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  • 1.
    Recent recommendations in 2020 Newborn Resuscitation Guidelines and Newborn Resuscitation Program (8th Edition)
    Xiangpeng Liao, Rui An
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (05): 527-535. DOI: 10.3877/cma.j.issn.1673-5250.2021.05.005
    Abstract (838) HTML (9) PDF (1834 KB) (379)

    In October 2020, the American Heart Association (AHA), American Academy of Pediatrics (AAP), and International Liaison Committee on Resuscitation (ILCOR) jointly published 2020 Neonatal Resuscitation Guidelines based on 2015 Neonatal Resuscitation Guidelines. And the Neonatal Resuscitation Program (8th Edition) was also released in June 2021 based on 2020 Neonatal Resuscitation Guidelines by AHA and AAP. Here, the authors overview and compare the important recent recommendations in the guidelines and programs on neonatal resuscitation, including the main contents in 2020 Neonatal Resuscitation Guidelines and differences between 2020 Neonatal Resuscitation Guidelines and 2015 Neonatal Resuscitation Guidelines, recent recommendations in Neonatal Resuscitation Program (8th Edition), and comparisons of algorithms for neonatal resuscitation, in order to provide reference for domestic clinicians′ understanding of the latest progresses and recommendations in international neonatal resuscitation.

  • 2.
    Atosiban Versus Ritodrine in the Treatment of Preterm Labour: A Systematic Review
    Xiaoyan Zhou, Wangming Xu, Lan Dong, Huiming Wang, Zengli Luo, Meiting Xie
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2014, 10 (02): 170-176. DOI: 10.3877/cma.j.issn.1673-5250.2014.02.010
    Abstract (101) HTML (0) PDF (1623 KB) (355)
    Objective

    To explore the clinical efficacy and safety between atosiban and ritodrine in treatment of preterm labour.

    Methods

    The relevant data base were searched according to the principles of systematic review to collect all the randomized controlled trials(RCT) involving treatment of preterm labour using atosiban and ritodrine. According to treatment strategies, the subjects were divided into atosiban group and ritodrine group. Meta-analysis of including studies was performed by Rev Man 5.1 software.

    Results

    A total of 4 pieces RCT were included with 420 subjects.①Three of them were English literature, RCT with high quality included patients of preterm labour.The Meta-analysis showed there were no statistic differences in tocolytic efficacy, gestational age at delivery, birth weight of neonatal, rates of neonatal asphyxia or perinatal death between two groups (P>0.05) .The incidence of maternal tachycardia and early drug termination due to adverse events in atosiban group were substantially lower than those in ritodrine group [RR=0.02, 95% CI(0.01-0.08) , P<0.01; RR=0.03, 95% CI(0.01-0.15) , P<0.01], respectively.②One Chinese study with relatively lower quality included patients of threatened preterm labour.A descriptive analysis conducted independently showed that there were no significant differences between two groups in time-to-effect, prolonged pregnancy duration, tocolysis rate, full-term delivery rate, birth weight or adverse events rate (P>0.05) .

    Conclusions

    Atosiban treatment of preterm labour was better than that of ritodrine. There had difference between domestic and abroad studies in term of incidence of adverse events. It is quite necessary to perform more high-quality and large-scale RCT in combination with cost-effectiveness evaluation to assess the exact clinic value of atosiban in treatment of preterm labour more reliably.

  • 3.
    Nutritious supplement for the males preparing for childbirth
    Baojun Wang, Le Ma, Linlin Wang
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2018, 14 (05): 497-502. DOI: 10.3877/cma.j.issn.1673-5250.2018.05.001
    Abstract (334) HTML (1) PDF (990 KB) (350)

    With the accelerated pace of life, changes in diet, accumulation of bad habits, increased mental stress and environmental deterioration have posed a great threat to males′ health. Infertility has become a common disease with high incidence. Infertile women or men of childbearing age and pregnant couples often hope that doctors can give them dietary guidance. At present, there are many studies on the rational nutrition supplement for women before pregnancy, and there have been many progresses. However, there are few studies on the rational nutrition supplement for men preparing for childbirth. This paper summarizes some nutrients related to male fertility in the current studies, such as minerals (zinc, iron, calcium, magnesium, selenium), vitamins (vitamin A, B9, B12, C, D and E), and other important auxiliary nutrients (L-carnitine, lycopene, amino acids, coenzyme Q10, fructose, citric acid), hoping to give guidance to the males preparing for childbirth.

