To summarize the research status, hotspots and evolutionary trends of the prevention and management of maternal venous thromboembolism (VTE) in China, so as to provide theoretical reference for better prevention and management of VTE during pregnancy and perinatal period. Methods Using the full-text periodical database of CNKI, Wanfang and VIP-CMJD as data sources, the CiteSpace software is used to visually analyze 2059 literatures related to the prevention and management of maternal VTE in China from 2000 to 2021. Further explore the frontier hotspots of maternal VTE prevention and management. Results The number of articles published on the prevention and management of VTE in Chinese pregnant and lying-in women is on the rise. The risk factors, auxiliary examination, drug and physical control of VTE are the current research hotspots, the research focus group is the women after cesarean section. Conclusions The research on the prevention and management of maternal VTE in China is limited in depth and breadth. In the future, cooperation between authors, institutions and disciplines should be further strengthened to improve the quality of the prevention and management of maternal VTE.

2023 Vol. 31　(1):　4- [Abstract]（ 963 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )

To investigate the mechanism progression of the influence of NLRP3-mediated pyroptosis and inflammatory response regulated by microRNA-703 (miR-703) of mice on their endometriosis (EM). Methods: The BABL/C mouse model of endometriosis was established by mouse-to-mouse intraperitoneal implantation. Mice were divided into study group and control group. Immunoblotting and enzyme-linked immunosorbent assay were used to detect the pyroptosis marker proteins (NLRP3, pro-caspase-1, and caspase-1) and the inflammatory factors expressions (IL-1β, IL-18, TNF-α and IL-6). Real-time PCR was used to detect the content of miR-703 in the two groups. Mice that were successfully modeled were intraperitoneally injected with miR-703 NC (EM+NC negative group) and pre-miR-703 (EM+miR-703 group), respectively. The size of the endometriotic tissue and the expressions of pyroptosis marker proteins and inflammatory factors of the mice in the two groups were detected. Results: The protein expressions of NLRP3 and caspase-1 of the mice in the study group were significantly higher than those of the mice in the control group. The levels of inflammatory cytokines, such as IL-1β, IL-18, TNF-α, and IL-6, of the mice in the study group were 1.33±0.11ng/ml, 0.66±0.08ng/ml, 179.69±3.78pg/ml, and 90.375±4.63pg/ml, which were significantly higher than those group (0.30±0.05ng/ml, 0.21±0.03ng/ml, 50.51±2.96pg/ml, and 24.99±1.81pg/ml) of the mice in the control group. The expression of miR-703 (0.52±0.09) in the ectopic tissues of the mice in the study group was significantly lower than that (1.00±0.07) of the mice in the control group (all P＜0.05). After transfection of pre-miR-703 in the mice with EM, the EM tissues of the mice in EM+miR-703 group became smaller, the expression of miR-703 of the mice in EM+miR-703 group was significantly higher than that of the mice in EM+NC negative group, the expression of pyroptosis marker protein of the mice in EM+miR-703 group was significantly lower than that of the mice in EM+NC negative group, and the levels of inflammatory factors of the mice in EM+miR-703 group were significantly lower than those of the mice in EM+NC negative group (all P＜0.05). Conclusion: MiR-703 may improve endometriosis symptoms by inhibiting NLRP3-mediated pyroptosis and inflammatory response.

2023 Vol. 31　(1):　15- [Abstract]（ 1103 ） HTML (0 KB)  PDF  (0 KB)  ( 17 )

To investigate the situation of childbirth fear of advanced primiparas, and to analyze its influencing factors. Methods: The convenience sampling method was used to select 160 advanced primiparas who wanted delivery in hospital from December 2021 to June 2022. The situation of maternal fear of childbirth was investigated by the childbirth fear scale. The general data, the scores of self-rating anxiety scale (SAS), perinatal health literacy scale, childbirth self-efficacy scale (CBSEI-C32), and social support rating scale (SSRS) of the primiparas were collected. Univariate analysis and Logistic multivariate regression analysis were used to explore the influencing factors of the childbirth fear of these primipara. Spearman correlation analysis was used to analyze the correlation between the childbirth fear of the advanced primipara and their scores of SAS, perinatal maternal health literacy scale, CBSEI-C32, and SSRS. Results: The average childbirth fear score of 160 primiparas was 36.91±8.63 points, and among which, 86.3% primiparas had fear of childbirth. Univariate analysis showed that there were significant differences in the education level, the infertility history, and the scores of SAS, perinatal maternal health literacy Scale, CBSEI-C32, and SSRS between the primiparas with fear of childbirth and the primiparas without fear of childbirth (P＜0.05). Logistic regression analysis showed that the education level of the primiparas was not the independent risk factors of their fear of childbirth (P＞0.05). Infertility history and SAS score of the primiparas were the independent risk factors for their fear of childbirth, while the scores of perinatal health literacy scale, CBSEI-C32, and SSRS of the primiparas were the protective factors for their fear of childbirth (all P＜0.05). Spearman correlation analysis showed that fear of childbirth of the primiparas was positively correlated with their SAS score, and was negatively correlated with their perinatal health literacy scale, CBSEI-C32, and SSRS scores (all P＜0.05). The incidence of childbirth fear of the advanced primiparas is high, and its influencing factors include infertility history, anxiety, perinatal health literacy, self-efficacy during childbirth, and social support, etc, so which can support the formulation of the clinical targeted intervention strategies.

