Objective:To understand the situation of folic acid release to pregnant women and folic acid intake of pregnant women in urban areas of Shanxi province, and to explore the influence factors on rate of standard intake folic acid. Methods: From April to June 2014, 1925 middle or late stage pregnant women with non agricultural domicile from 11 cities of Shanxi province were investigated by self designed questionnaire. Results: Of all the pregnant women, 94.5% took folic acid, but only 14.9% of them took folic acid based on standard. 43.1% of all women had received free folic acid, of which 97.0% took folic acid and only 16.4% took folic acid based on standard. Unconditional multivariate logistic regression analysis had showed that the pregnant women with 25 to 30 years old (OR=2.00, 95%CI=1.34-2.97) and women with >35 years old (OR=3.58 95%CI=1.89-6.76), the husband's education level equal to or above college (OR=1.80, 95%CI=1.04-3.11), accepted premarital examination (OR=1.58, 95%CI=1.19-2.11), and expected pregnancy (OR=3.80,  95%CI=2.31-6.26) were positively influence factors on the rate of standard intake folic acid. Conclusion: The pregnant women in urban areas have higher rate of folic acid intake, but have lower rate of folic acid intake based on standard. The free distribution of folic acid simply cannot improve folic acid intake based on standard. The health educations need to be strengthened to raise the rate of planning pregnancy and the rate of premarital examination, and also need to improve taking folic acid based on standard.

2018 Vol. 26　(11):　1019- [Abstract]（ 370 ） HTML (0 KB)  PDF  (0 KB)  ( 76 )

Objective:To observe the effect of different anesthesia in cesarean section of pregnant women with hepatitis cirrhosis. Methods: From January 2015 to January 2018, 112 pregnant women with hepatitis cirrhosis who wanted to cesarean section were selected as the subjects, and were divided in two groups (56 cases in each group) according to the platelet count (PLT). The women in observation group (PLT>50×109/L) was given single lumbar anesthesia, and the women in control group (PLT<50×109/L) was given general anesthesia. The maternal and neonatal related indicators and liver function indicators were compared between the two groups, and the Apgar scores of newborns at 1 and 5min after birth in the two groups were analyzed. Results: Before anesthesia, there were no significant different in liver function indexes, operation time, valume of intraoperative blood loss, neonatal birth weight, hospitalization days between the two groups (P>0.05). After induction of anesthesia, the level of albumin of women in observation group was significant lower than that of women in control group (P<0.05). There was no significant difference in levels of alanine aminotransferase, total bilirubin and alkaline phosphatase between the two groups (P>0.05). Postoperation 1 day, the level of albumin of women in observation group was significant lower than that of women in control group. The level of alkaline phosphatase of women in observation group was significant higher than that of women in control group (P<0.05), but there was no significant different in the other indexs between the two groups (P>0.05). In 1 min after born, the incidence of severe asphyxia of newborns in observation group was significant lower than that of newborns in control group (P<0.05), but there was no different in the incidence of asphyxia of newborns in 5min after born between the two groups (P>0.05). Conclusion: In order to ensure the safety of mother and infant, diffrent anesthetic method during cesarean section of women with cirrhosis should be selected based on the actual situation of pregnant women.

