Early-pregnancy ultrasound images often contain gestational sac, yolk sac, and embryo regions with blurred boundaries, variable shapes, and small target sizes, which makes accurate segmentation difficult. In addition, many existing segmentation networks have high computational cost and are not well suited for resource-constrained clinical devices. To address these challenges, we propose EFAU-Net, an efficient feature-enhanced U-shaped network for segmenting key structures in early-pregnancy ultrasound images. EFAU-Net introduces three components: a grouped channel shuffle fusion (GCSF) module to improve feature utilization in deep layers with low computational overhead, a local attention enhancement (LAE) module to strengthen multi-scale feature fusion and small-target representation, and a ground-truth boundary generation (GBG) module to enhance boundary supervision and improve contour alignment. Experiments show that EFAU-Net achieves Dice scores of 97.14

External cephalic version (ECV) corrects breech presentation and improves vaginal delivery success rate. To investigate factors influencing ECV success in breech-presenting pregnant women in southern China. A total of 484 pregnant women who underwent ECV from August 2021 to August 2023 were enrolled. Logistic regression analyzed factors associated with ECV success, and restricted cubic spline (RCS) evaluated relationships of amniotic fluid index (AFI) and gestational weight gain with ECV success. In all ECV, the success rate was 75.41

Physiological blood pressure changes in pregnancy are insufficiently defined. This paper describes the blood pressure changes across healthy pregnancies in a Southern Chinese population to present gestational - age - specific blood pressure ranges with smoothed centiles (3rd, 10th, 50th, 90th, and 97th). Antenatal blood pressure measurements [median (interquartile range) 9 (8 - 10) per woman] were repeated in 17, 776 women from a Southern China population. Multilevel cubic splines models were used to derive longitudinal reference ranges for systolic blood pressure (SBP) and diastolic blood pressure (DBP) from 6 to 42 weeks of gestation for the normal pregnancies (excluding chronic hypertension, preeclampsia, diabetic ones, and preterm birth et al.). Systolic and diastolic BP increased from 6 weeks of gestation: 50th centile (3rd - 97th centile) 106 (87 - 125); 61 (47 - 77) mm Hg to 12 weeks of gestation: 50th centile (3rd - 97th centile) 108 (88 - 129); 64 (49 - 81) mm Hg. Then, the lowest value of 107 (87 - 129); 62 (47 - 78) mm Hg was reached at 16 weeks and 20 weeks of gestation, respectively. Systolic and diastolic BP then rose to a maximum median (3rd - 97th centile) of 115 (96 - 135); 68 (53 - 85) mm Hg at 42 weeks of gestation. Additionally, the ascending tendency of SBP after 16 weeks of gestation was interrupted by two fluctuations that occurred at 24 weeks and 30 weeks of gestation. In summary, our study provides blood pressure reference values for Southern Chinese women with normal pregnancies. To identify gestational hypertension and hypotension, centiles for gestational - age - specific BP should be defined in healthy pregnancies. Understanding these changes in low risk pregnancies is essential to optimize maternal blood pressure management.

