剖宫产瘢痕妊娠( cesarean scar pregnancy,CSP)是指孕囊着床于既往子宫切口瘢痕处的一种特殊类型的异位妊娠,2016年中国《剖宫产术后子宫瘢痕妊娠诊治专家共识》[1]指出包块型CSP属于III型CSP的特殊类型,多见于CSP术后或流产后,子宫瘢痕处妊娠物残留并继续生长,伴凝血块或坏死机化组织而形成.

目的:探讨持续性剖宫产瘢痕妊娠(PCSP)并发症的临床特点、诊断和治疗.方法:对 4 例出现 PCSP 并发症的患者临床资料进行回顾性分析.结果:4 例PCSP患者中 3 例出现子宫动静脉瘘(UAVF),1 例出现大出血.患者均有CSP术后阴道出血表现,1 例出血约 1400ml.超声/磁共振(MRI)提示子宫前壁下段非均质包块,3 例提示 UAVF 可能.1 例UAVF 患者仅行双侧子宫动脉栓塞术,但术后包块持续存在;2 例UAVF 患者行宫腔镜宫内异物(瘢痕妊娠)取出术+宫腔组织吸引术+宫腔球囊放置术,术后恢复好;大出血患者双侧子宫动脉栓塞术后行腹腔镜下子宫病损切除+子宫修补+宫腔镜下诊刮术,术后恢复好.结论:超声、MRI、子宫动脉造影可为 UAVF 的诊断提供主要依据;UAVF和大出血患者根据出血情况酌情选择子宫动脉栓塞术,宫腔镜或腹腔镜手术均为安全有效的治疗方法.

目的 分析稽留流产患者阴道菌群情况.方法 选取 2020年 9月至 2021年 6 月首都医科大学附属北京妇产医院就诊的患者,将稽留流产患者 30 例纳入试验组,正常早孕拟行人工流产患者 30 例纳入对照组,并将稽留流产患者进一步根据胚胎绒毛染色体检查结果分为染色体正常组 16 例、染色体异常组 6 例、染色体不详组8 例,填写调查问卷,行阴道分泌物微生态检测,并将四组基线资料、阴道微生态指标进行单因素比较,同时采用16S rRNA高通量测序技术分析四组患者阴道菌群的差异.结果 四组基线资料与微生态指标比较结果显示,四组既往是否有盆腔炎病史、菌群多样性、优势菌比较,差异有统计学意义(P＜0.05),其中染色体异常组既往盆腔炎病史比例、初次性生活年龄高于对照组(P＜0.05),而既往流产史比例低于对照组(P＜0.05).OTU聚类分析结果显示,相较于稽留流产各组,对照组OTU数目更多,菌群更丰富;物种分类分析结果显示,与对照组比较,染色体正常组存在不同乳杆菌菌株比例失调(惰性乳杆菌增加,未分类乳杆菌减少)及除乳杆菌以外的其他细菌(加德纳菌、普雷沃菌、埃希氏-志贺菌等)相对丰度增加,而染色体异常组在乳杆菌丰度及菌株比例比较,差异无统计学意义(P＞0.05);Alpha多样性分析结果显示,四组菌群丰度比较,差异有统计学意义(P＜0.05),其中染色体正常组菌群丰度低于对照组(P＜0.05),染色体异常组与对照组菌群丰度比较,差异无统计学意义(P＞0.05);β多样性分析及线性判别分析结果显示,四组阴道菌群比较,差异无统计学意义(P＞0.05).结论 稽留流产患者存在阴道菌群失衡,可能与阴道菌群中存在乳杆菌相对丰度降低和/或不同乳杆菌菌株比例失衡及除乳杆菌以外的其他细菌(加德纳菌、普雷沃菌、埃希氏-志贺菌等)相对丰度增加有关,但其直接病因及机制有待进一步研究.

