械刺激或缓释避孕药来抑制女性受孕的避孕工具. 因其长效且可逆, 是我国妇女普遍采用的避孕措施[1].

产后避孕可以降低非意愿妊娠和短间隔妊娠(妊娠距前次分娩的时间短于18个月)的发生率[1] ,也可以减少今后妊娠时早产的发生率[2] . (非母乳喂养的女性通常在恢复月经前排卵,平均排卵日为产后39 d[3] .全母乳喂养的女性通常在首次月经后排卵.母乳喂养女性恢复排卵时间与哺乳频率有关,产后6 个月内、进行全母乳喂养并且闭经的女性,有可能不排卵[4] .有研究显示,在全母乳喂养的闭经女性中,1 % ~5 %在产后6个月内出现了排卵[5] .

Background With the development of industrialization, public exposure to toxic metals could occur everywhere, eventually affecting individuals' reproductive systems and even embryos and leading to early pregnancy loss. The aim of the study was to determine the profile of toxic metal levels in pregnant women in the general population and to identify biomarkers for metal toxicity in embryos. Methods A case-control study with pregnant women was conducted at Peking Union Medical College Hospital in 2016-2018. Women who experienced spontaneous abortion within 12 weeks of gestation comprised the case group, and women with pregnancies showing fetal cardiac activity who requested an induced abortion almost simultaneously were included in the control group. Blood and urine specimen were tested for concentrations of cadmium, chromium, selenium, arsenic, and mercury. Results A total of 195 patients were enrolled, with 95 in the case group and 100 in the control group. Significant differences in gravidity, parity, history of miscarriage, mean blood cadmium levels, and mean urine chromium levels were present between the two groups (P1 = 0.013, P2 = 0.000, P3 = 0.000, P4 = 0.002, P5 = 0.046); the odds ratios in the spontaneous abortion with blood cadmium >0.4 mu g/L, urine chromium >2 mu g/L, gravity <3, parity <2, and history of miscarriage >1 compared with the induced abortion group were 1.26 (1.09, 1.85), 1.56 (1.23, 2.53), 1.39 (1.17, 1.98), 1.72 (1.21, 4.62), and 1.18 (1.06, 1.65), with P-values of 0.003, 0.031, 0.003, 0.247, and 0.001, respectively. Conclusion Blood cadmium and urine chromium levels are two possible biomarkers of toxic metal embryotoxicity in the general population, which means that in the general population, blood cadmium >0.4 mu g/L or urine chromium >2 mu g/L might indicate an increased risk of spontaneous abortion.

胎儿体蒂异常是一组非常罕见的先天性畸形,主要表现为胎儿腹壁缺损、腹内脏器膨出、脊柱侧凸及肢体异常,致死率极高,生存率极低.胎儿体蒂异常的发生多数与胎膜早破、心血管异常以及生发层异常有关,绝大多数与染色体异常无关.因该病的致死率较高,胎儿出生后生存率较低,故产前诊断以及尽早终止妊娠为最佳处理准则.本文分析我院一例胎儿体蒂异常的病例,包括产前诊断、引产方法及产后情况.

月经过多（heavy menstrual bleeding）是青春期及育龄期妇女常见的妇科疾病，严重影响身体健康及生命质量。难治性月经过多目前尚无公认的定义，临床上主要指已排除结构性改变，使用可逆的、保留生育功能的、常规治疗方法治疗无效或效果差，或者治疗后好转但反复复发的月经过多。月经过多属于异常子宫出血（abnormal uterine bleeding， AUB）。北京协和医院收治了1例不除外合并血液系统疾病的难治性严重月经过多患者，患者年轻、未生育、要求保留生育功能，经依托孕烯(etonogestrel)皮下埋植剂治疗后，已理想控制了出血并纠正了贫血，随访至今治疗效果稳定。现结合文献复习报道如下。