Background: Twenty-four-hour urinary total protein excretion is an essential parameter used for evaluation of renal function and early detection of gestational complications. However, data on reference ranges of 24-hour urinary total protein excretion in normal pregnancy are scarce. Objective: This study aimed to determine reference ranges for 24-hour urinary total protein excretion in a population with uncomplicated singleton pregnancies using a standard method for urinary total protein. In addition, the values of 24-hour urinary total protein were stratified by maternal age and prepregnancy body mass index. Study design: This study was based on a prospective cohort study in Shenzhen, China. The pregnant women were enrolled at their first prenatal clinical visit. All the participants were instructed to collect 24-hour urine samples during the following successive gestational periods: 6(+0) to 13(+6), 14(+0) to 27(+6), and 28(+0) to 41(+6) weeks. Total urinary protein excretion was analyzed by a colorimetric method. Ultimately, the study encompassed a total of 4844 pregnant women with uncomplicated pregnancies. The nonparametric percentile method was used to determine reference ranges for 24-hour urinary total protein excretion during different trimesters in women with uncomplicated pregnancies (excluding those with previous kidney disorders, gestational or chronic hypertension, preeclampsia, and pregestational diabetes mellitus, among others). Results: The 24-hour urinary total protein levels expressed as medians and percentiles (5th, 95th) for each trimester were as follows: 72.0 (28.4, 165.0), 88.0 (34.0, 185.0), and 108.0 (37.5, 258.0) mg in the first, second, and third trimesters, respectively. A significant increase in 24-hour urinary total protein excretion was observed throughout pregnancy (all P values <.001). Moreover, 24-hour urinary total protein levels were higher in the older (>= 35 years) than in the younger (<35 years) group from mid-gestation. Specifically, the median (interquartile range) 24-hour urinary total protein levels by age were 72.2 (50.6-100.0) vs 70.5 (50.5-100.0) mg, 85.8 (62.0-117.0) vs 96.0 (68.0-127.8) mg, and 106.6 (76.0-146.2) vs 114.7 (81.5-153.6) mg in the first, second, and third trimesters, respectively. In addition, 24-hour proteinuria was significantly increased in higher-weight (overweight or obese) subgroups compared with lower-weight (underweight or normal-weight) subgroups (all P values <.05). Conclusion: Our study provides reference values for 24-hour urinary total protein excretion with apparently uncomplicated pregnancies. Understanding these changes in low-risk pregnancies is essential for optimizing maternal management.

患者34岁，孕6产2，因"停经25+4周，恶心、呕吐伴下腹痛8+ h"于2021年8月10日04：32收入深圳市龙岗区妇幼保健院妇科。入院前1周曾在外院行口服葡萄糖糖耐量试验(oral glucose tolerance test, OGTT)示：空腹血糖5.09 mmol/L，餐后1 h血糖11.11 mmol/L，餐后2 h血糖9.15 mmol/L，诊断妊娠期糖尿病，予以饮食运动指导，未规律检测血糖。入院前1天(8月9日)早餐进食糯米团等碳水化合物，出现口渴、多饮、多尿，8月9日夜间上述症状加重，19：00时进食牛奶后出现恶心，呕吐4次为胃内容物，伴下腹隐痛、腰部酸痛、坠胀感，有头痛、心慌、胸闷，无抽搐、昏迷。

OBJECTIVE:We aim to evaluate the effect of right lateral position on fetal hemodynamics (including umbilical artery [UA] and middle cerebral artery (MCA) blood flow-velocity waveform).METHODS:In total, 150 low-risk singleton full-term pregnant women were included in the study from November 2021 to January 2022. Doppler flow velocity waveforms of the fetal UA and MCA tested by ultrasound were collected in gestation of 37-40 weeks. Computational analysis was performed using the one-way ANOVA test.RESULTS:Compared with the maternal left lateral position, there was a significant increase in Doppler indices of UA-RI (P = .033), UA-S/D (P = .019) and MCA-PSV (P = .021) and a significant decrease in MCA-RI (P = .030) in the supine position group. There was no statistical significance in all Doppler indices between the left and right lateral position (P > .05). Among the Doppler indices of three different maternal positions, there was no significance in both UA-PI and MCA-PI (P > .05).CONCLUSION:There were no significant differences on changes of the fetal hemodynamics between left and right lateral positions. Pregnant women could adopt to lie in the left or right lateral position alternately to relieve the discomfort in late pregnancy.

Elucidating the physiological and pathological characteristics of preterm birth is critical to the development of effective prediction and intervention strategies. Here, we present a nested case control study on 51 spontaneous preterm birth (sPTB) and 70 women who delivered at term. Systems-level analysis revealed bacterial compositions and functional differences between two distinct pregnancy outcomes. As expected, the vaginal environment with preterm birth was dominated by a more complex bacteria interaction network, and these interactions frequently exhibited opposite effects on different pregnancy outcomes. Furthermore, key species and combinations were identified to construct preterm birth prediction model. The final model contained three features generated from six bacteria (A. christensenii and L. crispatus; B. breve and S. anginosus; P. timonensis and L. fermentum) (AUROC = 0.942 for independent test). The AUROC value was 0.965 when white blood cell (WBC) and neutrophil (NEU) data were included. Collectively, our study provided a comprehensive characterization of the vaginal microbiome and revealed the potential utilization of bacteria in predicting the risk of preterm birth.