目的:探讨瘢痕部位血管微循环参数联合子宫内膜容受性标志物诊断早孕期子宫瘢痕妊娠(CSP)价值.方法:回顾性收集2020年3月-2022年5月本院诊治的116例CSP患者为CSP组,同期剖宫产后妊娠早孕80例为对照组,比较两瘢痕部位血管微循环参数血管化血流指数(VFI)、血管化指数(VI)和血流指数(FI)和子宫内膜容受性指标整合素β3和白细胞病抑制因子(LIF).结果:CSP组子宫内膜容受性指标整合素β3(64.3±12.5 ng/ml)、LIF(6.8± 1.3 ng/ml)均低于对照组(86.1±15.9 ng/ml、8.2±2.8 ng/ml),瘢痕部位血管微循环参数均高于对照组(P＜0.05).受试者工作特征曲线分析,VI、FI、VFI、整合素 β3、LIF及联合上述指标诊断早孕期CSP的AUC分别为0.728、0.761、0.811、0.772、0.733及0.921.结论:瘢痕部位血管微循环参数联合子宫内膜容受性标志物诊断早孕期瘢痕妊娠有一定价值.

目的:分析过氧化物还原酶 3(PRX3)、胎盘生长因子胚胎生长因子(PLGF)、妊娠特异性糖蛋白 1(PSG1)在胚胎停育患者绒毛组织中的表达.方法:选取 2020 年 1 月-2022 年 8 月本院收治的 84 例胚胎停育患者作为观察组,60 例正常早孕行人工流产者作为对照组;采用 PCR 及 western blot 法检测两组绒毛组织中 PRX3、PLGF、PSG1 的mRNA及蛋白水平,logistics模型分析绒毛组织 PRX3、PLGF、PSG1 与胚胎停育关系.结果:观察组 PRX3 及 PSG1 mRNA(3.43±0.84、3.31±1.34)和蛋白水平(1.74±0.39、2.39±0.54)均高于对照组(1.54±0.42、2.26±0.43、1.01±0.27、1.83±0.39),PLGF mRNA(0.34±0.05)和蛋白水平(0.51±0.11)均低于对照组(0.42±0.06、0.93±0.24);绒毛组织中高PRX3、PSG1 水平和低PLGF水平均与胚胎停育有关(均P＜0.05).结论:相较于正常早孕,胚胎停育患者绒毛组织中PRX3、PSG1 明显偏高,PLGF水平明显偏低.

Brown adipose tissue (BAT), a unique tissue, plays a key role in metabolism and energy expenditure through adaptive nonshivering thermogenesis. It has recently become a therapeutic target in the treatment of obesity and metabolic diseases. The thermogenic effect of BAT occurs through uncoupling protein-1 by uncoupling adenosine triphosphate (ATP) synthesis from energy substrate oxidation. The review discusses the recent developments and progress associated with the biology, function, and activation of BAT, with a focus on its therapeutic potential for the treatment of polycystic ovary syndrome (PCOS). The endocrine activity of brown adipocytes affects the energy balance and homeostasis of glucose and lipids, thereby affecting the association of BAT activity and the metabolic profile. PCOS is a complex reproductive and metabolic disorder of reproductive-age women. Functional abnormalities of adipose tissue (AT) have been reported in patients with PCOS. Numerous studies have shown that BAT could regulate the features of PCOS and that increases in BAT mass or activity were effective in the treatment of PCOS through approaches including cold stimulation, BAT transplantation and compound activation in various animal models. Therefore, BAT may be used as a novel management strategy for the patients with PCOS to improve women's health clinically. It is highly important to identify key brown adipokines for the discovery and development of novel candidates to establish an efficacious therapeutic strategy for patients with PCOS in the future.