2023 Vol. 31　(1):　23- [Abstract]（ 453 ） HTML (0 KB)  PDF  (0 KB)  ( 19 )

To investigate the effects of Mirena combined with gonadotropin-releasing hormone agonist (GnRH-a) for treating patients with adenomyosis (AM) after operation on their uterine volume, serum human epididymis protein 4 (HE4) level, and pictorial blood loss assessment chart (PBAC) score. Methods: 96 patients with AM after operation were selected and were divided into three groups (32 cases in each group) according to the random number table method from January 2019 to August 2020. The patients in group A were given Mirena inserted after operation, the patients in group B were given GnRH-a treatment after operation, and the patients in group C were given Mirena inserted combined with GnRH-a treatment after operation. The degree of dysmenorrhea evaluated by visual analogue scale (VAS), the uterine volume, the serum HE4 level, the PBAC score, and the recurrence of AM of the patients were compared among the three groups. Results: At 6 and 12 months after treatment, the VAS scores (1.86±0.58 points and 1.45±0.47 points) of the patients in group C were significantly lower than those (3.42±1.07 points and 2.89±0.88 points) of the patients in group B, and those (7.14±1.27 points and 2.03±0.59 points) of the patients in group A. The values of the uterine volume (88.32±29.23cm3 and 89.35±27.49cm3) of the patients in group C were significantly lower than those (105.32±32.34cm3 and 104.78±32.57cm3) of the patients in group B, and those (108.27± 33.25cm3 and 104.78±32.57cm3) of the patients in group A. The serum HE4 levels (43.86±3.85 U/ml and 42.22±3.36 U/ml) of the patients in group C were significantly lower than those (50.28±4.27 U/ml and 48.43±4.14 U/ml) of the patients in group B, and those (49.44±4.46 U/ml and 47.86±4.32 U/ml) of the patients in group A. The PBAC score (78.62±19.63 points and 63.74±18.18 points) of the patients in group C were significantly lower than those (95.75±24.34 points and 90.89±29.94 points) of the patients in group B, and those (90.87±22.76 points and 88.65±28.92 points) of the patients in group A. The recurrence rates (0 and 0) of the patients in group C in 6 and 12 months after treatment were significantly lower than those (6.3% and 211.9%) of the patients in group B, and those (3.1% and 18.8%) of the patients in group A (all P＜0.05). Conclusion: Mirena combined with GnRH-a for treating the patients with AM after treatment can significantly reduce the degree of dysmenorrhea, decrease the size of the uterus, the serum HE4 level, the PBAC score, and the recurrence of AM.

2023 Vol. 31　(1):　32- [Abstract]（ 1151 ） HTML (0 KB)  PDF  (0 KB)  ( 22 )

To investigate the value of serum miR-21 level of patients with premature ovarian insufficiency (POI) for evaluating the efficacy and their pregnancy outcomes after treated by estradiol combined with dydrogesterone. Methods: 92 patients with POI who had reproductive demand were selected in this study from July 2018 to July 2021. These patients were treated with estradiol combined with dydrogesterone, and the levels of serum miR-21 level of the patients before and after treatment were measured. The correlation between the serum miR-21 level of the patients and their estrogen level was analyzed. Receiver operating characteristic (ROC) curve of the serum miR-21 expression level for diagnosing POI was drawn. The patients were divided into group A (55 patients with high miR-21 expression level ≥ 0.76) and group B (patients with low miR-21 expression level) according to the cutoff value of the serum miR-21 expression level. The pregnancy outcomes of the patients with different miR-21 expression level were analyzed. Results: After treatment, the serum miR-21 and estradiol (E2) levels of the patients with POI had increased significantly, while their follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels had decreased significantly (all P＜0.05). Pearson correlation analysis showed that the serum miR-21 expression level of the patients with POI was positively correlated with their E2 level (r=0.615, P＜0.05), and was negatively correlated with their FSH and LH levels (r=-0.549, -0.511, P＜0.05). After 3 months of treatment, the serum miR-21 expression level of the patients with effective treatment was significantly higher than that of the patients with ineffective treatment (P＜0.05). The AUC of the serum miR-21 level for diagnosing POI of the patients was 0.827, and the optimal cut-off value of which was 0.76. The rates of clinical pregnancy (54.6%) and biochemical pregnancy (65.5%) of the patients in group A were significantly higher than those (18.9% and 29.7%) of the patients in group B (P＜0.05). Conclusion：The serum miR-21 level of the patients with POI has certain value for evaluating the effect treated by estradiol combined with dydrogesterone, and the low expression of serum miR-21 level suggests the increased risk of adverse pregnancy outcomes of the patients.

2023 Vol. 31　(1):　43- [Abstract]（ 1091 ） HTML (0 KB)  PDF  (0 KB)  ( 22 )

To investigate the influence of self-weight management of obese women with polycystic ovary syndrome (PCOS) after in vitro fertilization-embryo transfer (IVF-ET) on their pregnancy outcomes. Methods：The convenience sampling method was used to select 108 obese women with PCOS who planned to receive IVF-ET in this study from January 2019 to December 2021. These women were divided into observation group (n=54) and control group (n=54) according to the random number table. The women in the control group were given conventional drug treatment, and the women in the observation group were given selfweight management based on treatment of the control group. The differences of body mass index (BMI), the time and dosage of gonadotropin hormone (Gn), the number of eggs obtained, the levels of adiponectin, leptin receptor, resistin, and leptin, and the rates of fertilization, optimal embryo, embryo implantation, and pregnancy of the women in the two groups were observed. The pregnancy outcomes of the women were compared between the two groups. Results: After treatment, The BMI value (24.8±1.5kg/m2), the duration of Gn used (10.7±1.3d), and the dosage of Gn used (1856.8±74.0IU) of the women in the observation group were significantly lower than those (27.6±1.8kg/m2, 13.1±1.6d, and 2483.6±78.4IU) of the women in the control group. The number of eggs obtained (16.35±2.51), and the levels of adiponectin (1.41±0.87ng/ml) and leptin receptor (3.40±1.14) of the women in the observation group were significantly higher than those (16.4±2.5, 0.97±0.62ng/ml, and 2.97±0.88) of the women in the control group. The levels of resistin (24.52±1.41ng/ml) and leptin (0.31±0.13mg/ml) of the women in the observation group were significantly lower than those (27.12±1.84 ng/ml and 0.43±0.15 mg/ml) of the women in the control group. The fertilization rate (85.2%), the optimal embryo rate (59.3%), the implanting rate (46.3%), and the pregnancy rate (48.2%) of the women in the observation group were significantly higher than those (72.2%, 44.4%, 24.1%, and 27.8%) of the women in the control group (all P＜0.05). Conclusion: Self-weight management of the obese women with PCOS is effective in reducing their BMI, and improving their treatment efficacy and pregnancy outcomes.

