2015年 · 第50卷第11期

About 50% of pregnant women in the first trimester of pregnancy will have nausea and vomiting, 25% will have nausea only without vomiting, and 25% will be asymptomatic. These symptoms mostly start at 4 weeks of pregnancy and are most severe at 9 weeks of pregnancy; Symptoms resolved spontaneously in 60% of pregnant women after 12 weeks of pregnancy, 91% after 20 weeks of pregnancy, and about 10% of pregnant women persisted in nausea and vomiting throughout pregnancy^[1,2]。 The recurrence rate of nausea and vomiting in the second pregnancy was 15.2% ~81.0%^[1,2]。 Hyperemesis gravidarum is the most serious stage of vomiting in pregnancy. It is often forced to terminate pregnancy due to doctors and patients' concerns about the safety of medication in early pregnancy, which delay medical treatment or insufficient treatment, resulting in serious complications and even endangering the mother's life. Therefore, early recognition and correct treatment have important clinical significance. The Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association organized relevant domestic experts to refer to the international guidelines for the diagnosis and treatment of hyperemesis gravidarum, as well as the latest evidence-based medical evidence on the application of antiemetics in early pregnancy, and combined with domestic clinical practice, to formulate the "Expert Consensus on Diagnosis and Clinical Management of Hyperemesis gravidarum (2015)", aiming at standardizing and guiding the clinical management of hyperemesis gravidarum by obstetricians and gynecologists, improving pregnancy outcomes and reducing unnecessary iatrogenic termination of pregnancy.

gonadotropin releasing hormone (GnRH) is a neurohormone secreted by the hypothalamus. It is a peptide hormone composed of 10 amino acids. Its main physiological function is to release LH and FSH, which plays an important role in the regulation of vertebrate reproduction. GnRH analogs include gonadotropin releasing hormone agonist (GnRH-a) and gonadotropin releasing hormone antagonist (GnRH-ant). GnRH-a is a decapeptide analog of GnRH, which can bind to pituitary GnRH receptor and promote the release of FSH and LH. Continuous application can inhibit the synthesis and release of pituitary gonadotropin (Gn) and ovarian gonadal hormone. However, GnRH-ant is mainly modified at the 6th and 8th amino acid sites of GnRH decapeptide, which prolongs the half-life, binds to the GnRH receptor of the pituitary gland but does not exert biological activity, and can completely block the effect of endogenous GnRH, causing the levels of FSH and LH in serum to decrease rapidly, and the LH peak cannot appear. Compared with GnRH-a, GnRH-ant has the advantages that it has no "flare-up" effect, can quickly inhibit the release of endogenous LH, and does not need pituitary desensitization, so the dosage of Gn is less than that of GnRH-a cycle; In addition, GnRH-a can be used instead of hCG to induce ovulation in the ovulation induction cycle of GnRH-ant, which can reduce the occurrence of ovarian hyperstimulation syndrome (OHSS). In recent years, the demand for clinical application of GnRH-ant in assisted reproductive therapy has gradually increased, but most clinicians have insufficient initial experience and long learning curve, so they need technical guidance and standardization urgently. Therefore, this consensus was drawn up by the Reproductive Medicine Branch of Chinese Medical Association organized by experienced experts in China to discuss and recommend it to clinicians for reference.

polycystic ovary syndrome (PCOS) is a common chronic disease with endocrine and metabolic abnormalities in women. Its pathogenesis is complex and its clinical manifestations are highly heterogeneous^[1]。 PCOS not only affects female reproductive health, but also is prone to diabetes, metabolic syndrome, endometrial cancer and cardiovascular disease. Ten years after the Rotterdam Criteria, the diagnostic criteria for PCOS jointly developed by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) in 2003, various prominent academic groups and institutions related to reproductive medicine and endocrinology include the Androgen Excess and PCOS Society (AE-PCOS)^[2]National Institutes of Health (National Institutes of Health, NIH)^[3]American Society of Endocrinology^[4]And European Endocrinology Society^[5]New consensus, analysis and new recommendations on the accuracy and operability of the current diagnostic criteria for PCOS have been published one after another. Prominently, these consensus and recommendations all emphasize the introduction of complications such as metabolic abnormalities of PCOS (abnormal glucose and lipid metabolism, metabolic syndrome, cardiovascular diseases, etc.) into the mainstream of PCOS diagnosis and treatment, and the concept of chronic disease management. The scope of diagnosis, treatment and research of PCOS has gone far beyond reproductive-related fields such as menstrual problems and infertility, but also involves multidisciplinary long-term management of chronic diseases such as metabolic diseases, cardiovascular diseases and tumors. For the diagnosis and treatment of PCOS, a chronic disease whose onset is known to be closely related to susceptibility genes, environment, lifestyle and other specific factors, how to use multidisciplinary theory and practice, combined with clinical and experimental data and molecular level information to achieve the maximum degree of individualized medicine, this is not only a new challenge but also an opportunity to stimulate our new thinking.

