Volume 06 · Issue 01 · 2024

在妇女的一生中，几个独特的健康特征与后期疾病发病率和/或过早死亡的风险增加有关（图1).例如，这些包括初潮早期^1,2（即“月经周期短、不规则或长”）^3,4、不孕不育史⁵、妊娠丢失⁶、几种主要妊娠并发症（如先兆子痫、妊娠高血压、妊娠糖尿病(GDM)和早产）^7,8,9以及绝经特征（如绝经过渡期长、绝经年龄早、存在血管舒缩症状）。^10,11此外，越来越多的证据支持孕产妇健康和福祉对儿童健康的代际影响。¹²综上所述，这些关联意味着实现健康长寿是一个终生的旅程。促进健康长寿应从年轻时开始，而不是推迟到晚年，以提高妇女及其后代的健康和生活质量。在这篇前瞻性文章中，我们旨在根据大型人类流行病学研究的结果，讨论生殖健康和妊娠结局与促进年轻、中年和未来老年妇女以及下一代健康长寿的相关性。

巨噬细胞是构成人类先天免疫系统的主要免疫细胞类型，参与各种生理过程，如组织发育、重塑、稳态和修复，对维持胚胎/胎儿的正常生长和发育至关重要。^1,2,3受其细胞来源和特定组织环境的影响，巨噬细胞表现出多种表型。^4,5,6,7在这些亚型中，血管周围巨噬细胞战略性地位于血管的近腔表面上或附近，对组织和血液之间的界面处的基本功能有显著贡献。^7,8,9

腹腔镜切开术或阴道前切开术描述了一种横向阴道切口。自19世纪以来就有描述^th世纪^1,2,3作为在第二阶段剖宫产（CS）期间分娩胎儿的方法。^4,5最近，已经发表了关于在宫颈完全扩张的紧急CS期间无意中进行腹腔镜取石术的报告，这是由于随着梗阻分娩持续时间的延长而发生的解剖变化。

Intrahepatic cholestasis of pregnancy (ICP) is a significant gestational complication in late pregnancy, potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth. The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines, recent evidence-based medical evidence about key clinical issues including risk factors, clinical manifestations, perinatal outcomes, diagnosis, severity grading, maternal and fetal monitoring, treatment methods, timing, and methods of pregnancy termination, and postpartum follow-up for ICP, with the aim to guide its clinical diagnosis, treatment, and management.

To determine whether an association exists between group B Streptococcus (GBS) colonization and preeclampsia among pregnant Black women.

This retrospective cross-sectional study involved Black women who gave birth at State University of New York Downstate Hospital between January 2010 and December 2017. Data were collected from the Obstetric Department, including delivery date, time, mode of delivery, age of the mother, weeks of gestation at delivery, and antepartum complications. The GBS test results were originally determined using the eSwab transport system. Preeclampsia was defined based on the American College of Obstetricians and Gynecologists criteria for the periods 2010-2012 and 2013-2017. The primary outcome was whether GBS was associated with the outcome of preeclampsia in the population of Black women. Covariates, including smoking status, gestational age, parity, body mass index, maternal age, and presence of herpes simplex virus (HSV) and human immunodeficiency virus (HIV) were examined as potential confounders. Chi-squared test and logistic regression model were used, presenting odds ratios with 95% confidence intervals (P < 0.050), analyzed with SAS on Demand for Academics (SAS Institute, Inc., NY).

Among the 8,019 Black women included in this study, GBS-positive women (n = 977) had a 53% reduction in the likelihood of being diagnosed with preeclampsia compared to GBS-negative women (adjusted odds ratio, 0.47; 95% confidence interval, 0.32-0.70). We did not find evidence of differences in the distribution of smoking habits (P = 0.783) or maternal age (P = 0.107) between GBS-positive and GBS-negative women. However, the GBS-positive women tended to be less likely to have a preterm delivery (9.62% (94/977) vs. 24.24% (1707/7042), P < 0.001), less likely to be nulliparous (33.37% (326/977) vs. 37.87% (2667/7042), P = 0.006), and less likely to be obese (51.38% (502/977) vs. 55.30% (3894/7042), P < 0.001) compared with GBS-negative women. In contrast, GBS-positive women were more likely to have a comorbid infection than their counterparts: HSV (5.94% (58/977) vs. 2.63% (185/7042), P < 0.001) and HIV (1.54% (15/977) vs. 0.82% (58/7042), P = 0.028).