目的 探讨稽留流产中胚胎染色体异常的影响因素.方法 回顾性分析2017—2020年在首都医科大学附属北京妇产医院计划生育科就诊的稽留流产要求刮宫手术的743名女性患者的临床资料.记录患者的一般情况及胚胎染色体和夫妻双方染色体结果,以及FM R1基因的CGG拷贝数(结果以CGG1和CGG2形式表达).根据胚胎染色体检查结果将患者分为胚胎染色体异常组(n=409)和胚胎染色体正常组(n=334),比较两组患者的基本情况、实验室检查以及妊娠结局.结果 743名患者中,胚胎染色体异常检出率为54.50％(409/743),胚胎染色体异常以染色体三体为主,占82.15％(336/409).与胚胎染色体正常组比较,胚胎染色体异常组患者的年龄显著升高[(32.66±4.60)v s.(31.17±3.74),P<0.05],孕、产次显著增多[分别为(2.01±1.29)vs.(1.83±1.05);(0.33±1.21)vs.(0.17±0.48)](P<0.05),FMR1基因CGG2序列重复数更小[(28.98±2.16)vs.(29.44±2.14),P<0.05],但FMR1基因CGG2序列均为正常型.以不同年龄分组比较发现,32岁为易发胚胎染色体异常的临界年龄(P<0.05).Logistics多因素回归分析表明,随着年龄的增长,胚胎染色体异常发生率增加(β=0.04,P<0.05);随着正常型的FMR1基因CGG2拷贝数增加,胚胎染色体异常发生率轻微降低(β=-0.08,P<0.05).结论 年龄为胚胎染色体异常的危险因素,32岁及以后胚胎染色体异常风险增加.正常型的FMR1基因CGG拷贝数不是胚胎染色体异常的危险因素.

目的 探讨流产后包块型宫角妊娠的治疗方法.方法 回顾性分析2016年2月至2022年2月在北京妇产医院治疗的16例流产后包块型宫角妊娠患者的临床资料,分析不同治疗方式的临床疗效.结果 ①16例患者中,腹腔镜下宫角切开术+子宫修补+宫腔镜检查2例;腹腔镜或B超监测下宫腔镜下宫角胚物切除术11例;药物保守治疗3例.所有患者均治疗成功,无失血性休克及子宫切除.②13例患者在宫腹腔镜下完成手术,无中转开腹,手术时间(48.1±10.5)min,术中出血量(57.3±30.0)mL,术后阴道流血时间(8.5±2.9)d,β-hCG恢复正常时间(14.5±6.4)d.③3例药物保守治疗的患者均未生育且均有输卵管手术史,术前血β-hCG(365.8±215.6)IU/L,病灶最大径线(2.7±0.6)cm;住院时间(12.7±4.7)d,β-hCG恢复正常时间(46.0±25.5)d,包块消失时间7～8个月.结论 流产后包块型宫角妊娠可根据个体化原则选择手术治疗或药物保守治疗,宫腹腔镜联合手术治疗是较安全、有效的治疗方法;如患者药物保守治疗意愿强烈,结合其妇科手术病史,血hCG<500 IU/L～1000 IU/L,包块<3 cm也可以考虑在严密监测下行药物保守治疗.

Abstract Backgrounds Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS. Methods A total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS. Results ① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination. Conclusions Terminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes.

目的:分析人工流产患者高危因素和重复人工流产高风险因素的变化,为高危人工流产和重复流产的管理及应对措施提供参考和依据.方法:回顾性分析2019年2-4月(2019年组)和2020年同期(2020年组)就诊本院自愿要求行人工流产终止妊娠妇女的临床资料,比较不同时间段内人工流产妇女高危因素及重复流产高风险因素的变化.结果:2020年组非本地户籍妇女占比(63.6％)较2019年组(29.2％)上升(P＜0.05);而未婚、大专以下文化程度者占比2020年组(46.3％、7.4％)较2019年组(62.5％、13.1％)下降(P＜0.05).2019年组人工流产前3位高危因素分别是剖宫产再孕、稽留流产、可疑或确诊的子宫异位妊娠;2020年组为剖宫产再孕、稽留流产、妊娠合并内外科疾患.重复人工流产的首位高风险因素,2019年组为未婚或性关系不稳定(64.3％),2020年组为人工流产术后尚无计划使用长效可逆避孕方法(56.9％).结论:不同时期人工流产高危因素和重复人工流产高风险因素均有明显变化;对其管理应有相应的调整.

