Volume 07 · Issue 02 · 2025

孕产妇和新生儿死亡率仍然是一个重大的全球公共卫生挑战，特别是在中低收入国家。根据世界卫生组织（世卫组织）2020年报告，每天约有800名妇女死于与怀孕或分娩有关的并发症，相当于每两分钟就有一名孕产妇死亡。通过及时和充分的医疗干预，这些死亡中的大多数是可以预防或治疗的。¹此外，据估计，2020年每天有6400名新生儿死亡，最终有230万新生儿在出生后第一个月内死亡。²尽管全球做出了重大努力，但改善孕产妇和新生儿健康结果仍然是一项艰巨的挑战，特别是在占全球孕产妇死亡近95%的低收入国家。¹冠状病毒疾病2019大流行进一步加剧了这些挑战，给已经不堪重负的医疗保健系统带来了额外的压力，并凸显了有针对性的干预措施的迫切需要。

领导力的概念在国内出现较晚，尤其是在学术医学领域，并没有得到广泛的重视。目前，中国只有少数医学院为医学生开设领导力教育项目。^1,2对于执业医生来说，缺乏系统的领导力讨论和对潜在未来领导者的培训。³由密歇根大学和北京大学医学部联合发起、中国医学委员会资助的“准备和推进女性健康科学领导力”（PAWLHS）是中国首个专门针对学术医学领域女性的女性领导力发展项目。

To compare the analgesic effects of ibuprofen administered orally via two modes combined with a conventional, patient-controlled intravenous analgesia pump on maternal pain after cesarean section (CS).

This prospective, randomized, controlled study enrolled females who underwent CS from August 2022 to August 2023 at Peking University First Hospital, Beijing, China. Participants were randomly assigned to either an as-needed ibuprofen group (300 mg orally upon request) or a scheduled ibuprofen group (300 mg every 12 hours for 48 hours). The primary outcomes assessed were postoperative pain levels using the Wong-Baker Faces Pain Scale-Revised and cumulative oxycodone consumption at multiple time points up to 48 hours post-delivery. Secondary outcomes included recovery parameters (time to first flatus, ambulation, and lactation initiation), patient satisfaction with pain control, and postpartum depression scores evaluated by the Edinburgh Postnatal Depression Scale on postoperative day 3. Normally distributed data analyzed with t-tests; non-normal data with Mann-Whitney U tests; categorical variables with chi-square or Fisher’s exact tests (SPSS 26.0, P < 0.05).

After excluding 61 non-eligible cases, 339 patients were included (171 as-needed vs. 168 scheduled). The scheduled group showed significantly better pain control at 12 hours (4.00 (2.00-5.50) vs. 4.00 (4.00-6.00), P < 0.001), 24 hours (4.00 (2.00-4.00) vs. 4.00 (2.00-6.00), P < 0.001), and 36 hours (2.00 (2.00-4.00) vs. 4.00 (2.00-4.00), P < 0.001), and 48 hours (2.00 (2.00-4.00) vs. 2.00 (2.00-4.00), P = 0.004) post-delivery and lower levels of oxycodone consumption at 36 hours (10.20 (8.20-13.35) vs. 11.00 (8.80-14.40), P = 0.042) and 48 hours (12.40 (10.40-15.95) vs. 13.80 (11.00-16.00), P = 0.020) postpartum compared with those in the as-needed group. Additionally, the time to the return of bowel movements was shorter in the scheduled group than in the as-needed group (23.50 (16.94, 31.47) vs. 27.00 (19.88, 35.97), P = 0.004). Differences in post-delivery ambulation, lactation initiation, satisfaction levels, and depression scores were not significantly different between the two groups.

The results of this study promote the use of ibuprofen (scheduled oral administration) combined with a conventional, patient-controlled intravenous analgesia pump for achieving better post-CS pain control than an as-needed dosage regimen.

Chinese Clinical Trial Registry, ChiCTR2400082474.

To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.

This institution-based prospective cohort study was conducted from March 1 to October 30, 2022, in three primary hospitals in the Hadiya zone of Southern Ethiopia. Participants were categorized into exposed (Hb < 11 g/dL) and non-exposed (Hb ≥ 11 g/dL) groups based on hemoglobin levels measured before delivery. Baseline characteristics were comparable between groups. Maternal and neonatal complications were considered as outcomes. Data were analyzed using STATA version 15. Descriptive statistics summarized baseline characteristics, and Chi-square tests assessed associations. Generalized linear models with a log link calculated adjusted relative risks (aRRs) with 95% CIs. Statistical significance was set at P < 0.05. Multivariable models adjusted for confounders, and sensitivity analyses evaluated robustness using multiple imputations for missing data.

