Volume 07 · Issue 04 · 2025

在中华医学会（CMA）迎来110周年之际^th2025年周年纪念日，我们回顾了它的变革之旅——从1915年点燃中国现代医学复兴，到今天指导母胎医学成为国际学术的灯塔。这一长达一个世纪的旅程反映了中国从医学觉醒到全球领导地位的崛起，由一代又一代的治疗师用同情的墨水书写。

为纪念100^th在中华医学会成立周年之际，这篇综述强调了产科重症监护病房（OICU）在中国的显著进步和未来前景——孕产妇重症监护的基石。然而，怀孕通常被认为是低风险的；一部分人出现并发症，需要入住OICU。本文描述了OICU在中国的发展轨迹，分为三个不同的阶段：形成阶段（2008年前）、扩张阶段（2009-2015年）和当前的质量导向阶段（2016年至今）。此外，它还对中国OICU的未来发展方向进行了前瞻性分析，重点是技术创新和临床转化、专业人才培养、多学科协作和整合诊疗模式的推广、区域医疗系统的协调发展以及建立健全的质量控制和患者安全框架。通过全面考察中国OICU的历史演变、现状和预期的未来趋势，本综述旨在为提高产科危重患者护理中的诊断、治疗和管理能力提供有价值的见解。

To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.

A retrospective, non-randomized study was conducted at Guangzhou Women and Children’s Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student’s t-test, Mann–Whitney U test, Chi-square test, and Kaplan–Meier survival analysis. A value of P < 0.050 was considered statistically significant.

Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively (χ² = 7.582, P = 0.006, odds ratio (OR) = 0.154, 95% confidence interval (CI): 0.035-0.685). The age (P = 0.005), PCOS subtype (P = 0.012), and levels of total cholesterol (P = 0.003), and high-density lipoprotein (P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester (χ² = 4.144, P = 0.040).

LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.

To assess the impact of maternal physiological and pathological factors on fetal birth weight in pregnancies in Kazakhstan.

This retrospective cross-sectional study was conducted from January 2016 to December 2021 at Aksu City Hospital, Atyrau Regional Perinatal Center, Altai Interdistrict Hospital, Abay Regional Perinatal Center of the Health Department, and Astana Multidisciplinary City Hospital No. 3, in the Republic of Kazakhstan using the stratified randomization grouping method. The study involved two maternal ethnicity groups, Asian (5101; 77.91%) and European (1446; 22.09%). All statistical analyses were performed using Stat Tech version 3.0.9 and SPSS 26.0.

This study involved 6547 pregnant women. Fetuses weighing < 2500 g were more common in the Asian group than in the European one (P = 0.001), while large fetuses (> 4000 g) were more common in the European group (P = 0.001). Multiple linear regression analyses revealed that a history of arterial hypertension and preeclampsia leads to decreased fetal weight, while gestational diabetes mellitus (GDM) was associated with increased fetal weight. In the Asian ethnic group, maternal physiological factors and a history of arterial hypertension, preeclampsia, and GDM significantly influenced fetal birth weight. In the European group, a history of hypertension and GDM did not affect birth weight.

Stillbirth and perinatal death were more likely among women of the Asian ethnic group when compared with women of the European ethnic group. Therefore, it is necessary to account for the maternal physiological and pathological factors that may influence fetal birth weight when assessing optimal fetal birth weight.

To evaluate the diagnostic efficacy and clinical application of the Obstetrical Chinese Disseminated Intravascular Coagulation (DIC) Scoring System (OCDSS).

This study is a retrospective study that collected 1063 cases from Wuhan Union Hospital, Yichang Central People’s Hospital, and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between July 2017 and June 2024. These cases were divided into DIC and non-DIC groups based on score standard. Diagnosis of DIC, the rate of hysterectomy, neonatal mortality, and severe asphyxia are the main outcome measures. All the laboratory indicators are all determined by clinical laboratory department of the hospital. Data were expressed as mean ± standard deviation or median (interquartile range) and frequencies. Independent sample t-test or non-parametric test were used to compare measurement data, while the chi-square test was used for count data. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to test the predictive accuracy. Using univariate and multivariate logistic regression analysis to study the high-risk factors. P < 0.050 indicates a statistical significance.

Of 1063 participants in this study, 29 participants (2.73%) were diagnosed with obstetrical DIC by OCDSS score standard, and all the participants were diagnosed as DIC with underlying disease. When the Takao, Clark, and Erez score standard is the "gold standard", the OCDSS score standard always shows good sensitivity and specificity, with all the AUC over 0.75. OCDSS score standard also has better predictive of hysterectomy (68.18%, 91.07%, 0.872), severe neonatal asphyxia and death (79.17%, 75.07%, 0.842) than the other three score standards. All the indicators included in the OCDSS score standard contributed to the DIC diagnosis (all the P < 0.001). The indicators in the DIC group were more abnormal than the non-DIC group (all the P < 0.001).

OCDSS is a first score standard, especially for pregnancies, it considers the underlying disease, clinical symptoms, and laboratory results. This score system shared a good diagnosis performance for DIC in the Chinese population and may help clinicians make timely decisions.

To compare pregnancy terminations for two reasons: intrauterine fetal death (IUFD) and fetal anomaly, focusing on obstetric data and termination processes to optimize clinical management.

