2025年 · 第07卷第04期

As the Chinese Medical Association (CMA) marks its 110^thanniversary in 2025, we reflect on its transformative journey—from igniting China’s modern medical renaissance in 1915 to guiding Maternal-Fetal Medicine as a beacon of international scholarship today. This century-long odyssey mirrors China’s ascent from medical awakening to global leadership, written with the ink of compassion by generations of healers.

In commemoration of the 100^thanniversary of the Chinese Medical Association, this review highlights the remarkable advancements and future prospects of Obstetric Intensive Care Unit (OICU) in China — a cornerstone of maternal critical care. However, the pregnancy is generally considered low risk; a subset experiences complications that necessitate admission to OICU. This article delineates the developmental trajectory of OICU in China across three distinct phases: the formative stage (pre-2008), the expansion phase (2009-2015), and the current quality-oriented stage (2016-present). In addition, it presents a prospective analysis of future directions for OICU development in China, with a focus on technological innovation and clinical translation, the training of specialized personnel, the promotion of multidisciplinary collaboration and integrated diagnostic-treatment models, the coordinated development of regional medical systems, and the establishment of robust quality control and patient safety frameworks. By comprehensively examining the historical evolution, current landscape, and anticipated future trends of Chinese OICU, this review aims to offer valuable insights to enhance diagnostic, therapeutic, and management capabilities in the care of critically ill obstetric patients.

To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.

A retrospective, non-randomized study was conducted at Guangzhou Women and Children’s Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student’s t-test, Mann–Whitney U test, Chi-square test, and Kaplan–Meier survival analysis. A value of P < 0.050 was considered statistically significant.

Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively (χ² = 7.582, P = 0.006, odds ratio (OR) = 0.154, 95% confidence interval (CI): 0.035-0.685). The age (P = 0.005), PCOS subtype (P = 0.012), and levels of total cholesterol (P = 0.003), and high-density lipoprotein (P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester (χ² = 4.144, P = 0.040).

LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.

To assess the impact of maternal physiological and pathological factors on fetal birth weight in pregnancies in Kazakhstan.

This retrospective cross-sectional study was conducted from January 2016 to December 2021 at Aksu City Hospital, Atyrau Regional Perinatal Center, Altai Interdistrict Hospital, Abay Regional Perinatal Center of the Health Department, and Astana Multidisciplinary City Hospital No. 3, in the Republic of Kazakhstan using the stratified randomization grouping method. The study involved two maternal ethnicity groups, Asian (5101; 77.91%) and European (1446; 22.09%). All statistical analyses were performed using Stat Tech version 3.0.9 and SPSS 26.0.

This study involved 6547 pregnant women. Fetuses weighing < 2500 g were more common in the Asian group than in the European one (P = 0.001), while large fetuses (> 4000 g) were more common in the European group (P = 0.001). Multiple linear regression analyses revealed that a history of arterial hypertension and preeclampsia leads to decreased fetal weight, while gestational diabetes mellitus (GDM) was associated with increased fetal weight. In the Asian ethnic group, maternal physiological factors and a history of arterial hypertension, preeclampsia, and GDM significantly influenced fetal birth weight. In the European group, a history of hypertension and GDM did not affect birth weight.

Stillbirth and perinatal death were more likely among women of the Asian ethnic group when compared with women of the European ethnic group. Therefore, it is necessary to account for the maternal physiological and pathological factors that may influence fetal birth weight when assessing optimal fetal birth weight.

To evaluate the diagnostic efficacy and clinical application of the Obstetrical Chinese Disseminated Intravascular Coagulation (DIC) Scoring System (OCDSS).

This study is a retrospective study that collected 1063 cases from Wuhan Union Hospital, Yichang Central People’s Hospital, and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between July 2017 and June 2024. These cases were divided into DIC and non-DIC groups based on score standard. Diagnosis of DIC, the rate of hysterectomy, neonatal mortality, and severe asphyxia are the main outcome measures. All the laboratory indicators are all determined by clinical laboratory department of the hospital. Data were expressed as mean ± standard deviation or median (interquartile range) and frequencies. Independent sample t-test or non-parametric test were used to compare measurement data, while the chi-square test was used for count data. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to test the predictive accuracy. Using univariate and multivariate logistic regression analysis to study the high-risk factors. P < 0.050 indicates a statistical significance.

Of 1063 participants in this study, 29 participants (2.73%) were diagnosed with obstetrical DIC by OCDSS score standard, and all the participants were diagnosed as DIC with underlying disease. When the Takao, Clark, and Erez score standard is the "gold standard", the OCDSS score standard always shows good sensitivity and specificity, with all the AUC over 0.75. OCDSS score standard also has better predictive of hysterectomy (68.18%, 91.07%, 0.872), severe neonatal asphyxia and death (79.17%, 75.07%, 0.842) than the other three score standards. All the indicators included in the OCDSS score standard contributed to the DIC diagnosis (all the P < 0.001). The indicators in the DIC group were more abnormal than the non-DIC group (all the P < 0.001).

OCDSS is a first score standard, especially for pregnancies, it considers the underlying disease, clinical symptoms, and laboratory results. This score system shared a good diagnosis performance for DIC in the Chinese population and may help clinicians make timely decisions.

To compare pregnancy terminations for two reasons: intrauterine fetal death (IUFD) and fetal anomaly, focusing on obstetric data and termination processes to optimize clinical management.