We found a reduced likelihood of preeclampsia among women who were positive for GBS at delivery. Given the cross-sectional nature of our study, more research is needed to further explore this association.

To establish the Chinese population's amniotic fluid deepest vertical pocket (DVP) reference curves for dichorionic twin pregnancies and to investigate DVP links with adverse perinatal outcomes.

This retrospective cohort study, conducted at Peking University Third Hospital from August 2011 to December 2020, used data from 375 women aged 20 to 45 years who had dichorionic twin pregnancies that were confirmed through first-trimester ultrasound. After exclusions, reference curves were developed using 318 women with 3,299 DVP scans, and the data analyzed included maternal demographics, pregnancy outcomes, ultrasound measurements, and neonatal information. DVPs were assessed via ultrasound at regular intervals and grouped by gestational age (GA) for analyses. Linear mixed models were used to create amniotic fluid reference curves. Associations between abnormalities and adverse perinatal outcomes were examined using Chi-squared or Fisher's exact tests. Logistic regression provided both crude and adjusted odds ratios, adjusting for pre-pregnancy weight, age, ethnicity, parity, and conception mode. Significance was set at P < 0.05 with 95% confidence intervals (CI), and the analyses were conducted using SPSS ver. 26.0 (IBM Corp., Armonk, NY) and SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA) software.

DVP increased from the first trimester to a maximum at 26 weeks (95% confidence interval (CI), 2.7-8.3 cm for twin 1 and 2.8-7.9 cm for twin 2) and then decreased gradually toward term. Differences between twins 1 and 2 were significant after 26 weeks (95% CI for twin 1: 5.3, 5.5; 95% CI for twin 2: 4.4, 4.5; P < 0.010). Polyhydramnios of twin 1 increased the risk of large for GA. Oligohydramnios of twin 1 increased the risk of small for GA. Polyhydramnios of twin 2 increased the risk of small for GA, premature birth, and neonatal complications. Oligohydramnios of twin 2 increased the risk of preeclampsia, hypertensive disorder complicating pregnancy, and premature rupture of membranes.

Reference curves for twin amniotic fluid volumes vary by GA and differ between twins, with potential implications for pregnancy outcomes.

This review aimed to summarize the major progress in maternal-fetal medicine achieved by Chinese scientists in recent years. PubMed was systematically searched from January 2020 to November 2023. Publications that reported the progress in embryo implantation, placentation, and parturition made by Chinese scientists in the last 3 years were selected. The milestone events during gestation, embryo implantation, endometrial decidualization, placentation, and parturition are pivotal to a successful pregnancy. Embryo implantation requires intricate interactions between implantation-competent blastocysts and receptive endometrium. To adapt to pregnancy, endometrial stromal cells transform into specialized decidual cells, which occur spontaneously under the influence of ovarian hormones in humans but require the presence of embryos in mice. With embryonic development, the placenta forms to support fetal growth until parturition. The maternal-fetal interface is composed of diverse cell types, including endometrial decidual cells, placental trophoblast cells, endothelial cells, and various immune cells, a sophisticated interplay among which contributes to the maintenance of pregnancy. Near term, the uterus transitions from quiescence to contractility, in preparation for delivery. Disruptions to these events lead to pregnancy-related disorders such as repeated implantation failure, recurrent pregnancy loss, preeclampsia, fetal growth restriction, preterm birth, and infertility. In recent years, Chinese scientists have made prominent achievements in basic research on the aforementioned pregnancy events. Chinese scientists have made remarkable contributions to reproductive biology and maternal-fetal medicine research in recent years, highlighting future research directions in this field.

Pregnancy with solid pseudopapillary tumor of the pancreas (SPTP) is rare. Because pregnancy hormones may cause tumor progression, the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment. We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP. Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis. Medical termination of pregnancy was performed. The patient has lived with the tumor until now without surgery. We retrieved the published case reports, summarized the clinical characteristics of pregnancy with SPTP, and explored its management during the perinatal period. Most patients with SPTP have a good prognosis with good maternal and fetal outcomes, and it is important to choose an appropriate treatment method and timing. However, pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

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