2023 Vol. 31　(1):　52- [Abstract]（ 420 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )

To explore the efficacy of hysteroscopic electrocision combined with progesterone intrauterine system (IUS) for treating patients with endometrial polyps, and to study its influence on the levels of estrogen and progesterone receptor expressions and the inflammatory factors of these patients. Methods: A total of 142 patients with endometrial polyps were selected and randomly divided into two groups (71 cases in each group) from January 2018 to January 2020. The patients in the control group were given hysteroscopic resection of endometrial polyps, and the patients in the observation group were given hysteroscopic resection of endometrial polyps and IUS inserted. The different levels of estrogen receptor (ER), progesterone receptor (PR), and the levels of inflammatory factors, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), C-reactive protein (CRP) of the patients before and after treatment were compared between the two groups. Results: In the sixth month after surgery, the score of menstrual blood loss map, the menstrual cycle, and the endometrial thickness of the patients in both groups had decreases significantly, the hemoglobin level of the patients in both groups had increases significantly, and the change ranges of which of the patients in the observation group were significantly more than those of the patients in the control group. The expression levels of PR and ER (0.94±0.43 and 1.66±0.60) of the patients in the observation group were significantly lower than those (1.50±0.62 and 1.94±0.74) of the patients in the control group. The levels of inflammatory factors, such as IL-6, TNF-α, IFN-γ, and CRP of the patients in both groups after surgery had decreased significantly, and which of the patients in the observation group were significantly lower than those of the patients in the control group (all P＜0.05). The recurrence rate (2 cases, 2.8%) of the patients in the observation group was significantly lower than that (11 cases, 15.5%) of the patients in the control group (P＜0.05). Conclusion: Hysteroscopic resection combined with IUS for treating endometrial polyps of the patients can effectively regulate the expression of their estrogen and progesterone receptors after surgery, and can reduce their level of inflammatory factors and their recurrence of endometrial polyps.

2023 Vol. 31　(1):　60- [Abstract]（ 385 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To study the efficacy comparation of ergostine combined with hemabate or oxytocin for treating postpartum hemorrhage. Methods: A total of 208 women with postpartum hemorrhage were selected as the research objects from June 2021 to June 2022. According to the different treatment methods, these women were divided into observation group (124 cases with treatment of ergostine combined with hemabate) and control group (84 cases with treatment of ergostine combined with oxytocin). The blood loss at 2 hours, 12 hours, or 24 hours after treatment of the women was compared between the two groups. The coagulation function, the uterine recovery, and the adverse reactions of the women were compared between the two groups. The prognostic factors of the women in the two groups were analyzed. Results: The blood loss in 2h (218.57±35.49 ml), 12h (239.59±81.47 ml), and 24h (265.72±55.73ml) after treatment, and the duration of bleeding (32.68±4.64d) of the women in the observation group were significantly lower than those (236.38±36.68 ml, 286.59±83.68 ml, 389.59±56.47 ml, and 43.38±6.68d) of the women in the control group. The values of coagulation function indexes, such as fibrinogen (2.36±0.53) and activated partial thrombin time (28.59±3.49s) of the women in the observation group were significantly lower than those (3.86±0.56 and 29.98±4.29s) of the women in the control group. The contraction amplitude (236.60±124.29 mm), contraction strength (1524.68±220.42 mm), and contraction tension (1429.69±225.70 mm) of uterus of the women in the observation group were significantly lower than those (428.58±124.31 mm, 1769.52±223.16 mm, and 1589.32±129.68 mm) of the women in the control group. The frequency of contractions (1-2 times /min) of uterus of the women in the observation group was significantly higher than that (1 time /min) of the women in the control group (all P＜0.05). The factors influencing the number of complications of the women included treatment methods, delivery mode, cause
of bleeding, age, body mass index, duration of treatment, volume of bleeding in 12h after treatment, duration of bleeding, uterine tension, and D-dimer level. Conclusion: Ergostine combined with hemabate for treating postpartum hemorrhage of the women has higher effective, which can reduce bleeding, promote uterine recovery, accelerate coagulation, and reduce the incidence of complications.

2023 Vol. 31　(1):　69- [Abstract]（ 449 ） HTML (0 KB)  PDF  (0 KB)  ( 23 )

To investigate the effects of painless labor of pregnant women with hypertensive disorder complicating pregnancy (HDCP) on their serum inflammatory factors and hemodynamics. Methods: A total of 120 women with HDCP who had given birth in hospital were selected from January 2018 to March 2021, which included 60 cases with routine delivery in group A and 60 cases with painless delivery in group B. Another 60 healthy pregnant women who underwent painless labor were selected in group C during the same period. The levels of serum inflammatory cytokines, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and hemodynamic indicators, such as heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO) of the women in the three groups before analgesia (T1), full opening of the uterine orifice (T2), fetal delivery (T3), and 24h of fetal delivery (T4) were detected. Results: The first stage of labor time, the second stage of labor time, the third stage of labor time, and the time the colostrum feeding of the women in group B and group A showed no significant different, but which of the women in group B and group A were all significantly lower than those of the women in group C. The 1min Apgar of newborns in group B and group A showed no significant different, but which of the newborns in group B and group A were all significantly higher than those of the newborns in group A (all P＜0.05). There was no significant difference in 5min Apgar score of the newborns among the three groups (P＞0.05). There were no significant differences in the levels of serum IL-6 and TNF-α of the women at T1 among the three groups (P＞0.05). The levels of serum IL-6 and TNF-α of the women in group B and group C at T2, T3 and T4 showed no significantly different, but which of the women in group B and group C were significantly lower than those of the women in group A (P＜0.05). There were no significant differences in the values of hemodynamic indexes, such as HR, MAP, CO, of the women at T1 and T4 among the three groups (P＞0.05), but the values of hemodynamic indexes of the women in group B and group C at T2 and T3 were significantly lower than those of the women in group A (P＜0.05). Conclusion: Painless delivery can effectively reduce the levels of serum inflammatory factors of pregnant women with HDCP during the perinatal period, and which has little effect on the maternal hemodynamics. Reasonable implementation of painless delivery for the pregnant women with HDCP is safe and effective.

