2014年 · 第49卷第11期

abnormal uterine bleeding (AUB) is a common symptom and sign in gynecology. As a general term, it refers to abnormal bleeding originating from the uterine cavity that does not match any one of the normal menstrual cycle frequency, regularity, menstrual length and menstrual bleeding amount^[1]。 The AUB described in this guideline is limited to non-pregnant women of childbearing age, so pregnancy and puerperal-related bleeding is excluded, and prepubertal and postmenopausal bleeding is excluded. There is confusion in medical terms and definitions describing AUB in countries around the world^[2]For this reason, the International Union of Obstetrics and Gynecology (FIGO) published a consensus on "Terms related to normal and abnormal uterine bleeding" in 2007, and published a new classification of AUB etiology in non-pregnant women of childbearing age PALM-COEIN system in 2011^[3,4]Use uniform words to guide clinical treatment and research. There is also some confusion in the gynecological circles in China, such as AUB, dysfunctional uterine hemorrhage (dysfunctional bleeding), and menorrhagia. These three terms are mixed indiscriminately^[2]。

Pregnancy with thyroid diseases, including hypothyroidism (hypothyroidism), hyperthyroidism (hyperthyroidism), postpartum thyroiditis, pregnancy with thyroid nodules and thyroid cancer, etc. With the gradual promotion of thyroid function screening technology, the incidence of such diseases is increasing. Internationally, in recent years, the diagnosis and treatment of such diseases has made a lot of progress, and the clinical standard for the diagnosis and treatment of pregnancy complicated with thyroid diseases has gradually been formed^[1]。 However, in comparison, the understanding and treatment of pregnancy complicated with thyroid diseases in China still need to be improved. In 2012, the Endocrinology Branch of the Chinese Medical Association and the Perinatal Medicine Branch of the Chinese Medical Association jointly referred to relevant foreign guidelines and combined with some clinical data in China to formulate the Guidelines for the Diagnosis and Treatment of Pregnancy and Postpartum Thyroid Diseases^[1]。 However, due to the differences in laboratory quality control standards, establishing standardized diagnosis and treatment methods for such diseases and exploring the diagnosis and treatment characteristics of Chinese population is still an important aspect of the current obstetrics field in China, which deserves the attention and active response of every obstetrician.

Acute myocardial infarction is a myocardial necrosis caused by acute persistent ischemia and hypoxia of the coronary arteries. Pregnancy complicated by acute myocardial infarction is a rare clinical complication, which can cause the death of mother and child, and is rarely reported in China. The General Hospital of the People's Liberation Army recently treated a patient with acute myocardial infarction in the third trimester of pregnancy and successfully treated, which is now reported in combination with the literature review as follows.

Hereditary coagulation factor VII (FVII) deficiency is a kind of hereditary coagulation dysfunction disease caused by the decrease of FVII activity due to the abnormality of FVII gene. Current studies suggest that this disease is an autosomal recessive disease with an incidence of 1/500,000~1/300,000^[1]The clinical manifestations can be symptoms such as epistaxis, skin and mucous membrane bleeding, menorrhagia and cerebral hemorrhage, or they can be completely asymptomatic. Pregnancy complicated by hereditary FVII deficiency is rare. So far, only dozens of cases have been reported abroad, and no similar cases have been reported in China. In order to further improve clinicians' understanding of pregnancy complicated by hereditary FVII deficiency, this paper analyzes the clinical data of 2 cases of pregnancy complicated by hereditary FVII deficiency recently admitted to the Department of Obstetrics of Peking University People's Hospital, and discusses the problems related to pregnancy in combination with literature review.

granulosa cell tumor (GCT) is the main type of ovarian sex cord stromal tumor (SCST), with an incidence of 0.05/100 000 to 1.7/100 000. It is a group of low-grade malignant, late recurrent functional tumors^[1,2,3,4]。 Pathological types are divided into adult type and juvenile type, adult type accounts for 95%, and mostly occurs in middle-aged or postmenopausal women; The juvenile type mostly occurs in children and adolescents. Its pathogenesis is unknown. Recently, it has been found that in most adult patients, the forkhead transcription factor forkhead box L2 gene (FOXL2) manifests as a single, recurrent somatic heterozygous mutation c.402C→G^{[5,6,7,8,9,10,11]}。 FOXL2 is the earliest landmark promoter gene that has been discovered to determine ovarian differentiation. It regulates the transcription and protein expression of target genes through transcriptional regulation, participates in the proliferation and differentiation of granulosa cells, and is of great significance for follicular development and female reproduction. In addition, several studies have also confirmed that FOXL2 c.402C→G gene mutation is more than 90% in adult GCT, but rarely in juvenile GCT^{[6,7,8,9,10,11]}。 In this study, the clinicopathological data of 53 GCT patients admitted to the Second Hospital of West China of Sichuan University were retrospectively analyzed, and the occurrence of FOXL2 c.402C→G mutation in adult and juvenile GCT was analyzed, so as to explore the differences of this mutation in different symptoms and signs and different stages of GCT, and then provide some reference for the diagnosis, treatment and prognosis of GCT.

