Objective:This study aims to construct and validate a nomogram model based on clinical and laboratory indicators to predict the risk of histological chorioamnionitis in patients with premature rupture of membranes at term, and to evaluate its predictive efficacy and effectiveness. Methods:A total of 319 PROM patients admitted between May 2023 and December 2024 were randomly divided into a modeling group (n=221) and a validation group (n=98) at a 7:3 ratio. Based on placental and fetal membrane histopathology, the modeling group was classified into a non-HCA group (grade 0, n=138) and an HCA group (grades I-II, n=83). Results:Compared with the non-HCA group, patients in the HCA group had significantly higher rates of body temperature ≥37.3 °C, baseline fetal heart rate ≥160 beats/min, rupture-to-delivery time ≥12 h, cesarean delivery, WBC ≥15×109/L, neutrophil percentage ≥75%, and PCT ≥0.05 mg/L (all P<0.05). Multivariate logistic regression identified body temperature ≥37.3 °C, cesarean delivery, WBC ≥15×109/L, neutrophil percentage ≥75%, and PCT ≥0.05 mg/L as independent risk factors for HCA (P<0.05). The AUC of the nomogram was 0.890 (95% CI: 0.805-0.913) in the modeling group and 0.885 (95% CI: 0.776-0.918) in the validation group. Calibration curves and the Hosmer-Lemeshow test demonstrated good model fit (P>0.05). Decision curve analysis showed that within risk thresholds of 0.1-0.8 (modeling group) and 0.1-0.7 (validation group), the nomogram provided greater net clinical benefit than "treat-all" or "treat-none" strategies. Conclusion:Body temperature, delivery mode, WBC, neutrophil percentage, and PCT are significantly associated with HCA in PROM patients. The nomogram model shows good discrimination, calibration, and stability, and may assist in predicting HCA risk in clinical practice.

Background: Chorioamnionitis is a significant contributor to adverse maternal and neonatal outcomes in pregnant women with preterm premature rupture of membranes (PPROM). This study explored the predictive value of several blood-derived inflammatory indices for histologic chorioamnionitis (HCA) in PPROM. Methods: Pregnant women with PPROM admitted between July 2017 and July 2025 were retrospectively included. According to postpartum placental pathology, patients were classified into an HCA group (n = 45) and a non-HCA group (n = 152). Clinical characteristics and laboratory indices were compared, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and neutrophil-to-platelet ratio (NPR). Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. Univariate and multivariable logistic regression analyses identified independent predictors of HCA. Results: Compared with the non-HCA group, the HCA group had an earlier gestational age at rupture (≤34 weeks: 51.11% vs. 19.08%, p < 0.001) and a higher incidence of low birth weight (<2.5 kg: 60.00% vs. 32.24%, p < 0.001). White blood cell count (WBC), neutrophil count, C-reactive protein (CRP), NLR, PLR, SII, and SIRI were significantly higher in the HCA group, whereas LMR was lower. Among all indices, SIRI showed the largest area under the ROC curve (AUC = 0.727) and remained independently associated with HCA after adjustment. Conclusions: SIRI is a simple, noninvasive marker derived from routine blood counts and showed the best discriminatory performance for HCA among the tested indices. Its clinical utility should be validated in prospective, multicenter studies before being implementation in clinical decision-making.

Background Preeclampsia (PE) is currently one of the major causes threatening the health and leading to death of pregnant women and fetuses. The onset of PE is attributed to cellular biological dysfunction resulting from the disruption of the molecular regulatory network in the trophoblast cells. We discovered that FOXO1 was downregulated in the placenta of preeclampsia. Methods In order to delve deeper into the involvement of FOXO1 in the development of preeclampsia, trophoblast cell lines were generated with manipulated levels of FOXO1, either through overexpression or knockdown, to elucidate its biological function and underlying mechanisms. Results The expression level of FOXO1 is positively correlated with the invasive, migratory, and proliferative abilities of trophoblast cells. Transcriptome sequencing analysis revealed DUSP9 as a potential target gene of FOXO1. The suppression of DUSP9 expression has been shown to markedly diminish the invasive, migratory, and proliferative abilities of trophoblast cells. Silencing DUSP9 in trophoblast cells that exhibit elevated levels of FOXO1 can attenuate their physiological functions. We found that overexpression/inhibition of FOXO1 can correspondingly suppress/activate the p38/JNK signaling pathway. Notably, the inhibition of DUSP9 in the context of FOXO1 overexpression can activate the p38/JNK signaling pathway. Conclusions FOXO1 modulates the biofunctions of trophoblast cells in preeclampsia via the DUSP9/p38/JNK signaling pathway.