2018 Vol. 26　(11):　1028- [Abstract]（ 377 ） HTML (0 KB)  PDF  (0 KB)  ( 89 )

Objective:To explore the clinical value of serum CA125 combined with CA19-9 for assessing the illness state and postoperative recurrence of patients with endometriosis. Methods: From January 2014 to February 2016, 104 patients with endometriosis in Shiyan taihe hospital of Hubei province were selected  and divided into stage I group (31 cases), stage II group (31 cases), stage III group (41 cases), and stage IV group (28 cases) according to the illness state. At the same time, all included women also were divided into rehabilitation group (81 cases) and the recurrent group (19 cases) according to whether postoperative recurrence. Serum CA125 and CA19-9 levels of all patients were detected. Serum CA125 and CA19-9 levels and pain scores of patients in menstrual period were compared among the groups. ROC curve was used to evaluate the sensitivity of serum level of CA125 or CA19-9 for predicting recurrence of patients with endometriosis. Results: The serum levels of CA125 and CA19-9 of patients in stage I and II groups were signifficent lower than those of patients in stage III group (P<0.05), and the serum levels of CA125 and CA19-9 of patients in stage III group were signifficent lower than those of patients in stage IV group (P<0.05). There was a positive correlation between serum level CA125 and serum level CA19-9 (r=0.758, P<0.05). The serum levels of CA125 and CA19-9 of patients in recurrent group were significant higher than those of patients in rehabilitation group (P<0.05). ROC curve analysis had showed that the cutpoint of serum level of CA125 for predicting the endometriosis recurrent was 37.25 U/ml, and its sensitivity and specificity was 66.7% and 90.7%, respectively. And the cutpoint of serum level of serum CA19-9 for predicting the endometriosis recurrent was 40.5μg/ml, and its sensitivity and specificity were 37.5% and 95.3%, respectively. The sensitivity and specificity of serum level of CA125 combined with CA19-9 for predicting the endometriosis recurrence were 79.2% and 97.68%, respectively. Conclusion: Serum levels of
CA125 combined with CA19-9 is highly sensitive to assess the illness state and to predict postoperative recurrence of patients with endometriosis.

2018 Vol. 26　(11):　1037- [Abstract]（ 431 ） HTML (0 KB)  PDF  (0 KB)  ( 85 )

Objective:To investigate the clinical value of dydrogesterone combined with aromataseinhibitor for treating patients with endometriosis. Methods: A total of 104 patients with endometriosis treated in Nanyang central hospital from Oct 2015 to Oct 2017 were selected as study subjects, and all included patients were divided control group and observation group (52 patients in each group) by the random digital table. The patients in control were treated by dydrogesterone, and the patients in observation group were treated letrozole (byaromataseinhibitor) except by dydrogesterone. The effects of treatment, the changes of serum levels of carbohydrate antigen 125 (CA125), matrix metalloproteinase-3 (MMP-3), vascular endothelial growth factor (VEGF) and sex hormone of patients in the two groups were observed before treatment and 6 months after treatment. The incidence of adverse reactions during the medication of patients in the two groups were also recorded. Results: The total effective rate of patients in observation group was 94.2%, which was statistically significant higher than that of patients (80.8%) in control group (P< 0.05). There were no significant different in serum levels of CA125, MMP-3, VEGF and sex hormone between the two groups before treatment (P>0.05), but the levels of serum CA125, MMP-3, VEGF and sex hormone of all patients had decrease after treatment. After treatment, the levels of serum CA125, MMP-3, VEGF, follicle stimulating hormone (FSH), estradiol (E2) and luteinizing hormone (LH) of patients in observation group were statistically significant lower than those of patients in control group (P<0.05). The incidence of adverse reactions during medication in observation was 17.31%, which had no statistically significant different to that (15.38%) in control group (P>0.05). Conclusion: The dydrogesterone combined with aromataseinhibitor for treating patients with endometriosis has significant effect, which can significantly reduce the levels of serum CA125, MMP-3, VEGF, can improve the status of sex  hormones, and has better safety.

2018 Vol. 26　(11):　1044- [Abstract]（ 327 ） HTML (0 KB)  PDF  (0 KB)  ( 63 )

Objective:To investigate the expression characteristics of nuclear transcription factor GATA6 in endometrial carcinoma tissue, and to analyze the relationship between GATA6 expression and clinicopathological parameters or prognosis of patients with endometrial carcinoma. Methods: Immunohistochemistry was used to detect the expression of GATA6 in specimens of 82 patients with endometrial carcinoma, specimen of 60 patients with atypical intimal hyperplasia, and 50 specimens of normal endometrium. The GATA6 expression differences were compared among the threen groups, and the relationship between GATA6 expression and clinicopathological parameters or prognosis of patients was analyzed. Results: The positive expression rates of GATA6 in endometrial carcinoma tissue, atypical endometrial hyperplasia tissue, and normal endometrium tissue were 63.4%, 18.3%, and 6.0%, respectively, which had statistically significant different (P<0.05). The expression of GATA6 was not associated with the pathological type of endometrial carcinoma (P>0.05). It was associated with TNM stage, differentiation degree, myometrial infiltration depth and lymph node metastasis (P<0.05). The 3-year survival rate of patients with GATA6 low expression was 92.3%, and the median survival time was 40 months. The 3-year survival rate of patients with GATA6 high expression was 54.7%, and the median survival time was 20 months, which had statistically significant different between the patients with GATA6 high expression  and GATA6 low expression (P<0.05). Conclusions: GATA6 has highly expression in endometrial carcinoma tissue, and it is associated with invasiveness and poor prognosis of patients with endometrial carcinoma.