  • 4.
    Expert consensus on prevention of intraventricular hemorrhage in preterm infants(2025)
    Physicians Branch of Chinese Medical Doctor Association Neonatal, Branch of Beijing Medical Doctor Association Neonatologist, Qiuping Li, Zhichun Feng, Dezhi Mu, Jun Tang, Tao Xiong, Shanghong Tang
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2025, 21 (01): 1-14. DOI: 10.3877/cma.j.issn.1673-5250.2025.01.001
    Abstract (667) HTML (51) PDF (1162 KB) (338)

    Intraventricular hemorrhage(IVH)in preterm infants is a significant complication leading to mortality and severe neurological disabilities,particularly in preterm infants with a gestational age<32 weeks.In recent years,the number of preterm infants receiving medical treatment in China has significantly increased,and the survival rates of very preterm infants(gestational age ≥28-31 weeks)/extremely preterm infants (gestational age<28 weeks)have greatly improved.However,the incidence of IVH in extremely preterm infants remains high at 48%,with the occurrence of severe IVH showing an annual upward trend,markedly higher than that in developed countries,garnering significant attention.Currently,there is no expert consensus or guideline for the prevention of IVH in preterm infants within China.Therefore,the Neonatologist Branch of the Chinese Medical Doctor Association and the Neonatologist Branch of the Beijing Medical Doctor Association have organized experts to develop ExpertConsensusonPreventionof IntraventricularHemorrhageinPretermInfants2025)(hereinafter referred to as ThisConsensus).These initiatives in ThisConsensus is based on reference to relevant research progress and clinical guidelines both domestically and internationally,aiming to further standardize the prevention and clinical management of IVH in preterm infants,reduce the incidence of IVH,and improve both shortterm and long-term neurological development outcomes for preterm infants.

  • 5.
    Clinical effects of CO2 laser on cervical intraepithelial neoplasia and vaginal intraepithelial neoplasia
    Yu Xue, Dan Wu, Zhunan Li, Zhengrong Zhang, Jing Lin, Ying Xu, Zhenhong Xiong, Dan Cao
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2020, 16 (04): 483-491. DOI: 10.3877/cma.j.issn.1673-5250.2020.04.017
    Abstract (316) HTML (2) PDF (851 KB) (292)
    Objective

    To investigate the clinical efficacy of CO2 laser in the treatment of cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN).

    Methods

    A retrospective analysis was conducted on 607 patients with CIN and (or) VaIN, who were hospitalized at International Peace Maternity and Child Health Hospital, Affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2016. Independent-samples t test was used for statistical analysis of age between different patients. Chi-square test was used to compare the composition ratio of different CO2 laser positions, the composition ratio of different CO2 laser times and the history of loop electrosurgical excision procedure (LEEP). Multivariate unconditional logistic regression analysis was used to analyze influencing factors of human papillomavirus (HPV) negative rate and pathological degradation after CO2 laser treatment. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

    Results

    ① The total effective rate of CO2 laser treatment was 95.4% (579/607), and the disease recurrence rate was 4.6% (28/607). Among them, the effective rates of CO2 laser treatment for CIN, VaIN and CIN with VaIN were 95.3% (430/451), 98.1% (102/104) and 90.4% (47/52), respectively. ② After CO2 laser treatment, the negative rate of HPV was 74.1% (450/607). The negative rates of HPV in CIN, VaIN and CIN with VaIN were 80.0% (361/451), 54.8% (57/104) and 61.5% (32/52), respectively. ③ Multiple unconditional logistic regression analysis showed that the history of LEEP (OR=0.500, 95%CI: 0.273-0.915, P=0.025) was an independent protective factor for HPV turning negative 2 years after CIN and/or VaIN patients received CO2 laser treatment. ④ After CO2 laser treatment, the rate of pathological grade reduction was 93.7% (569/607). Among them, the pathological grade reduction rates of CIN, VaIN and CIN with VaIN were 93.6% (422/451), 98.1% (102/104) and 86.5% (45/52), respectively. Multiple unconditional logistic regression analysis showed that the location of CO2 laser treatment was cervix with vagina (OR=11.727, 95%CI: 1.337-102.859, P=0.026), which was an independent risk factor for CIN and/or VaIN patients′ pathological grade reduction after CO2 laser treatment.

    Conclusion

    CO2 laser treatment of CIN and (or) VaIN is safe and effective. After treatment of CO2 laser, HPV becomes negative and the pathological grade decreases due to different factors in CIN and (or) VaIN patients.

  • 6.
    Prenatal diagnosis of 440 fetuses with hemoglobin H disease in Guangxi area
    Lifang Wang, Pingshan Pan, Dahua Meng, Li Lin, Yangjin Zuo, Xiaoxia Qiu
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (01): 75-80. DOI: 10.3877/cma.j.issn.1673-5250.2021.01.011
    Abstract (220) HTML (0) PDF (765 KB) (255)
    Objective

    To explore the prenatal diagnosis, gene mutation types and pregnancy outcome of fetal hemoglobin (Hb) H disease in Guangxi Zhuang Autonomous Region.

    Methods

    A total of 440 fetuses diagnosed with Hb H disease were selected as research subjects in the Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region from January 1, 2015 to December 31, 2019. The genomic DNA of fetuses and their parents was extracted by DNA extraction kit. Three common deletion mutations of α-Thalassemia genes (--SEA, -α3.7, -α4.2) were detected by gap-crossing PCR (Gap-PCR), and the common α- and β-Thalassemia genes point mutations were detected by PCR-reverse dots blot hybridization. For couples whose test results of the above-mentioned conventional methods were normal while Thalassemia screening suggesting a high risk, multiplex ligation-dependent probe amplification (MLPA) or DNA sequencing technology was used for further testing.The detection rate of fetal Hb H disease from 2015 to 2019 was compared using linear-by-linear association chi-square test.The procedure followed in this study complied with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