A total of 490 participants were enrolled in the study, with 245 in each of the exposed and non-exposed groups. Due to loss to follow-up, 220 participants in the exposed group and 239 in the non-exposed group were assessed for outcomes. Prolonged labor (adjusted RR (aRR)= 3.235; 95% CI: 1.658, 6.312; P = 0.003) and postpartum hemorrhage (aRR = 2.901; 95% CI: 1.202, 7.910; P = 0.045) were identified as adverse maternal pregnancy outcomes of anemia. We observed low birth weight (aRR = 3.020; 95% CI: 1.233, 6.010; P = 0.002) and respiratory distress syndrome (aRR = 4.820; 95% CI: 2.901, 9.012; P = 0.001) as neonatal complications. Furthermore, having no previous history of anemia reduced the risk of prolonged labor (aRR = 0.078; 95% CI: 0.033, 0.188; P = 0.015) and low birth weight (aRR = 0.480; 95% CI: 0.370, 0.592; P = 0.001).

Mothers who have experienced maternal anemia in the past or present face serious consequences for both themselves and their children. Preventing anemia should thus start before conception and continue through pregnancy.

Alternative splicing (AS) is a crucial process that produces functionally distinct proteins from a single gene, depending on the developmental or physiological state of cells in multicellular organisms. It plays a significant role in cellular proliferation, survival, and differentiation, including embryonic development, spermatogenesis, and a broad spectrum of diseases. However, the precise involvement of AS in embryo implantation is still unclear. In this review, we summarize the potential roles of AS in regulating mesenchymal-epithelial transitions during embryo implantation, specifically in epithelium regeneration and decidualization initiation via the mesenchymal-epithelial transformation process. Overall, this review emphasizes the impact of AS and splicing variants on embryo implantation and offers novel insights into the potential application of alternative splicing in the treatment of female infertility.

34岁汉族女性，22岁⁺⁴孕周，2022年9月21日到医院就诊，发热持续10小时以上。她的体温为38.4摄氏度，血液检查显示感染标志物升高。然而，没有其他全身感染的症状。她入院时被诊断为“妊娠中期不明原因发热”。获得患者同意在文章中发表临床信息。

基德(JK)血型系统包含Jka、Jkb和Jk3抗原。Kidd抗原通常引起典型的急性溶血性输血反应，但由于强烈的记忆反应也引起迟发性溶血性输血反应。Jkb抗体可导致新生儿溶血性疾病（HDN），但很少导致严重的胎儿贫血。¹我们报告了一例由Jkb抗体引起的严重早期宫内贫血（23 g/L，妊娠22周）的成功病例，在三次宫内输血（IUT）后妊娠结局良好。

胎儿和新生儿溶血病（HDFN）是一种由母体对红细胞（RBC）抗原的同种免疫引起的危及生命的疾病。多年来，预防和治疗措施的引入显著降低了孕妇抗D和非D免疫接种的频率，导致HDFN病例下降。产后和产前施用抗D免疫球蛋白已将孕妇中抗D抗体的患病率降低至0.5%以下。¹然而，随着免疫预防的广泛采用，非D抗体的相对重要性增加了。在非D抗体中，来自Rh系统的抗体和抗K抗体是HDFN的最常见原因。大约50%的非D抗体孕妇有输血史。²因此，向育龄妇女输血与Kell、Rhc、RhE和Rhc抗原相容的RBC可进一步降低非D抗体和HDFN的发生率。

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2020年，全球估计有287,000名妇女在怀孕和分娩期间死亡，其中很大一部分发生在中低收入国家。印度占这些死亡人数的8%，孕产妇死亡率为每10万活产103人，突出表明迫切需要可获得的医疗保健和有效的干预措施。¹尽管有各种避孕药具，但印度仍有19%的计划生育需求未得到满足，导致妇女生育的孩子多于预期，而且生育间隔往往不足。印度的计划生育方案已经从控制人口转向优先考虑孕产妇和新生儿健康。确保健康的怀孕时间和间隔对于改善生殖、孕产妇、新生儿、儿童和青少年健康结果至关重要。²

孕产妇保健服务是公共卫生的基石，在确保母亲和新生儿的福祉方面发挥着关键作用。这在南非农村地区尤为关键，那里对这类服务的需求远远超过现有供应。在这些地区提供有效的孕产妇保健受到复杂因素相互作用的阻碍，包括基础设施不足、人员短缺、护理质量不佳和社会文化障碍。这封信综合了为评估这些挑战而进行的系统文献综述的结果，强调了迫切需要有针对性的干预措施，以加强服务不足社区的服务提供。