Background Physiological glycated hemoglobin (HbA1c) values in each trimester are not well defined. This study aimed to determine trimester-specific reference intervals for HbA1c levels in non-diabetic pregnant women in China. Methods In this cross-sectional study, 5,042 Chinese pregnant women from 6 to 41 weeks of gestation were screened. An inclusion of 4,134 non-diabetic women was made to determine the reference intervals, they were divided into three trimesters: trimester 1 (T1), 6 weeks to 13 weeks + 6 days, trimester 2 (T2), 14 weeks to 27 weeks + 6 days, and trimester 3 (T3), 28 weeks to 41 weeks + 6 days. A total of 4,134 women (T1 n = 760, T2 n = 1,953, and T3 n = 1,421) provided blood samples which were analyzed for HbA1c concentrations. HbA1c was measured using high-performance liquid chromatography. The median and percentile (2.5th to 97.5th) for the HbA1c reference intervals were calculated for each trimester. Results In total, 8,732 HbA1c measurements were taken. Reference intervals for HbA1c expressed as median and percentile (2.5th to 97.5th) for each trimester were: T1: 4.7 (4.0–5.5%), T2: 4.5 (3.9–5.3%), and T3: 4.8 (4.1–5.7%) respectively. The HbA1c levels were significantly lower in the second trimester compared to those in the first trimester (p < 0.0001), and higher in the third trimester compared to the second trimester (p < 0.0001). Conclusions The reference intervals for HbA1c levels were 3.9–5.7% with upper limits of 5.5% in the first trimester, 5.3% in the second trimester, and 5.7% in the third trimester. These findings highlight the importance of considering trimester-specific reference intervals for HbA1c in non-diabetic pregnant women to promote maternal and fetal health.

目的 评价加速康复外科(ERAS)干预对剖宫产术后功能恢复的影响.方法 收集2021年9月1日至2022年9月1日在深圳市龙岗区妇幼保健院产科行剖宫产分娩的194例产妇为研究对象,采用前瞻性、随机单盲的研究方法,使用随机数表法将产妇随机分为快速康复组(ERAS组,96例)和常规组(98例).ERAS组给予跨越术前、术中和术后的综合干预措施;常规组给予常规围手术期干预措施.观察剖宫产围手术期的ERAS措施对产妇疼痛视觉模拟评分(VAS)、术后阿片类药物使用情况、胃肠道恢复情况、膀胱功能、首次下床活动时间、24 h阴道出血量等的影响.结果 ERAS组和常规组基线资料比较均无显著性差异(P＞0.05).ERAS组产妇剖宫产术后回病房0 h的VAS与常规组无显著性差异(P=0.546),但术后回病房4 h、12 h、16 h和24 h的VAS显著低于常规组(P均＜0.05).ERAS组术后需要联合使用舒芬太尼和地佐辛的比率显著低于常规组(29.2％vs.46.9％,P＜0.05).ERAS组术后首次进食流质时间[(2.6±1.1)h vs.(4.3±2.3)h]、进食半流质时间[(7.5±6.8)h vs.(20.5±15.0)h]、进食普食时间[(35.1±15.7)h vs.(41.4±13.2)h]、拔尿管时间[(9.8±5.1)h vs.(23.5±4.5)h]、拔尿管后首次排尿时间[(12.9±5.4)h vs.(25.9±4.3)h]及首次下床时间[(13.8±6.0)h vs.(26.8±6.7)h]均显著短于常规组(P＜0.01).两组的首次肛门排气时间及产后24h出血量均无显著性差异(P＞0.05).结论 ERAS干预应用于剖宫产孕妇围手术期,能够减轻产妇疼痛,具有阿片节省效应,还能有效缩短孕产妇空腹时间,促进膀胱功能恢复和产后尽早活动.