The objective of the study was to evaluate the contribution of insulin resistance and β cell dysfunction to gestational diabetes mellitus (GDM) in Chinese women stratified by pre-pregnant body mass index (BMI). A total of 847 pregnant women were enrolled. They were divided into low BMI and high BMI groups according to the median of pre-pregnancy BMI. The homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-β), Matsuda index, and 60-min insulinogenic index (IGI60) were used to evaluate insulin resistance and β cell function. In all the participants, 150 (17.71

目的 探讨宫颈机能不全接受经阴道宫颈环扎术后孕妇妊娠结局及影响因素.方法 本研究为回顾性研究.搜集2014年2月—2019年2月42例行经阴道宫颈环扎术孕妇的病例资料.根据环扎时子宫颈长度分为＜2.0 cm组(16例)、≥2.0 cm组(26例);再根据环扎的手术时机,分为预防组(18例)、紧急组(24例).分析组间孕妇的临床特征及妊娠结局,分析影响其预后的因素.符合正态分布的计量资料以xˉ±s表示、采用t检验,不符合者以M(Q1,Q3)表示、采用Mann-Whitney U秩和检验;计数资料以例数(%)表示、采用χ2检验或Fisher确切概率法.结果 (1)＜2.0 cm组与≥2.0 cm组孕妇的环扎孕周分别为(22.0±4.2)、(18.5±4.7)周,分娩时孕周分别为(29.4±6.8)、(35.1±5.7)周,延长孕周时间分别为(7.4±6.0)、(16.6±6.0)周,足月分娩率分别为18.7%(3/16)、50.0%(13/26),胎儿存活率分别为50.0%(8/16)、84.6%(22/26),新生儿出生中位体质量分别为1 300、3 040 g,两组上述指标比较,差异均有统计学意义(P均＜0.05);两组的手术时间、分娩出血量比较,差异均无统计学意义(P均＞0.05).(2)预防组与紧急组孕妇环扎时子宫颈长度分别为(3.1±0.5)、(1.5±0.7)cm,环扎时孕周分别为(13.1±3.2)、(22.6±3.7)周,延长孕周时间分别为(20.4±6.2)、(7.1±2.7)周、足月分娩率分别为55.5%(10/18)、25.0%(6/24),新生儿出生中位体质量分别为3 175、2 200 g,两组上述指标比较,差异均有统计学意义(P均＜0.05);两组的手术时间、胎儿存活率、剖宫产分娩率、胎膜早破发生率、分娩出血量比较,差异均无统计学意义(P均＞0.05).结论 环扎时子宫颈长度≥2.0 cm孕妇的妊娠结局明显优于＜2.0 cm的孕妇;预防性宫颈环扎术较紧急环扎术可显著延长孕妇的分娩孕周、提高足月分娩率及胎儿存活率;紧急环扎术是可行的补救措施.

目的 探讨染色体核型分析联合拷贝数变异测序(copy number variation sequencing,CNV-seq)在孕中晚期产前诊断中的应用价值.方法 选取2020年9月至2022年2月在首都医科大学附属北京朝阳医院产前诊断中心就诊、具备产前诊断指征且接受羊膜腔穿刺的孕妇343例,采用染色体核型分析和CNV-seq技术进行产前诊断,比较二者单独及联合应用的诊断结果.结果 羊水染色体核型分析和CNV-seq同时检出了染色体数目异常14例,核型分析额外检出嵌合体1例和平衡易位3例,CNV-seq额外检出7例致病性拷贝数变异、1例可能致病性拷贝数变异和17例临床意义未明变异,CNV-seq的异常检出率(11.37％,39/343)高于染色体核型分析(5.25％,18/343),差异有显著性(P<0.05),二者联合应用的异常检出率为12.54％(43/343).在不同产前诊断指征的孕妇中,单独及合并无创产前筛查异常者的异常检出率最高(61.54％,8/13),单独超声异常者的异常检出率为14.04％(8/57),单独高龄者的异常检出率较低(7.69％,15/195).具有两项及以上产前诊断指征的孕妇异常检出率并不比仅有一项高危因素的孕妇高(P>0.05).结论 染色体核型分析与CNV-seq技术各具优势,二者的检测结果可以相互印证.在染色体低比例嵌合、平衡易位及倒位等方面,染色体核型分析更具优势,而CNV-seq可以检出微缺失、微重复,弥补核型分析的不足;但在临床上要依靠大量数据的积累和对最新文献的跟进,尽可能减少临床意义未明变异报告的产生.联合应用两种检测方法可降低漏诊率,有效提高产前诊断的质量.