Preeclampsia is an important obstetric disease that leads to maternal death and fetal death, and the incidence rate accounts for about 5% of pregnant women^[1]。 The research on the pathogenesis of preeclampsia has been a hot spot in obstetrics, but its pathogenesis is still unclear. At present, it is believed that the pathogenesis of preeclampsia is mainly related to shallow placental implantation, vascular endothelial damage, immune response, genetic factors, inflammatory response, etc^[2]。 Studies have shown that genetic factors play an important role in the pathogenesis of preeclampsia^[3]And more and more scholars believe that abnormal placenta formation may be a predisposing factor for preeclampsia^[4,5]。 The imperfect development of the placenta is mainly due to poor erosion of trophoblast cells. At this time, the abnormal recasting of spiral arterioles causes lumen stenosis, so that the placental blood flow is reduced, and the placenta is ischemic and hypoxic. Studies have shown that abnormal expression of CXCL12 gene can interfere with the normal differentiation of trophoblast cells and cause physiological dysfunction, which may be the cause of preeclampsia^[6]。 CXCL12 gene polymorphism is considered to be an important genetic factor affecting CXCL12 gene expression^[7,8]At present, there are no reports on the relationship between CXCL12 gene polymorphism and preeclampsia. This study mainly investigated the correlation between G801A polymorphism of CXCL12 gene and the pathogenesis of preeclampsia, and explored the pathogenesis of preeclampsia from the perspective of molecular genetics.

gamete intrauterine transfer (GIUT) is an assisted fertility technology that mixes the removed egg cells and processed sperm and transplants them into the uterine cavity^[1]。 in recent years, the application of in vitro fertilization-embryo transfer IVF-ET has become more and more widespread, while the application of GIUT has decreased relatively. However, as a kind of assisted reproductive technology, GIUT still has its irreplaceable advantages and value. This article retrospectively analyzed the clinical data of two infertile patients in the Reproductive Hospital affiliated to Shandong University. Two patients changed to GIUT due to poor embryo quality after IVF, and all of them obtained clinical pregnancy. The report is now as follows.

gestational diabetes mellitus (GDM) is one of the common complications during pregnancy, which has serious near-term and long-term harm to mother and child. At present, it is believed that GDM is closely related to insulin resistance^[1,2,3,4,5]。 Recent studies have found that insulin resistance is closely related to oxidative stress and cytokines and their inflammatory response^[6]。 Studies have shown that advanced glycation end products (AGE) can promote oxidative stress and inflammatory response through various mechanisms^[7,8,9], leading to the development of insulin resistance^[10,11]And is closely related to the occurrence of GDM^[12,13,14]。 The mechanism of action of AGE and its relationship with GDM are reviewed as follows.

Lectins are a class of proteins that contain domains that recognize pathogenic carbohydrates. mannose-binding lectin or mannan-binding lectin (MBL) is a C-type collagen-like lectin, which is widely related to infectious diseases, autoimmune system diseases and other systemic diseases. MBL can bind to sugar groups such as mannose on the surface of pathogens and play a role. It is an important immune factor of natural immune system and the first line of defense against pathogenic microorganisms. It is known as "generalized antibody"^[1]。 Studies have confirmed that the natural immune factors represented by MBL are correlated with the occurrence, development and prognosis of vaginal inflammation.

At present, endometrial cancer is one of the common malignant tumors in women worldwide, and its morbidity and mortality are increasing year by year. In developed countries such as Europe and America, its incidence has accounted for the first place in gynecological malignant tumors^[1]。 Although the incidence of endometrial cancer is lower in developing countries, its mortality rate is significantly higher than that in developed countries. The mortality rate of endometrial cancer patients in developing countries is 34% and the 5-year survival rate is 67%, while the mortality rate of endometrial cancer patients in developed countries is 21% and the 5-year survival rate is 82%^[2]。 70% of endometrial carcinoma were early stage and 30% were middle and late stage at initial diagnosis^[3]； However, the prognosis of patients in the middle and late stages is poor (5-year survival rate is 21% ~56%), and conventional surgery, radiotherapy, chemotherapy or comprehensive treatment can not cure^[4]。

endometrial cancer (EC) is a common gynecological tumor. Epidemiological investigations show that androgens may play an important role in the etiology of EC^[1]。 Studies have shown that androgen receptor (AR) is expressed in EC cells and tissues^[2]Moreover, androgens may have an anti-cell proliferation effect^[3]。 Therefore, some scholars have suggested that androgen effect (referring to a series of pathophysiological reactions produced after androgen action) can be used as a potential target for disease treatment. Whether it is normal tissue or tumor tissue, the role of androgen and its receptors in the female reproductive system is complex, including the synthesis of sex hormones, local metabolism and receptor activation, etc. Changes in any link may affect the occurrence of tumor and disease progression^[4]。 This article reviews the current research progress on the role of androgens in the pathogenesis of EC, in order to provide new ideas on the pathogenesis and treatment options of EC.

With the increase of cesarean section rate, many clinical problems have attracted more and more attention, such as uterine rupture, placenta previa, placental implantation, cesarean scar pregnancy (CSP) after cesarean section, infertility, intraabdominal organ adhesion, etc. Among them, CSP, as one of the important early pregnancy complications of women after cesarean section, has become a common new type of obstetrics and gynecology emergency. CSP refers to the implantation of the gestational sac in the uterine scar or the diverticulum formed in the previous cesarean section, so it can be considered as a special type of ectopic pregnancy. As a long-term complication of cesarean section, clear and unified guidance is urgently needed in its diagnosis and treatment. CSP has become a "new disease" and has received unprecedented attention, and the number of related academic articles published at home and abroad continues to rise. The types of articles also range from early case reports to more recent series of studies with increasing case numbers. Under the historical background of high cesarean section rate in China, the incidence of CSP may be particularly serious. Therefore, it is more urgent for scholars to continue to study and summarize in depth, and formulate industry norms in line with China's characteristics, so as to improve the diagnosis and treatment level of CSP and the quality of perinatal health care. This article focuses on one of the most serious and difficult problems in CSP, that is, the dangerous placenta previa with placenta implantation caused by CSP continuing to develop in the first trimester of pregnancy. Moreover, the focus of this article is not to explain the placenta implantation in the second half of pregnancy, but the related problems related to CSP, placenta implantation in the first trimester and the first trimester of the second trimester of pregnancy, so as to strengthen clinicians' understanding of this serious obstetric complication, so as to identify and properly deal with it in clinic as soon as possible.