2017年 · 第52卷第08期

advanced maternal age is a pregnant woman whose childbirth age is 35 years or older. With the implementation of China's "two-child" policy, it is expected that in the next 3~5 years, the demand for "two-child" of women of childbearing age will be released in a concentrated manner, and the pregnant women of older age will appear in a relatively concentrated manner, and then they will enter a normal state. With the increase of age, the incidence of fetal malformations and birth defects, pregnancy complications and/or complications, childbirth complications and postpartum psychological problems in older pregnant women will increase. In view of the risks of elderly pregnant women, the National Health and Family Planning Commission issued the "Opinions on Doing a Good Job in Management Services and Clinical Treatment of Elderly Pregnant Women", requiring extensive publicity and health education, prenatal consultation and evaluation and high-risk screening, strengthening clinical treatment of critical and severe cases, establishing a coordination and cooperation mechanism, improving the referral network of critical and severe cases, strengthening the construction of talent team, and taking multiple measures to do a good job in management services and clinical treatment of elderly pregnant women. It will be the focus of obstetric clinical workers in the future to reduce the occurrence of related maternal and child adverse events caused by elderly pregnant women, strengthen the management of elderly pregnant women, and ensure the safety of their mothers and children.

endometrial polyp (EP) consists of glands in the basal layer of the endometrium, interstitial and mature thick-walled blood vessels. It mainly manifests as abnormal uterine bleeding or infertility. EP can occur at any age after puberty^[1,2]。 mast cells (MC) are classical effector cells of acute and chronic allergic reactions, and play an important role in various non-allergic innate and adaptive immune responses. As the local immune cells of the endometrium, MC participates in the regulation of physiological function, immune response and inflammatory response of the endometrium through degranulation after activation. mast cell tryptase (MCT) and mast cell chymase (MCC) are the main serine proteases pre-synthesized in MC, which can promote tissue proliferation and vascularization. Among them, MCT can specifically reflect the activation of MC. There are a variety of cytokine receptors on the surface of MC, among which stem cell factor (SCF) receptor c-kit (also known as CD₁₁₇) is an important receptor on the surface of MC to regulate its function, and with the ligand SCF^[3]The proliferation, differentiation and chemotaxis of MC were enhanced after binding. It was found that there were high levels of overactivated MC in benign nasal polyps, colon polyps and EP tissues of fertile women, which was speculated to promote the formation and development of polyps. In this study, the expression of MCT, MCC and c-kit in EP tissues of women during reproductive period was examined to explore the role of MC and c-kit in the development of EP.

Uterine adenosarcoma mostly occurs in postmenopausal women, accounting for 5% of uterine sarcomas^[1]It is a low-grade malignant tumor, consisting of benign epithelial components and low-grade malignant mesenchymal components, and the main treatment is surgery. In general, the prognosis of patients with uterine adenosarcoma is good, and the related risk factors for its recurrence and metastasis include deep muscle invasion, sarcoma overgrowth, lymphovascular invasion, extrauterine invasion and the presence of abnormal cells in the tumor. Uterine adenosarcoma is rare in clinical practice. Recently, 4 such patients were admitted to Drum Tower Hospital affiliated to Nanjing University School of Medicine, which is now reported in combination with the literature review as follows.

The patient was 33 years old, pregnant 3 and gave birth 2. She was admitted to the hospital on January 30, 2016 due to "menopause for 70 days and vaginal bleeding for more than 1 month". Usually, my menstruation is regular, and my last menstruation was on November 21, 2015. Cesarean section was performed 12 years ago and 7 years ago, respectively. More than a month ago, I went to a local doctor due to vaginal bleeding. I reported that the gestational sac in the uterine cavity could be seen by B-ultrasound, and I was given abortion protection treatment. 10 days later, vaginal bleeding still occurred. B-ultrasound examination in the local municipal hospital showed: twin live fetuses, lower uterine cavity pregnancy (suspected scar pregnancy), and right uterine horn pregnancy; Blood hCG>225 000 U/L; Intramuscular injection of methotrexate (MTX) and oral administration of mifepristone. On the second day, I came to our hospital. Physical examination: vital signs were stable. Gynecological examination: there was a little dark red blood in the vagina, the uterus was as big as 3 months of pregnancy, the right uterine horn was full, no tenderness, and there was no abnormality in the bilateral adnexal area. Hemoglobin 101 g/L, blood β-hCG 196 636 U/L. B-ultrasound examination suggests: (1) Uterine malformation? (A hypoechoic band about 0.6 cm wide seems to be seen between the two gestational sacs to separate the two); (2) Ectopic pregnancy (one child is considered uterine scar pregnancy, and the other child is located in the right uterine corner). SeeFigure 1。