目的 比较妊娠期和产后盆腔器官脱垂(POP)时肛提肌形态学和阴道粘膜神经分布的变化,探讨妊娠和阴道分娩后POP时盆底神经肌肉病理学特征. 方法 常规产前检查的正常初产妇100名,在妊娠37周以后和产后42d进行盆腔器官脱垂评分(POP-Q)评价盆腔器官脱垂情况.阴道分娩时在第三产程后,取阴道前、后壁粘膜组织和肛提肌组织.肛提肌组织进行组织学染色,观察肛提肌形态学变化、测量肛提肌肌纤维直径并进行分型；阴道粘膜组织分别进行蛋白基因产物9.5(PGP9.5)、血管活性肠肽(VIP)和神经肽Y(NPY)等三种免疫组化染色,镜下分别计数阴道粘膜内三种抗体阳性神经纤维末梢的数目. 结果 阴道分娩后产妇肛提肌既有神经源性改变也有肌源性改变,既有急性期改变也有慢性期改变.妊娠期和阴道分娩后无论是否有POP,肛提肌组织活检标本中Ⅰ型肌纤维均占优势(妊娠期为78.5％～83.5％,阴道分娩后为78.3％～82.2％),Ⅰ型和Ⅱ型肌纤维的直径和比例在POP和非POP组产妇中无统计学差异(P＞0.05).妊娠期和产后有/无阴道壁脱垂的产妇Ⅰ型肌纤维的直径和Ⅰ型、Ⅱ型肌纤维的比例比较均无统计学差异(P＞0.05).妊娠期阴道后壁脱垂的产妇与妊娠期阴道后壁无脱垂的产妇比较,Ⅱ型肌纤维的直径差异有统计学意义(P＜0.05).产后阴道壁脱垂产妇与产后阴道壁无脱垂产妇比较,阴道壁内血管活性肠肽(VIP)和神经肽Y(NPY)能神经末梢的分布有统计学差异(P＜0.05),妊娠期有/无阴道壁脱垂的产妇阴道壁内的神经末梢分布没有统计学差异(P＞0.05). 结论 产妇肛提肌形态学改变、肌纤维直径以及Ⅰ型和Ⅱ型肌纤维比例的改变,不是引起妊娠期和产后阴道壁脱垂的直接原因.阴道前壁内VIP和NPY能神经纤维末梢分布减少,可能是产后阴道壁脱垂的发生机制之一.

Objective To investigate the neuromuscular characteristics of the pelvic floor in women with urinary incontinence (UI) during pregnancy and after vaginal delivery and the pathologic characteristics of the levator ani muscle (LAM)and innervation of the vaginal mucosa. Methods From Jul. to Dec. 2006, 100 primiparas presented to Peking Union Medical College Hospital were enrolled, and symptoms of UI were assessed by International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module. After the third stage of labor, biopsies of levator ani muscle (LAM) and anterior and posterior vagina mucoaa were obtained. LAMs's structure were successfully stained in 27 cases for examination of the morphological changes, classification and measurement. Vaginal mucosa specimens were successfully stained in 40 cases with the following immunohistochemistry stainings: PGP9.5, VIP and NPY staining, and the positive stained nerve fibers were calculated respectively. Results The type Ⅰ muscular fibers were predominant(76.5%～79.6%) in LAMs in both UI and non-UI groups and no significant difference was observed in either diameters or ratio of muscular fibers of type Ⅰ or Ⅱ fibers (P>0.05).Innervation of VIP nerve fibers in the lamina propria of the anterior vaginal wall was different between the UI and non-UI group post delivery[(3.7±1.0)/HPE vs (5.2±2.1)/HPE, P<0.05)].Parturients in the UI group had experienced longer duration in the second stage than those in non-UI group [(63.3±25.4) min vs (44.8±23.3) rain, P<0.05]. Prolonged second stage of labor is the risk factor of UI after vaginal delivery (Logistic regression coefficient = 0.028, P< 0.05).Conclusions The changes of morphology, muscular fiber diameters and proportions in LAMs of parturients is directly associated with neither antipartum nor postpartum UI. Decreased innervation of VIP nerve fibers in the lamina propria of the anterior vaginal wall may contribute to the pathogenesis of UI after normal delivery. Prolonged second stage constitutes a risk factor for postpartum UI.

