Volume 01 · Issue 01 · 2019

我们很荣幸能推出创刊号母胎医学(MFM），中华医学会新刊。我们谨代表编辑团队，向读者表示热烈的欢迎MFM我们也借此机会感谢我们的作者、编辑和审稿人，他们都为本刊的成功创刊做出了巨大贡献。

In the past 9 years, several externally blinded validation and implementation studies have shown that it is now possible, through analysis of cell-free (cf) DNA in maternal blood, to effectively detect a high proportion of fetuses affected by trisomies 21, 18, and 13 at a much lower false positive rate than all other existing screening methods. This article aims to review the technical and clinical considerations for implementing cfDNA testing in routine practice, including methods of analysis, performance of the test, models for clinical implementation, and interpretation of results.

世界范围内的剖宫产率正在上升，在许多国家，剖宫产率远高于医学指征。¹观察到国家和地区之间的巨大差异。²使用不足会导致孕产妇和围产期死亡率和发病率。相反，过度使用剖腹产并没有显示出好处，反而会造成伤害。³在撒哈拉以南非洲的农村地区，剖腹产率为1%-2%，但在埃及和希腊，剖腹产率超过50%。在低风险分娩中，尤其是在巴西和中国受教育程度较高的妇女中，剖腹产率较高。²产妇要求是高剖宫产率的一个原因，但产时剖宫产率也远高于医学指征。在中国，剖宫产率为45%⁴;近2/3的城市妇女通过剖腹产分娩，农村地区为25%。由于努力降低高剖宫产率，在上海的一个城市三级护理中心观察到剖宫产率显著下降。未观察到新生儿结局的显著差异。⁵剖宫产率高于10%与孕产妇和新生儿死亡率的降低无关。⁶剖宫产与后续妊娠中子宫破裂、胎盘异常、宫外孕、死产和早产的风险增加相关。⁷避免首次剖宫产会影响后续分娩的分娩方式。世卫组织建议，应尽一切努力为有需要的妇女提供剖腹产手术，而不是努力达到一个特定的比率。⁸降低剖宫产率的努力是多方面的，包括政策变化、患者教育和医生培训。

To evaluate the effectiveness of the use of a modified Zhukovsky double (vaginal and uterine) balloon to improve the results of treatment in women with obstetric hemorrhage.

We conducted an observational controlled study including 701 puerperas, which were divided into two groups: The main group consisted of 508 women, who underwent a combined management, that is, traditional (transfusion of fresh frozen plasma, erythrocyte mass, uterotonics, hemostatic agents), surgical hemostasis in cases of caesarean section, and insertion of a double Zhukovsky balloon; while the comparison group included 193 patients, who were managed traditionally. The main group and the comparison group were divided into subgroups according to the main etiology of obstetric hemorrhage: IA and IB—postpartum; IIA and IIB—placenta accreta; IIIA and IIIB-postpartum hysterectomy.

The most frequent causes of massive obstetric hemorrhage were atony of the uterus (39.2%), placenta previa (29.1 %), and placental abruption (11.5%). Of the 508 balloon insertions, 345 (70.7%) were inserted for hemorrhage during cesarean section and 148 (29.3%) for obstetric hemorrhage after spontaneous delivery. Among the obstetric hemorrhage at caesarean section, lower segment bleeding prevailed (78.1%), caused mainly by placenta previa, placenta accreta, placental abruption, polyhydramnios, and uterine scar defects. Combined management, including surgical hemostasis and insertion of vaginal and uterine balloon of Zhukovsky, reduced blood loss by 1.5 times and the number of hysterectomies by 6.72 times compared to controls.

The use of a modified Zhukovsky double balloon in the management of obstetric hemorrhage may reduce the number of hysterectomies and the amount of blood loss.

To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).

Patients diagnosed with PPWPP were assessed for pregnancy termination at 34–36 weeks of gestation. During the operation, we performed circular resection of the uterine tissue at the placental attachment part. Then the characteristics of the operation and the follow-ups were recorded.