Expounding the heterogeneity for ovarian cancer (OC) with the cognition in developmental biology might be helpful to search for robust prognostic markers and effective treatments. In the present study, we employed single-cell RNA-seq with ovarian cancers, normal ovary, and embryo tissue to explore their heterogeneity. Then the differentiation process of clusters was explored; the pivotal cluster and markers were identified. Furthermore, the consensus clustering algorithm was used to explore the different clinical phenotypes in OC. At last, a prognostic model was construct and used to assess the prognosis for OCs. As a result, eight diverse clusters were identified, and the similarity existed in some clusters between embryo and tumours based on their gene expression. Meaningfully, a subtype of malignant epithelial cluster, PEG10+ EME, was associated with poor survival and was an intermediate stage of embryo to tumour. PEG10 was a CSC marker and might influence CSC self-renewal and promote cisplatin resistance via NOTCH pathway. Utilising specific gene profiles of PEG10+ EME based on public data sets, four phenotypes with different survival and clinical response to anti-PD-1/PD-L1 immunotherapy were identified. These insights allowed for the investigation of single-cell transcriptome of OCs and embryo, which advanced our current understanding of OC pathogenesis and resulted in promising therapeutic strategies.

目的:探讨宫内宫外同时妊娠(HP)的临床诊断及治疗.方法:回顾性分析3例HP患者的临床资料,并文献复习.结果:2例自然受孕且在人工流产术后20+d及10+d发现HP;1例是IVF术后,稽留流产清宫手术前再次复查超声时发现同时合并异位妊娠.3例患者经过及时有效的治疗,预后良好.结论:对停经后出现腹痛或阴道出血的宫内早孕的女性,无论是IVF术后还是自然妊娠,均应排除异位妊娠的可能.早期诊断和及时治疗能维持良好的宫内妊娠结局及防止发生危及生命的严重并发症.

目的:探讨实施人工流产后避孕(PAC)服务优化流程的临床效果.方法:比较分析2019年2-4月采用标准化PAC流程和2020年2-4月采用优化策略后长效可逆避孕措施(LARC)人工流产术后即刻落实情况.结果:2019年2-4月和2020年2-4月人工流产手术在妇科门诊手术占比分别为78.9％(709/899)、75.5％(764/1012),差异无统计学意义(P＞0.05);高危人工流产占比分别为46.8％(332/709)、40.1％(306/764),差异有统计学意义(P＜0.05);LARC即刻落实率分别为12.7％(90/709)、15.3(117/764),差异无统计学意义(P＞0.05).结论:实施PAC服务优化流程可有效保障LARC即刻落实率.

目的 探讨不同方式治疗Ⅱ型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床疗效.方法 回顾性分析2016年1月至2017年12月在北京妇产医院生殖调节科手术治疗的225例Ⅱ型CSP的临床资料,其中114例行宫腔镜手术(非介入球囊组),72例行宫腔镜手术联合子宫动脉栓塞术(uterine artery embolization,UAE)(介入组),39例行宫腔镜手术联合宫腔球囊压迫(球囊组),分析不同治疗方式的临床疗效.结果 ①3组在年龄、孕次、剖宫产次数、流产次数、距离前次剖宫产时间、孕囊处最薄肌层厚度及是否保胎方面比较,差异无统计学意义(P>0.05);但介入组在停经天数、孕囊大小、术前血人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)值、宫腔积血率及活胎率方面高于非介入球囊组(P<0.05),术前血hCG值及孕囊大小在3组间差异有统计学意义(P<0.05).②介入组手术时间短且术后血hCG下降快,但术后血hCG恢复正常时间、月经恢复时间及住院时间长,差异均有统计学意义(P<0.05).结论 Ⅱ型CSP患者行宫腔镜手术,部分联合宫腔球囊压迫或UAE治疗疗效确切.大部分未予UAE治疗的Ⅱ型CSP患者术后恢复快.对有多个高危因素如停经天数长、孕囊较大、术前血hCG值高、活胎且有宫腔积血的Ⅱ型CSP患者优先考虑UAE.