    Results

    ①In this study, the overall detection rate of fetal Hb H disease was 9.95% (440/4 421). There was no statistically significant difference in the detection rates of fetal Hb H disease from 2015 to 2019 (P>0.05). ②Among 440 Hb H disease fetuses, the top 4 Hb H disease genotypes were -α3.7/--SEA, αCSα/--SEA, -α4.2/--SEA and αWSα/--SEA, which accounting for 39.32% (173/440), 30.23% (133/440), 14.09% (62/440) and 10.91% (48/440), respectively. In addition, 32 cases of Hb H disease fetuses were detected with β-Thalassemia gene mutations, and 20 cases were detected with βCD41-42N genotype, 6 cases with βCD17N, 2 cases with βCD17CD17 genotype, 2 cases with βCD71-72N, 1 case with βCD43N, and 1 case with β-28N.③Among 440 pregnant women with fetal Hb H disease, 1 case (0.23%) had spontaneous abortion, 228 cases (51.82%) chose artificial termination of pregnancy; 135 cases (30.68%) had spontaneous delivery, 65 cases (14.77%) gave birth by cesarean section; and 11 cases (2.50%) had an unknown pregnancy outcome.

    Conclusions

    The detection rate of fetal Hb H disease in Guangxi Zhuang Autonomous Region is 9.95% (440/4 421). There are various types of gene mutations, and some of them are combined with β-Thalassemia gene mutations. The proportion of pregnant women with fetal Hb H disease choosing artificial termination of pregnancy is high. Extensive implementation of Thalassemia screening and prenatal genetic diagnosis for the fertile population is of great significance for prevention and control of birth defects in Hb H disease.

  • 7.
    Research progresses of pathogenesis of neonatal necrotizing enterocolitis
    Na Ma, Mohd Jaish Siddiqui, Bin Xia
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2020, 16 (06): 739-744. DOI: 10.3877/cma.j.issn.1673-5250.2020.06.018
    Abstract (227) HTML (3) PDF (851 KB) (227)

    Neonatal necrotizing enterocolitis (NEC) is the frequent and lethal gastrointestinal inflammation disease in neonatal intensive care units, and seriously endangering the life of neonates. At present, the main risk factors of NEC consist of prematurity, microbiome dysbiosis, inflammatory reaction, blood products transfusion and improper feeding, etc., but the pathogenesis of NEC is not identify yet. This article reviews the latest research on the pathogenesis of NEC in recent years.

  • 8.
    Clinical analysis of listeriosis during pregnancy
    Hui Li, Chengbin Xie, Qingyuan Jiang, Zhi Yu, Li Qiu
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2019, 15 (04): 396-402. DOI: 10.3877/cma.j.issn.1673-5250.2019.04.007
    Abstract (221) HTML (0) PDF (875 KB) (214)
    Objective

    To study the clinical characteristics and pregnancy outcomes of listeriosis during pregnancy in order to improve the obstetricians′ understanding of the disease and the prognosis of patients and their newborns.

    Methods

    A total of 14 patients of listeriosis during pregnancy from April 2011 to August 2018 in Sichuan Provincial Hospital for Women and Children, were chosen as research subjects. Their clinical case data were analyzed retrospectively, including general conditions, clinical symptoms, laboratory results, antibiotics treatment and pregnancy outcomes of patients, and general conditions of fetus or newborns, also clinical symptoms, treatments and outcomes of alive newborns. Spearman rank correlation analysis method was used to analyze the correlation between rash and death of alive newborns infected by Listeria monocytogenes (LM). Mann-Whitney U test was used to compare the time of first use of antibacterials between cured and dead newborns who were live birth and infected by LM. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

    Results

    ①The average age of 14 patients of listeriosis during pregnancy was 29.3 years old, ranging from 21 to 40 years old, and the average gestational age at onset was 31+ 2 weeks. Three cases of them occurred in the second trimester and the other 11 cases occurred in the third trimester of pregnancy. Fever of patients and fetal movement abnormalities were the most common clinical symptoms of patients of listeriosis during pregnancy, the ratio of these two clinical symptoms were 85.7% (12/14) and 64.3% (9/14), respectively. Other clinical symptoms including abdominal pain (57.1%, 8/14), uterine tenderness (35.7%, 5/14) of patients, etc.. Among the 11 patients of listeriosis during pregnancy in the third trimester, there were 9 cases (81.8%, 9/11) of abnormal of fetal monitoring and 9 cases (81.8%, 9/11) of amniotic fluid. ② The samples of LM detected in our study were blood, amniotic fluid and cervical secretions of patients of listeriosis during pregnancy, and blood and cerebrospinal fluid of their newborns. Among 8 cases of 14 patients of listeriosis during pregnancy who took placenta pathological examinations, all of them were acute chorioamnionitis. ③ All the 14 patients of listeriosis during pregnancy were treated by anti-infection and their prognosis was favorable. However, among 15 cases of fetuses or newborns (including twins) of 14 patients of listeriosis during pregnancy, 11 cases (73.3%) were live births, and among them, 5 cases were cured and 6 cases died. The mortality of 15 fetuses or newborns was 66.7% (10/15). ④The correlation analysis showed that there was a correlation between rash and death of alive newborns infected by LM (r=0.633, P=0.036). There was no significant differences between cured and dead newborns who were live birth and infected by LM in the time of first use of antibacterials (Z=—0.471, P=0.638).