Objective Acute pancreatitis in pregnancy (APIP) is a rare and serious complication during pregnancy. It has acute onset and is difficult to diagnose and treat. The aim of the present study was to describe the etiology, clinical manifestations, and maternofetal outcomes of APIP. Methods We retrospectively reviewed 32 pregnant women who were treated at three tertiary care hospitals in Beijing, China. The correlation between the causes of APIP, severity, laboratory indices, and outcomes was analyzed. Results The most common causes of APIP were hypertriglyceridemia (56.2%,18/32) and gallstones (28.1%, 9/32). Hypertriglyceridemia-induced APIP was associated with a higher rate of severe acute pancreatitis ( P = 0.025). Serum level of triglycerides showed a positive correlation with the severity of APIP ( P = 0.039). The most frequent presentation of APIP was abdominal pain (93.7%, 30/32). There were no maternal or fetal deaths in our study. Apgar scores at 1 min, 5 min, and 10 min of the premature neonates was correlated with the severity of APIP of the mother ( P = 0.022; 0.002; 0.002). Conclusion High level of triglycerides may serve as a useful marker of the severity of APIP. The severity of APIP was associated with higher risk of neonate asphyxia. Appropriate timing of termination of pregnancy is a key imperative for APIP patients.

妊娠合并肠内疝是临床上一种罕见的妊娠期急腹症，早期临床表现不典型，易误诊、漏诊，造成严重后果。临床工作中需注意与产科严重并发症胎盘早剥、子宫破裂，以及妊娠合并外科急腹症如急性阑尾炎、急性胰腺炎、胃肠穿孔等进行鉴别诊断。本文通过报道首都医科大学附属北京朝阳医院妇产科收治的1例妊娠晚期肠内疝致肠扭转并肠坏死孕妇，结合文献分析，旨在为妊娠合并急腹症的诊治提供借鉴。

Background: Pregnant women themselves are at higher risk for psychological symptoms. The impact of ongoing COVID-19 may increase the risk. However, it is uncertain whether COVID-19 affects pregnant women's psychological symptoms directly or indirectly being mediated. Methods: This survey was conducted in four obstetrics and gynecology hospitals in Beijing from February 28, 2020, to April 26, 2020. Pregnant women who visited the antenatal-care clinic were mobilized to finish the online questionnaires, including the Generalized Anxiety Disorder 7-Item Scale, Patient Health Questionnaire-9, Connor-Davidson resilience scale, and Insomnia Severity Index. Results: A total of 828 pregnant women were included in the analysis. The estimated self-reported rates of anxiety, depression, insomnia, and any of the three were 12.2 %, 24.3 %, 13.3 %, and 33.1 %, respectively. Mediating effect analysis showed that pregnant women's response to COVID-19 was not directly associated with psychological symptoms but indirectly through the mediating effect of maternal concerns, which accounted for 32.35 % of the total effect. Stratified analysis by psychological resilience showed that women's attitude toward COVID-19 (OR, 2.68, 95 % CI: 1.16-6.18) was associated with a higher risk of psychological symptoms in those with poor psychological resilience. Limitations: The study was a non-probability sampling survey, and the causal relationship between maternal concerns and psychological symptoms could not be determined due to the study's design. Conclusions: Under public health emergencies such as COVID-19, routine antenatal care should still be prioritized, and concerns related to childbirth-related caused by such emergencies should also be addressed, especially for those with weak psychological resilience.

We aimed to determine disseminated intravascular coagulation (DIC)-associated organ failure and underlying diseases based on data from three ICU wards in tertiary hospitals in China from 2008 to 2016. The diagnosis of DIC was confirmed by an International Society of Thrombosis and Hemostasis score greater than or equal to 5. The maternal outcomes included the changes in organ function 24 h after ICU admission. The durations of hospital stay and ICU stay were recorded as secondary outcomes. Among 297 ICU admissions (median Sequential Organ Failure Assessment score, 4) for obstetric diseases, there were 87 DIC cases, with an estimated DIC incidence of 87 per 87,580 deliveries. Postpartum hemorrhage was the leading disease associated with DIC (71, 81.6%), followed by hypertensive disorders (27, 31.0%), sepsis (15, 17.2%), acute fatty liver of pregnancy (11, 12.6%) and amniotic fluid embolism (10, 11.5%). Compared with patients without DIC, those with DIC had higher rates of multiple organ dysfunction syndrome/death (27.6% vs 4.8%, p = 0.000), organ failure (36.8% vs 24.3%, p = 0.029), among which organ failure included acute renal failure (32.2% vs 10.0%, p = 0.000), respiratory failure (16.1% vs 8.6%, p = 0.057), disturbance of consciousness (12.6% vs 2.4%, p = 0.000) and DIC group also had higher rates of massive transfusion (52.9% vs 21.9%, p = 0.000), hysterectomy (32.2% vs 15.7%, p = 0.001), longer ICU (4 days vs 2 days, p = 0.000) and hospital stays (14 days vs 11 days, p = 0.005). DIC and amniotic fluid embolism were independent risk factors for organ failure in patients admitted to the ICU. Postpartum hemorrhage was the leading cause of DIC associated organ failure in obstetrics admitted to the ICU. The control of obstetric bleeding in a timely manner may improve obstetric prognoses.