During the operation, the vital signs were stable. The mean intraoperative blood loss, packed red blood cells units transfusion, fresh frozen plasma transfusion, and operation time were 2140 mL, 6 U, 440 mL, and 179.8 minutes, respectively. There was no bowel, ureter, or bladder injury. And there was no patient transferred to the ICU after operation. The mean postoperative blood loss was 458.6 mL. There was no fever, infection, intestinal obstruction, or other complications after operation during the hospitalization. The shape and the blood flow of the uterus were normal. After the patients were discharged, one had developed cesarean scar diverticulum. The mean lochia duration was 30 days. The menstrual cycle and volume were as before. The shape and the blood flow of the uterus and the ovarian were normal.

The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP. It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.

Preeclampsia (PE) is a multisystem disorder of pregnancy classically characterized by hypertension with significant proteinuria after 20 weeks’ gestation. This disorder is one of the leading causes of maternal and perinatal morbidity and mortality. PE can be subdivided into preterm PE (with delivery at <37 weeks’ gestation) and term PE (with delivery at ≥37 weeks’ gestation). Preterm PE is associated with a higher risk of adverse maternal and perinatal outcomes than term PE. Traditional method of screening as recommended by professional guidelines has limited predictive performance and therefore should be updated to reflect recent scientific evidence that the target of screening should be preterm PE, the best way to identify the high-risk group is the Bayes-based method that combines maternal risk factors and biomarkers, the threshold should be set at screen positive rate of 10%, aspirin should be started before 16 weeks’ gestation, and the daily dose should be higher than 100 mg.

Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. Despite extensive research in the past 50 years, the universal approach to diagnose GDM continues to be debated around the world and clinical practices vary from country to country and unit to unit within the same country. As new evidence emerges, the diagnostic criteria of GDM has continuously evolved since the 1990s. In 2011, after the announcement of the landmark International Association of Diabetes and Pregnancy Study Groups diagnostic criteria, many international organizations have accepted and advocated its use. However, there are differences in glucose metabolism among different ethnic groups, and the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study lacked data from mainland China. Whether the criteria developed based on the HAPO study are applicable to China remains to be further validated. In this current review, we will discuss the evolution of GDM diagnostic criteria and guidelines in China, and compare them to that in western countries to figure out the proper recommendations on the diagnosis of GDM among Chinese women.

Antiphospholipid antibody syndrome is an autoimmune disorder that primarily affects reproductive age women and poses significant obstetric complications. Here we review the pathogenesis, diagnosis, obstetric complications, and management in women with antiphospholipid antibody syndrome.

Mother-to-infant transmission of hepatitis B virus (HBV) is a main cause of chronic HBV infection. Maternal high HBV DNA level or positive hepatitis B e antigen (HBeAg) is the major risk factor for the transmission. With recommended passive and active immunoprophylaxis, the transmission occurs in nearly 0 and 4–12% of infants born to HBV-infected mothers with negative and positive HBeAg, respectively. Therefore, pregnant women with negative HBeAg appear not requiring antiviral therapy to prevent mother-to-infant transmission of HBV. Recent studies demonstrated that oral antivirals (lamivudine, telbivudine, or tenofovir) in pregnant women with high viral load or positive HBeAg, starting from 28–32 weeks of gestation, together with neonatal immunoprophylaxis, can almost completely prevent the transmission, indicating that it does not require antiviral therapy before 28 weeks of gestation. Accumulated evidence showed that the antivirals may be stopped upon delivery, and the infants may receive breast feeding after birth. However, these issues, as well as HBV DNA threshold for antiviral therapy during pregnancy, optimal timing for start and discontinuation of antivirals, and the drug safety of fetuses/infants, require further investigations to optimize the antiviral therapy during pregnancy. The proof of safety of fetal exposure to antivirals needs more evidence, which can be achieved from the real-world data analysis.

There are many ways to perform cesarean section, with many methods developing from local traditions. Following a 3-year study process, a modified, evidence-based method has been developed, which is now in use in many countries.

The abdomen incision is based on the Joel-Cohen incision, the peritoneum is opened by repeated stretching, and the uterus is opened transversely after pushing the bladder down.

After delivery the uterus is sutured with one layer using a large needle, and the abdomen is closed with only two layers, fascia and skin.

This method was subject to scores of studies, with all upholding its superiority over traditional methods. As a result, the "Stark (Misgav Ladach) method" is recommended to become a standard procedure across China.

致编辑：

Where required, abstracts are limited to 500 words, which is excluded from the overall manuscript word count. The abstract is unstructured and should briefly describe: (1) the problem being addressed in the study, (2) how the study was performed, (3) the salient results, and (4) what the authors conclude from the results.