OBJECTIVE:To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. METHODS:A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007. RESULTS:The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05). CONCLUSIONS:Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Objective To investigate the effects of repeated caesarean section (RCS) on maternal and neonatal outcomes. Methods From January 1998 to December 2007, 412 cases underwent RCS at Peking Union Medical College Hospital were reviewed and divided into two groups based on the number of CSs: RCS group (n= 394) and multiple caesarean section (CS) group (MCS group, n= 18). General conditions, maternal complications and neonatal outcomes were compared among RCS group, MCS group and first CS groups (FCS group) which consisted of 480 women underwent the first CS during the same period. Results The incidence of RCS was 4. 0% with an increasing trend during the past ten years. (1) The mean age of RCS and MCS group were (33.7± 4. 3) yrs and (34. 5±5.1)yrs respectively, higher than FCS group (P<0. 05). The average gravidity in RCS and MCS group were (3.5±1.4), (4. 7±1.5) respectively, higher than FCS group (2.1± 1.2, P<0. 05). (2) The rate of severe pelvic adhesion and uterus rupture were significantly higher in RCS group than in FCS group (13.5% vs 0. 4%, 1% vs 0%, P<0. 05). (3) The mean gestations of RCS group and MCS group were (38.1±1.8)weeks and (37.3±2.5)weeks respectively, while it was (38. 9±2. 1) weeks in the FCS group (P<0. 05). Conclusions RCS rate is growing. Although RCS would increase the incidence of dense adhesion and uterine rupture, it is a relatively safe procedure without increasing the neonatal morbidity.

OBJECTIVE:To investigate the effect of pregnancy and spontaneous delivery on the morphologic characteristics of the levator ani muscle and innervation of the vaginal mucosa. METHODS:Eight nullipara without pelvic floor dysfunction (PFD) and 64 normal primipara undergoing spontaneous delivery were enrolled in this study during July to December 2006 in Peking Union Medical College Hospital. Biopsy specimens of levator ani muscle (LAM) and anterior and posterior vaginal walls were obtained from the puerpera as well as from the 8 nullipara undergoing vaginal operation. The structures of LAM were examined with histological techniques. Vaginal mucosa specimens were examined using immunohistochemistry staining for protein gene product 9.5 (PGP 9.5), vasoactive intestinal peptide (VIP) and ne uropeptide Y (NPY), and the positive stained nerve fibers were calculated respectively. RESULTS:The LAMs of the puerpera undergoing spontaneous delivery presented myogenetic and neurogenetic changes, both acute and chronic. Type I muscular fibers were predominant (79%) with both types increasing in diameters [(86 +/- 9) microm and (79 +/- 15) microm]. Significantly different (P < 0.05) innervation of PGP 9.5, VIP, and NPY nerve fibers was observed between epithelial lamina of anterior vaginal wall (5.9 +/- 3.3, 7.6 +/- 3.1 and 8.2 +/- 3.2, respectively) and that of posterior vaginal wall (3.8 +/- 2.9, 5.9 +/- 3.1 and 6.0 +/- 3.0, respectively), with the nerve fibers being more in epithelial lamina of anterior vaginal wall, while no difference in the innervation of nerve fibers was observed in the lamina propria. Significantly different (P < 0.05) innervation of PGP 9.5 and VIP nerve fibers was observed in the lamina propria of the anterior vaginal wall in puerperal undergoing vaginal delivery (6.9 +/- 3.2 and 4.9 +/- 2.1) compared with those in nullipara (3.9 +/- 3.6 and 3.1 +/- 1.2). CONCLUSIONS:Pathologic changes occur in LAMs and pelvic floor nerves during labor and delivery. LAM fibers become hypertrophy to adapt to the physiological changes during pregnancy. Richer innervation of PGP 9.5 and VIP nerve fibers in the lamina propria of the anterior vaginal wall in puerpera undergoing spontaneous delivery is beneficial for dilation of the blood vessels and smooth muscles and makes preparation for delivery.