BACKGROUND:Pernicious placenta previa complicated by placenta accreta spectrum (PAS) often leads to hysterectomy or even maternal death due to massive bleeding. In recent years, the application of balloons has received increasing attention. It is easier to use and has reasonably good effect. However, for some patients, especially those who still have some placental residue, there might still be active bleeding. To solve this problem, we propose a method of pressure sutures around the balloon to provide a better hemostasis effect.METHODS:An observational study was conducted on patients with pernicious placenta previa and PAS at the Beijing Chaoyang Hospital, Beijing, China, between January 2018 and January 2021. During surgery, an intrauterine balloon was used to compress the hemorrhage site, and two or more absorbable sutures were placed around the uterus to apply strong pressure on the balloon. This method is an updated modification of the Lu-suture which uses a Foley catheter balloon and only one suture. The main improvements include choosing different kinds of balloons depending on various conditions and the addition of a suture below the balloon to provide much stronger pressure and prevent the balloon slipping out through the dilated cervix.RESULTS:A total of 10 women underwent the procedure. The mean estimated intraoperative blood loss was 1,190±548 mL. Post-surgery, the blood loss was less than 200 mL in all patients. The mean blood transfusion [packed red blood cells (pRBC)] required was 2.2±2.6 units. The mean hemostatic time was 8.1±3.4 minutes.CONCLUSIONS:The modified suture technique provided an easy, cheap, and efficient surgical choice for patients with pernicious placenta previa and PAS.

随着新型冠状病毒肺炎(COVID-2019)的爆发和蔓延,儿童感染者也有较明显的增多趋势,新生儿病例亦有报道.新生儿是新型冠状病毒易感人群,一旦感染,对新生儿这一特殊免疫低下人群易造成严重危害.加强新型冠状病毒肺炎防控,有效预防新型冠状病毒在新生儿的传播和流行至关重要.本文结合首都医科大学附属北京朝阳医院防控管理工作实际,从新生儿新型冠状病毒肺炎门急诊预检分诊、患儿分类排查、病区分区准入及标准操作程序(support onented process,SOP)再造等内容进行实践探索,旨在建立一套行之有效的新生儿新型冠状病毒肺炎防控管理模式.

目的:研究组蛋白去乙酰化酶3(HDAC3)与人附睾蛋白4(HE4)在卵巢恶性肿瘤中的关系,探究其对恶性肿瘤生物学行为影响的机制.方法:用免疫组化、Western blot法和Real-time PCR法测定HDAC3在卵巢恶性肿瘤组织中的表达.转染慢病毒敲降或过表达HDAC3蛋白,比较卵巢癌细胞增殖、侵袭及迁移能力的变化.免疫组化检测HDAC3和HE4蛋白在卵巢上皮组织中的表达.结果:HE4是HDAC3的相关蛋白,HDAC3通过促进HE4表达使卵巢癌细胞的增殖、侵袭及迁移能力提高.卵巢癌组织中HDAC3和HE4表达明显高于正常卵巢组织及良性卵巢病变组织(P<0.05).结论:HDAC3在卵巢癌中高表达,通过调控HE4表达促进卵巢癌细胞的增殖、侵袭及迁移能力.阻断HDAC3与HE4之间的联系,可能会作为卵巢恶性肿瘤治疗的潜在方法.

Objective: To evaluate the reproductive outcomes of cesarean scar pregnancy (CSP) pretreated with methotrexate (MTX) and uterine artery embolization (UAE) prior to curettage. Materials and methods: The medical records of patients with CSP who were pretreated with MTX and UAE prior to curettage in our institute from January 2013 to December 2015 were collected and retrospectively reviewed. Results: A total of 53 patients were eligible for further analysis. Consecutive systemic MTX or a single dose of MTX was administered in 31 or 15 patients, respectively. The UAE procedure was uneventful, and no side effects occurred. The duration of the curettage operation was 21.4 +/- 10.4 min, and the volume of blood loss was 23.5 +/- 61.6 ml. The serum 13 HCG level returned to normal 36.1 +/- 10.1 days after the date of initial MTX administration. Eight of 10 patients with a desire to have children became pregnant naturally. Two (25%) patients developed recurrent CSP during the first trimester. One patient underwent emergency cesarean delivery and hysterectomy due to placental implantation and sudden massive hemorrhage during delivery. A total of 6 live newborns were delivered. Conclusion: Pretreatment with MTX and UAE prior to curettage is safe and effective for the management of CSP. The reproductive outcomes are encouraging. (C) 2020 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.