This retrospective, single-center study included singleton pregnancies terminated for intrauterine fetal death or fetal anomaly (≥ 10 weeks’ gestation) between January 2020 and December 2021. Demographic, obstetric, and procedural data were collected. Termination methods included misoprostol, balloon catheter, curettage, and hysterotomy, following FIGO guidelines. Feticide was performed when indicated. Statistical analysis was conducted using t-test, chi-square test, and Pearson correlation; significance was set at P < 0.050.

A total of 173 termination cases (104 IUFD, 69 fetal anomalies) were analyzed. Mean gestational age was 16.6 ± 4.2 weeks. Termination and hospitalization times were longer in anomaly cases (P < 0.001). Gravida and parity were lower in the anomaly group (P = 0.005, P = 0.011). Misoprostol use showed a positive correlation with termination time (r = 0.251, P = 0.001); parity was negatively correlated (r = –0.175, P = 0.021). Balloon, curettage, and feticide rates were higher in anomaly cases (all P < 0.001). Complications occurred in 4 patients (2.3%).

Clinical approaches to pregnancy termination differ based on the underlying condition. Obstetric history and fetal pathology influence the methods and timing of the procedure, emphasizing the need for individualized care to improve patient outcomes.

To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine, norepinephrine, and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.

This PRISMA-based systematic review included English random control trails (RCTs) of women with singleton preeclampsia (American College of Obstetricians and Gynecologists (ACOG) criteria) undergoing cesarean delivery with spinal anesthesia, excluding chronic hypertension or systemic disease. Interventions were intermittent bolus phenylephrine, norepinephrine, or ephedrine, with outcomes on maternal hemodynamics, neonatal status, and adverse events. Searches of PubMed, ScienceDirect, Google Scholar, and Cochrane (to December 2024) plus reference screening identified eligible studies. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Due to heterogeneity in vasopressor regimens and outcome measures, results were synthesized narratively.

Of 2333 records screened, six RCTs (sample sizes 20-166) were included, all in preeclamptic women undergoing cesarean delivery. Overall risk of bias was low. Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine, with higher cardiac output (6.31 ± 1.08 vs. 5.45 ± 1.21 L/min; P = 0.009) and lower uteroplacental resistance (0.04 ± 0.02 vs. 0.06 ± 0.03; P = 0.002). Ephedrine caused higher heart rates (84.9 ± 7.1 vs. 76.6 ± 6.9 bpm; P < 0.05) and more nausea/vomiting. Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine (7.32 ± 0.02 vs. 7.31 ± 0.03; P < 0.050), while Apgar scores did not differ. Adverse events favored norepinephrine, which reduced bradycardia versus phenylephrine (5.1% vs. 20.5%; relative risk (RR) = 0.25; P = 0.042) and tachycardia versus ephedrine (16.1% vs. 36.4%; RR = 0.54; P = 0.020).

Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety, making it optimal for preeclamptic cesarean deliveries. Phenylephrine is effective for blood pressure control but may induce bradycardia, while the use of ephedrine is limited by its association with neonatal acidosis. Tailored vasopressor selection is thus essential for optimal outcomes.

Advances in prenatal screening have significantly improved the early detection of fetal anomalies and chromosomal abnormalities. Among these, first-trimester soft markers have emerged as valuable indicators of potential adverse outcomes. This review explores the clinical relevance of key markers—including increased nuchal translucency (NT), nasal bone hypoplasia, tricuspid regurgitation, aberrant right subclavian artery, and abnormal ductus venosus flow—and their associations with aneuploidy, structural malformations, and pregnancy complications such as preeclampsia and fetal growth restriction. We emphasize the importance of interpreting soft markers within a comprehensive clinical context, rather than in isolation, and examine their underlying pathophysiological mechanisms and associated statistical risks. Particular attention is given to the integration of soft marker findings with advanced screening techniques, including cell-free DNA (cfDNA) testing and maternal serum biochemistry, to improve diagnostic accuracy. In addition, we review current recommendations for clinical management, such as the use of follow-up diagnostic procedures like chorionic villus sampling or amniocentesis, and the role of multidisciplinary counselling in high-risk pregnancies. Future research should aim to validate novel soft markers and promote the standardization of screening protocols to enhance maternal and fetal outcomes.

Vaginal bleeding during the first trimester of pregnancy is a common symptom, often associated with threatened abortion, which occurs in 15-20% of all pregnancies. While multiple marker tests can predict pregnancy outcomes in the first trimester, there is limited research identifying reliable cutoff progesterone values linked to poor prognosis.^1,2Given that placenta formation begins around 8 weeks of gestation, progesterone levels are typically measured between 5-8 weeks of pregnancy. To explore this further, we conducted a retrospective study to analyze progesterone levels in the first trimester, prior to any progesterone therapy, across different pregnancy outcomes.

Large for gestational age (LGA) infants—defined as those with birth weight above the 97^thpercentile—constitute approximately 3% of all newborns. The genetic underpinnings of LGA are increasingly recognized, with associations reported in rare syndromes such as Pallister-Killian syndrome and Beckwith-Wiedemann syndrome. These disorders typically manifest as generalized or segmental overgrowth during the fetal and/or childhood period, frequently accompanied by tall stature, visceromegaly, and macrocephaly.¹

To editor:

To editor,