中华妇产科杂志最新文献

Objective: To analyze the reproductive and psychological health status of pregnant women with placenta accreta spectrum disorders (PAS) after fertile-preserving surgery, and to follow up their subsequent pregnancy and delivery. Methods: A total of 269 cases of abnormally invasive placenta (AIP) who underwent pregnancy supervision and surgical treatment in Peking University First Hospital from January 2010 to August 2020 were collected as AIP group. A total of 300 pregnant women without other complications who underwent elective cesarean section due to cesarean section history in the same center and at the same time period were selected as the control group. Their clinical information was collected, and their menstruation, fertility and psychological health were followed up by telephone and online questionnaire. Results: (1) In AIP group, 222 (82.5%, 222/269) valid questionnaires were returned, of which 171 (77.0%, 171/222) completed the subjective scale. The control group returned 254 valid questionnaires (84.7%, 254/300), of which 191 (75.2%, 191/254) filled in the complete subjective scale. There was no significant difference in the demographic characteristics between AIP group and control group (all P>0.05), but the intraoperative blood loss, the incidence of short-term postoperative complications and the length of hospital stay in AIP group were higher than those in control group. (2) There were no differences in reproductive physiological health status, including the time to resume sexual life, menstruation, re-pregnancy, pelvic ultrasound manifestations and long-term complications between AIP group and control group. The fertility intention of AIP group was lower than that of control group [12.3% (25/204) vs 19.3% (49/254)]. (3) In AIP group, 17 women tried to get pregnant again, and 12 of them (12/17) had successful pregnancy and delivered, and no PAS occurred again. (4) FSFI scores of women undergoing hysterectomy (18 cases) were lower than those undergoing fertive-sparing surgery (204 cases) in AIP group, but there was no differences in the proportion of pelvic floor dysfunction and suspicious emotional disorder. Conclusions: The physiological function of pelvic organs in women with AIP can be restored after fertive-preserving surgery, which is similar to that of women with a history of cesarean section. The risk of pelvic floor dysfunction and emotional disorders is not significantly increased after hysterectomy, but the risk of sexual dysfunction is higher. Hysterectomy is not recommended as the first-line treatment for PAS. Women with fertility desire can get pregnant again and deliver by cesarean section, but PAS should be closely monitored for recurrence during pregnancy.

Objective: To analyze the clinical characteristics, diagnosis and treatment of pregnancy complicated with diffuse uterine leiomyomatosis (DUL), and to explore the treatment strategies for its complications during pregnancy and perinatal period. Methods: The clinical data of 12 pregnant women with DUL who delivered in Peking University Third Hospital from May 2017 to October 2024 were collected, and their complications during pregnancy and perinatal period, radiological features, and treatment strategies were analyzed. Results: The median age of 12 pregnant women with DUL was 32 years (range: 28 to 38 years), and all of them were primiparas with singleton pregnancy. Among the 12 pregnant women, only 7 cases (7/12) were suspected of DUL by imaging examination during pregnancy. Five cases (5/12) only showed multiple uterine fibroids by ultrasound and magnetic resonance imaging during pregnancy, which were finally diagnosed according to intraoperative exploration. Five cases (5/12) of DUL had signs of threatened abortion or threatened preterm birth such as uterine contraction and bleeding during pregnancy, including 3 cases of preterm birth (2 cases of spontaneous preterm birth and 1 case of iatrogenic preterm birth due to prenatal hemorrhage). Among the 12 pregnant women with DUL, 2 cases (2/12) had abnormal fetal position, 3 cases (3/12) had placental adhesion, and 1 case (1/12) had fibroid degeneration. Among the 12 pregnant women with DUL, 9 cases (9/12) were delivered by cesarean section, of which 3 cases were converted to cesarean section because of failed trial of labor, and 6 cases were directly terminated by cesarean section because of abnormal fetal position or previous myomectomy history. Postpartum hemorrhage occurred in 5 cases (5/12), including 4 cases of severe postpartum hemorrhage, and uterine tamponade had good hemostatic effect. Three cases (3/12) had fever after operation or postpartum. All the 12 pregnant women were discharged in a stable condition. Among the 12 neonates, 2 (2/12) were transferred to the department of pediatrics due to premature birth and finally discharged smoothly. Conclusions: Pregnancy complicated with DUL is a high-risk pregnancy, which increases the risk of complications during gestation, delivery and postpartum. Uterine cavity compression hemostasis may be an effective measure to deal with postpartum hemorrhage.