2023 Vol. 31　(1):　80- [Abstract]（ 1117 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )

To investigate the application effect of opioid-free laryngeal mask general anesthesia during cervical conization. Methods: A total of 60 patients with elective cervical conization in the hospital were selected and divided into group A (30 cases with opioid-free laryngeal mask in general anesthesia) and group B (30 cases with conventional opioid laryngeal mask in general anesthesia) by random number table metho from February 2022 to July 2022. The changes of mean arterial pressure (MAP) and heart rate (HR) of the patients before anesthesia induction (T0), 5 minutes after anesthesia induction (T1), when the laryngeal mask was inserted (T2), sliced (T3), and 5 minutes after the removal of the laryngeal mask (T4) were compared between the two groups. The application of vasoactive drugs during the operation, the pain score by visual analog scale (VAS) before returning to the ward, and 4h, 12h, and 24h after surgery, the adverse reactions rate, and postoperative recovery situation of the patients in the two groups were counted. Results: There was no significant difference in the MAP value of the patients in group A between T1-4 and T0 (P＞0.05). The HR value of the patients in group A at T1-3 was significantly lower than that at T0 (P＜0.05). The MAP and HR values of the patients in group B at T1-3 were significantly lower than that at T0 (P＜0.05). The MAP value of the patients in group A at T1-3 was significantly higher than that of the patients in group B (P＜0.05). No urapidil was used in the patients in the two groups. The rate of ephedrine used (0 cases) of the patients in group A was significantly lower than that (23.3%) of the patients in group B (P＜0.05). The rate of atropine used (16.7%) of the patients in group A had no significantly different from that (13.3%) of the patients in group B (P＞0.05). There were no significant differences in the VAS scores of the patients at all time after surgery between the two groups (P＞0.05). The incidences of hypotension, and nausea and vomiting (3.3% and 3.3%) of the patients in group A were significantly lower than those (23.3%, 26.7%) of the patients in group B. The recovery time of directional force (9.6±2.7min), the stay time in resuscitation room (21.3±6.4min), and the time to the first anal exhaust (8.9±2.7h) of the patients in group A were significantly shorter than those (20.8±4.0min, 38.6±8.0min, and 15.8±3.5h) of the patients in group B (all P＜0.05). Conclusion: Opioid-free laryngeal mask general anesthesia used during cervical conization has the same effect as the conventional opioid anesthesia, but which has more stable intraoperative circulation, lower incidences of hypotension, and nausea and vomiting, and faster postoperative recovery.

2023 Vol. 31　(1):　90- [Abstract]（ 1150 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To observe the clinical value of transvaginal three-dimensional power Doppler ultrasound (3D-PDU) used after transvaginal resection of adhesion (TCRA) of severe intrauterine adhesions (IUA). Methods: 95 women with severe IUA who had fertility requirements and wanted TCRA were selected as study subjects between June 2018 and June 2020. All these women were examined by 3D-PDU before and one monty after surgery. The endometrial volume (EV), and the blood flow parameters of uterine, such as endometrial vascular index (VI), blood flow index (FI), and vascular blood flow index (VFI), of the women before and after surgery were recorded. All these women were followed up for 12 months and their pregnancy outcomes were recorded. The predictive value of endometrial volume and blood flow parameters of these women for their postoperative pregnancy was observed. Results: The levels of EV, VI, EI, and VFI of 95 women after surgery were significantly higher than those before surgery (P<0.05). There were 37 women with pregnancy after surgery, with the pregnancy rate of 39.0%. The levels of EV, VI, EI, and VFI of the women with pregnancy were significantly higher than those of the women without pregnancy (P<0.05). The areas under the receiver operator characteristic curve of the EV, VI, EI, and VFI levels of the women for predicting their postoperative pregnancy after TCRA were 0.840, 0.807, 0.976, and 0.638, respectively. Conclusion: The blood flow parameters and endometrial volume of the women with severe IUA after TCRA by 3D-PDU can help predict their postoperative pregnancy outcomes, and can provide imaging basis for determining the subsequent treatment regimen.

2023 Vol. 31　(1):　100- [Abstract]（ 394 ） HTML (0 KB)  PDF  (0 KB)  ( 19 )

To explore the effects of carboprost tromethamine combined with balloon compression for treating post-cesarean hemorrhage of women with placenta previa on their coagulation function and stress state. Methods: A total of 84 women with postpartum hemorrhage after cesarean section due to placenta previa were selected and divided into two groups (42 cases in each group) by random number table from May 2017 to May 2022. The women in the control group were given one-time intrauterine balloon compression therapy, while the women in the observation group were given prostaglandin tromethamine combined with balloon compression therapy. The blood loss, coagulation function, stress state, and complications situation of the women were compared between the two groups. Results: The blood loss of the women in the control group during delivery (381.52±45.15 ml), postpartum 2h (296.47±38.15 ml), and postpartum 24h (352.14±41.16 ml) were significantly more than those (235.74±34.61 ml and 198.74±27.16 ml, and 273.06±36.15 ml) of the women in the observation group (P＜0.05). The serum fibrinogen level, the prothrombin time, and activated partial thrombin time of the women in the two groups after treatment had decreased significantly, and which (3.17±0.43 g/L, 10.16±1.13s, and 37.04±3.08s) of the women in the observation group were significantly lower than those (4.25±0.62g/L, 13.74±1.21s, and 45.17±3.41s) of the women in the control group. The levels of serum norepinephrine, epinephrine, and cortisol of the women in the two groups after treatment had increased significantly, but which (297.45±28.66 pg/ml, 52.65±6.47 pg/ml, and 274.26±35.21 ng/ml) of the women in the observation group were significantly lower than those (354.06±34.12) pg/ml, 69.58±7.21 pg/ml, and 327.28±43.05 ng/ml) of the women in the control group (all P＜0.05). The complication rate (9.5%) of the women in the observation group had no significantly different from that (19.0%) of the women in the control group (P=0.212). Conclusion: Carboprost tromethamine combined with balloon compression for treating post-cesarean hemorrhage of women with placenta previa has a significant clinical effect, which can improve the coagulation function, effectively control the stress state of the women, with higher safety.

