2016年 · 第51卷第07期

Progestin plays an important role in maintaining decidual endometrium, relaxing uterine smooth muscle, improving uterine blood supply and immune regulation in early pregnancy. It is widely used in the prevention and treatment of abortion and progestin supplementation related to assisted fertility technology in clinic, and has achieved good results^[1,2]。 At present, there is no accurate and appropriate method for judging luteal function, and there are differences in the dosage form and dosage of progesterone applied in clinic, which affects the observation of drug efficacy. So far, there is still a lack of evidence-based medical evidence, so there is still controversy in the specific efficacy^[3,4,5]。 To this end, we have established a Chinese expert group on the consensus of progesterone in maintaining early pregnancy and preventing and treating abortion with the participation of experts in gynecological endocrinology, obstetrics and reproductive medicine. The experts reached this consensus through in-depth exchange and discussion on the indications, contraindications, caution and clinical application points of progesterone application based on clinical research and diagnosis and treatment experience, aiming to give guidance to gynecologists, obstetricians and reproductive medicine specialists on the use of progesterone in maintaining early pregnancy, preventing or treating abortion.

intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related liver disease. The main clinical features of ICP are skin pruritus and elevated serum total bile acid (TBA) levels, which are reversible, and clinical symptoms and abnormal laboratory tests can recover quickly after delivery. Compared with the effects on pregnant women, ICP is more harmful to the fetus and can even lead to unpredictable fetal death. At present, there are no sensitive indicators to predict fetal prognosis. The purpose of this study was to investigate the relationship between maternal and infant outcomes of pregnant women with ICP and serum TBA levels of pregnant women and total TBA levels of pregnant women, and to understand whether serum TBA levels of pregnant women can be used as a predictor of fetal prognosis.

With the increase of the incidence of syphilis in the general population, the number of pregnant women infected with syphilis in China is also increasing year by year^[1,2]。 Early syphilis screening for pregnant women and timely treatment after infection can effectively reduce the occurrence of adverse pregnancy outcomes. Penicillins are the first choice for the treatment of pregnancy complicated by syphilis. The alternative treatment of pregnancy complicated with syphilis is still controversial, and there are few studies on the clinical efficacy of cephalosporin antibiotics in the treatment of pregnancy complicated with syphilis^[3]。 This study collected the surveillance data of pregnancy complicated with syphilis in eastern China in 2013 to explore the clinical efficacy of benzathin penicillin, procaine penicillin and ceftriaxone in the treatment of pregnancy complicated with syphilis to reduce neonatal congenital syphilis and other adverse pregnancy outcomes.

Endometriosis (endometriosis) is an estrogen-dependent disease, which seriously affects the quality of life and fertility of women of childbearing age. Regarding its pathogenesis, Sampson first put forward "menstrual blood reflux theory", and in recent years "eutopic endometrial determinism"^[1]It is believed that the eutopic endometrium of endometriosis is essentially different from that of non-endometriosis, and its molecular biological behavior may originate from estrogen exposure. Estrogen acts on ER and initiates corresponding signaling pathways. The interaction of multiple signaling pathways promotes the growth of reflux endometrium outside the uterine cavity. activator protein 1 (AP-1; also known as c-jun) is an important regulator of nuclear transcription, which is involved in various physiological processes such as cell proliferation, differentiation and apoptosis; After binding to ER, estrogen depends on ER conduction pathway to regulate the activity of transcription factors (such as AP-1 and nuclear factor κ B), and then regulate the expression of corresponding cytokines (such as vascular endothelial growth factor (VEGF)). As a third generation selective ER modulator (SERM), badoxifen can significantly inhibit the proliferation of endometrium, reduce the volume of ectopic lesions, and significantly reduce the expression of ER and proliferating cell nuclear antigen (PCNA) in ectopic lesions and eutopic endometrium of rats with endometriosis^[2]Because of its therapeutic effect on endometriosis in rats, it gradually entered the field of vision of scholars. In this study, the expressions of ER α, ER β, AP-1 and VEGF in ectopic lesions and eutopic endometrial tissues of endometriosis model rats were detected by immunohistochemistry method by treating endometriosis model rats with badoxifene, so as to explore the possible molecular mechanism of badoxifene in the treatment of endometriosis in rats, and provide evidence for the clinical application of badoxifene.

Endometrial cancer is a common malignant tumor in the female reproductive system, which occurs in postmenopausal women. Previous clinical studies have shown that chitinase protein 40 (YKL-40) is highly expressed in both serum and cancer tissues of endometrial cancer patients, and can be used as one of the candidate tumor markers of endometrial cancer^[1]。 Studies have shown that YKL-40 has the ability to promote tumor cell proliferation and angiogenesis^[2]And anti-tumor cell apoptosis, but its specific biological function is still unknown. In this study, the expression of YKL-40 gene in endometrial cancer cell line HEC-1A was silenced by small molecule interfering RNA (siRNA) to explore its effect on the proliferation and invasion ability of HEC-1A cells, which provided a theoretical basis for further exploring the biological function of YKL-40.