Objective: To investigate the risk factors of endometrial polyps (EP) in patients with endometriosis (EM) and to analyze the predictive value of body composition measurement for EP. Methods: From January 1st, 2022 to June 30th, 2024, patients with EM who underwent hysteroscopy combined with laparoscopy in Chongqing Health Center for Women and Children due to "infertility" were enrolled. According to whether they had EP or not, they were divided into EP group and non-EP group. The general data and body composition (including skeletal muscle mass, body fat mass, body fat percentage and visceral fat level, waist-to-hip ratio, neck circumference, chest circumference, arm circumference, thigh circumference, etc.) of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the high-risk factors of EP in infertile patients with EM. Body type was classified according to body fat percentage combined with lean body mass index. Body type classification and normal weight obesity rate were compared between the EP group and the non-EP group. Results: (1) A total of 180 patients with EM were enrolled, including 77 patients (42.8%, 77/180) in the EP group and 103 (57.2%, 103/180) patients in the non-EP group. There were no significant differences in body mass index (BMI), fasting blood glucose and blood lipid levels between the two groups (all P>0.05). The incidence of primary infertility, body fat mass, body fat percentage, visceral fat level, and thigh circumference in the EP group were higher than those in the non-EP group, and the differences were statistically significant (all P<0.05). (2) Multivariate logistic regression analysis showed that age≥30 years old (OR=3.079, 95%CI: 1.594-5.947), primary infertility (OR=2.914, 95%CI: 1.482-5.729), visceral fat level ≥10 grade (OR=2.838, 95%CI: 1.584-5.729) were the risk factors of EP in infertile patients with EM (all P<0.05). (3) In the EP group, there were no significant differences in BMI and body composition between single and multiple polyps, and between the largest polyp diameter <1 cm and ≥1 cm (all P>0.05). (4) The proportion of obese and puffy type in the EP group was higher than that in the non-EP group, and the difference in body type classification between the two groups was statistically significant (P=0.026). The proportion of patients with normal weight obesity in the EP group was significantly higher than that in the non-EP group [92.1% (35/38) vs 64.3% (36/56); χ²=9.480, P=0.002]. Conclusions: The occurrence of EP in infertile patients with EM is closely related to the increase of body fat mass, body fat percentage and visceral fat level, but not to BMI. The measurement of body composition is of great value for assessing the hidden obesity in infertile patients with EM.

Objective: To summarize the clinical characteristics, management and short-term and long-term outcomes of pregnant women with chronic kidney disease (CKD) stage 4-5. Methods: The clinical data of pregnant women with CKD stage 4-5 admitted by the multidisciplinary team (MDT) of CKD pregnancy management in the Third Affiliated Hospital of Chongqing Medical University from September 2019 to July 2024 were collected and retrospectively analyzed, including medical history, laboratory examination, pregnancy outcome, treatment options, and renal function outcome. To summarize the experience of prenatal counseling, pregnancy management, dialysis indications and lifestyle intervention in pregnant women with CKD stage 4-5. Results: A total of 10 pregnant women with CKD stage 4-5 were enrolled, aged (29.0±4.2) years (range: 23 to 36 years). Among the 10 cases, 3 cases were induced abortion in the second trimester, 1 case had missed abortion in the first trimester, and 6 cases were finally delivered successfully. Renal biopsy was performed in 4 cases to determine the type of primary nephropathy, and genetic testing was performed in 4 cases to confirm the diagnosis of hereditary nephropathy. Among the six CKD stage 4-5 pregnant women who successfully delivered, three started dialysis treatment in the second and third trimesters of pregnancy, and the other three started dialysis treatment immediately, 5.5 months and 18.3 months after delivery, respectively. All pregnant women were terminated by cesarean section and none of them had postpartum hemorrhage. The gestational age at delivery was (33.8±1.1) weeks (range: 32⁺¹ to 35⁺¹ weeks). All neonates were premature, with no fetal death and neonatal death. Two cases were small for gestational age and the other four were appropriate for gestational age. The length of neonatal intensive care unit (NICU) stay was (23.0±11.0) days (range: 10 to 38 days). No serious complications occurred during NICU stay. All newborns grew and developed well during the follow-up period of 10-60 months. Conclusions: CKD stage 4-5 is not an absolute contraindication for pregnancy. Comprehensive evaluation of doctor-patient shared decision-making on the premise of sufficient doctor-patient communication, precise management of MDT, close maternal and fetal monitoring, lifestyle medical intervention and timely initiation of dialysis can help pregnant women with CKD stage 4-5 achieve safe pregnancy and good maternal and fetal outcomes.