    Conclusions

    Patients of listeriosis during pregnancy has no specific clinical manifestation. The empirical antibiotic therapy before final diagnosis has poor therapeutic effect. The prognosis of patient of listeriosis during pregnancy after treatment by anti-infection is favorable, but the prognosis of its newborn is poor.

  • 9.
    Values of artificial intelligence breast ultrasound in diagnosis and prognosis assessment of breast carcinoma
    Chuanbo Xie, Qin Man, Hong Luo
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2020, 16 (03): 368-372. DOI: 10.3877/cma.j.issn.1673-5250.2020.03.018
    Abstract (345) HTML (0) PDF (790 KB) (209)

    The application of artificial intelligence (AI) breast ultrasonography for diagnosis breast carcinoma and prognosis prediction of breast cancer treatment can not only save time for ultrasound doctors, but also reduce the misdiagnosis and miss diagnosis cause by the lack of experience and skills of beginners. Modern medical imaging is one of the earliest areas where AI plays an important role in clinic. As a cross-sectional imaging technology, breast ultrasound image (BUI) collected by AI breast ultrasonography uses a computer-aided design (CAD) system to perform computer-aided diagnosis of breast cancer, and it can improve the accuracy of clinical diagnosis of breast cancer. Up to now, the intelligent CAD system can help ultrasound doctors more effectively screening early breast cancer. AI breast ultrasound can automatically identify and classify breast cancer lesions, and even simulate clinicians in diagnosis and prognosis prediction of patients with breast cancer. This article focuses on the latest research progresses of diagnosis and prognosis prediction of breast cancer by AI breast ultrasound.

  • 10.
    Analysis of 37 482 newborns screened for inborn errors metabolism in minority nationality regions of Hainan Province
    Haijie Shi, Zhendong Zhao
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (01): 30-36. DOI: 10.3877/cma.j.issn.1673-5250.2021.01.005
    Abstract (341) HTML (6) PDF (812 KB) (203)
    Objective

    To explore the incidence of various inborn errors metabolism (IEM) in newborns in minority nationality regions of Hainan Province.

    Methods

    A total of 37 482 newborns born from January 1, 2018 to January 31, 2020 in minority nationality regions of Hainan Province were selected as research subjects. All guardians of these newborns agreed to be screened for IEM. Tandem mass spectrometry was used to screen neonatal heel blood (dried blood spots of disk bioassay) for various IEM. For part of newborns whose screening results were suspicious of IEM, their peripheral blood were collected and sent out for genetic testing to confirm the types of IEM and genetic mutations.The lowest incidence of IEM between male and female children in minority nationality regions of Hainan Province were compared statistically by chi-square test. This study was approved by the Medical Ethics Committee of Hainan General Hospital [Approval No. Medical Ethics (2018) No. 14].

    Results

    ① Among 38 586 live births in research regions during the research period, there were 37 482 cases received IEM screening, and the coverage rate of neonatal IEM screening was 97.1%. ②Among 37 482 newborns, 89 of them were suspected of IEM. Among 89 suspected of IEM newborns, 24 of them were conducted genetic testing, and 19 were firmly diagnosed as IEM. The diagnostic rate of IEM in 24 suspected newborns was 79.2% (19/24).Because only part of newborns with suspected IEM received genetic testing, the lowest incidence of IEM among newborns in the research regions was 51/100 000 (19/37 482). In this study, the lowest incidence of IEM were 57/100 000 (12/21 136) for males and 43/100 000 (7/16 346) for females newborns, and there was no significant difference between them (χ2=0.354, P=0.552). ③ Among 19 newborns with firmly diagnosis of IEM all had gene mutations, and there were 5 cases of aminoacidopathy, 5 cases of organic acid metabolism disorder, 2 cases of urea circulation disorder and 7 cases of fatty acid β oxidation metabolism disorder, respectively.

    Conclusions

    The incidence of IEM in newborns in the research regions was relatively high and with many types.We suggest that various IEM screening should be carried out among newborns in minority nationality regions of Hainan Province to improve life quality of IEM newborns.

  • 11.
    Research progress of risk factors associated with polycystic ovary syndrome and impact of reducing fat by exercises on patients
    Lin Liang
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2016, 12 (03): 354-359. DOI: 10.3877/cma.j.issn.1673-5250.2016.03.019
    Abstract (101) HTML (2) PDF (868 KB) (177)

    Along with the increasing of influence factors of female hormone secretion, and the increasing risks of food quality and safety in China, the incidence of polycystic ovary syndrome (PCOS) is increasing year by year gradually. PCOS has a great impact on women's health. PCOS not only affects the female patients themselves, infertility caused by PCOS but also directly relateds to the health of their off-springs. To study the pathogenesis mechanism and treatment strategies of PCOS has become a hot issue in clinical research. Recent studies have confirmed that through reducing fat by exercises, other lifestyle adjustments, and long-term interventions could play a positive role on PCOS patients. At present, treatment strategies of PCOS are multi-faceted, in order to improve the life quality of PCOS patients. The article focuses on revealing the mechanism of PCOS and research progress of risk factors associated with PCOS and impact of reducing fat by exercises on patients.

