2015年 · 第50卷第04期

In 1995, the International Agency for Research on Cancer (IARC) symposium identified HPV infection as the key and necessary cause of cervical cancer. There is a definite precancerous lesion between HPV infection and cervical cancer-squamous intraepithelial lesion (SIL), which can be divided into low-grade SIL [LSIL; i.e. cervical intraepithelial neoplasia (CIN) Ⅰ] and high-grade SIL (HSIL; i.e. CIN Ⅱ ~ Ⅲ). This process can last from several years to more than ten years. In recent years, with the development of molecular biology technology, HPV detection methods have been continuously improved, and the detection quality has become increasingly updated and accurate, which provides a powerful means for pathogen identification, genotyping, risk stratification, lesion shunt, follow-up analysis and vaccination monitoring in cervical cancer screening. At the same time, it also puts forward new requirements and questions.

Pregnancy complicated by acute aortic dissection is a serious threat to the life of pregnant women and fetuses. About 24% of pregnant women die due to cardiovascular events^[1]。 Without timely diagnosis and treatment, the risk of maternal mortality increases at a rate of 1% to 3% per hour, with about 25% death in the first 24 hours, about 70% death in the first week, and about 80% death in the second week^[2,3]。 By Stanford Type Method^[4]Clinically, aortic dissection is divided into A and B types. Recently, two pregnant patients with acute aortic dissection type A were admitted to Changhai Hospital affiliated to the Second Military Medical University and delivered successfully. Now, the clinical data of these patients were retrospectively analyzed in combination with the literature, aiming at exploring the timing of pregnancy termination and perioperative management of pregnant patients with acute aortic dissection.

heavy menstrual bleeding is a common gynecological disease in adolescent and childbearing women, which seriously affects their health and quality of life. There is currently no generally accepted definition of refractory menorrhagia. Clinically, it mainly refers to menorrhagia that has excluded structural changes, is ineffective or poorly effective using reversible, fertility-preserving, conventional treatment methods, or improves but relapses after treatment. Menorrhagia belongs to abnormal uterine bleeding (AUB). Peking Union Medical College Hospital admitted a patient with refractory severe menorrhagia without excluding hematological diseases. The patient was young, barren, and required to preserve fertility. After treatment with etonogestrel subcutaneous implant, the bleeding was ideally controlled and the anemia was corrected, and the treatment effect was stable until now. Combined with the literature review, the report is as follows.

With the development of cervical cancer screening technology and tumor treatment technology, the number of patients with early cervical cancer has increased and the survival time has been prolonged, so more young patients have the need to preserve their reproductive function. 1995, Dargent and Mathevet^[1]The world's first extensive vaginal cervicectomy is reported. This innovative technology retains the fertility of patients with early cervical cancer by removing the diseased cervix and parauterine tissues to preserve the uterine body. Since then, transabdominal extensive cervicectomy and laparoscopic extensive cervicectomy have also begun to be applied in clinical practice. In 2008, Chuang et al.^[2]The application of robotic surgical system for extensive resection of the cervix is reported. The Department of Obstetrics and Gynecology of the People's Liberation Army General Hospital carried out extensive cervical resection by robot surgery system in December 2013. At present, the patient has been followed up for more than one year, and the review report is as follows in combination with relevant literature.

With the continuous rise of cesarean section rates worldwide and the widespread development of laparoscopic myomectomy in women of childbearing age, the problem of repregnancy with scar uterus cannot be avoided^[1,2]。 However, with the adjustment of China's population policy (separate two-child policy), the problem of re-pregnancy with scar uterus needs special attention and attention^[3]。 High cesarean section rate causes a large number of scar uterus, and repeated cesarean section after re-pregnancy with scar uterus further increases cesarean section rate. In recent years, the concept of trial of labor after previous cesarean delivery (TOLAC) has been gradually accepted by obstetricians. The National Institutes of Health (NIH) discussed the safety and outcome of vaginal trial delivery with scar uterus at a symposium in 2010, and finally reached a consensus: vaginal trial delivery is a reasonable choice for many pregnant women with a history of cesarean delivery, and successful vaginal delivery is an effective way to reduce the rate of cesarean delivery.^[4]。 Subsequently, the clinical problems related to vaginal trial delivery of scar uterus have also become the research hotspot in recent years. This paper combines the latest foreign guidelines and research progress at home and abroad^[2,4,5,6]This paper discusses the risks and indications of vaginal trial labor with scar uterus, related factors affecting the success rate of vaginal trial labor with scar uterus, induction and induction of labor in scar uterus pregnancy, and labor management in scar uterus pregnancy.

Endometriosis (endometriosis) is a common disease in women of reproductive age and an important factor leading to infertility. Its infertility rate can reach 30% ~50%, which is 20 times that of non-endometriosis people^[1]。 deep infiltrating endometriosis (DIE) refers to endometriosis with an infiltration depth ≥5 mm. In 1992, Koninckx and Martin^[2]The concept of DIE is proposed for the first time.

Cervical cancer is the second largest malignancy threatening the health of Asian women^[1]Persistent HPV infection is a necessary condition for its occurrence. Cervical intraepithelial neoplasia (CIN) is an important cervical precancerous lesion. It takes about 10~20 years to develop from CIN to cervical cancer. This period provides a favorable time for cervical cancer screening. The application of various screening techniques effectively reduces the incidence and mortality of cervical cancer^[2]。 Cytology examination and HPV detection are the main screening methods for cervical cancer at present. In recent years, the detection of biomarkers has begun to attract attention. HPV detection is no longer limited to DNA, but continuously developed in protein, mRNA, methylation detection, etc. In this paper, the main biomarkers and new technologies of HPV detection are reviewed.

The WHO clearly pointed out that timely replenishment of energy and fluids during vaginal delivery is one of the technical measures to reduce cesarean section, but it is recommended not to routinely replenish intravenous fluids. So how should energy and fluids be replenished during vaginal birth? Make up for what? How much? It is a matter of great concern to everyone. However, there is no research data in this area in China. Therefore, by consulting domestic and foreign literatures and according to clinical practice, the following lectures on the management of intake in normal labor are presented.

stress urinary incontinence (SUI) is a common disease of middle-aged and elderly women, which affects the life, work and social interaction of patients. Surgical treatment is the main treatment method. At present, it is believed that SUI can be divided into two categories: simple type and complex type. These two types of SUI have different preoperative evaluation and management, so they should be treated differently. In June 2014, the American Association of Obstetricians and Gynecologists (ACOG) issued an announcement on the definition of simple SUI and its preoperative evaluation methods "evaluation of uncomplicated stress urinary incontinence in women before surgical treatment" (i.e., ACOG Committee Opinion No. 603; published in Obstetrics and Gynecology, Volume 123, Issue 6, pp. 1403-1407), the following is the main content of the announcement and its interpretation.