2023 Vol. 31　(1):　108- [Abstract]（ 333 ） HTML (0 KB)  PDF  (0 KB)  ( 23 )

To investigate and compare the effects of phloroglucinol and estradiol valerate both of which combined with misoprostol, respectively, applied in women with menopause over two years who had the surgical evacuation of an intrauterine device (IUD). Methods: 80 women with menopause of 2-6 years who had the surgical evacuation of IUD and visited our outpatient clinic from November 2019 to March 2022 were selected as our observation subjects. These women were divided into two groups, one is phloroglucinol combined with sublingual misoprostol group (hereafter, the observation group) and another is estradiol valerate combined with sublingual misoprostol group (hereafter, the control group). Parameters including the degree of cervical softening, pain scores（VAS）, operation time, smooth degree of operation, intraoperative blood loss, discomfort degree，etc. were compared for the two groups accordingly. Results: After the removal of IUD, the total softening degree of the cervix in the observation group (100%) is higher than that in the control group (95.0%)，the VAS in the observation group（2.2）is better than that in the control group（3.1）, the mean operation time in the observation group (12.5 minutes) is shorter than that in the control group (17.5 minutes), the occurrence rate of difficulty in removing IUD in the observation group (65.0%) is lower than that in the control group (87.5%), the incidence of severe induced abortion syndrome during operation in the observation group（7.5%）is lower than that in the control group (17.5%), indicating these differences between the two groups are of statistically significant (P < 0.05). The intraoperative mean blood losses are 8.0mL and 9.1mL in the observation group and the control group, respectively, indicating the difference is of no statistically significant (P > 0.05). Conclusions: The results show that the application of phloroglucinol injection combined with sublingual misoprostol in women with menopause over two years is able to reduce the occurrence rate of difficulty in removing IUD, the incidence of severe induced abortion syndrome during operation and the operation time, indicating this method is worthy of clinical popularization.

2023 Vol. 31　(1):　117- [Abstract]（ 343 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )

To study the differences of blastocyst grade and development speed （D5 and D6）on the clinical outcomes of frozen-thawed blastocyst transfer cycles. Methods：The data of 1429 frozen-thawed blastocyst transfer cycles in Reproductive Medical Center of the Shenzhen people’s Hospital were analyzed in this retrospective cohort study. Patients were divided into four groups according to the blastocyst morphological score and development speed: D5 top-quality single blastocyst group、D6 top-quality single blastocyst group、 D5 non-top quality single blastocyst group and D6 non-top quality single blastocyst group. The pregnancy outcomes were compared among four groups when the transferred blastocysts morphological score are fit well．Results：The clinical pregnancy rate(67.0%) and live birth rate (57.3%)of D5 group were higher than that of D6 group(52.0%,40.3%) for those who transferred top-quality single blastocyst patients; the early spontaneous abortion rate (13.1%) of D5 group was lower than that of D6 group (19.1%), and all of the differences were statistically significant(P＜0.05). For those who transferred non-top quality single blastocyst patients, the clinical pregnancy rate(44.7%) and live birth rate(34.3%) of D5 group were better than that of D6 group(31.1%, 20.9%), and there were significant statistically differences between groups. There was not significant difference in spontaneous abortion rate between two groups (13.7% vs 21.7%)(P>0.05). The clinical outcomes were better in D6 top-quality single blastocyst group than D5 non-top quality single blastocyst group but that didn't reach statistical significance. Logistic regression analyses of the clinical data based on single blastocyst group indicated that slow blastocyst development speed was a risk factor for clinical pregnancy (OR=0.57) and early spontaneous abortion (OR=1.76). Blastocyst morphology score is an independent influencing factor of clinical pregnancy(OR=2.45). Conclusions：It is necessary to comprehensively evaluate the blastocyst development speed and morphological score before single blastocyst transfer. The following sequence can be referred to when selecting single blastocyst for transplantation: D5 top-quality blastocysts、D6 top-quality blastocysts、D5 non-top blastocysts、D6 non-top blastocysts.

2023 Vol. 31　(1):　125- [Abstract]（ 337 ） HTML (0 KB)  PDF  (0 KB)  ( 18 )

To investigate the effect of ultrasound-guided bilateral uterine artery chemoembolization (UACE) combined with uterine evacuation for treating cesarean incision scar pregnancy (CSP) of patients, and to study its influence on the ovarian function of these patients. Methods: 82 patients with CSP were selected and were divided into two groups according to the treatment methods from January 2017 to January 2020. 41 cases had received UACE treatment were included in control group, and 41 cases had received UACE combined with uterine evacuation were included in observation group. The treatment effect and the complication rate of the patients were compared between the two groups. The levels of serum anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and prolactin (PRL) of the patients in the two groups before surgery and in 3 months after surgery were detected. Results: There were no significant differences in the success rate of surgery (97.6% vs. 100.0%) and the complication rate (7.3% vs. 2.4%) of the patients between the two groups (all P＞0.05). The intraoperative blood loss (76.1±17.2ml), the duration of hospital stay (7.0±1.3d), the time of HCG recovery (17.8±3.6d), the time of mass regression (24.9±3.7d), and the time to menstrual recovery (30.2±3.7d) of the patients in the observation group were all significantly lower than those (121.1±33.7ml, 9.9±1.9d, 27.8±6.1d, 33.2±9.3d, and 38.9±6.7d) of the patients in the control group (all P＜0.05). There were no significant differences in the postoperative menstrual cycle and re-pregnancy of the patients between the two groups (P＞0.05). Three months after operation, there were no significant differences in the levels of serum AMH, FSH, LH, E2, and PRL of the patients between the two groups (P＞0.05). Conclusion：Ultrasound-guided bilateral UACE combined with uterine evacuation for treating CSP of the patients is safe and effective, and which has little influence on the ovarian function of the patients, and had better postoperative recovery.