aggressive angiomyxoma (AAM) is a rare soft tissue tumor derived from mesenchymal tissue, which occurs in the vulva, vagina and pelvic cavity of women of childbearing age. Local invasiveness and in situ recurrence are its important characteristics. A patient with massive vulvar and pelvic AAM was admitted to our hospital. Combined with the literature review, the report is as follows.

Teratoma is a common germ cell tumor, but uterine teratoma is rare in clinic. This paper reports a case of mature uterine submucosal teratoma. At the same time, we search and review the relevant literature at home and abroad, and analyze the clinical characteristics of uterine teratoma, so as to improve the understanding of the diagnosis and treatment of this disease.

cervical cerclage is the only surgical method and effective method for the treatment of cervical insufficiency at present. The traditional cervical cerclage is a transvaginal procedure during pregnancy proposed by Shirodkar and modified by MacDonald in 1955. Laparoscopic cerclage of isthmus during pregnancy has a higher success rate than transvaginal cervical cerclage in obtaining live babies, but the operation is more difficult. On the basis of mastering laparoscopic isthmus cerclage before pregnancy, six pregnant women with a history of late abortion were treated with laparoscopic polypropylene cerclage with isthmus cerclage during pregnancy from July 2013 to May 2014. The surgical method, obstetric prognosis, advantages and related problems of this operation are discussed later.

The 51-year-old patient was transferred to the First Affiliated Hospital of Jinan University on June 10, 2013 due to the discovery of adenomyosis, endometriosis (endometriosis) for 17 years and abdominal pain for 10 days. The patient developed lower abdominal pain at menstrual cramps 10 days ago, which was persistent. The other hospital treated it with "pelvic inflammatory disease", but the abdominal pain was still unbearable and came to our hospital for treatment. In the past, the patient had regular menstruation, severe dysmenorrhea, three pregnancies and one delivery, and two induced abortions. In 1992, he underwent cesarean section. In 1996, a mass with a diameter of about 6 cm was found at the surgical incision of the abdominal wall, and the surgical pathological diagnosis was incision endometriosis. In 2010, the cervical mass was found to be about 3 cm in diameter, and cervical biopsy was performed. The pathological diagnosis was chronic cervicitis and physical therapy was performed. Gynecological examination: a small amount of old vaginal hemorrhage, difficulty in exposure of the posterior fornix, smooth cervix, pain in lifting, contact bleeding, cystic mass about 8 cm in diameter can be palpable on the posterior lip, with fluctuating sensation and tenderness. There was no tenderness in bilateral uterine appendages. Tumor marker examination: CA₁₂₅25.6 kU/L, CA₁₉₉19.6 kU/L, AFP<1.7 μ g/L, Carcinoembryonic antigen<0.5 μ g/L. Ultrasound examination on admission: the echo of the posterior wall of the uterus was uneven, and a cystic heterogeneous mass was detected in the myometrium of the cervical canal, with a size of about 74 mm ×61 mm ×71 mm, thick wall, poor border, poor cystic fluid, and star-shaped blood flow signals were seen on the cystic wall. The cervical mass was punctured and chocolate-like fluid was extracted. Admission diagnosis: adenomyosis, endometriosis, cervical cyst nature to be investigated, cervical endometriosis (CEM) possible.