目的 探讨加速康复外科应用于计划生育住院手术患者的临床疗效观察.方法 将首都医科大学附属北京妇产医院120例住院手术患者根据随机数表法分为观察组和对照组,每组60例.对照组采用常规方法进行干预,观察组采用加速康复外科理念进行干预.观察两组患者术后疼痛评分、并发症发生例数、术后住院时间、住院费用以及生活质量评价.结果 观察组术后疼痛评分明显低于对照组,差异有显著性(P<0.05);观察组并发症发生例数明显低于对照组,差异具有显著性(P<0.05);观察组住院时间和住院费用均低于对照组,差异具有显著性(P<0.05);观察组生活质量评分明显高于对照组,差异具有显著性(P<0.05).结论 加速康复外科计划可以明显改善患者的围术期并发症、降低患者住院时间和住院费用,可以有效地提高患者的满意度.

Hydatidiform moles are classified at the genetic level as androgenetic complete mole and diandric-monogynic partial mole. Conflicting data exist whether heterozygous complete moles are more aggressive clinically than homozygous complete moles. We investigated clinical outcome in a large cohort of hydatidiform moles in Chinese patients with an emphasis on genotypical correlation with post-molar gestational trophoblastic disease. Consecutive products of conceptions undergoing DNA genotyping and p57 immunohistochemistry to rule out molar gestations were included from a 5-year period at Beijing Obstetrics and Gynecology Hospital. Patient demographics and clinical follow-up information were obtained. Post-molar gestational trophoblastic disease or gestational trophoblastic neoplasia was determined by the 2002 WHO/FIGO criteria. A total of 1245 products of conceptions were classified based on genotyping results into 219 complete moles, 250 partial moles, and 776 non-molar gestations. Among 219 complete moles, 186 were homozygous/monospermic and 33 were heterozygous/dispermic. Among 250 partial moles, 246 were triploid dispermic, 2 were triploid monospermic, and 2 were tetraploid heterozygous partial moles. Among 776 non-molar gestations, 644 were diploid without chromosomal aneuploidies detectable by STR genotyping and 132 had various genetic abnormalities including 122 cases of various trisomies, 2 triploid digynic-monoandric non-molar gestations, 7 cases of possible chromosomal monosomy or uniparental disomy. Successful follow-up was achieved in 165 complete moles: post-molar gestational trophoblastic disease developed in 11.6% (16/138 cases) of homozygous complete moles and 37.0% (10/27 cases) of heterozygous complete moles. The difference between the two groups was highly significant (p = 0.0009, chi-square). None of the 218 partial moles and 367 non-molar gestations developed post-molar gestational trophoblastic disease. In conclusion, heterozygous/dispermic complete moles are clinically more aggressive with a significantly higher risk for development of post-molar gestational trophoblastic disease compared with homozygous/monospermic complete moles. Therefore, precise genotyping classification of complete moles is important for clinical prognosis and patient management.

