Objective:To investigate the effect of transfusion protocol on maternal outcomes in patients with placenta accreta spectrum (PAS) and severe postpartum hemorrhage (sPPH).Methods:Make a retrospective analysis of the clinical data of 262 puerpera who were diagnosed with PAS, underwent cesarean delivery, developed sPPH, and received a blood transfusion from January 1, 2018 to October 31, 2021, in the Third Affiliated Hospital of Guangzhou Medical University. The patients were divided into groups according to the total amount of bleeding in 24 hours after the operation and the infusion ratio of red blood cell (RBC) to fresh frozen plasma (FFB): 151 cases of moderate sPPH (the total amount of bleeding 24 hours >1000~2000 ml) were divided into four groups: 1A (RBC∶FFB<1∶1, 17 cases), 1B (RBC∶FFB=1∶1, 45 cases), 1C(RBC∶FFB>1∶1, 17 cases) and 1D (RBC only, 72 cases); Severe SPPH (the total amount of bleeding 24 hours >2000 ml, 111 cases) were divided into three groups: 2A(RBC∶FFB<1∶1, 19 cases), 2B(RBC∶FFB=1∶1, 43 cases) and 2C (RBC∶FFB>1∶1, 49 cases). The general clinical data, intraoperative conditions, blood consumption in 24 hours and postoperative complications of puerpera in each group under different bleeding conditions were analyzed.Results:(1) The total blood loss at 24 h after operation of the four groups 1A-1D were 1510.91±285.72, 1440.22±244.87, 1563.41±167.13, and 1340.93±293.16, respectively, the 1C was the most and the 1D was the least, and there was a statistical difference between the 1C and 1D (P<0.05). The infusion of RBC (U) were 2.91±1.27, 3.28±1.21, 4.88±0.99, and 2.61±1.12, respectively. The 1C was the most and the 1D was the least, and there was statistical difference between 1C and 1A, 1B, and 1D respectively (P<0.05); the infusion of FFB (ml) were 452.94±141.94, 327.78±121.34, 308.02±93.93, 0, respectively, 1A was the most which had statistical differences with 1B and 1C (P<0.05). According to the transfusion of blood products in the 24 hours after the operation(RBC and FFB), 1D used the least blood in the four groups. The total blood loss at 24 h after operation of the three groups 2A-2C were not statistically significant (P>0.05); infusion of RBC (U) were 5.76±2.48, 5.30±1.63, 8.20±4.16, 2C was the most, and there were statistical differences with 2A and 2B (P<0.05); FFB infusion (ml) were 760.53±292.77, 530.23±162.62, and 548.98±326.04, respectively, 2A was the most which had statistically significant differences with 2B and 2C (P<0.05). According to the transfusion of blood products in the 24 hours after the operation(RBC and FFB), 2B used the least blood in the three groups. (2) There was no significant difference in the length of hospital stay, transfer rate to ICU, and postoperation complications (except the ratio of PLT decrease) among the four groups 1A-1D and the three groups 2A-2C (P>0.05). All puerpera survived with no deaths.Conclusions:For patients with placenta accreta spectrum undergoing cesarean section, the blood transfusion strategy of a single infusion of RBC can be considered in moderate sPPH patients while RBC∶FFB=1∶1 can be considered firstly in serve sPPH patients, and then perform individualized blood transfusion according to subsequent bleeding and blood test indicators.

Objective To investigate and analyze the current status,risk factors and clinical characteristics of venous thrombosis in women during pregnancy and puerperium.Methods A retrospective analysis was made in 139 women who was objectively diagnosed with venous thrombosis in 11 medical units in 9 provinces and cities（10 third-class hospitals,1 second-class hospital）from January 1,2018 to December 31,2018.The clinical data of 139 pregnant and puerperal women was analyzed（1 of the 139 patients had incomplete clinical data,so only 138 patients were included in the later analysis）.According to the time of venous thrombosis,they were divided into two groups:pregnancy and puerperium,and the current status,risk factors and clinical characteristics of venous thrombosis were analyzed retrospectively.Results（1） The incidence of venous thrombosis during pregnancy and puerperium varied from 0.09‰ to 5.89‰.（2） Among the 138 cases of venous thrombosis,there were 33 pregnant women（23.9%） and 105 women（76.1%） in the puerperium.Among the risk factors related to thrombosis,inactivity or dehydration,age≥35 years,pregnancy comorbidities and surgical procedures during pregnancy or puerperium excluding perineal sutures) accounted for 34.1%（47/138）,32.6%（45/138）,32.6%（45/138）,and 22.5%（31/138）.Caesarean section accounted for 92.4%（97/105） in patients with puerperal thrombosis,and only 10.1%（14/138） of patients had no associated risk factors.（3） Thrombosis during pregnancy or puerperium was dominated by lower extremities deep vein thrombosis（73.2%,101/138）.Deep vein thrombosis is more common in the left lower extremity（73.3%,74/101）,and10.0%（2/20） of patients with superficial vein thrombosis of upper extremities had deep vein thrombosis,while 57.1%（8/14）of patients with superficial vein thrombosis of lower extremities had deep vein thrombosis.（4）Four（2.9%）patients in this study had pulmonary embolism（4/138）,1 case occurred in the second trimester,1 case occurred in the third trimester,and 2 cases occurred in the puerperium;3 cases survived after positive treatment and 1 case died.Conclusion During pregnancy and puerperium,it is necessary to screen all women for risk factors of venous thrombosis in order to identify high-risk patients early and provide necessary preventive or therapeutic measures.

再生障碍性贫血（AA）是一种多因素导致的骨髓衰竭综合征，以免疫介导的造血干细胞破坏为特征，常表现为贫血、出血、感染等，妊娠合并AA在我国孕妇中发病率为（0.3~0.8）/10万，妊娠合并极重型AA（VSAA）极为罕见，对产科医师来说是重大的挑战。本文报道了一例妊娠合并VSAA患者，于妊娠21周 +首次发病，进行以支持治疗为主的孕期管理，于妊娠29周 +3行剖宫产术分娩，随访至今，母儿预后良好。通过对本例诊治经过的介绍及文献复习，以期提高产科医师对妊娠合并VSAA的认识。

免疫检查点抑制剂通过抑制免疫系统中抑制性信号通路免疫检查点发挥生物学作用,在妇科肿瘤中的应用尚处于早期阶段,是目前临床研究的一个活跃领域,其治疗成功的关键在于识别潜在患者并从中获益.应用免疫检查点抑制剂抗CTLA-4抗体、抗PD-1/PD-L1抗体治疗卵巢癌,单药应答率10％ ～15％,联合治疗应答率有所提高.文章综述当前研究的最新临床数据结果,以期对当前治疗给予用药指导,并简要展望未来.