目的 探讨以问题为基础的学习(PBL)联合临床技能多站式考试(OSCE)教学策略在高质量产科模拟教学中的应用效果.方法 选取2016级产科1班和2班为研究对象,按照实施教学管理方案不同,将产科1班作为试验组,实施PBL联合OSCE教学策略,产科2班作为对照组,实施常规教学指导,每组30名.比较两组教学效果和专业OSCE考试成绩.结果 试验组在提高分析及解决能力、激发学习兴趣、促进内容记忆、提高临床思维能力、加强团队协作及提高医患沟通能力占比均高于对照组,差异有统计学意义(P＜0.05).试验组病史采集、病历书写、产前检查、临床技能操作及产科手术操作评分均高于对照组,差异有统计学意义(P＜0.05).结论 产科模拟教学指导过程中,以PBL联合OSCE教学策略指导,能够提高产科模拟教学质量.

目的 探讨孕妇BMI及血脂指标与妊娠期高血压、子痫前期的相关性,分析其对妊娠结局的影响.方法 选取2019年6月1日-2020年1月31日于某院分娩的妊娠期高血压疾病产妇115例作为研究组,其中妊娠期高血压63例,子痫前期52例;健康产妇115例,作为对照组.比较2组孕产妇BMI及血脂指标差异,并进行多因素分析.比较2组不良妊娠结局的发生率.结果 孕前、孕16周、孕37周BMI及孕16周TC、TG、HDL、LDL、孕37周TC、TG均是影响孕产妇妊娠期高血压及子痫前期发生的独立危险因素(P<0.05).研究组胎儿窘迫、低体重儿发生率分别为4.35％、6.96％,显著高于对照组(P<0.05).结论 BMI及血脂异常与妊娠期高血压及子痫前期发生具有相关性,可导致不良妊娠结局发生,应对其进行干预,改善母婴结局.

目的:研究快速康复途径(ERAS)应用于剖宫产围手术期对母婴结局的影响.方法:选择我院收治剖宫产孕妇240例作为研究对象,病例均选自2020年7月至2021年8月.采用单盲、随机分组原则将孕妇分成两组,对照组120例给予常规手术干预方法,试验组120例给予ERAS临床干预(快速康复组).比较术中出血量、胃肠功能恢复时间、平均住院时间、住院平均费用;同时比较两组产后抑郁评分、疼痛耐受情况,以及术后并发症.结果:试验组术中出血量少于对照组,术后肠鸣音恢复、术后排气时间短于对照组,平均住院时间、住院费用均少于对照组,差异有统计学意义(P<0.05);试验组孕妇产后抑郁SDS评分与疼痛VAS评分均少于对照组,差异有统计学意义(P<0.05);试验组术后并发症发生率1.67％低于对照组7.50％,差异有统计学意义(P<0.05).结论:在剖宫产围手术期临床干预中应用ERAS快速康复途径可改善母婴结局,值得应用.

目的 研究apelin受体的内源性配体(APELA)基因cg02779075位点在6项胎盘全基因组甲基化中与子痫前期关联的甲基化改变.方法 系统回顾APELA基因cg02779075位点在6项胎盘全基因组甲基化中与子痫前期关联的甲基化改变.此外,回顾性采集医院2019年1-2019年12月采集获取的47例子痫前期以及50例正常妊娠孕妇胎盘组织样本.分析两组母婴基线资料以及CpG稳点甲基化水平的差异.结果 6项研究中cg02779075位点于子痫前期胎盘中DNA甲基化水平显著下调,其中4项研究结果存在明显差异(均为P＜0.05).异质性检验分析结果显示:各文献之间存在明显异质性(I2=0.64,P=0.016),通过随机效应模型计算合并SMD值为-1.16,较各单项文献更为明显,但尚未达到全基因组显著水平.子痫前期孕周、产妇收缩压、产妇舒张压均高于正常妊娠,且胎盘重量、新生儿出生体质量均低于正常妊娠(均为P＜0.05).子痫前期APELA基因 CpG1～CpG4位点甲基化水平分别为(0.12±0.05)、(0.07±0.02)、(0.22±0.07)、(0.43±0.12),均明显低于正常妊娠的(0.22±0.08)、(0.18±0.04)、(0.30±0.10)、(0.51±0.16),差异有统计学意义(均为P＜0.05).结论 子痫前期产妇胎盘中APELA基因cg02779075位点甲基化调控异常,值得临床重点关注.