OBJECTIVE: To assess if missed abortions are associated with chromosomal aberrations, FMR1 gene abnormalities, and maternal age. STUDY DESIGN: Women with delayed miscarriage, with no disease during pregnancy, were included in the study. The embryonic karyotypes, chromosomal abnormalities, FMR1 gene, and maternal age were analyzed via blood and chorionic villi samples obtained from parents. RESULTS: Miscarriage was mainly caused by embryonic chromosomal abnormalities. There was no statistically significant difference between embryo chromosome abnormality and the number of pregnancies, number of deliveries, miscarriage times, and induced abortion times. Only the maternal age had a close relationship with embryo chromosome abnormality (p<0.01). The rate of chromosomal abnormalities in older women was significantly higher than that in younger women, whereas that of monosomy X occurrence was significantly higher in younger women. Rate of trisomy abnormalities increased with increasing maternal age. The most frequent abnormal maternal/paternal karyotype was human inversion (p12; q13). No significant associations were found between CGG repeat length and missed abortions among non-trisomy abnormalities, trisomy abnormalities, or chromosomally normal losses or between intermediate CGG repeat length and trisomy/ non-trisomy abnormalities. CONCLUSION: Maternal age is an important factor affecting chromosomal anomalies. Abnormal maternal/paternal karyotypes may cause missed abortion. The CGG repeat length was not associated with the trisomy risk in missed abortions among Chinese women.

目的 分析已生育女性人工流产术后长效可逆避孕方法(LARC)的落实情况并探讨其影响因素.方法 收集2018年4月至2019年3月在我院计划生育科门诊就诊、自愿要求终止妊娠行人工流产的已生育女性2165例,按照术后采取避孕措施的不同分为LARC组(607例,术后落实LARC)和对照组(1558例,术后未落实LARC).比较两组的人口学资料,并对影响人工流产术后LARC落实情况的因素进行分析.结果 LARC组高危人工流产占46.1％,75.6％的患者经历过重复人工流产;对照组高危人工流产占37.8％,55.9％的患者经历过重复人工流产;LARC组剖官产率为41.0％,对照组剖官产率为35.5％;LARC组中69.2％的患者未来没有生育计划,对照组中35.9％的患者未来无生育计划;LARC组已生育2孩者占40.9％,对照组已生育2孩占16.0％,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示:经历过重复人工流产[OR=1.90,95％CI(1.519,2.371)]、已生育2孩[OR=2.22,95％CI(1.762,2.805)]、有剖官产史[OR=1.25,95％CI(1.016,1.536)]、无生育计划[OR=2.92,95％CI(2.340,3.650)]的已生育女性在人工流产术后更倾向于选择LARC.人工流产术后未落实LARC的主要原因是担心影响生育能力(27.2％).LARC组患者术后1年的续用率为93.3％.结论 已生育女性中经历过重复人工流产、已生育2孩、既往有剖宫产史、未来无再生育计划者,人工流产术后更倾向于选择LARC.

Objectives To evaluate the severe outcomes in pregnancies with pernicious placenta previa and prior cesarean delivery, and to analyze the predictive examinations and prevention strategies regarding severe complications in these women. Design Multicentre retrospective cohort study. Setting Thirteen hospitals in China. Population Selected 747 women with pernicious placenta previa and prior cesarean history. Methods The basic data relating to pregnancy, the examinations during gestation and the outcomes were collected and analyzed. Main outcome measures Outcomes including massive bleeding, placenta implantation and hysterectomy were monitored. Results Our results showed that placental implantation occurred in 47.5% of patients and the hysterectomy rate was 10.4%. The incidence of massive bleeding and blood transfusion was 55.8% and 64%, respectively. The women with placenta implantation predicted by both ultrasound and MRI had higher blood loss than those diagnosed only by either one of the examinations. Surprisingly, vascular occlusion had no effect on the occurrence of severe hemorrhage and hysterectomy. The latter was even higher in the vascular blocking group compared to that in the non-blocking group (34.2% and 8.6%, respectively). Conclusions: The pregnancies with pernicious placenta previa and prior cesarean delivery, had a dramatically higher risk of placenta implantation, hysterectomy and massive hemorrhage. MRI combined with ultrasound examination presented high accuracy in predicting severe outcomes in these patients. Vascular occlusion does not appear to be an effective approach to prevent severe outcomes. Surgical hemostasis should be the key goal in blocking massive bleeding, preserving the uterus and improving the prognosis of the patients.