2016年 · 第51卷第01期

At the beginning of the new year, everything is renewed; The new editorial board was set up with high spirits. A new starting point, in the new year, we should do new things.

Regarding the definition of recurrent spontaneous abortion (RSA), the criteria of the American Society of Reproductive Medicine are 2 or more pregnancy failures; The Royal College of Obstetricians and Gynaecologists (RCOG) defines it as fetal loss with the same sexual partner three or more times in a row and before 24 weeks of gestation; However, in China, three or more fetal losses before 28 weeks of pregnancy are usually called recurrent abortion. However, most experts believe that two consecutive abortions should be taken seriously and evaluated, because the risk of recurrent abortion is similar to that of three^[1,2,3,4]。 The etiology of RSA is complex and diverse and lacks specific clinical manifestations. A series of targeted screening is needed in the process of etiology diagnosis. In addition, some treatment measures for RSA are still controversial. In order to meet the needs of clinical work, the Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association specially formulated an expert consensus on the diagnosis and treatment of RSA. Due to the limited relevant research data in China, especially the lack of evidence-based medical evidence such as large-sample randomized controlled trials, this expert consensus is based on the "RSA Diagnosis and Treatment Guidelines" issued by the American Society of Reproductive Medicine and RCOG, and combined with the experience and actual situation in clinical work in China, it is organized and written, aiming at providing reference for the clinical diagnosis and treatment of RSA. Some of the views recommended in this expert consensus are still preliminary understanding and need to be verified by more robust evidence-based medical evidence.

As the concept of fetus as a patient continues to spread out, fetal medicine is gradually standardized in mainland China. In recent years, fetal medicine has developed rapidly with the help of information technology platform. Fetal medical management includes intrauterine diagnosis, genetic counseling, intrauterine monitoring and evaluation, intrauterine treatment, etc. How to carry out systematic management to reduce the short-term and long-term complications of fetuses and newborns and improve the quality of life is the goal pursued by fetal medicine.

controlled ovarian hyperstimulation (COH) is the first step and key link in in vitro fertilization-embryo transfer (IVF-ET). The rate of egg acquisition is high, but the clinical pregnancy rate is not ideal, which is closely related to the production of superphysiological amounts of estrogen and progesterone during COH. At present, it is generally believed at home and abroad that the superphysiological amounts of estrogen and progesterone during COH can lead to changes in blood coagulation function, cause different degrees of microcirculation obstacles, and thus lead to the occurrence of adverse pregnancy events such as implantation failure and repeated abortion^[1]。 At present, the main research focus of fibrinolysis process, especially D-dimer, is still in normal pregnant population^[2]Or normal menstrual cycle^[3]On the above, there is no systematic clinical study of people who need COH during IVF. This study prospectively investigated the effect of COH on plasma D-dimer levels through self-control of D-dimer levels before and after COH in infertile patients.

Because the dissemination of lymphoma involves the reproductive system later, lymphomas with ovarian tumors as the first sign are less common. On January 2, 2014, the Affiliated Obstetrics and Gynecology Hospital of Fudan University admitted a patient with ovarian Burkitt lymphoma with clinical manifestations similar to advanced ovarian germ cell tumor. In view of the sensitivity of ovarian germ cell tumor to chemotherapy and the unmarried child, only one adnex was removed during the operation, and the tumor tissue of the contralateral ovary was removed, retaining the fertility function, and received adjuvant chemotherapy after the operation. This article combines the literature review and reports as follows.

Epithelial ovarian carcinoma (ovarian cancer) is one of the major malignant tumors that seriously endanger women's health, and its mortality rate ranks first among gynecological malignant tumors. Among all ovarian cancer patients, 10% to 15% are patients with hereditary breast-ovarian cancer syndrome (HBOC)^[1]。 HBOC is related to BRCA1/2 gene, and pathogenic mutations of BRCA1/2 gene exist in up to 16% ~21% of patients with high grade serous ovarian adenocarcinoma^[2]。 A meta-analysis in 2007 showed that women with pathogenic mutations in BRCA1 and BRCA2 had an average cumulative risk of breast cancer of 57% and 49%, respectively, and an average cumulative risk of ovarian cancer of 40% and 18%, respectively, before age 70^[3]。 A recent prospective study of 1 887 carriers of BRCA1/2 gene pathogenic mutation found that the average cumulative risk of breast cancer before age 70 in BRCA1 and BRCA2 gene pathogenic mutation carriers was 60% and 55%, respectively, and that of ovarian cancer was 59% and 16%, respectively^[4]。 It can be seen that BRCA1/2 gene detection and screening of pathogenic mutations in ovarian cancer patients, so as to determine whether their children or other first-degree relatives carry pathogenic mutations, so that carriers of pathogenic mutations of BRCA1/2 gene can get individualized physical examination and appropriate intervention, which will play a huge role in improving the early diagnosis rate and reducing the incidence of ovarian cancer and breast cancer. Unfortunately, however, domestic work in this area is still in its infancy. In this study, the next generation sequencing (NGS) technology was used to detect the mutation of the whole exon of BRCA1/2 gene in patients with high-grade ovarian serous adenocarcinoma, and then to clarify the carriage of pathogenic mutations in patients' children, which provided information for the gene screening of HBOC family.