2018 Vol. 26　(11):　1052- [Abstract]（ 391 ） HTML (0 KB)  PDF  (0 KB)  ( 54 )

Objective:To explore the effect of different dosage of methoxamine in spinal combined with epidural anesthesia of cesarean section. Methods: 136 pregnant women wanted delivery by cesarean section were randomly divided into group A, group B, group C, and group D (34 cases in each group). The women in group A, group B, group C were given 2, 4 and 6 mg methoxamine,repectively (methoxamine added into 20 mL normal saline, and were infused at the speeds of 0.1, 0.2 and 0.3 mg/min immediately after lumbar puncture success). The women in group D were infused 20ml physiological saline. The systolic blood pressures (SBP), diastolic blood pressures (DBP), heart rate (HR), and pulse oxygen saturation (SPO2) of all women were recorded when entered the operating room, 1 and 5 min after spinal anesthesia, 1 min before delivery, and 5 min after delivery. The incidences of adverse reactions of women included hypotension, nausea and vomiting, and bradycardia were observed during operation. The neonatal Apgar score and umbilical vein blood gas indexes were recorded. Results: SBP of all women in the four groups in T1, T2 and T5 were significant lower than those in T0 (P<0.05). SBP of women in group A, B and C in T3 were significant lower than those in T2 (P<0.05). HR of women in group A and D in T1 were significant higher than those in T0 (P<0.05), and HR of women in group C in T1 were significant lower than that in T0 (P<0.05), but there was no significant different in HR between T1 and T0 (P>0.05). The incidence of hypotension of women in group A, group B, or group C was significant lower than those of women in group D (P<0.05). The incidence of nausea of women in group B was significant lower than those of women in group D (P<0.05). The incidence of bradycardia of women in group C was significant higher than that of women in group D (P<0.05). There was no significant different in blood gas indexes and Apgar score of newborns at 1, 5 min after born among the four groups (P>0.05). Conclusion: Prophylactic methoxamine infused by micropump at the speed of 0.2 mg/min after spinal anesthesia during cesarean section is effective for preventing hypotension, and can make maternal hemodynamic fluctuations more stable.

2018 Vol. 26　(11):　1060- [Abstract]（ 326 ） HTML (0 KB)  PDF  (0 KB)  ( 49 )

Objective:To explore the effect of low dose progesterone injection combined with Xiaoyao pill for treating pregnant women with threatened abortion. Methods: 90 women with threatened abortion in the people's liberation army no. 98 hospital from January 2015 to January 2017 were selected and divided into observation group and control group (45 cases in each group) according to the random digital table method. In addition to routine treatment such as rest and given folic acid and vitamin E, the women in control group were intramuscularly injected low dose progesterone (10mg, 1 times /d, 14 days). The women in observation group were given Xiaoyao pill (8 pills per time, 3 times /d, 14 days) except intramuscularly injected low dose progesterone and routine treatment.  The levels of serum human chorionic gonadotropin (β-HCG), progesterone (P), estradiol (E2) and cancerantigen 125 (CA125) were measured in 1 and 2 weeks during treatment, and symptom scores were calculated, and curative effect were evaluated after treatment, and adverse reactions during treatment were recorded. Results: The levels of serum β-HCG, P and E2 of women in observation group were signifficant higher than those of women in control group in 1 and 2 weeks during treatment, and the level of CA125 of women in observation group was signifficant lower than that of women in control group (P<0.05). After the treatment, the scores of symptoms and physical signs of women in observation group were signifficant less than those of women in control group, and the overall effacy of women in observation group was better than that of of women in control group (P<0.05). During treatment, dizziness, headache, fatigue, urticaria, nausea and vomiting, and breast swelling had been found in some women, but there were no significant different in the incidence of above adverse reactions between the two groups (P>0.05). Conclusion: For women with threatened abortion, low doses of progesterone intramuscular injection combined with oral Xiaoyao pill can improve the rate of tocolytic successful, and it has high safety.