Mesenchymal stromal cells (MSCs) show potential for treating preclinical models of newborn bronchopulmonary dysplasia (BPD), but studies of their therapeutic effectiveness have had mixed results, in part due to the use of different media supplements for MSCs expansion in vitro. The current study sought to identify an optimal culture supplement of umbilical cord-derived MSCs (UC-MSCs) for BPD therapy. In this study, we found that UC-MSCs cultured with human platelet lysate (hPL-UCMSCs) were maintained a small size from Passage 1 (P1) to P10, while UC-MSCs cultured with fetal bovine serum (FBS-UCMSCs) became wide and flat. Furthermore, hPL was associated with lower levels of senescence in UC-MSCs during in vitro expansion compared with FBS, as indicated by the results of β-galactosidase staining and measures of senescence-related genes (CDKN2A, CDKN1A, and mTOR). In addition, hPL enhanced the proliferation and cell viability of the UC-MSCs and reduced their doubling time in vitro. Compared with FBS-UCMSCs, hPL-UCMSCs have a greater potential to differentiate into osteocytes and chondrocytes. Moreover, using hPL resulted in greater expression of Nestin and specific paracrine factors (VEGF, TGF-β1, FGF2, IL-8, and IL-6) in UC-MSCs compared to using FBS. Critically, we also found that hPL-UCMSCs are more effective than FBS-UCMSCs for the treatment of BPD in a rat model, with hPL leading to improvements in survival rate, lung architecture and fibrosis, and lung capillary density. Finally, qPCR of rat lung mRNA demonstrated that hPL-UCMSCs had lower expression levels of inflammatory factors (TNF-α and IL-1β) and a key chemokine (MCP-1) at postnatal day 10, and there was significant reduction of CD68+ macrophages in lung tissue after hPL-UCMSCs transplantation. Altogether, our findings suggest that hPL is an optimal culture supplement for UC-MSCs expansion in vitro, and that hPL-UCMSCs promote lung repair in rat BPD disease.

AIMS Currently, there is no reliable method to effectively predict and diagnose early-onset preeclampsia (EOPE). microRNAs (miRs) are promising biomarkers for EOPE. This study investigated the role of miR-320a in EOPE. METHODS Expressions of miR-320a and insulin-like growth factor-1 receptor (IGF-1R) in serum of EOPE patients and normal pregnant women were detected. The clinical diagnostic efficacy of miR-320a and IGF-1R for EOPE was analyzed using receiver operating characteristic curve. The correlation between miR-320a expression and EOPE clinical indicators [mean arterial pressure (MAP), 24-h urinary protein excretion, serum creatinine (SCR), uric acid (UA), albumin (ALB) and platelet count] was analyzed. The correlation and binding relationship between miR-320a and IGF-1R was predicted and verified. RESULTS miR-320a was upregulated, and IGF-1R was downregulated in EOPE patients with their differential expressions more obvious in severe EOPE than mild EOPE. miR-320a and IGF-1R possessed potent clinical diagnostic efficacy for EOPE. miR-320a expression showed a positive correlation with MAP, 24-h urinary protein excretion, UA and SCR levels, and a negative correlation with ALB level and platelet count in EOPE patients. Moreover, miR-320a targeted IGF-1R. CONCLUSION We demonstrated that miR-320a was aberrantly elevated in EOPE and showed powerful clinical diagnostic efficacy for EOPE, which may be achieved by directly targeting IGF-1R. This study provided great reference values for EOPE early diagnosis and novel targets for EOPE treatment.