Autophagy is a catabolic process in which substrates to be degraded are sequestered by autophagosome encapsulation in a bilayer membrane-like structure in eukaryotic cells and transported to lysosomes for degradation and recycling for reuse^[1], mainly occurs under conditions such as hypoxia, immune impairment, stress and nutritional deficiency^[2], is considered to be a defense mechanism of cells against adverse environmental stimuli^[3]。 However, both excessive or insufficient autophagy can lead to the development of disease. Studies have shown that autophagy is involved in pathological processes in multiple diseases, such as tumors^[4]neurodegenerative disease^[5]Cardiovascular disease^[6]Infection and immunodeficiency, etc.^[7]。 In recent years, some scholars have also reported the correlation between autophagy and preeclampsia. However, the exact mechanism of action of autophagy on trophoblast in preeclampsia is not clear whether it promotes its survival or leads to its death or functional impairment. Therefore, this paper reviews the research progress of autophagy and preeclampsia in order to explore the pathogenesis of preeclampsia from the perspective of autophagy.

compound oral contraceptives (COC) are one of the widely used contraceptive methods in the world, but their application rate varies greatly among different countries and regions. Compared with Europe and the United States, the usage rate in China is low, and only less than 3% of women of childbearing age use COC for contraception. This is largely related to the fact that users have great concerns about the side effects of COC. One of the concerns is whether COC affects ovarian function. I am worried that long-term use of COC will lead to irreversible inhibition of ovarian function, resulting in premature failure of ovarian function. Ovarian function decreases gradually with age, and menopausal age is the simplest and most objective indicator to reflect ovarian failure. To investigate the relationship between COC and ovarian function, it is a good way to reflect ovarian function indirectly by using natural menopausal age, which has been adopted by most studies. This article reviews the published literature, and hopes to clarify the effect of COC on ovarian function by exploring the effect of COC on menopausal age.

Controlled superovulation induction is important for assisted reproductive technology, which can enable infertile patients to obtain multiple oocytes simultaneously in one physiological cycle. However, the maturity of these oocytes is often uneven, and even the development of batches stops, resulting in the failure of the entire treatment cycle. Therefore, it is of important clinical significance to study the mechanism of oocyte development arrest, which is helpful to improve the utilization rate of oocyte. The factors involved in the maturation of oocytes are complex, and the origin of oocytes can be traced back to primordial germ cells. During embryonic development, primitive germ cells enter the genital crest to grow and stay in the bilinear phase of the first meiosis (MⅠ) prophase (Prophase Ⅰ) until puberty. After puberty, some primary oocytes return to MⅠ and further mature, after which the oocytes will stay in the metaphase (metaphase II) of the second meiosis (MⅡ), waiting for ovulation and fertilization.

As early as the end of the 19th century, the changes in the surrounding tissues of cervical invasive squamous cell carcinoma have been discovered, and it has been gradually recognized that there are precancerous lesions in cervical squamous cell carcinoma. In laboratory and clinical research begun in the 1960s, the concept of cervical intraepithelial neoplasia (CIN) was introduced, and it was classified into CIN Ⅰ, Ⅱ and Ⅲ according to the differentiation maturity of cells, nuclear atypia and mitotic activity, so as to guide clinical management. However, the morphological boundaries of these CIN subclassifications are not clear. High-risk HPV infection is a necessary condition for the occurrence of cervical cancer and its precancerous lesions, but most initial HPV infections are only productive infections. At this time, squamous epithelial cells have not yet entered the state of precancerous lesions, but still maintain the ability to differentiate. Most of these mildly abnormal squamous epithelial cells can regress spontaneously and return to normal. Only a small number of high-risk HPV infections accompanied by overexpression of E6, E7 and other gene products have cancerous potential (i.e. transformational infection). At this time, the morphological and biological characteristics are in line with the true sense of precancerous lesions. Accordingly, scholars revised the classification and naming system of CIN, borrowed from the TBS classification of cervical cytology, and used "low-grade squamous intraepithelial lesion (LSIL)" and "high-grade squamous intraepithelial lesion (HSIL)" to classify cervical squamous intraepithelial lesions in two levels, and replaced neoplasia with lesion. In 2014, WHO published the 4th edition of the Classification of Female Genital Organ Tumors^[1]This classification system was adopted in, that is, CIN I and related HPV infections were classified as LSIL, while CIN II and III were classified as HSIL.