  • 12.
    Promoting awareness of children with XYY syndrome
    Sha Gao, Jie Chen, Haiyan Yu
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2019, 15 (04): 459-462. DOI: 10.3877/cma.j.issn.1673-5250.2019.04.017
    Abstract (940) HTML (17) PDF (858 KB) (167)

    XYY syndrome, also named as super male syndrome, is the most common Y chromosome abnormality disease behind Klinefelter syndrome. The clinical phenotypes of XYY syndrome are quite different. The detection rate of XYY syndrome was low in the past, but with the development of prenatal diagnosis technics and the increasing attention paid by couples to the fetuses, the rate of prenatal diagnosis of fetal XYY syndrome is increasing. Currently, after the intrauterine diagnosis of fetal XYY syndrome, a multidisciplinary team is required to evaluate the prognosis of the fetus, and provide detailed and unbiased clinical consultations to the pregnant couples. After the birth of children with XYY syndrome, multidisciplinary team is still needed to carry out rehabilitation intervention and training for some children with XYY syndrome who have behavioral and cognitive problems. Assisted reproductive technology is needed to improve the pregnancy rate of patients with XYY syndrome and avoid adverse pregnancy outcomes. This article focuses on the latest research progresses in genetic background, diagnosis, fetal perinatal outcomes and postnatal survival, clinical phenotypes, evaluation and treatment of children with XYY syndrome, so as to provide clinical reference for childbearing couples who may be pregnant with children with XYY syndrome.

  • 13.
    Analysis of non-invasive prenatal screening in 50 975 pregnant women in Guangxi region
    Yaqin Lei, Yunli Lai, Shang Yi, Fuben Xu, Yanqing Tang, Xiaoshan Huang, Jian Yi, Xiaoxia Qiu
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (04): 410-419. DOI: 10.3877/cma.j.issn.1673-5250.2021.04.006
    Abstract (555) HTML (0) PDF (1949 KB) (161)
    Objective

    To investigate the clinical performance of non-invasive prenatal testing (NIPS) in the detection of chromosome aneuploidies and genome-wide copy number variation (CNV).

    Methods

    A total of 50 975 serum specimens from singleton pregnant women who received NIPS at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2018 to December 2019 were selected into this study. Based on different risk factors, they were divided into 3 groups. Those with serologic screening results of high risk + elderly pregnant women + adverse maternal history/family history were included in high-risk group (n=22 852), those with moderate risk/critical risk of serologic screening and abnormal ultrasound soft indicators were included in moderate-risk group (n=4 584), and those without the above risk factors were included in low-risk group (n=23 539). For those with high risk of NIPS detection, chromosome karyotype analysis and chromosome microarray analysis (CMA) were used for interventional prenatal diagnosis. The study protocol was approved by the Ethics Review Committee of Guangxi Maternal and Child Health Hospital (approval No.[2020]9-2).

    Results

    ① Of 50 975 pregnant women who underwent NIPS, 702 cases showed high risk, with a total positive rate of 1.38%. Among them, the high risk of 21-, 18-and 13-trisomy was 175 cases (0.34%), 67 cases (0.13%) and 63 cases (0.12%), respectively, the high risk of sex chromosome aneuploidy abnormalities (SCA) was 205 cases (0.40%), the high risk of rare chromosome number abnormality (RCA) was 96 (0.19%), and the high risk of copy number variation (CNV) was 96 (0.19%). ②A total of 555 of the 702 positive cases (79.06%) were followed up by karyotyping and (or) CMA, 93 (16.76%) refused confirmatory diagnosis, 42 (7.57%) did not perform prenatal diagnosis because of abortion or induced labor, and 12 (1.71%) lost follow-up. ③The positive predictive values for trisomy 21, trisomy 18, trisomy 13, SCA, RCA, and CNV were 85.09% (137/161), 57.14% (28/49), 16.67% (9/54), 42.31% (66/156), 5.56% (4/72), and 42.86% (27/63), respectively. ④In 16 cases with high risk of NIPS screening, NIPS was not detected by interventional prenatal diagnosis, but other abnormal results were detected. Of the 4 fetuses with high risk of trisomy 21, CNV was detected in 3 and complex structural variation of chromosome 21 was detected in 1. In one case of 18-trisomy high-risk fetus, the karyotype analysis results suggested that it was 21-trisomy. Among the 2 fetuses with 13-trisomy high risk, one was a chimera with chromosome structural variation, and the other was CNV. CNV of other chromosomes was detected in 3 fetuses with high SCA risk and 2 fetuses with high RCA risk. Among the 4 fetuses with high risk of CNV, 47, XYYY were detected in 1 case and other CNV abnormalities were detected in 3 cases.

    Conclusions

    NIPS has a high clinical value for screening common chromosomal aneuploidies such as 21-, 18-, and 13-trisomies. the positive predictive value of NIPS for screening SCA, RCA and CNV is low, but combined with prenatal ultrasound and other related examination, it can provide a basis for genetic counseling and further prenatal diagnosis.