2023 Vol. 31　(1):　135- [Abstract]（ 400 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )

To explore the predictive value of prenatal ultrasound combined with coagulation markers of women for their postpartum lower extremity deep venous thrombosis. Methods: A retrospective analysis was performed on the clinical data of 1126 pregnant women with single fetus who had been given regular antenatal examination and delivered in hospital from January 2019 to March 2022. All these women had received lower limb ultrasound examination and coagulation markers detection before delivery. Among them, 43 women with postpartum lower limb deep vein thrombosis were included in observation group, and another 50 women were randomly selected in control group from the rest women. The results of prenatal lower extremity examined by ultrasonography and the coagulation markers level of the women were compared between the two groups. Results: The ultrasound positive rate (48.8%) of the women in the observation group was significantly higher than that (12.0%) of the women in the control group, and the levels of fibrinogen (FIB), D-dimer (D-D), and thrombin regulating protein (TM), and the plasminase-anti-plasminase complex (PAP) value of the women in the observation group were significantly higher than those of the women in the control group (all P＜0.05). There were no significant differences in the values of prothrombin time (PT), activated partial prothrombin time (APTT), and thrombin time (TT) of the women between the two groups (P＞0.05). The receiver operating characteristic (ROC) curve analysis showed that the AUC of prenatal ultrasound results, the D-D level, the TM level, and the PAP value of the women for predicting their postpartum DVT were 0.733, 0.712, 0.811, and 0.869, respectively. The optimal truncation values of the D-D level, the TM level, and the PAP value of the women for predicting their postpartum DVT were 4.59 mg/L, 34.12 ng/L, and 1.95μg/L, respectively, the sensitivity of which were 73.2%, 71.9%, 74.3%, and 84.7%, respectively, and the specificity of which were 80.8%, 82.3%, 86.2%, and 79.3%, respectively. The AUC, the sensitivity, and the specificity of ultrasound results combined with the coagulation markers values of the women for predicting their postpartum DVT were 0.909, 98.6%, and 95.4%, respectively. Conclusion: The examination of lower extremity by prenatal ultrasonography combined with the coagulation markers detection of the women has high sensitivity and specificity for predicting the postpartum lower extremity deep vein thrombosis of the women, which has a certain warning value.

2023 Vol. 31　(1):　144- [Abstract]（ 331 ） HTML (0 KB)  PDF  (0 KB)  ( 18 )

To observe the effect of low molecular weight heparin combined with cyclosporine A for treating pregnant women with unexplained recurrent spontaneous abortion (URSA), and to study its influence on the immune balance and hemorheology of these women. Methods: 83 pregnant women with URSA diagnosed and treated in the hospital were selected and divided into the research group (n=42) and control group (n=41) according to different treatment schemes from June 2017 to June 2021. On the basis of routine treatment of fetal protection, the women in the control group were given cyclosporine A, and the women in the research group were given low molecular weight heparin combined with cyclosporine A, and both of which were treated until 12 gestational weeks. The levels of T lymphocyte subsets, helper T cell (Th) 1 and Th2 related factors, the hemorheology indexes, the curative effect, the adverse reaction, and the success rate of fetal protection of the women were compared between the two groups. Results: The levels of serum CD8+, interleukin (IL) -10, and IL-4 of the women in both groups after treatment had increased significantly, while the levels of CD4+, CD4+/CD8+, interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) of the women in both groups after treatment had decreased significantly, and the change ranges of which of the women in the research group were significantly more than those of the women in control group (P＜0.05). After treatment, the values of plasma viscosity, whole blood reductive viscosity high cut, and whole blood reductive viscosity low cut, and the fibrinogen level of the women in the research group were significantly lower than those of the women in the control group, the total effective rate (90.5%) of the women in the research group was higher than that of the women in the control group (73.2%), and the success rate of fetal protection (95.2%) of the women in the research group was significantly higher than that (78.1%) of the women in the control group (all P＜0.05). There was no significant difference in the adverse reactions (19.1% vs. 9.8%) of the women between the two groups (P＞0.05). Conclusion: Low molecular weight heparin combined with cyclosporine A for treating the pregnant women with URSA can promote their immune balance and hemorheology, which can significantly improve the curative effect and the success rate of fetal protection, with good safe and reliable.

2023 Vol. 31　(1):　153- [Abstract]（ 330 ） HTML (0 KB)  PDF  (0 KB)  ( 18 )

To analyze the effects of different delivery methods on the anatomical structure of pelvic diaphragmatic hiatus and bladder neck mobility in postpartum women evaluated by transperineal pelvic floor real-time three-dimensional ultrasound. Methods: The retrospective analysis was performed on the clinical data of 170 puerperae who gave birth in the hospital between January 2020 and October 2021. These puerperae were divided into group A (104 women with vaginal delivery) and group B (66 women with cesarean section) according to the delivery methods. 50 healthy women without childbearing who came to the hospital for examination were enrolled in group C during the same time period. The changes in anteroposterior diameters, left-right diameters, and areas of pelvic diaphragmatic hiatus, and differences of bladder neck mobility of the women at rest, valsala action, and anal contraction action in the 6th weeks and the 3rd month after delivery were compared among the three groups. The women in group A and group B had undergone 3-month pelvic floor function rehabilitation in the 3rd month after delivery, and the changes of strengths of class I and II muscles of the women before rehabilitation and after 3 months of rehabilitation were compared between the two groups. Results: The anteroposterior diameters, left-right diameters, and areas of pelvic diaphragmatic hiatus of the women in group A at rest, valsala action, and anal contraction action in the 6th weeks and the 3rd month after delivery were significantly higher than those of the women in group B，and which of the of the women in group A and B were significantly higher than those of the women in group C. The anteroposterior diameters, left-right diameters, and areas of pelvic diaphragmatic hiatus of the women in group A and B at rest, valsala action, and anal contraction action in the 3rd month after delivery were significantly higher than those of the women in the 6th week. The bladder neck mobility degree of the women in group A and B at rest, valsala action, and anal contraction action in the 3rd month after delivery were significantly lower than those in the 6th week, and which of the women in group A were significantly higher than those of the women in group B (all P＜0.05). After rehabilitation, the strengths of class I and II muscles of the women in group A were significantly lower than those in B. the strengths of class I and II muscles of the women in group A and B after 3 months of rehabilitation were significantly higher than those before rehabilitation (all P＜0.05). Conclusion: There is a significant difference in the anatomical structure of postpartum pelvic diaphragmatic hiatus of the women with different delivery methods, and the influence of vaginal delivery on the anatomical structure is the most. Transperineal pelvic floor real-time three-dimensional ultrasound can intuitively and accurately evaluate the morphological changes of pelvic diaphragmatic hiatus and bladder neck mobility, and which is helpful for early diagnosing the pelvic floor diseases of the women. 