Endometrial cancer is a common malignant tumor of female reproductive system, and the incidence of endometrial cancer is gradually increasing in recent years. In 2002, there were 198,000 new cases of endometrial cancer worldwide; Statistics in 2015 show that the number of new cases worldwide has increased to 319,000 each year^[1]。 The number of new cases in the United States was 43,470 in 2010 and rose to 54,870 in 2014^[2]。 In China, with the improvement of economic level, the occurrence of endometrial cancer is on the rise. The main metastatic route of endometrial cancer is translymphatic metastasis, and the traditional staged surgical scope includes pelvic and para-abdominal aortic lymph node resection. However, in recent years, many domestic and foreign studies have put forward new views on the value of lymph node resection. In order to understand the new progress of lymph node resection in endometrial cancer, the recent literature is reviewed.

In recent years, noninvasive prenatal testing (NIPT) technology, which detects free fetal DNA (cfDNA) in peripheral blood of pregnant women through high-throughput sequencing technology to screen for fetal chromosomal polyploidy abnormalities, is being increasingly used in clinical practice. It has the characteristics of safety, high efficiency and high accuracy, and is bringing revolutionary changes to prenatal diagnosis technology. NIPT technique can intervene in prenatal examination in three ways: alternative serological screening; Alternative to invasive prenatal prenatal diagnosis; As an intermediate step between serological screening and invasive diagnosis. It is expected that NIPT technology can replace the current invasive prenatal diagnosis technologies such as serological screening of pregnant women and chromosome analysis of fetal exfoliated cells of amniotic fluid. Scholars at home and abroad have successively carried out related research on this. This article will give a lecture on NIPT technology and its related clinical applications.

Since the first lecture tour of "Chinese Medical Association Magazine Guidelines and Progress Lecture Tour (Obstetrics)" was launched in Chongqing in November 2014 and received enthusiastic response, Chinese Medical Association Magazine and Chinese Journal of Obstetrics and Gynecology held lecture tours in seven cities across the country (Tai' an, Shenyang, Harbin, Fuzhou, Shenzhen, Chengdu and Zhengzhou) in 2015; More than 140 expert lectures were held, with more than 5,300 participants. The chairman of the obstetrics guide lecture project is Professor Yang Huixia, head of the obstetrics group of the Obstetrics and Gynecology Branch of Chinese Medical Association. The lecture expert is a well-known domestic professor who drafts or participates in the discussion of related professional diagnosis and treatment guidelines. The lecture content closely focuses on the obstetrics guidelines and the latest progress.

Chitty and Kroese reiterated the effectiveness of NIPT, which detects cell-free fetal DNA (cffDNA) in maternal plasma, over traditional prenatal screening methods in their review "How to Achieve Genetic Counseling Based on non-invasive prenatal testing (NIPT)". However, this comparison is based on a study conducted by Norton et al., which compared NIPT with standard first-trimester screening methods, and did not compare it with other methods with higher sensitivity and specificity. The research team of Norton et al. also conducted a study that included 452,901 pregnant women, of which 74% were younger than 35 years old. The detection rate of abnormal karyotypes in NIPT (based on cffDNA) was 75.4%, slightly lower than the standard combined screening method (81.6%). Overall, the detection efficacy of combined screening is higher than that of NIPT.

Cesarean section is a surgical procedure commonly used all over the world. Postoperative intestinal obstruction (POI) is a common complication after abdominal surgery and is defined as: a brief cessation of coordinated intestinal peristalsis after surgery, thus preventing efficient delivery of intestinal contents and/or ingestion. POI delays postoperative recovery, prolongs hospital stay, and increases medical costs. Despite evidence that chewing gum after gastrointestinal (GI) surgery helps reduce intestinal obstruction, a conflicting piece of evidence-based evidence limits its use after cesarean section. This systematic review and meta-analysis evaluated the effect of chewing gum after cesarean section to determine the effect of this method in routine postoperative care.