  • 14.
    Clinical significance of the prevalence of thyroid-related autoantibodies in childhood systemic lupus erythematosus
    Yingjie Xu, Yalin Wang, Fuying Song, Lijuan Ma, Xiaolan Huang, Gaixiu Su, Min Kang, Jun Hou, Jianming Lai
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2022, 18 (03): 282-289. DOI: 10.3877/cma.j.issn.1673-5250.2022.03.006
    Abstract (251) HTML (0) PDF (1704 KB) (159)
    Objective

    To investigate the clinical significance of the prevalence of thyroid-related antibodies in childhood systemic lupus erythematosus (cSLE) patients for the detection of thyroid injury and autoimmune thyroiditis (AITD).

    Methods

    Fifty children with first-onset cSLE who were hospitalized at the Department of Rheumatology and Immunology, Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to August 2021 were selected into this study and included in cSLE group. Another fifty healthy children who underwent physical examination at same hospital were also selected and included in control group. The general clinical data and positive rate of thyroid-related antibodies of 2 groups were retrospectively analyzed. Moreover, the clinical characteristics, positive rate of thyroid-related antibodies, thyroid injury, treatment and follow-up of patients in cSLE group were retrospectively analyzed. Thyrotropin receptor antibody (TRAb), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were detected by electrochemiluminescence method. The procedure followed in this study was in line with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013. Informed consent for clinical research was obtatin from each patient′s guardians.

    Results

    ① There were no significant differences in general clinical data such as gender ratio and age between two groups (P>0.05). ② Among 50 children in cSLE group, the age ranged from 4 to 15 years old [(11.0±2.5) years old], and all the 50 children had negatime family history of thyroid diseases. At the first visit, Systemic Lupus Erythematosus Disease Activing Index (SLEDAI-2k) of all children were higher than 5, and only one patient presented with thyroid injury. TRAb, TgAb and TPOAb were positive in 6 cases (12.0%), 18 cases (36.0%) and 20 cases (40.0%) of 50 children with cSLE, respectively. There were no significant differences in the positive rates of thyroid-related antibodies among cSLE children with different disease activities (P>0.05). ③ The positive rates of three thyroid-related antibodies in cSLE group were higher than those in control group, and the differences between two groups were statistically significant (P<0.05). ④ Among 50 children in cSLE group, 13 case (26.0%, 13/50) were diagnosed as AITD, including 12 cases (24.0%, 12/50) were Hashimoto′s thyroiditis (HT) and 1 case (1/50, 2.0%) was Graves disease (GD); 2 cases (2/50, 4.0%) were diagnosed as hypothyroidism (subclinical type); 9 cases (9/50, 18.0%) had no symptoms of thyroid diseases, and their thyroid function and ultrasonic examination results were normal, although thyroid-related antibodies were positive. The remaining 26 cases had no thyroid injury. ⑤After treatment with glucocorticoids and immunosuppressants, cSLE in 50 children was relieved from 6 months to 18 months after treatment (SLEDAI-2k score <5). Among them, 13 cases with cSLE complicated with AITD were given levothyroxine or methimazole orally. After 6 to 48 months of follow-up, the symptoms disappeared, the thyroid function returned to normal, and the thyroid-related antibodies turned negative or even medication discontinuation. Two cases with cSLE complicated with hypothyroidism and negative thyroid-related antibodies were given oral levothyroxine. With the remission of the primary disease, thyroxine tablets could be reduced, and the thyroid-related antibodies did not turn positive.

    Conclusions

    Thyroid injury is more common in children with cSLE, most of whom have AITD, with HT predominating, but most thyroid injuries are insidious. Therefore, for children with newly diagnosed cSLE, especially those with active SLE, thyroid autoantibodies should be routinely detected in addition to thyroid function, regardless of whether SLE is severely active or not. Once thyroid injury is found, cSLE should be actively controlled, and thyroxine or methimazole should be taken as symptomatic treatment. With the remission of cSLE, thyroid-related antibodies can turn negative and thyroid function can be restored.

  • 15.
    Diagnosis and treatment of children with familial acute necrotizing encephalopathy caused by RANBP2 gene mutation and literature review
    Zemin Luo, Jiuwei Li, Xingyu Liu, Qiong Jiang, Shuyao Zhu, Danfeng Xie
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2020, 16 (04): 398-408. DOI: 10.3877/cma.j.issn.1673-5250.2020.04.005
    Abstract (337) HTML (0) PDF (1635 KB) (144)
    Objective

    To investigate clinical characteristics, diagnosis, treatment and prognosis of familial acute necrotizing encephalopathy (ANE1) caused by RANBP2 gene mutation.

    Methods

    A total of 2 children with ANE1 caused by RANBP2 gene mutation who were confirmed in Beijing Children′s Hospital in January 2018 (case 1) and in Sichuan Provincial Hospital for Women and Children in March 2019 (case 2), were chosen as research subjects. We retrospectively analyzed their clinical case data, including clinical manifestations, laboratory examination results, head MRI features, treatment and follow-up data. Meanwhile, literature related to ANE1 caused by RANBP2 gene mutation were searched in mainstream databases for literature review. And the procedure followed in the whole study were in accordance with World Medical Association Declaration of Helsinki revised in 2013.

