Objective: To investigate the intention for the second child of people of married reproductive age people (20 to 49 years old) in Linfen city of Shanxi province. Methods: The investigation was conducted by multistage stratified random sampling. The questionnaire included the basic situation, the actual fertility situation, and the willingness for the second child. Results: The age structure of married people mainly distributed between 25 to 39 years old in the Linfen city. The ideal average number of child was 1.79, 63.8% family with single child though two children were better, and 48.4% people planned to have the second child. The Logistic regression analysis showed that the income, medical insurance, and gender preference for the second child were the impact factors of the willingness for the second child. Conclusion: The situation of the willingness for the second child should be paid attention to from various aspects. Besides focusing on people’s income, medical insurance should be reinforced, furthermore, the gender preference for the second child presents new model.

2018 Vol. 26　(08):　660- [Abstract]（ 430 ） HTML (0 KB)  PDF  (0 KB)  ( 53 )

Objective: To investigate clinical effect of laser drilling-artificial shrinkage (LDAS) of blastocoels before blastocysts vitrification cryopreservation. Methods: The human blastocysts free-thawed blastocyst cycles (FTB) were performed with laser-drilling shrinkage before vitrified cryopreservation (shrinkage group) or without laser-drilling shrinkage before vitrified cryopreservation (control group). The outcomes were compared between the two groups. Results: All the frozenthawed blastocysts in two groups had been embryos transferred in clinic, which included total 317 FTB cycles. 178 FTB cycles have been taken in control group, and other 139 FTB cycles had been taken in shrinkage group. the age of patients, the years of infertility, endometrium thickness on ovulation day, average number of the embryos transferred, high quality blastocyst rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate had no statistical difference in the two groups (P>0.05). The clinical pregnancy rate (44.9%) and the implantation rate (34.4%) in control group were significant lower than those in shrinkage group (66.9% and 48.5%, respectively) (P=0.001). Conclusion: The clinical pregnancy rate and implantation rate of FTB are significantly improved by LDAS of blastocoels before vitrified cryopreservation, which is worthy of clinical exploration and application.

2018 Vol. 26　(08):　669- [Abstract]（ 477 ） HTML (0 KB)  PDF  (0 KB)  ( 56 )

Objective: To observe the effect of triodone estradiol tablets for uterine recovery after induced abortion. Methods: From January to April 2017, 130 women who undergo artificial abortion in family planning outpatient of Maanshan City maternal and children health care hospital were included and divided into two groups by random number table (65 cases in each group). Women in control group were given symptomatic treatment after abortion, and women in observation group were given tricholetin estradiol tablets on the day after abortion except symptomatic treatment. The situations of uterine and menstrual recovery were compared between the two groups. Results: The time of vaginal bleeding and the time of menstrual recovery of women in observation group were significant shorter than those of women in control group (P < 0.05), and vaginal bleeding amount of women in observation group was significant less than that of women in control group (P < 0.05). On the 14 d or 21 d after abortion, the endometrial thickness of women in observation group was significant greater than that of women in control group (P < 0.05). On the 14 d after abortion, the negative conversion ratio of urine HCG of women in observation group was significant higher than that of women in control group (P < 0.05). The rates of postoperative complications, such as cervical adhesion, pelvic infection, and intrauterine residue of women in observation group were all significant less than those of women in the control group (P < 0.05). No serious adverse reactions were observed in both groups. Conclusion: Tricholetin esterase tablet can promote the recovery of endometrium and menstrual recovery after abortion, can shorten the time of vaginal bleeding, and can reduce the rate of complications of induced abortion.

2018 Vol. 26　(08):　676- [Abstract]（ 397 ） HTML (0 KB)  PDF  (0 KB)  ( 38 )

Objective: To explore the clinical effect of diphereline combined with estradiol valerate for treating endometriosis. Methods: A total of 94 patients with endometriosis from November 2015 to November 2017 were selected, and they were divided into two groups by random number table (47 cases in each group). The patients in control group were given Diphereline treatment, and the patients in observation group were given estradiol valerate add-back therapy except Diphereline treatment. The clinical efficacy of women in the two groups before and after treatment were observed, and the incidence of adverse reaction of women during treatment in both groups were also observed. Results: 3 months after treatment, visual analogue scale (VAS), estradiol (E2) level, bone mineral density (BMD), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin- 8 (IL-8) of patients in the two groups were significantly different when compared to those before treatment (P<0.05), but there was no significant difference in above indexes of patients between the two groups before treatment (P>0.05). 3 months after treatment, the level of E2 and the BMD of patients in observation group were significantly higher than those of patients in control group (P<0.05), but the VAS score and the level of TNF-α, IL-6 and IL-8 had no significant difference between the two groups (P>0.05). During treatment, the incidences of tidal sweats, vaginal dryness, joint pain and mood swings of patients in observation group were significant lower than those of patients in control group (P<0.05), but there were no significant difference in incidences of sexual desire and fatigue between the two groups (P > 0.05). Conclusion: Diphereline combined with estradiol valerate for treating endometriosis can significantly alleviate the pain symptoms, reduce the level of inflammatory factors, and has excellent curative effect. It can also regulate estrogen levels and inhibit bone loss, and had less adverse reaction. It is worthy of clinical application.