2018 Vol. 26　(11):　1068- [Abstract]（ 327 ） HTML (0 KB)  PDF  (0 KB)  ( 69 )

Objective:To explore the effect of delivery mode and opportunity of pregnancy termination on maternal and infant outcomes of pregnant women with expired pregnancy. Methods: The data of 1425 pregnant women from March 2014 to January 2018 in 3201 hospital of China aviation industry were collected and analyzed retrospectively. According to the gestational weeks, 1094 pregnant women were included into normal pregnancy group (37-40+6 gestational weeks), 239 pregnant women were included into excess time of pregnancy group (41+6 gestational weeks), and 92 pregnant women were included into overdue pregnancy group (42-45 gestational weeks). Mode of pregnancy termination, maternal complications, and neonatal outcomes were compared among the three groups. Results: There were significant different in rates of vaginal delivery, cesarean section and postpartum hemorrhage among the three groups (P<0.05). The rate of postpartum hemorrhage and cesarean section of women in overdue pregnancy group was the highest among the three groups, and those of women in excess time of pregnancy group were significant higher than those of women in normal pregnancy group. The rates of fetal distress, macrosomia, neonatal asphyxia, neonate transfer to NICU, and neonatal mortality had significant different among the three groups (P<0.05), and the rates of fetal distress, macrosomia, neonatal asphyxia, neonate transfer to NICU, and neonatal mortality were the highest in overdue pregnancy group, but were the lowest in normal pregnancy group. The levels of AFII and E3 of women in overdue pregnancy group were significant lower than those of women in excess time pregnancy group or normal pregnancy group (P<0.05). The rate of Ⅲ category fetal heart rate monitoring (before trial delivery) of women in overdue pregnancy group was significant higher than that of women in excess time pregnancy group or normal pregnancy group (P< 0.05). In 92 women with overdue pregnancy, , the rate of neonatal asphyxia of women experienced cesarean section directly was significant lower than that of women experienced vaginal delivery or trial delivery (P<0.05), and the Apgar score of newborns of women experienced cesarean section directly was significant higher than that of women experienced vaginal delivery or trial delivery (P<0.05). Conclusion: the overdue pregnancy is harmful to the parturient and perinatal infants, which leads to complications and adverse outcomes. The gestational weeks, placental function, amniotic fluid index, and changes of signs of pregnant women should be considered comprehensively, and guideline of highrisk pregnancy should be referred to. It is suggested that pregnant women with overdue pregnancy should be terminated by direct cesarean section to ensure the safety of mother and child.

2018 Vol. 26　(11):　1077- [Abstract]（ 413 ） HTML (0 KB)  PDF  (0 KB)  ( 74 )

Objective:To investigate the expression of serum MiR-222 and estrogen receptor-α (ERα) of pregnant women with gestational diabetes mellitus (GDM), and to analyze its clinical significance. Methods: Collected 100 pregnant women with GDM in affiliated hospital of north China Science and Technology University were selected into research group from August 2014 to August 2016, and another 100 normal pregnant women during the same period were selected into control group. The clinical indexes of all included pregnant women in the two groups were observed. qRT-PCR method was used to detect the expressions of serum miR-222 and ER mRNA, Western blot was used to detect the expression level of ERαprotein. the relationship between the expressions of miR-222 or ERαand the clinical indicators of pregnant women with GDM were compared between the two groups. Pearson method was used for further analyzing the correlation between the expression of miR-222 and the expression level of ERα. And according to the test results of the median value of miR-222 and ERαexpression, pregnant women with GDM were divided into high expression group and low expression group, and the relationships between miR-222 or ERαexpression and the prognosis of the newborns were analyzed. Results: The BMI, FPG and FINS of pregnant women in research group were significant higher than those of pregnant women in control group (P<0.05). Compared with the control group, the expression of serum miR-222 of pregnant women in research group was increased significantly (P<0.05), while the expression of ERαmRNA and the level of ER protein expression were decreased significantly (P<0.05). The expression of miR-222 of pregnant women with GDM was positively correlated with BMI, FPG, FINS or TC (P<0.05), while the expression of ERαmRNA was negatively correlated with FPG (P<0.05). Pearson correlation analysis had showed that the expression of miR-222 was negatively correlated with ER mRNA expression (P<0.05), and the expressions of miR-222 or ERαmRNA were significant correlated with neonatal pathological jaundice (P<0.05). Conclusion: The up-regulation of serum miR-222 expression of pregnant women with GDM can regulate down the expression of ER, and then involve in the occurrence and development of GDM. As for pregnant women with GDM, serum miR-222 expression is negatively correlated with ER mRNA expression, so it can be used as a biological indicator for early diagnosing GDM of pregnant women, and also can be as a biological indicator for evaluating neonatal prognosis.