孕产妇是新型冠状病毒易感人群,一旦感染,病情发展迅速,易进展为重症,因此,应高度重视孕产妇新型冠状病毒肺炎防控,避免孕产妇院内感染暴发.结合医院实际,从新型冠状病毒肺炎疫情期间孕产妇分级防控体系、分区分类管理、接诊处理、信息报送、日常督查及出院远程随访等内容进行探讨,旨在探索综合医院新型冠状病毒肺炎疫情期间孕产妇感染防控管理模式.

Objective:To compare conservative management and cesarean hysterectomy in patients with placenta increta or percreta. Materials and methods:In this multicenter retrospective study, we recorded data on 2219 patients with placenta increta or percreta from 20 tertiary care centers in China from 1 January 2011 to 31 December 2015. Propensity score analysis was used to control for baseline characteristics. We divided patients into conservative management (C) and hysterectomy (H) groups. The primary outcome was operative/postoperative maternal morbidity; secondary outcomes were maternal-neonatal outcomes. Results:In total, 17.9% (398/2219) of patients had placenta increta and percreta; 82.1% (1821/2219) of the patients were in group C. After propensity score matching, 140 pairs of patients from the two groups underwent one-to-one matching. Group C showed less average blood loss within 24 h of surgery (1518 +/- 1275 vs. 4309 +/- 2550 ml in group H,p<.001). There were more patients with blood loss >1000 ml in group H than in group C (93.6% [131/140] vs. 61.4% [86/140],p<.001). More patients received blood transfusions in group H than in group C (p=.014). There was no significant difference between the groups in terms of bladder injury, postoperative anemia, fever, and disseminated intravascular coagulation. Neonatal outcomes in the two groups were similar. Conclusion:Either conservative management or hysterectomy should be considered after thorough evaluation and detailed discussion of risks and benefits. A balance between bleeding control and fertility can be achieved.

BackgroundTo summarize the clinicopathological features and prognostic factors of pregnancy with gastric cancer.MethodsThe clinical data of pregnant patients with gastric cancer diagnosed and treated in our hospital from 2009.1 to 2019.12 were analyzed. Two sex-, age-, and stage- matched controls for each case were identified from the medical data. Clinical characteristics, pathological features and prognosis were summarized.ResultsThe median overall survival time of the pregnancy with gastric cancer and the control group were 8.0 months and 11.0 months, respectively (P = 0.05). The advanced stage was associated with poor prognostic factors. Pregnancy with gastric cancer was associated with a longer time from diagnosis to treatment (19.0 days vs 9.0 days, p = 0.012). The median age was 32 years old (26.0ཞ41.0 years old). The diagnosed time of prengnancy week was 9.0 ~ 37.0 weeks. Of 22 patients, 4 patients had gastric cancer family history. Abdominal pain (6/22, 27.3%) was the most common presentation, and other symptoms were nausea and/or vomiting (3/22, 13.6%), nonspecific dyspepsia (3 cases, 13.6%), and melena (1 case, 4.5%). Other 9 patients (41.0%) were identified with metastatic features, including abdominal distention, ascites, abdominal mass, and jaundice. 5 cases(22.7%) received curative gastrectomy, 5 patients (22.7%) received chemotherapy,and other 12 patients (54.6%) received supportive therapy. ConclusionsThe prognosis of patients with gastric cancer in pregnancy is very poor, and patients often cannot be diagnosed in time. The tumor differentiation is poor with advanced stage, always progresses rapidly with high mortality. And the tumor stage was the significant factor influecing the prognosis.

Objective: To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods: Totally, 2 219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1%, 1 755/2 219) and the placenta percreta (PP) group (20.9%, 464/2 219) , according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results: The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ(2)=157.961) and placenta previa (χ(2)=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions: Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

Objective: The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China. Materials and methods: We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings. Results: The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p = .003), blood transfusion (86.2% versus 46.5%, p < .001), hysterectomy (43.3% versus 11.2%, p < .001), preterm birth (65.7% versus 49.9%, p < .001), and the need for neonatal intensive care unit (NICU) admission (54.5% versus 36.7%, p < .001). Conclusion: The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.