2018 Vol. 26　(08):　683- [Abstract]（ 342 ） HTML (0 KB)  PDF  (0 KB)  ( 53 )

Objective: To investigate the levels of serum uric acid (UA) and lactate dehydrogenase (LDH) of women with hypertensive disorder complicating pregnancy (HDCP), and to analyze their significances. Methods：80 women with pre-eclampsia who had been hospitalized in the affiliated hospital of north China university of science and technology from October 2016 to April 2018 were selected into observation group, which were divided into mild pre-eclampsia group (n=25) and severe preeclampsia group (n=55) according to the severity of pre-eclampsia. And the women with severe pre-eclampsia were also divided into early onset severe pre-eclampsia group (n=23) and late onset severe pre-eclampsia group (n=32). Another 80 normal pregnant women were selected in control group.  The serum levels of UA and LDH of women were compared between observation group and control group, and the serum levels of UA and LDH of women with different types of preeclampsia were also compared. Results：Serum UA and LDH levels of women in observation group were significant higher than those of women in control group (P<0.05). Compared with those of women with mild pre-eclampsia, the levels of serum UA and LDH of women with severe pre-eclampsia were significant higher (P<0.05). Compared with those of women with early onset severe preeclampsia, the levels of serum UA and LDH of women with late onset of severe pre-eclampsia were significant higher (P<0.05). Furthermore, with the pre-eclampsia aggravated, the incidence of perinatal adverse outcomes had increased, and there was a significant difference in perinatal adverse outcomes among normal pregnant women, women with mild preeclampsia, and women with severe pre-eclampsia (P < 0.05). Conclusion：Serum levels of UA and LDH will increase following the pre-eclampsia aggravating, so serum levels of UA and LDH maybe monitoring indicators of the changes in condition of women with HDCP.

2018 Vol. 26　(08):　691- [Abstract]（ 342 ） HTML (0 KB)  PDF  (0 KB)  ( 42 )

Objective: To investigate the diagnostic value of detection of serum β2-microglobulin (β2-MG) combined with detection of retinolbinding protein 4 (RBP4) and urine neutrophil gelatinaseassociated lipocalin (NGAL) for early renal impairment of patients with hypertensive disorder complicating pregnancy (HDCP). Methods: 63 patients with HDCP were selected in observation group, and another 42 normal pregnant women were selected in control group. Based on the urinary protein excretion rate (UAER), the patients in observation group were also divided into normal proteinuria group (16 cases, UAER<20 ug/min), and microalbumin (23 patients, 20 ug/min<UAER<200 ug/min), and massive proteinuria group (24 patients, UAER>200 ug/min). The levels of serum β2-MG, RBP4, and urinary NGAL of patients were measured in each group. Differences among these groups was analyzed, and receiver operating characteristic curve (ROC) analysis of β2-MG detection combined with detection of RBP4 and NGAL was used to evaluated the value for early diagnosing renal damage of patients with HDCP. Results: The serum levels of β2-MG, RBP4 and urinary NGAL of patients in massive proteinuria group were significant higher than those of patients in microal buminuria group, those of patients in microal buminuria group were significant higher than those of patients in normal proteinuria group, and those of patients in normal proteinuria group were significant higher than those of patients in healthy control group (all P<0.05). The positive rates by combined detection in normal proteinuria group, in microproteinuria group, and in macroalbuminuria group were 31.3%, 95.7%, and 100%, respectively, which were significant higher than those by individual detection. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and positive likelihood ratio by combined detection for diagnosing early renal injury of patients with HDCP were 89.4%, 92.8%, 90.3%, 93.0%, 93.8%, and 9.0, respectively, which were significant higher than those detected by individual detection, but the negative likelihood ratio of combined detection (1.02) was significant lower than that by individual detection. The area under the curve (AUC) of β2-MG, RBP4, NGAL, and combined detection by ROC analysis for diagnosing early renal injury of patients with HDCP was 0.64 (95% CI: 0.03-1.38), 0.73 (95% CI: 0.64-9.03), 0.80(95% CI: 0.03-13.06, and 0.90 (95% CI: 0.03-6.31). Conclusion: The serum β2-MG detection combines with detection of RBP4 and urinary NGAL can improve the accuracy of diagnosis early renal injury of patients with HDCP, which can provide a reliable evidence for clinical diagnosis and treatment.