2018 Vol. 26　(11):　1086- [Abstract]（ 342 ） HTML (0 KB)  PDF  (0 KB)  ( 82 )

Objective:To explore the relationship between serum miR-21 expression of women with polycystic ovary syndrome (PCOS) and their obesity or metabolism of glucose and lipid. Methods: 96 women with PCOS (in observation group) were treated in Luohe central hospital of Henan province from February 2016 to December 2017 were selected into the data. At the same time, another 60 infertility women with basal body temperature were selected into control group. Serum miR-21 expressions of women in the two groups were detected by RT-PCR. The obesity of women diagnosed by BMI > 25 kg/m2, and 96 women with PCOS were also divided into PCOS with obesity group and PCOS with normal weight group. The expressions of serum miR-21 of women in different group were analyzed and compared. Pearson correlation analysis had been used to find the correlation between miR-21 and obesity or abnormal glucose and lipid metabolism. Results: The serum miR-21 expressions of women in observation group (2.71±0.69) was significant higher than that (1.10±0.26) of women in control group (P<0.05). The serum miR-21 expressions of obesity women with PCOS (2.91±0.82) was significant higher than that (1.80±0.36) of normal weight women with PCOS (P< 0.05). The serum miR-21 of expressions of abnormal glucose and lipid metabolism women with PCOS (2.81±0.72) was significant higher than that (1.50±0.16) of normal glucose metabolism women with PCOS (P<0.05). There was a positive correlation between miR-21 and LDL-C, HOMA-IR or BMI of women in observation group (r=0.430, 0.516, 0.356, P<0.05), but there was no correlation between miR-21 and LDL-C, HOMA-IR or BMI of women in control group. Conclusion: The expression of miR-21 is up-regulated of women with PCOS, and it is associated with obesity and abnormal glucose and lipid metabolism of women with PCOS.

2018 Vol. 26　(11):　1094- [Abstract]（ 428 ） HTML (0 KB)  PDF  (0 KB)  ( 86 )

Objective:To observe the relationship between uterine arterial blood flows by vaginal color doppler ultrasonography and the prognosis of pregnant women at first stage with threatened abortion. Methods: The data of pregnant women at first stage with threatened abortion in maternal and children health care hospital of BeiLun district of Ningbo city were analyzed retrospectively, and all included women were divided into group A (pregnancy lasted equal to or over 16 gestational weeks) or group B (pregnancy lasted less than 16 gestational weeks) according to the outcomes of pregnancy, and during the same time, the normal early pregnancy women were selected into group C. The uterine artery blood flow mechanics parameters, such as values of S/D, RI and PI of pregnant women were compared on among the three groups, and values of S/D, RI and PI were also compared between pregnant women less than 10 gestational weeks and pregnant women at 10 to 12 gestational weeks. The correlation of values of S/D, RI and PI to pregnancy outcomes were analyzed. Results: The values of S/D and RI of uterine artery blood flow indexes of women were different among the three groups, in which value of S/D of women in group A had no significant different to that of women in group C (P>0.05), but there was significant different in value of S/D of women among the other groups (P<0.05). The value of PI had no statistical different among the three groups. When the gestational weeks was less than 10, the values of S/D, RI, and PI of women were different among the three groups, in which values of S/D and PI of women in group A had no significant different to those of women in group C (P>0.05), but there were significant different in value of S/D and PI of women among the other groups (P<0.05). When women at 10-12 gestational weeks, the value of RI of uterine artery blood flow was different among the three groups, in which value of RI of women in group A had no significant different to that of women in group C (P>0.05), but there was significant different in value of S/D of women between group B and group A or group C (P<0.05). The values of S/D and PI had no statistical different among the three groups. The S/D and RI values were the high risk factors of the prognosis of pregnant women with threatened abortion during early stage (OR=5.895, 2.535, P=0.001, 0.009), but the value of PI had no impact on prognosis of pregnant women with threatened abortion. Conclusion: The indicators of uterine artery blood flow maybe have predictive value to the prognosis of pregnant women with threatened abortion during early stage, especially to pregnant women with threatened abortion less than gestational weeks, so these indexes can provide some evidences for clinical spuc treatment.