The patient was 43 years old, pregnant 2 and gave birth 1. Because of 7 courses of postoperative chemotherapy for squamous cell carcinoma of left ovary (squamous cell carcinoma), the condition was uncontrolled, and vaginal metastasis was found for 1 month, and he was transferred to our hospital on October 12, 2006. The patient had a previous history of left ovarian endometriosis cyst removal. On April 10, 2006, he underwent exploratory laparotomy in a local hospital due to sudden lower abdominal pain. During the operation, left ovarian cyst rupture and intra-abdominal hemorrhage were found. Intraoperative frozen pathology revealed that the left ovarian epithelial malignant tumor, mainly poorly differentiated squamous cell carcinoma, underwent total hysterectomy + bilateral adnexectomy + omentectomy. According to the consultation of the pathology department of our hospital, it is suggested that poorly differentiated squamous cell carcinoma of left ovary is likely to be derived from endometriosis. On 10 May 2006, he received 3 courses of intraperitoneal chemotherapy and 2 courses of intravenous chemotherapy with paclitaxel + cisplatin regimen. On September 5, 2006, vaginal metastasis was found at follow-up, and 2 courses of chemotherapy with cisplatin + doxorubicin + cyclophosphamide regimen were carried out. The vaginal smear performed by the local hospital indicated that highly suspicious cancer cells were seen, and the postoperative tumor was not controlled, so it was transferred to our hospital for treatment. Gynecological examination: induration was seen on the anterior wall of the vaginal opening, like infiltrating lesions, no abnormalities in the upper 2/3 of the vagina, and the pelvic cavity was empty, without abnormalities. Serum CA₁₂₅CA_19-9And carcinoembryonic antigen (CEA) levels were within the normal range. Surgical treatment was performed on October 17, 2006. During the operation, there was a hard mass of about 4 cm ×2 cm under the urethra on the anterior wall of the vagina, and hard masses of about 2 and 3 cm in diameter could be reached on the left and right side walls of the vagina, respectively. All three masses were flaky and thickened and adhered to each other. The clitoris can reach hard nodules with a diameter of 1.5 cm, and vaginal lesion resection + clitoplasty is performed. Postoperative pathological examination showed that a large number of poorly differentiated squamous cell carcinoma infiltrated in vaginal nodules and tumor thrombus in lymphatic vessels. Postoperatively, paclitaxel + carboplatin regimen was given intravenous therapy for 6 courses (the last chemotherapy was on November 30, 2006). The patient developed anal discomfort in December 2006, with obvious pain in the anal area when sitting, and increased frequency of defecation. On December 9, 2006, pelvic CT examination showed that there were nodular mass shadows on the left posterior bladder and the left side of the rectum, and it was considered that recurrence and metastasis were likely. Pelvic mass conformal radiotherapy + bilateral inguinal region irradiation was administered 10 times (pelvic cavity 30 Gy, bilateral inguinal region 10.8 Gy each). Two months after radiotherapy (February 2007), the patient died due to extensive tumor metastasis and respiratory and circulatory failure.

preeclampsia (PE) is a common systemic disease during pregnancy, with a global incidence of 3% ~5%^[1]。 The clinical manifestations of PE are hypertension, proteinuria and edema during pregnancy, which can be accompanied by damage to multiple organs in the whole body. The symptoms of hypertension, proteinuria and edema can disappear after delivery; Patients with eclampsia can die due to convulsions, coma, cerebral hemorrhage, pulmonary edema, heart failure, DIC. 10% ~15% of maternal deaths were directly related to PE and eclampsia^[2]。

Cryopreservation technology is an important part of assisted reproduction and fertility preservation technology. In 1983, after the first human frozen embryo was successfully transferred and clinical pregnancy was obtained, slow programmed freezing technology was gradually used in clinical work. However, the irreversible damage caused by the formation of ice crystals and the change of osmotic pressure during freezing has been widely concerned. The emergence of vitrification technology is undoubtedly a great progress. It inhibits the formation of intracellular ice crystals by rapid cooling, reduces the damage to cells caused by osmotic pressure and chilling, and improves the survival rate of oocytes after resuscitation. Because of its advantages such as fast freezing speed, simple process, no expensive programmed freezer, high resuscitation rate and high pregnancy rate, it has gradually replaced the traditional slow programmed freezing. In addition, vitrification of ovaries is also commonly used before chemotherapy of female malignant tumors, which provides a solution to the problem of female fertility preservation. However, the loss of blastomere and the damage of follicular ultrastructure caused by vitrification process inevitably affect the developmental potential of embryo to some extent, but there is no definite conclusion whether it affects the epigenetic modification.

In recent years, the number of patients with pregnancy complicated by tumors is increasing; Cervical cytology abnormalities were found in 1% to 5% of pregnant women during pregnancy, and cervical cancer was found in (1 to 12) /10 000 pregnant women^[1]； The relevant clinical data in China are not perfect at present. The diagnosis, treatment and delivery timing of pregnancy complicated with cervical cancer are very difficult problems, which require the joint efforts of a professional team (including obstetrics, gynecological oncology, pediatrics, anesthesiology, oncology chemotherapy and radiotherapy). The ultimate goal of pregnancy complicated with cervical cancer treatment is to achieve the same prognosis as non-pregnant cervical cancer patients^[2]。 In view of the lack of guidelines for the treatment of pregnancy complicated with cervical cancer, there is little experience for reference, and it is urgent to formulate corresponding norms to guide clinical treatment. The research progress in the diagnosis and treatment of pregnancy complicated with cervical cancer in recent years is summarized as follows.