2023 Vol. 31　(1):　163- [Abstract]（ 443 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To explore the clinical detection significance of blood homocysteine (Hcy), thrombelastogram (TEG), and coagulation indexes of pregnant women with earlyonset severe preeclampsia. Methods: The clinical data of 106 pregnant women with preeclampsia between January 2021 and March 2022 collected retrospectively. These women were divided into group A (59 cases with preeclampsia) and group B (47 cases with severe preeclampsia) according to disease severity. Another 83 normal pregnant women undergoing antenatal examination were enrolled in group C. According to the occurrence of fetal growth restriction (FGR), the women in group B were divided into group B1 (20 cases with FGR) and group B2 (27 cases without FGR). The diagnostic value of the Hcy level, the values of TEG indexes, such as reaction time (R value), coagulation time (K value), Angle horn, maximum amplitude (MA value), and comprehensive coagulation index (CI value), and the values of coagulation indexes of the women for the severity of preeclampsia and the FGR occurrence were analyzed. Results: The levels of Hcy and fibrinogen (FIB) of the women in group B, group A, and group C had decreased gradually, while the values of R, K, CI, the partially activated thrombin time (APTT), and thrombin time (TT) of the women in group B, group A, and group C had increased gradually (all P＜0.05). The Hcy level of the women in group B was negatively correlated with their APTT value (P＜ 0.05). The levels of Hcy and FIB of the women in group B1 were significantly higher than those of the women in group B2, the values of R, K, and CI of the women in group B1 were significantly were lower (all P＜0.05). The AUC of the combined of the values of Hcy and TEG indexes, and the coagulation indexes for evaluating the severity of preeclampsia and for diagnosing FGR of the women were 0.941 and 0.908, which were significantly higher than those of the values of Hcy and TEG indexes, and the coagulation indexes alone (all P＜0.05). Conclusion: The combined detection of Hcy, TEG, and coagulation indexes of the women has Diagnostic valueS for the severity of preeclampsia and FGR.

2023 Vol. 31　(1):　172- [Abstract]（ 418 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To explore the correlation between the blood glucose and lipid levels of pregnant women with hypothyroidism during pregnancy and their severity of hypothyroidism and pregnancy outcomes. Methods：The clinical data of 180 pregnant women with hypothyroidism during pregnancy between August 2018 and April 2021 were collected. According to the severity of hypothyroidism, these women were divided into group A1 (75 women with hypothyroidism), group A2 (59 women with subclinical hypothyroidism), and group A3 (46 women with hypothyroxinemia). According to the pregnancy outcomes, these women were divided into group B1 (117 women with normal pregnancy outcomes) and group B2 (63 women with adverse pregnancy outcomes). The levels of glucose metabolism indexes, such as fasting blood glucose (FBG) and glycosylated hemoglobin (HbAlc), and lipid metabolism indexes, such as triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), and low density lipoprotein (LDL), of the women were compared among the three groups, and the value of which for predicting for the severity of hypothyroidism and pregnancy outcomes was analyzed. Results: The FBG level of the women in group A1 was significantly higher than that of the women in group A2, and of the women in group A3. The levels of HbAlc, TG, and LDL of the women in group A1, group A2, and group A3 had decreased gradually (all P＜0.05), there were no significant differences in the levels of TC and HDL of the women among the three groups (P>0.05). The levels of FBG, TG, LDL, and HbAlc of the women in group B1 were significantly lower than those of the women in group B2 (P＜0.05), there were no significant differences in the TC and HDL levels of the women between the two groups (P>0.05). The levels of FBG, HbAlc, TG, and LDL of the women were positively correlated with their severity of hypothyroidism (P＜0.05). The area under the curve (AUC) of the combined of glycemic and lipid metabolism indexes levels of the women for evaluating their severity of hypothyroidism and for predicting their pregnancy outcomes were 0.927 and 0.887, which were significantly higher than those of each index of glycemic and lipid metabolism (all P＜0.05). Conclusion: The glucose-lipid metabolism of the pregnant women with gestational hypothyroidism is abnormal. The combined detections of glucose-lipid metabolism indexes have evaluation value for the severity of hypothyroidism and pregnancy outcomes of the pregnant women with gestational hypothyroidism.

2023 Vol. 31　(1):　182- [Abstract]（ 331 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To explore the clinical value of maternal blood soluble myeloid cell trigger receptor-1 (sTREM-1) and macrophage inflammatory protein-3α(MIP-3α) levels for predicting premature rupture of membranes complicated with intrauterine infection. Methods: The clinical data of 219 pregnant women with premature rupture of membranes from May 2019 to May 2022 were collected prospectively. The levels of maternal blood sTREM-1 and MIP-3α of the women at admission were detected by enzyme-linked immunosorbent assay. These women were divided into group A (58 women with intrauterine infection) and group B (161 without intrauterine infection). The diagnostic value of maternal blood sTREM-1 and MIP-3α for diagnosing the premature rupture of membranes complicated with intrauterine infection was evaluated by receiver operating characteristic curve (ROC). The risk factors of the premature rupture of membranes complicated with intrauterine infection were explored by multivariate logistic regression analysis. Results: The levels of prenatal sTREM-1 and MIP-3α in blood (72.16±8.43 pg/ml and 49.62±5.39 pg/ml) of the women in group A were significantly higher than those (31.05±4.18 pg/ml and 25.16±3.24 pg/ml) of the women in group B (P＜0.05). The area under curve (AUC) of the blood sTREM-1 and MIP-3α levels of the women for predicting their premature rupture of membranes combined with intrauterine infection were 0.832 and 0.769, the cutoff values of which were 51.61pg/ml and 37.39pg/ml, the specificity of which were 67.5% and 52.3%, and the sensitivity of which were 93.1% and 93.1%. The AUC, the specificity, and the sensitivity of the combined of blood sTREM-1 and MIP-3α levels of the women for predicting their premature rupture of membranes combined with intrauterine infection were 0.911, 85.4%, and 86.2%, respectively. Preterm premature rupture of membranes, sTREM-1≥51.61pg/ml, MIP-3α≥37.39pg/ml of the women with premature rupture of membranes were the risk factors of their intrauterine infection (P＜0.05). Conclusion: The levels of serum sTREM-1 and MIP-3α of the pregnant women with premature rupture of membranes complicated with intrauterine infection increase abnormally, and both of which can be used as biological indicators for predicting intrauterine infection of the pregnant women with premature rupture of membranes, and the combined detections of the levels of serum sTREM-1 and MIP-3α of the women can increase the predicting specificity.