The patient was 75 years old and was admitted to the hospital on 27 April 2012 due to "abdominal distension for more than 4 months". Pelvic MRI examination after admission revealed space-occupying lesions, considered ovarian origin. Then an exploratory laparotomy was performed on May 3rd. During the operation, pale yellow ascites in the abdominal cavity was found about 2 900 ml. Scattered nodular masses were seen on the surfaces of pelvic and abdominal cavity, peritoneum, intestine, mesentery, uterus and bladder. The larger one was 0.8 cm in diameter. The right ovary was brittle and cauliflower-like mass with a size of 4.0 cm ×3.0 cm ×3.0 cm. No abnormality was found in the right fallopian tube, the left ovary was atrophied, and a cauliflower-like mass with a diameter of 1.0 cm was seen at the umbrella end of the left fallopian tube, and the greater omentum was contractured and thickened. Intraoperative rapid freezing pathological examination showed poorly differentiated carcinoma of the right ovary, and satisfactory tumor cytoreduction was performed. Postoperative diagnosis: poorly differentiated serous adenocarcinoma of the ovary stage IIIC. The patient underwent 6 courses of chemotherapy with paclitaxel + nedaplatin (TP) regimen after operation. Six months later, the patient underwent ascites and serum CA₁Recurrence was diagnosed for the first time with an elevated level of 25. In the subsequent relapse treatment, the patient developed platinum resistance, so second-line chemotherapy drugs (gemcitabine hydrochloride, etoposide, loblatin), biological therapy, and targeted drug bevacizumab were added. As of August 10, 2016, a total of 32 courses of chemotherapy were performed. On July 7, 2015, total abdominal MRI examination revealed for the first time that a small nodule shadow with a diameter of 0.7 cm appeared in the fat layer on the left side of the abdominal wall scar; The patient was not followed up as required, and total abdominal MRI examination by 27 Dec 2015 revealed that the lesion diameter was approximately 2.0 cm (Figure 1), after ultrasound-guided puncture of the abdominal wall lesion, pathological examination confirmed that it was metastatic ovarian carcinoma. During the treatment, regular imaging and gynecological examinations were performed. By June 23, 2016, skin metastases were widely distributed in the subcutaneous tissues near the abdominal incision, upper abdomen, chest, upper limbs and other parts. Among them, the number of lesions of different sizes could be palpable as many as 13, the larger one was 7.0 cm ×4.2 cm and the smaller one was 2.0 cm ×1.8 cm. The nodules were hard in texture, poor in mobility and unclear in boundary. SeeFigure 2。 The patient died of circulatory failure in October 2016.

In the short term after the implementation of the "two-child" policy, obstetric clinicians are faced with the rising proportion of advanced maternal age (AMA). In addition, due to the accelerated pace of urban life and increased life pressure, the proportion of elderly primiparas has also increased. AMA refers to pregnant women with a delivery age ≥35 years old, and their pregnancy-related risks are significantly higher than those of non-elderly pregnant women. According to previous statistics, the proportion of AMA in China has increased from 2.96% in 1996 to 8.56% in 2007^[1]10.1% in 2011^[2]； According to the special news report of the "Two Sessions" in 2017, the proportion of AMA in Beijing has risen to 14% in 2016^[3]。 A series of potential risks associated with AMA are emerging, which bring new challenges to perinatal management. This article reviews these potential risks of AMA.

Cervical cancer is one of the common malignant tumors in women, and it is the only malignant tumor with clear etiology at present. Statistics in 2002 show that the number of deaths from cervical cancer reached 270,000 every year in the world; About 1/4 of these are from China. In recent years, the incidence and mortality of cervical cancer are increasing, and it obviously tends to be younger. Since the International Agency for Research on Cancer (IARC) officially announced in 1995 that persistent infection of certain types of HPV is the most important factor leading to cervical Cancer, more than 200 types of HPV have been discovered so far. According to carcinogenicity, they are divided into high-risk types and low-risk types.

Epithelial carcinoma of the ovary (ovarian cancer) consistently ranks first in case fatality among malignant tumors of the female reproductive system. Global cancer statistics reported in 2015 show that there are about 240,000 new ovarian cancer patients worldwide and more than 150,000 deaths^[1]。 The onset of ovarian cancer is hidden and difficult to detect in the early stage, and about 75% of patients are in the advanced stage (stage III ~ IV) when they see the doctor. After conventional treatments such as tumor cytoreductive surgery and platinum-based chemotherapy, most patients who have reached complete clinical remission still face the threat of recurrence or death, and the 5-year survival rate is only about 30%. Although chemotherapy strategies are constantly improving, the improvement in patient prognosis in the past 30 years has been very limited^[2]。 In recent years, with the inclusion of the anti-angiogenic drug bevacizumab (BEV) in the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for ovarian cancer, the biological treatment of ovarian cancer has received increasing attention and attention, and more and more studies and trials have provided important clinical evidence for this.