2014年 · 第49卷第12期

Induced labor in the third trimester of pregnancy is to initiate the labor process before natural labor through drugs and other means to achieve the purpose of delivery. It is one of the commonly used methods in obstetrics to deal with high-risk pregnancy. The success of induction of labor mainly depends on the degree of cervical maturity. However, if it is not applied properly, it will endanger the health of mothers and children. Therefore, the indications for induction of labor should be strictly mastered and the operation should be standardized to reduce the occurrence of complications. In 2008, the Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association published the Guidelines for Promoting Cervical Maturation and Induction of Labor in Late Pregnancy (Draft).^[1]Based on the evidence of evidence-based medicine at home and abroad in recent years, it has been revised to a large extent to provide evidence-based medicine suggestions for promoting cervical maturation and inducing labor in the third trimester of pregnancy.

Repeated ectopic pregnancy refers to the first ectopic pregnancy after surgical treatment or conservative treatment, and then again in the ovary, fallopian tube, abdominal cavity, cervix or broad ligament other parts outside the uterine cavity^[1]It is one of the common acute abdomen in obstetrics and gynecology. In recent years, the incidence of repeated ectopic pregnancy is on the rise, the incidence rate is 10.8% ~40.5%, which seriously affects the quality of life of women of childbearing age and even threatens their life safety^[2,3]。 This study aims to provide some basis for the clinical treatment of repeated ectopic pregnancy by analyzing the clinical characteristics of repeated ectopic pregnancy and finding suitable clinical treatment strategies.

The patient was 28 years old with primary infertility; The man has azoospermia and sperm from testicular puncture. In March 2013, the sperm was extracted by testicular puncture and treated with intracytoplasmic sperm injection (ICSI) of oocytes. Using conventional short-term controlled ovulation induction, 14 eggs were obtained under the guidance of transvaginal ultrasound, 6 eggs were fertilized normally and 6 eggs were cleaved after ICSI. Two embryos (8A, 8A) were transferred 3 days after egg retrieval, and no embryos were cryopreserved, and the corpus luteum was supported. Two weeks after transplantation, blood hCG was 1 129 U/L, and luteal support continued. Four weeks after transplantation, vaginal ultrasound examination showed that a bichorionic gestational sac was seen in the enlarged uterine cavity. The size of gestational sac A was 30 mm ×14 mm ×24 mm, and the size of gestational sac B was 21 mm ×19 mm ×16 mm. Both of them showed punctate fetal buds and yolk sac, but no fetal heart beat was seen. Ultrasound diagnosis: early intrauterine pregnancy (bichorionic biamniotic sac). The corpus luteum support was continued until 5 weeks after transplantation. Re-examination of vaginal ultrasound showed that the size of gestational sac A was 39 mm ×23 mm ×25 mm, with embryo and primitive cardiac tube pulsation, head and hip length 11 mm, and yolk sac was seen inside; The size of gestational sac B is 29 mm ×24 mm ×27 mm, and there are 3 embryos and primitive cardiac tube beats in it. The head and hip length are 11 mm, and there are 3 yolk sacs in it. Ultrasound diagnosis: intrauterine double gestational sacs and four embryos, such as 51 days of gestation.

The patient was 27 years old, pregnant 3 and delivered 0. Because 39 days after in vitro fertilization-embryo transfer (IVF-ET), no intrauterine gestational sac was found in color ultrasound, and ectopic pregnancy was suspected, she was admitted to Dalian Maternal and Child Health Hospital on April 18, 2014. The patient usually has regular menstruation. In 2008, he underwent left salpingectomy in an external hospital due to ectopic pregnancy, and in 2012, he underwent right salpingectomy in our hospital due to ectopic pregnancy. On March 10, 2014, IVF-ET was performed in our hospital under the guidance of color Doppler ultrasound. The blood β-hCG was 22 U/L on 14 days after ET, and the anechoic area in uterine cavity was 14 mm ×9 mm on 30 days after ET. On 35 days after ET, blood β-hCG was 7 058 U/L, and color ultrasound on the same day showed no gestational sac in the uterus or in the periuterus; 39 days after ET, color ultrasound showed that there was still no gestational sac in the uterus, so I was admitted to hospital, and the blood β-hCG level was reexamined at 18 210 U/L. On April 19th, color ultrasound showed that the size of the uterus was normal, the endometrium was 16 mm thick, the bilateral ovaries were enlarged, and the dark area of the uterorectal fossa fluid was 18 mm deep. No obvious abnormal echoes were found after repeated exploration of bilateral uterine horns and bilateral adnexal areas; A gestational sac-like echo was seen immediately in front of the abdominal aorta, about 22 mm ×19 mm ×16 mm, with yolk sac and embryo inside, and cardiac tube pulsation was seen by color Doppler flow imaging (CDFI). Ultrasound diagnosis: abnormal echo in front of the abdominal aorta, considering abdominal pregnancy. There was no abnormality in the physical examination at admission. Gynecological examination showed that there was no cervical pain, soft uterine constitution and no tenderness, and no abnormal mass in the bilateral adnexal area. Admission diagnosis: abdominal pregnancy, postoperative IVF-ET.

