2014年 · 第49卷第08期

Pregnancy complicated diabetes include pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM)^[1]PGDM may have been diagnosed before pregnancy or first diagnosed during pregnancy. With the increasing incidence of diabetes and the widespread attention paid to the screening and diagnosis of GDM, the number of pregnant patients with diabetes is increasing. In 2007, the Obstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association and the Pregnancy Complicated Diabetes Collaboration Group of the Perinatal Medicine Branch of the Chinese Medical Association formulated the Recommended Guidelines for Clinical Diagnosis and Treatment of Pregnancy Complicated Diabetes (Draft) [abbreviated as the Guidelines (Draft)]^[2], has played an important role in guiding clinical management.

At present, G-banding chromosome karyotyping is still the "gold standard" for prenatal diagnosis of cytogenetics, but this technology has the limitations of long cell culture, low resolution and labor consumption. Although the introduction of rapid prenatal diagnosis technology including fluorescence in situ hybridization (FISH) technology has the advantages of rapid and high specificity, it can't achieve global analysis of chromosome genome. chromosomal microarray analysis (CMA) technology, also known as "molecular karyotyping", can scan at the whole genome level and detect unbalanced copy number variants (CNV) of chromosomes, especially for detecting unbalanced rearrangements such as microdeletions and duplications of chromosomes. According to the different chip design and detection principle, CMA technology can be divided into two categories: array-based comparative genomic hybridization (aCGH) technology and single nucleotide polymorphism array (SNP array) technology. The former needs to label the DNA of the sample to be tested and the DNA of the normal control sample separately and perform competitive hybridization to obtain quantitative copy number detection results, while the latter only needs to compare the DNA of the sample to be tested with a complete set of normal genome control data to obtain diagnosis results. CNV can be well detected by aCGH technology, and SNP array can detect most uniparental disomy (UPD) and triploidy in addition to CNV, and can detect a certain level of chimera. The design of a chip covering CNV + SNP detection probes can have the characteristics of CNV and SNP chips at the same time^[1]。

Transabdominal uterine or vaginal sacral fixation is a surgical method for the treatment of middle pelvic defects. This surgery bridges the uterine or vaginal apex with the anterior longitudinal ligament of the sacrum through graft. It is still recognized as the "gold standard" surgery for the treatment of apical prolapse (I level defects), and the long-term success rate can reach 74% ~98%^[1,2,3]。 Depending on the surgical path, it can be done transabdominally, by laparoscopy or robotic laparoscopy. In 1957, France took the lead in carrying out transabdominal vaginal sacral fixation, which was widely used in clinical practice. In 1991, with the rise of laparoscopic techniques, the first laparoscopic sacrocolpopexy (LSC) was completed. Nowadays, this operation has also become one of the indications of robotic laparoscopy.