    Results

    ① Clinical case data: clinical manifestation of case 1 was presented with headache after fever, drowsiness, poor mental response, indifferent expression, unstable walking in a straight line, and recent memory decline; and of case 2 with fever, headache, vomiting, progressive disturbance of consciousness and facial paralysis after infection of influenza A virus. Their head MRI examinations revealed symmetrical damage to multiple parts of thalamus, insula, pons and external capsule, with some cystic changes. Their gene detection results showed that heterozygosity mutation of RANBP2 gene on exon 12: c. 1754 C>T (p.Thr585Met), a missense mutation. After treatment with gamma globulin, glucocorticoids to regulate immunity, and " mitochondrial cocktail therapy" to repair mitochondrial function, their intracranial lesions improved, and mental and athletic abilities were restored. ② Clinical features of ANE1 caused by RANBP2 gene mutation of 74 cases by literature review and 2 cases in this study were summarized. Their clinical features were as follows: their age of onset ranged from 5 months to 40 years old, median age of first onset was 3.5 years old, the ratio of male to female patients was 35∶41. Among main clinical manifestations, ratio of fever was 82.5% (47/57), epilepsy was 81.1% (41/53), focal neurological deficit (FND) was 28.6% (8/28), encephalopathy was 93.4% (71/76), elevated CSF protein (EP) was 90.3% (56/62), pleocytosis in CSF (Pl) was 28.6% (8/28). Head MRI/CT showed that main lesions of patients were located in thalami (83.1%, 49/59), brainstem (72.9%, 43/59), temporal lobe (71.2%, 42/59), cerebellum (26.3%, 5/19), spinal cord (13.8%, 4/29), basal ganglia (8.5%, 5/59).

    Conclusions

    ANE1 caused by RANBP2 gene mutation has typical clinical features and characteristic head MRI findings. Febrile disease with symmetrical lesions in thalamus and other brain parts should be a vigilant signal to ANE1 patients. For patients suspected of ANE1, early detection of RANBP2 gene will be helpful to clarify diagnosis, rational treatment and improve their prognosis.

  • 16.
    Fetal MRI: plays a key role in prenatal imaging diagnosis of birth defects
    Gang Ning
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (03): 257-261. DOI: 10.3877/cma.j.issn.1673-5250.2021.03.003
    Abstract (312) HTML (2) PDF (1336 KB) (142)

    Prenatal imaging diagnosis includes prenatal fetal ultrasound and fetal MRI, which is an important means of secondary prevention and control of birth defects. The advantage of fetal MRI is safe, and so far, it has not been found that MRI examination of 3.0 T or below will bring any adverse consequences to pregnant women and fetuses. MRI has become an important supplementary means for prenatal ultrasound diagnosis of fetal structural abnormalities in the second and third trimester of pregnancy, because of good soft tissue contrast, wide field of vision, multi-orientation and multi-parameter imaging, and advantages of non-radiation and non-invasion, and not affected by factors such as maternal obesity, oligohydramnios, and fetal head calcification. The purpose of fetal MRI examination is to confirm results of prenatal ultrasound examination, or when an abnormality is suspected by prenatal ultrasound without a definitive diagnosis. MRI examination may obtain more information from fetus than prenatal ultrasound, and make up for some deficiencies of prenatal ultrasound. Indications of fetal MRI include central nervous system congenital malformations suspected of fetus by prenatal ultrasound examination, ventricular dilatation, brain midline structural abnormalities, posterior cranial fossa widening or abnormalities of cerebellar vermis of fetus, whether fetal cleft lip accompanied by cleft palate or alveolar bone abnormalities, whether fetal auricle malformations associated with atresia of the external auditory canal or dysplasia of the middle and inner ears, extracardiac macrovascular malformations suspected by ultrasound examination, location and characterization of abdominal and pelvic masses, evaluation of intestinal malformations, genitourinary tract malformations and singleton twins complications, evaluation of curative effect and prognosis before and after treatment of fetal diseases, and evaluation before termination of pregnancy for severe diseases of fetus, etc.. Overall, fetal MRI examination can provide relevant information of fetus for prenatal diagnosis, eugenics and genetic counseling, and provide basis for fetal treatment plan formulation, delivery mode selection and doctor-patient communication. Although fetal MRI can make a standard and complete evaluation of fetal anatomy, it is still not the first choice for prenatal imaging diagnosis.

  • 17.
    Interpretation of the Guidelines of the Brazilian Society of Oncologic Surgery for Pelvic Exenteration in the Treatment of Cervical Cancer
    Yiran Wang, Ping Wang
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (02): 142-151. DOI: 10.3877/cma.j.issn.1673-5250.2021.02.004
    Abstract (174) HTML (0) PDF (9150 KB) (138)

    The Guidelines of the Brazilian Society of Oncologic Surgery for Pelvic Exenteration in the Treatment of Cervical Cancer (hereinafter referred to PE Guidelines) had been published in December 2019 for patients with locally persistent or recurrent cervical cancer (PRCC) after radiotherapy or chemotherapy. Recommendations for the best management of patients with locally PRCC undergoing salvage pelvic exenteration (PE) were developed and based on the best evidence available in literature. This is the first guideline or consensus on PE in the treatment of locally PRCC which has been proposed in the world. The research contents of PE Guidelines include indications for curative and palliative PE, preoperative and intraoperative evaluation, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-ups, which will be interpreted in this article.