The child was 3 years old. He was admitted to our hospital on December 7, 2012 due to right lower abdominal pain for 2 days. The child had no nausea, vomiting, and normal urine and stool. No family history of hereditary disease. Physical examination: Generally, there is no pigmentation in the oral cavity and skin and mucosa. Mild tenderness in the right lower abdomen without rebound pain. Laboratory tests: Blood and urine routine normal, blood biochemistry and CA₁₂₅The levels are all in the normal range. Pelvic B-ultrasound examination: the uterus was anterior, naive, with a size of 3.0 cm ×1.9 cm, with uniform muscle layer echo and clear and centered endometrium; A solid mass of 6.3 cm ×4.6 cm was detected in the right adnexal area (Figure 1), blood flow signal was seen inside, the boundary was clear, and no obvious abnormal echo was seen in the left adnexal area. Ultrasound diagnosis: solid mass in the right adnexal area. Right adnexal tumor resection was performed on 11 December under general anesthesia. The child was cured and discharged 7 days after operation, and there was no abnormality in growth and development of the child after 1 year and 2 months of follow-up.

occult stress urinary incontinence (OSUI) refers to patients with pelvic organ prolapse (POP) who usually have no symptoms of stress urinary incontinence (SUI) and have urinary leakage when abdominal pressure increases after prolapse reduction. The incidence of SUI increased in POP patients with OSUI after repair surgery, and the relevant literature reported that it was 26.3% ~44.1%^[1,2,3,4]But only 5.3% ~15.8%^[2,3]The patient needs to be reoperated. Concurrent or two-step approach to anti-SUI surgery is controversial and no consensus has been reached^[2,3,5,6]。 This article summarizes the new progress in the field of OSUI diagnosis and treatment as follows.

heterotopic pregnancy (HP) refers to the coexistence of intrauterine pregnancy and ectopic pregnancy. It is relatively rare, and the incidence rate is 1/30 000 in women with natural pregnancy. With the development of assisted reproductive technology, the incidence rate has increased, and the incidence rate is about 1% in women treated with assisted reproductive technology^[1]。 HP people often have tubal infertility factors, high estrogen and progesterone levels, and a large number of oocytes or transferred embryos. In addition to the embryo transfer technology itself, some scholars believe that the volume and viscosity of the medium used in the process of embryo transfer also have a certain influence on the occurrence of HP^[2]。 History of pelvic inflammation is also a predisposition factor for HP. Ectopic pregnancy, which coexists with intrauterine pregnancy, can cause severe bleeding, put the pregnant woman in a state of danger, and even endanger the life of the pregnant woman and the normal embryo in the uterus. Therefore, for HP women with fertility requirements, early detection and timely treatment of ectopic pregnancy can not only avoid adverse consequences, but also help the continuation of intrauterine pregnancy.

Cervical cancer is a malignant tumor that relies on gynecological examination results for clinical staging. With the increase of clinical stage, its accuracy is getting worse and worse. It is reported in the literature that about 25% of patients with clinical stage I ~ II and 60% of patients with clinical stage III are underestimated^[1]Patients with underestimated stages failed because the lesions in the abdominal aorta area could not be accurately determined during imaging evaluation and were omitted during treatment. Pre-treatment surgical pathological assessment of para-aortic lymph node status can provide accurate information and provide strong clinical evidence for subsequent treatment. However, the surgical indications, surgical methods, resection scope, surgical complications and prognostic effects of para-aortic lymphadenectomy (PAL) in the treatment of cervical cancer still attract much attention and controversy^[2]。

Epithelial ovarian cancer (ovarian cancer) ranks 8th in incidence and 7th in mortality among female tumors in the world. It is an important disease that threatens women's health^[1]。 Currently, the initial treatment of ovarian cancer includes comprehensive staging surgery or tumor cytoreductive surgery and individualized adjuvant chemotherapy based on platinum. 90% of ovarian malignancies were epithelial, and about 2/3 of the patients were stage III or IV at initial diagnosis. The overall prognosis was poor, and the median disease-free survival time (DFS) after initial treatment was only 16 months^[2]。 Epidemiological studies show that hormone supplementation therapy can increase the risk of ovarian cancer by more than 20%, while early menopause and oral contraceptives can reduce the risk of ovarian cancer^[2]。 Basic research has found that there are many kinds of hormone receptors expressed in ovarian cancer cells, and sex hormones acting on the corresponding receptors will produce tumor-promoting or tumor-inhibiting effects^[3,4,5,6]。 All these suggests that sex hormones and their receptors are related to the pathogenesis of ovarian cancer. In recent years, sex hormone receptor and its downstream signaling pathway have gradually become a new hot spot in ovarian cancer research, and a variety of sex hormone receptor subtypes have been discovered one after another. This article will focus on clinical practice, combined with the role of sex hormone receptor in the pathogenesis of ovarian cancer, the expression of sex hormone receptor in ovarian cancer and its pathological subtypes, and the influence on the treatment and prognosis of ovarian cancer are reviewed.