2018 Vol. 26　(11):　1102- [Abstract]（ 368 ） HTML (0 KB)  PDF  (0 KB)  ( 98 )

Objective:To investigate the effect of rehabilitation therapy of patients with stress urinary incontinence on their pelvic floor function and structure evaluated by transperineal ultrasound. Methods: 80 patients with stress urinary incontinence were divided into the rehabilitation group and control group. The patients in control group were treated by routine pelvic floor muscle exercise, and the patients in rehabilitation group were treated by rehabilitation therapy excepted routine pelvic floor muscle exercise. The pelvic structure changes of all included patients in resting state or after Valsalva action were detectioned before and after treatment by the perineum four-dimensional ultrasound. The changes of muscle fiber muscle strength of class I and II before and after treatment were evaluated by neuromuscular stimulation therapy instrument. Results: In resting state or after Valsalva action, the area of pelvic septum, bladder and posterior urethral space and the urethral space of the levator ani muscle of all patients decreased significantly after rehabilitation therapy, and the vertical distance from the bladder neck to the inferior edge of the pubic symphysis and the thickness of the levator ani muscle of all patients increased significantly (P<0.05). The area of pelvic septum, bladder and posterior urethral muscle and urethral space of the levator ani muscle of patients in the rehabilitation group were significant lower than those of patients in control group after treatment, and the vertical distance from the posterior margin of the bladder neck to the pubic symphysis and the thickness of the levator ani muscle in the rehabilitation group were significant higher than those of patients in control group (P<0.05). Muscle fibers of class I and class II of patients in both groups were increased significantly after treatment (P<0.05), and muscle fibers of class I and class II of patients in rehabilitation group after the treatment were significant higher than those of patients in control group (P<0.05). Conclusion: Rehabilitation therapy can improve the function and structure of pelvic floor of patients with
stress urinary incontinence, and the curative effect can be evaluated effectively by transperineal fourdimensional ultrasound.

2018 Vol. 26　(11):　1111- [Abstract]（ 328 ） HTML (0 KB)  PDF  (0 KB)  ( 79 )

Objective:To compare the clinic effect of transvaginal hysterotomy and uterine curettage after uterine artery embolization (UAE) for treating patients with cesarean scar pregnancy (CSP). Methods: The clinical data of 50 patients with CSP in Shanghai first maternity and infant hospital from July 2015 to Jun 2017 were retrospectively analyzed in this study. 23 patients treated by transvaginal hysterotomy were in transvaginal surgery group, and 27 patients received uterine curettage after UAE were in UAE group. The clinical information on these patients and clinical outcomes were reviewed and compared. Results: All the 50 patients were treated successfully. The incidence of postoperative abdominal pain of patients in transvaginal surgery group (21.7%) was significant lower than that of patients in UAE group (89.2%). The cost of hospitalization (16101.9±5500.6 yuan) of patients in transvaginal surgery group was also significant lower than that of patients in UAE group (20124.5±2200.6 yuan). There were no significant difference in decrease of blood-hCG postoperation and menstrual recovery time between the two groups. During the followed up, there was 1 cases of amenorrhea in the UAE group, and another 1 cases in UAE group had CSP again after 6 months. Conclusion: Transvaginal hysterectomy for treating patients with CSP has perfect effectiveness. Compared with uterine curettage after UAE, it has less postoperative pain, and the treatment costs is lower.

2018 Vol. 26　(11):　1119- [Abstract]（ 406 ） HTML (0 KB)  PDF  (0 KB)  ( 81 )

Monogenic disorders occupies an important share in birth defects, especially recessive hereditary diseases. Carriers screening of monogenic disorders is an important part of the 3 levels prevention and control of birth defects. In recent years, expanded carriers screening has been widely promoted. This article will review the development and challenges of expanded carrier screening.

2018 Vol. 26　(11):　1131- [Abstract]（ 381 ） HTML (0 KB)  PDF  (0 KB)  ( 95 )