This retrospective, single-center study included singleton pregnancies terminated for intrauterine fetal death or fetal anomaly (≥ 10 weeks’ gestation) between January 2020 and December 2021. Demographic, obstetric, and procedural data were collected. Termination methods included misoprostol, balloon catheter, curettage, and hysterotomy, following FIGO guidelines. Feticide was performed when indicated. Statistical analysis was conducted using t-test, chi-square test, and Pearson correlation; significance was set at P < 0.050.

A total of 173 termination cases (104 IUFD, 69 fetal anomalies) were analyzed. Mean gestational age was 16.6 ± 4.2 weeks. Termination and hospitalization times were longer in anomaly cases (P < 0.001). Gravida and parity were lower in the anomaly group (P = 0.005, P = 0.011). Misoprostol use showed a positive correlation with termination time (r = 0.251, P = 0.001); parity was negatively correlated (r = –0.175, P = 0.021). Balloon, curettage, and feticide rates were higher in anomaly cases (all P < 0.001). Complications occurred in 4 patients (2.3%).

Clinical approaches to pregnancy termination differ based on the underlying condition. Obstetric history and fetal pathology influence the methods and timing of the procedure, emphasizing the need for individualized care to improve patient outcomes.

To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine, norepinephrine, and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.

This PRISMA-based systematic review included English random control trails (RCTs) of women with singleton preeclampsia (American College of Obstetricians and Gynecologists (ACOG) criteria) undergoing cesarean delivery with spinal anesthesia, excluding chronic hypertension or systemic disease. Interventions were intermittent bolus phenylephrine, norepinephrine, or ephedrine, with outcomes on maternal hemodynamics, neonatal status, and adverse events. Searches of PubMed, ScienceDirect, Google Scholar, and Cochrane (to December 2024) plus reference screening identified eligible studies. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Due to heterogeneity in vasopressor regimens and outcome measures, results were synthesized narratively.

Of 2333 records screened, six RCTs (sample sizes 20-166) were included, all in preeclamptic women undergoing cesarean delivery. Overall risk of bias was low. Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine, with higher cardiac output (6.31 ± 1.08 vs. 5.45 ± 1.21 L/min; P = 0.009) and lower uteroplacental resistance (0.04 ± 0.02 vs. 0.06 ± 0.03; P = 0.002). Ephedrine caused higher heart rates (84.9 ± 7.1 vs. 76.6 ± 6.9 bpm; P < 0.05) and more nausea/vomiting. Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine (7.32 ± 0.02 vs. 7.31 ± 0.03; P < 0.050), while Apgar scores did not differ. Adverse events favored norepinephrine, which reduced bradycardia versus phenylephrine (5.1% vs. 20.5%; relative risk (RR) = 0.25; P = 0.042) and tachycardia versus ephedrine (16.1% vs. 36.4%; RR = 0.54; P = 0.020).

Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety, making it optimal for preeclamptic cesarean deliveries. Phenylephrine is effective for blood pressure control but may induce bradycardia, while the use of ephedrine is limited by its association with neonatal acidosis. Tailored vasopressor selection is thus essential for optimal outcomes.

Advances in prenatal screening have significantly improved the early detection of fetal anomalies and chromosomal abnormalities. Among these, first-trimester soft markers have emerged as valuable indicators of potential adverse outcomes. This review explores the clinical relevance of key markers—including increased nuchal translucency (NT), nasal bone hypoplasia, tricuspid regurgitation, aberrant right subclavian artery, and abnormal ductus venosus flow—and their associations with aneuploidy, structural malformations, and pregnancy complications such as preeclampsia and fetal growth restriction. We emphasize the importance of interpreting soft markers within a comprehensive clinical context, rather than in isolation, and examine their underlying pathophysiological mechanisms and associated statistical risks. Particular attention is given to the integration of soft marker findings with advanced screening techniques, including cell-free DNA (cfDNA) testing and maternal serum biochemistry, to improve diagnostic accuracy. In addition, we review current recommendations for clinical management, such as the use of follow-up diagnostic procedures like chorionic villus sampling or amniocentesis, and the role of multidisciplinary counselling in high-risk pregnancies. Future research should aim to validate novel soft markers and promote the standardization of screening protocols to enhance maternal and fetal outcomes.

妊娠前三个月阴道出血是一种常见症状，通常与先兆流产有关，占所有妊娠的15-20%。虽然多种标志物测试可以预测妊娠早期的妊娠结局，但确定与不良预后相关的可靠孕酮临界值的研究有限。^1,2鉴于胎盘在妊娠8周左右开始形成，孕酮水平通常在妊娠5-8周之间测量。为了进一步探讨这一点，我们进行了一项回顾性研究，以分析不同妊娠结局的孕酮水平，在任何孕酮治疗之前。

大胎龄儿（LGA）-定义为出生体重超过97^th百分位数——约占所有新生儿的3%。LGA的遗传基础越来越被认识，在罕见综合征如Pallister-Killian综合征和Beckwith-Wiedemann综合征中报道了相关性。这些疾病通常表现为胎儿和/或儿童期的全身性或节段性过度生长，常伴有身材高大、内脏肿大和大头畸形。¹

致编辑：

致小编，