  • 18.
    Research status of infertility mechanism and pregnancy assisting strategies in patients with endometriosis-associated infertility
    Linshuang Li, Hanwang Zhang
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2020, 16 (03): 272-277. DOI: 10.3877/cma.j.issn.1673-5250.2020.03.004
    Abstract (231) HTML (0) PDF (790 KB) (136)

    Endometriosis (EMS) is a common disease in women of childbearing age. Ectopic endometrium can affect the pelvic internal environment through a variety of mechanisms, causing pelvic adhesion, reducing gamete and embryo quality, and ultimately leading to infertility. At present, three commonly used treatments for patients with EMS-associated infertility are drug therapy, surgical therapy and assisted reproductive technology (ART). The earliest treatment method of those patients is drug therapy, which mainly alleviates clinical symptoms such as dysmenorrhea, chronic pelvic pain, and dyspareunia. The subsequent laparoscopic surgery can improve the pregnancy rate of patients with EMS-associated infertility to a certain extent. ART, which has developed rapidly in recent years, provides a new treatment method for severe EMS patients and patients with postoperative recurrence. The author intends to elaborate on current research status of EMS-associated infertility from three aspects of drug, surgery and ART based on the common clinical treatment methods and clinical practice, to provide reference for further optimizing the clinical diagnosis and treatment ideas of EMS-associated infertility.

  • 19.
    Research status of mirror syndrome
    Lei Li, Hongbo Qi
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (03): 273-277. DOI: 10.3877/cma.j.issn.1673-5250.2021.03.006
    Abstract (257) HTML (0) PDF (1344 KB) (135)

    Mirror syndrome is normally defined as development of maternal edema in association with hydrops fetalis (HF) and placenta hydrops. The incidence rate of mirror syndrome is rare and estimated to be 1/(5 800-10 000). It is known that a variety of etiologies including alloimmune response and non-immune factors may cause HF and then lead to mirror syndrome, but the specific pathophysiological mechanism is still unclear. The diagnosis of mirror syndrome is not difficult when finding HF and maternal hydrops at the same time. The etiological diagnosis of HF and mirror syndrome is also very important for clinical treatment, prognosis and recurrence risk assessment. In general, the prognosis of mirror syndrome is poor with very high fetal and neonatal mortality. The treatment mainly depends on the cause of HF. If there are no effective measures to alleviate HF, it is recommended to terminate pregnancy as soon as possible.

  • 20.
    Clinical effect of bioelectric stimulation on endometrial repair after artificial termination of pregnancy
    Yunjie Yang, Wenjing Shi, Fang Cheng
    Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) 2021, 17 (01): 93-98. DOI: 10.3877/cma.j.issn.1673-5250.2021.01.014
    Abstract (211) HTML (0) PDF (755 KB) (130)
    Objective

    To explore clinical effects of bioelectric stimulation on endometrial repair after artificial termination of pregnancy.

    Methods

    From January 2017 to June 2018, a total of 100 patients who underwent artificial termination of pregnancy in Huai′an Women and Children Health Hospital were selected as research subjects. According to the random number table method, they were divided into observation group (n=50, treated with bioelectric stimulation) and control group (n=50, treated with oral drospirenone ethinyl estradiol). The general clinical data, endometrial thickness, uterine spiral artery pulsatility index (PI) and resistance index (RI) were observed before and after treatment. This study complies with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013, and was approved by the Ethics Committee of Huai′an Women and Children Health Hospital (Approval No. 2016008). Informed concent was obtained from each participates.

    Results

    ① There were no significant differences between two groups in the aspects of age, times of artificial termination of pregnancy and body mass index (BMI) (P>0.05). ② After treatment, the endometrial thickness of observation group was (9.8±2.8) mm, which was thicker than that of control group (8.0±2.5) mm, and the difference was statistically significant (t=7.012, P=0.007). In addition, there were significant differences in endometrial thickness before and after treatment of observation group and control group, respectively (t=15.619, 12.952, P<0.001, <0.001). ③ After treatment, PI and RI of uterine spiral artery of observation group were 1.0±0.1 and 0.7±0.1, respectively, which were significantly higher than those of control group (0.9±0.1 and 0.6±0.1, respectively), and the difference between two groups was statistically significant (t=4.106、2.028, P=0.003, 0.016). In addition, there were significant difference in PI and RI of uterine spiral artery before and after treatment of observation group and control group, respectively (observation group: t=3.261, 12.432, P=0.010, <0.001; control group: t=3.065, 10.307, P=0.021, <0.001).

    Conclusions

    The effect of bioelectric stimulation on endometrial repair was better than that of oral drospiroone ethinylestradiol treatment. Because this study is just a retrospective study, the clinical application value of this technology needs to be confirmed by the results of large sample, multicenter and randomized controlled study.