At present, with the rapid development of prenatal ultrasound technology, many fetal structural malformations can be diagnosed before birth. But most diagnoses of fetal structural abnormalities are not detected until routine ultrasound in the second or third trimester. This imposes a heavy burden on pregnant women and their families with severely malformed fetuses, and also makes fetal medicine workers face difficulties in handling them. How to advance the diagnosis of fetal structural malformation and improve its correct diagnosis rate is the main research direction of prenatal ultrasound workers at present.

aerobic vaginitis (AV) is a newly recognized vaginal infectious disease in recent years, mainly caused by aerobic bacteria infection, which is characterized by the production of H in the vagina₂O₂Lactobacillus is reduced or deleted, and other bacteria such as Group B Streptococcus, Staphylococcus, Escherichia coli and Enterococcus and other aerobic bacteria are increased, and inflammatory changes of vaginal mucosa are produced. Because of insufficient knowledge of AV in the past, it was treated as bacterial vaginosis (BV) or non-specific vaginitis, which led to treatment failure, which led to complications such as pelvic inflammatory diseases, infertility, miscarriage, premature rupture of membranes, and premature delivery^[1,2]。 The pathogenesis and therapeutic status of AV are reviewed.

Epithelial ovarian cancer (ovarian cancer) is a gynecological malignant tumor with the highest mortality rate. The clinical symptoms and signs of early patients are not obvious. About 75% of ovarian cancer patients are in the advanced stage at the time of consultation, and about 75% of patients who receive effective initial treatment will relapse. Therefore, although the diagnosis and treatment level of ovarian cancer has improved compared with the past, its 5-year survival rate has only increased from 37% to 46% compared with 30 years ago^[1]。 The malignant degree of ovarian cancer is high, the mortality rate of patients is high, the prognosis is poor. Therefore, exploring specific and sensitive monitoring indicators can not only provide a basis for early detection of ovarian cancer in clinic, but also provide a powerful evaluation means for disease progression, efficacy monitoring and efficient follow-up of ovarian cancer. Currently, CA₁₂₅It is the most widely used serological tumor marker of ovarian cancer in clinic, but it has many shortcomings. Nearly 50% of patients with recurrent ovarian cancer have serum CA₁₂₅The level is within the normal range, and various benign diseases such as pelvic inflammatory disease, benign ovarian cyst, endometriosis, etc. can also cause CA₁₂₅Elevated levels, thus affecting clinical judgment^[2]。 Therefore, seeking more sensitive and accurate tumor markers has important practical significance and application value. The discovery of circulating tumor cell (CTC) undoubtedly provides a new direction for clinical research of ovarian cancer.

The fifth national gynecological pelvic floor academic conference sponsored by the Gynecological Pelvic Floor Group of Obstetrics and Gynecology Branch of Chinese Medical Association was held in Shanghai from October 11 to 13, 2013. This is the fifth national conference after Fuzhou (2004), Chengdu (2007), Nanjing (2009) and Beijing (2011). This conference was co-organized by Tongji Hospital affiliated to Tongji University. The main purpose of this conference is to popularize new theories, technologies and advances related to pelvic floor diseases, and promote the standardization of diagnosis and treatment of pelvic floor diseases. In view of the hot and difficult issues in the field of gynecological pelvic floor, this conference carefully planned and organized 7 invited speeches, 18 keynote lectures, 22 conference exchanges and 8 surgical video demonstrations. The meeting was opened by Academician Lang Jinghe, head of the gynecological pelvic floor group, and began with a solemn national anthem. In order to increase the interactivity of the conference and the sense of participation of the participants, the conference also set up a "face-to-face with experts" activity and a field answer survey on hot issues in gynecological urology. The whole conference was colorful, frugal and practical, and the live discussion was lively. More than 100 papers were received at the conference, and more than 500 obstetricians, gynecologists and urologists from all over the country attended the conference, reflecting the vigorous development of gynecological urology in China. The main contents of the meeting are presented below.