2023 Vol. 31　(1):　191- [Abstract]（ 283 ） HTML (0 KB)  PDF  (0 KB)  ( 21 )

To investigate the clinical value of three-dimensional tomography ultrasonography imaging (TUI) combined with three-dimensional ultrasound comprehensive scoring for diagnosing intrauterine adhesions (IUA). Methods: The clinical data of 182 with suspected IUA from April 2021 to June 2022 were selected in the study. These patients had been diagnosed by TUI combined with three-dimensional ultrasound comprehensive scoring. Based on the hysteroscopy pathological diagnosis as the gold standard, the consistency of TUI combined with three-dimensional ultrasound comprehensive scoring for diagnosing IUA was analyzed. The characteristics of TUI were compared among the patients with mild IUA, the patients with moderate IUA, and the patients with severe IUA. Results: There were 92 patients with IUA diagnosed by hysteroscopy in the 186 patients, which including 32 cases with mild IUA, 34 cases with moderate IUA, and 26 cases with severe IUA. With the increase of the degree of IUA, the unsmoothness rate of endometrial edge of the patients in TUI examination increased (P＜0.05), but there were no significant differences in the other features, such as defects, cohesion, and calcification in TUI examination among the patients with different degree of IUA (P>0.05). The hysteroscopy results as the gold standard, the sensitivity, the specificity, the coincidence rate, the positive predictive value, the negative predictive value, and Kappa value of three-dimensional ultrasonic comprehensive scoring for diagnosing IUA were 95.7%, 92.6%, 94.1%, 92.6%, 95.6%, and 0.882, respectively, and the sensitivity, the specificity, the coincidence rate, the positive predictive value, the negative predictive value, and Kappa value of TUI for diagnosing IUA were 97.8%, 94.7%, 96.2%, 94.7% 97.8%, and 0.925, respectively. The sensitivity, the specificity, rate, the positive predictive value, the negative predictive value, and Kappa value of three-dimensional ultrasound combined with TUI for diagnosing IUA were 94.6%, 100.0%, 97.3%, 100.0%, 95.0%, and 0.946, respectively. Conclusion: TUI combined with three-dimensional ultrasonic comprehensive scoring method for IUA has high diagnostic value.

2023 Vol. 31　(1):　201- [Abstract]（ 386 ） HTML (0 KB)  PDF  (0 KB)  ( 19 )

To explore the value of two-dimensional ultrasound combined with color Doppler flow imaging (CDFI) for diagnosing the benign or malignant ovarian lesion. Methods: A retrospective analysis was performed on the clinical data of 131 patients with ovarian tumors between April 2018 and April 2021. These patients were divided into group A (cases with benign ovarian tumors) and group B (cases with malignant ovarian tumors) based on the histological examination results of the patients. In order to obtain the mean value, range, and distribution of the ovarian RI value of the patients, the ultrasound morphological structure and blood flow status of ovarian masses of the patients were analyzed by two-dimensional ultrasound and CDFI. The detection situations of ovarian benign lesions of the patients by two-dimensional ultrasound and CDFI were counted. The diagnostic efficiency of two-dimensional ultrasound or CDFI for ovarian tumors was calculated. Results: Among 131 patients with ovarian tumors, there were 86 cases with benign ovarian tumors, mainly including serous tumors and ovarian endometriosis, and there were 45 cases with malignant ovarian tumors, mainly including mainlyepithelial ovarian cancer. Ultrasound morphological analysis showed that the benign ovarian tumors were the manifestations of simple unilocular and simple multilocular mainly, and the malignant ovarian tumors were the manifestations of unilocular cyst combined with nipple manifestation mainly. There were 24 patients without blood flow signal in benign tumors of 86 patients, and there were 45 patients with blood flow signal in malignant tumors of 45 patients. The RI value of the patients in group B was 0.41±0.10 (0.25-0.64), which was significantly lower than that ［0.53±0.11(0.33-0.74)］ of the patients in group A (P＜0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve and the cut-off value of RI value for distinguishing benign and malignant ovarian tumors of the patients were 0.794 and was 0.46. The sensitivity, the specificity, and the accuracy of two-dimensional ultrasound combined with CDFI for diagnosing benign or malignant ovarian lesions of the patients were 97.8%, 76.7%, and 84.0%, respectively. Conclusion: There are significant differences in the manifestations examined by two-dimensional ultrasound and CDFI between benign and malignant ovarian tumors in B-US and CDFI. The combined application of two-dimensional ultrasound and CDFI has good differential diagnostic efficiency for benign or malignant ovarian lesions.

2023 Vol. 31　(1):　210- [Abstract]（ 377 ） HTML (0 KB)  PDF  (0 KB)  ( 17 )

2023 Vol. 31　(1):　218- [Abstract]（ 1239 ） HTML (0 KB)  PDF  (0 KB)  ( 22 )

Genitourinary syndrome of menopause (GSM) is a highly prevalent perimenopausal symptom that progressively worsens over time but it is currently not appropriately treated in a timely manner due to lack of awareness and attention by patients and their physicians. Current therapies for this localized symptom include Menopause Hormone Therapy (MHT) and non-hormonal approaches, with MHT for local vaginal delivery of estrogen being the current first-line treatment option for GSM due to its reliable safety and efficacy. The main topical estrogen Drug Delivery System (DDS) for GSM in recent years include tablets, capsules, suppositories, creams, vaginal rings (IVRs) and gels. This article reviews the relevant marketed drugs and the progress of their development in recent years to provide some reference in clinical.

2023 Vol. 31　(1):　226- [Abstract]（ 323 ） HTML (0 KB)  PDF  (0 KB)  ( 20 )