2026年 · 第08卷第02期

The traditional discipline of obstetrics is undergoing a transformation and is being revitalized. While classical theories, such as Friedman’s labor curve, are being challenged by new evidence, innovative technologies, including artificial intelligence (AI), multi-omics, and minimally invasive fetal surgery, are increasingly being integrated into clinical diagnosis and treatment strategies. With the advancement of new evidence-based medicine and novel technologies, obstetric decision-making is shifting from an empirical approach to a precision-based one. The delivery room, as the core clinical area in obstetrics, involves rapid and uncertain changes in the patient’s condition driven by regular uterine contractions. Physicians and midwives must remain vigilant at all times and actively employ innovative methods to make timely, comprehensive, and anticipatory decisions guided by evidence-based medicine and clinical guidelines. Only through individualized and precise management of each patient can optimal maternal and neonatal outcomes be achieved.

Maternal mortality remains a pressing global health challenge, with stark regional disparities persisting despite advancements in care. China has made remarkable strides by reducing its maternal mortality rate from 1500 per 100,000 in 1949 to 17.8 per 100,000 in 2019, achieving the Millennium Development Goals ahead of schedule.¹This progress stems from enhanced delivery care quality and public health initiatives, yet challenges endure as China aims for a further reduction to 12.0 per 100,000 by 2030 under the Healthy China 2030 Plan.²The management of critically ill obstetric patients is pivotal to this goal, directly influencing maternal survival. Strengthening critical care centers—now over 3000 nationwide—serves as the last line of defense, but gaps in infrastructure, training, and regional equity demand urgent attention. The study involved human participants, and the protocol was approved by the Third Affiliated Hospital of Guangzhou Medical University (IRB (2024)-154). All participants provided informed consent before participation.

The management of dystocia represents one of the most significant challenges in modern obstetrics; however, paradoxically, the World Health Organization (WHO) had not yet provided a unified definition of this condition.¹Dystocia is responsible for a substantial proportion of cesarean deliveries worldwide. The journey from this definitional confusion to a potentially preventive framework illustrated how sequential innovations in classification and measurement could transform obstetric practice. Robson’s Ten Group Classification System (TGCS)²first illuminated the magnitude of the problem through epidemiological clarity. By stratifying cesarean sections into mutually exclusive categories, the TGCS revealed significant variations in cesarean rates across different obstetric populations, with particularly high rates observed in specific groups such as Group 2A (nulliparous women with induced labor). Although this stratification highlighted the cases in which cesareans are more frequently used, it did not explain the reasons. While the TGCS quantified and categorized the problem, it did not identify the specific factors leading to cesareans, with a particular focus on dystocia.

Postpartum hemorrhage (PPH) is a major threat to pregnant women worldwide and disproportionately affects developing countries or resource-limited areas. Every 4-5 minutes, a woman dies from PPH.^1,2For women who survived PPH, many of them suffered organ damage and physical or mental trauma either from a delay in controlling the hemorrhage or from the invasive procedures. Over the past few decades, many guidelines on the prevention and management of PPH have been issued by local, national, or international organizations, but implementation of any guideline is hampered by multidimensional barriers, and no substantial progress has been made in reducing PPH-related morbidity and mortality.³The etiology of PHH is complex, and identifying the exact cause of PPH can be challenging because more than one cause is often present.⁴Delay in controlling the PPH will lead to coagulopathy and myriad complications or even death.^1,2

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, affecting approximately 2% to 8% of pregnancies worldwide.¹Multifetal pregnancies are associated with a 2- to 3-fold increased risk of preeclampsia compared to singleton pregnancies.²In twin pregnancies, severe preeclampsia tends to manifest earlier and progress more rapidly.³Although the exact etiology and pathogenesis of preeclampsia remain incompletely understood, the only definitive treatment is delivery. As such, prolonging pregnancy to improve perinatal outcomes presents a major clinical challenge.

Pregnancy complicated by systemic lupus erythematosus (SLE) is associated with adverse outcomes for both the mother and the infant, alongside increased obstetric risks.^1,2,3,4,5Recent case reports have highlighted the risk of thinning of the myometrium and abnormal placental implantation in patients with SLE during pregnancy, which require rigorous clinical attention.

Congenital laryngeal atresia (CLA) is one of the primary etiologies of congenital high airway obstruction syndrome (CHAOS), and it is a rare malformation with an extremely high neonatal mortality rate. The core cause of neonatal death lies in the failure of airway establishment after birth. Although some medical institutions can perform intrapartum tracheotomy to establish the airway, the obstruction of the upper airway will still lead to the retention of pulmonary fluids, which in turn causes overdistension of the fetal lungs and airways, and induces diaphragmatic reversal and even fetal hydrops. Eventually, it results in severe pulmonary hypoplasia and diaphragmatic dysfunction, thus keeping the neonatal mortality rate persistently high. The whole-process management including fetal therapy, the ex utero intrapartum treatment (EXIT) procedure and neonatal surgery remains challenging, but offers the possibility of fetal salvage and good long-term outcomes.

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Fetal growth restriction (FGR), affecting about 10% of pregnancies, is widely recognized for its association with stillbirth and low birth weight, but its role in long-term neurodevelopmental injury—particularly periventricular leukomalacia (PVL)—may be underappreciated. PVL, a common form of white matter injury in preterm infants, often stems from fetal or neonatal hypoxic-ischemic events and presents as cystic or non-cystic lesions in the periventricular region, frequently resulting in lasting neurological deficits. Given that FGR often reflects chronic placental insufficiency and intrauterine hypoxia, it should be considered not only a marker of restricted growth but also a potential early warning sign of irreversible brain injury—one that deserves far greater clinical vigilance.¹