目的 探讨宫颈扩张球囊计划分娩术后即刻破膜、2h破膜对母婴结局的影响,为临床选择最佳破膜时机提供参考依据.方法 选取2018年7月-2019年7月深圳市龙岗区妇幼保健院产科100例待产孕妇为研究对象,随机抽签分为A组和B组,各50例.两组孕妇均使用宫颈扩张球囊计划分娩,A组取出宫颈扩张球囊后即刻行人工破膜,B组取出宫颈扩张球囊2h后给予人工破膜.对比两组孕妇的计划分娩结果、分娩方式、计划分娩情况、产后并发症发生率及新生儿Apgar评分.结果 A组计划分娩成功率、阴道分娩率分别为76.00％、70.00％显著低于B组94.00％、92.00％,差异有统计学意义(均P＜0.05).A组宫颈成熟度评分低于B组,差异有统计学意义(P＜0.05);A组第一、第二产程时间及产后出血量高于B组,差异有统计学意义(均P＜0.05);A组产后体温与B组比较差异无统计学意义(P＞0.05).A组产后并发症总发生率26.00％显著高于B组10.00％,差异有统计学意义(P＜0.05).两组新生儿出生时均无重度窒息情况,A组新生儿出生后1 min、5 min、10 min Apgar评分高于B组,差异有统计学意义(均P＜0.05).结论 宫颈扩张球囊计划分娩术后2 h后破膜,能加快产程,减少孕妇产后并发症发生率,改善母婴结局,是促进足月妊娠宫颈成熟和顺利计划分娩的理想方法,具有很高的临床应用价值.

目的:探讨规范化治疗改善妊娠糖尿病孕妇妊娠结局的作用.方法:2019年8月-2020年7月收治妊娠糖尿病孕妇100例,随机分为两组,各50例.对照组给予常规保守治疗;研究组给予规范化治疗.比较两组血糖水平变化及妊娠结局.结果:研究组治疗后空腹血糖及餐后2 h血糖水平均低于对照组,差异有统计学意义(P<0.05);研究组产妇及新生儿不良事件发生率均低于对照组,差异有统计学意义(P<0.05).结论:规范化治疗更有助于调控并稳定妊娠糖尿病孕妇血糖水平,并进一步优化产妇及新生儿结局.

胎母输血综合征(fetomaternal hemorrhage,FMH)是指一定量的胎儿血液经过已经受到损伤的胎盘绒毛进入母体中,导致胎儿失血和母亲体内出现溶血性反应的一种临床症状,是胎儿非免疫性水肿不可忽视的原因之一[1-2].在妊娠与分娩过程中,有体积程度的胎儿血液融入到母体当中,通常是5～30 mL不等,但由于孕妇的血容量比较多,胎儿血液进入到母体中很快被稀释,因此不会影响到血型的鉴定[3].但当胎儿血液体积较多,红细胞数量达到一定比例的时候,就会出现胎儿贫血的情况[4].本研究拟将2019年3月10日1例诊断为胎母输血综合征孕妇及其新生儿状态汇报如下.

胎盘间叶发育不良(PMD)在临床上较为罕见,其特征是干绒毛囊性扩张和囊泡形成、胎盘肥大和血管异常等,常伴有胎儿生长发育受限(FGR)、死胎、Beckwith-Wiedemann综合征,以及一些染色体异常等,临床上需与葡萄胎加以鉴别.本文报道1例母婴结局良好的PMD患者,并针对已知的PMD发病机制,对PMD临床诊疗的手段进行文献复习及讨论,以期为临床上PMD患者确定终止妊娠时机和分娩方式选择以及优化产前筛查等提供一定参考.

目的 分析瘢痕子宫再次妊娠经阴道分娩的可行性和安全性.方法 选取2018年7～12月我院收治的200例产妇的临床资料进行回顾性分析,根据分娩方式的不同分为研究组和对照组,每组各100例.研究组经阴道分娩,对照组剖宫产分娩.比较两组预后情况、产后出血、产褥感染发生率及新生儿预后情况.结果 研究组产时出血量为(151.54±29.79)ml,少于对照组的(296.90±74.25)ml,住院时间为(3.05±0.60)d,短于对照组的(7.19±0.59)d,住院费用为(2962.27±460.45)元,低于对照组的(5526.42±420.70)元,差异均有统计学意义(P＜0.05);两组均未发生子宫破裂情况,研究组产后出血发生率为4％,产褥感染发生率为0％,低于对照组的12％、5％,差异均有统计学意义(P＜0.05);研究组和对照组新生儿Apgar评分[(9.22±0.60、9.36±0.67)分]、新生儿体重[(3322.39±201.05、3382.09±246.93)g]、新生儿湿肺发生率(0％、2％)比较,差异无统计学意义(P＞0.05).结论 合理掌握适应证,瘢痕子宫再次妊娠经阴道分娩是可行的、安全的,产后恢复效果显著.