2018 Vol. 26　(08):　698- [Abstract]（ 303 ） HTML (0 KB)  PDF  (0 KB)  ( 62 )

Objective: To assess the efficacy and safety of medical abortion for terminated pregnant at 10-14 gestational weeks of women with chronic Hepatitis B. Methods: A retrospective study was conducted. From January 2013 to December 2017, 40 pregnant women with chronic Hepatitis B at 10-14 gestational weeks in Beijing You’an hospital of capital medical university were included in observation group, whose transaminase (ALT) level had elevated ranging from 2-10 ULN, and when their ALT level decreased to ≤2ULN after given antiviral and liver protection treatment, these women had experienced medical abortion by mifepristone combined with misoprostol voluntarily. At the same period, another 80 pregnant women with chronic Hepatitis B were selected into control group, whose ALT level were normal, and they also had experienced medical abortion by mifepristone combined with misoprostol voluntarily. The ratio of complete abortion, the change of ALT after abortion and the incidence of adverse events were compared between the two groups. Results: There was no statistical significant difference in the age of women, the frequency of gravida and para of women, gestational weeks, and PTA between the two groups. The positive rate of E antigen, amount of HBV-DNA load and ALT level of women at the first visited hospital in observation group were significant higher than those of women in control group. The success rate of abortion had no significant difference between the two groups (P>0.05). After abortion, the rate of abnormal ALT level of women in observation group (40%) were significant higher than that (2.5%) of women in control group (P<0.05), and all women with abnormal ALT had recovered health after treatment continually. There was no significant difference in other incidence of adverse events between the two groups. 55.6% (10/18) women with ALT value equal to or over 3ULN when the first visited hospital in observation group had ALT value over 2ULN after abortion, which was higher than that of women with ALT value less than 3ULN (27.3%, 6/22), but there was no significant difference(P>0.05). Conclusion: Mifepristone combined with misoprostol for terminated pregnant at 10-14 gestational weeks of women with chronic Hepatitis B is safe and effective, however, the high risk factors should be evaluated before abortion, and pregnant women with chronic Hepatitis B and ALT level elevated should be given treatment of liver protection and antiviral. Pregnant women with ALT value equal to or over 3ULN should select artificial abortion method cautiously.

2018 Vol. 26　(08):　706- [Abstract]（ 400 ） HTML (0 KB)  PDF  (0 KB)  ( 83 )

Objective: To explore clinical significance of levels of serum ferritin, TNF-α (tumor necrosis factor-α), CRP (C-reactive protein) and IFN-γ (interferon-γ) of patients with preeclampsia. Methods: 68 pregnant women with preeclampsia in Yichang maternal and child health care hospital were included in study group, and another 50 healthy pregnant women were selected in control group. The levels of serum Hb (Hemoglobin), Alb (plasma albumin), Tp (total plasma protein), serum ferritin, TNF-α, CRP and IFN-γof pregnant women in both groups were detected by ELISA. Then the correlation between each serum index and pregnancy outcomes of patients with preeclampsia was analyzed. Results: The average levels of Hb, Alb, and Tp of patients in study group had no significant different from those of patients in control group (P>0.05). But in study group, the average levels of Alb and Tp of patients with moderate or severe preeclampsia were significant lower than those of patients with mild preeclampsia (P <0.05). Compared with those of patients in control group, levels of serum ferritin, TNF-α, CRP, and IFN-γof patients in study group were significant higher (P<0.05). And in study group, the levels of ferritin, TNF-α, CRP and IFN-γof patients with severe preeclampsia were significant higher than those patients with mild preeclampsia (P<0.05). The levels of TNF-α, CRP, and IFN-γ of patients with different onset time of preeclampsia had significant different (P<0.05), which included that the levels of TNF-α, CRP, and IFN-γof patients with early onset of preeclampsia were highest, and those of patients with late onset of preeclampsia were lowest. The levels of serum ferritin, TNF-α, CRP, and IFN-γof patients with adverse pregnancy outcomes were significantly higher than those of patients with normal pregnancy outcomes (P<0.05). Conclusion: The occurrence and development of preeclampsia are closely related to the increase of levels of serum ferritin and inflammatory cytokines, such as TNF-α, CRP and IFN-γ, so the pregnancy outcomes of patient can be predicted by monitoring the levels of serum ferritin, TNF-α, CRP and IFN-γin clinical practice.

2018 Vol. 26　(08):　714- [Abstract]（ 273 ） HTML (0 KB)  PDF  (0 KB)  ( 70 )

Premature ovarian insufficiency (POI) is characterized by amenorrhea for 4-6 months with elevated gonadotropin levels affecting 1% of women before the age of 40 years. Although majority of cases are idiopathic, premature ovarian failure can be caused by genetic conditions, autoimmune disease, environmental factors, infectious agents, chemotherapy, and pelvic surgery. Members of the transforming growth factor- β (TGF- β) super family, which including TGFβs, bone morphogenetic proteins (BMPs), growth differentiation factors (GDFs), inhibins, activins, follistatin and anti mullerian hormone (AMH). Via paracrine and/or autocrine mechanisms is involved in regulating follicular growth and development. Here, we review the studies which had reported genetically the genetic mutation of TGF β super family in POI patients.

2018 Vol. 26　(08):　754- [Abstract]（ 332 ） HTML (0 KB)  PDF  (0 KB)  ( 71 )