2026年 · 第08卷第02期

Cervical incompetence occurs when the cervix fails to maintain its normal morphology and function during second-trimester, leading to recurrent second-trimester miscarriages or preterm births. To standardize and guide the clinical diagnosis and treatment of cervical insufficiency in China, the Perinatal Medicine Branch of the Chinese Medical Association and the Obstetrics Group of the Chinese Society of Obstetrics and Gynecology developed this consensus by referencing related research evidence and so on. This consensus provides evidence-based analysis and recommendations on key clinical issues including the diagnosis of cervical incompetence, indications for cervical cerclage, surgical techniques, timing of intervention, perioperative management, and adjunctive therapies, offering evidence-based guidance for obstetric clinical practice.

Objective: To analyze factors influencing satisfaction in pregnant women during labor as patients and the relationship of the level of satisfaction with pain management through transcutaneous electrical nerve stimulation (TENS). Methods: A randomized and double-blind controlled trial was conducted. All participants completed the satisfaction scale immediately after childbirth. A total of 63 participants were randomly assigned to one TENS device to relieve the pain, with a different dose in each group. Patients’ responses were measured with 2 scales; the satisfaction level was measured with the Care in Obstetrics: Measure for Testing Satisfaction scale, and pain was measured with the visual analogue scale. Results: A total of 63 women were randomized into three groups: Active TENS (n = 21), Placebo TENS (n = 21), and Control (n = 21). Baseline characteristics, including maternal age, parity, body mass index, and gestational age, showed no significant differences among the groups (P > 0.05). The active TENS group showed significantly greater pain relief, with a mean visual analogue scale score reduction of (3.3 ± 1.2) compared to (1.1 ± 0.9) in the placebo group and (0.8 ± 0.7) in the Control group (P < 0.001). Maternal satisfaction scores were also highest in the Active TENS group (median 8.0, interquatile range (IQR): 7.0-9.0) compared to Placebo (median 6.0, IQR: 5.0-7.0) and Control (median 5.0, IQR: 4.0-6.0) groups (P < 0.001). Multivariate linear regression indicated that only the type of TENS used was significantly associated with maternal satisfaction (β = 0.42, P = 0.007). Other variables, including parity, BMI, perceived support, and baseline pain severity, were not statistically significant predictors (P > 0.05). Conclusion: Overall, a high level of satisfaction with care during the labor process was obtained; we recommend the use of TENS for pain relief to improve general satisfaction.

Objective: To investigate the risk factors for severe postpartum hemorrhage (SPPH) in vaginal delivery and explore targeted prediction and prevention strategies. Methods: A retrospective cohort study of singleton pregnancies with vaginal deliveries after 28 weeks of gestation from January 1, 2021, to December 31, 2024, in the Peking Union Medical College Hospital was conducted. Women with multiple pregnancies, those with gestational age less than 28 weeks, and those giving birth through cesarean section were excluded. The primary outcome was SPPH, defined as blood loss of 1000 mL or more within 24 h of childbirth, or the presence of signs or symptoms of low blood volume requiring a transfusion of four or more units of red blood cells. Multivariate logistic regression was used to identify potential risk factors for SPPH. Results: A total of 6784 women were included in the study, with a SPPH rate of 1.31 %. Low-lying placenta or placenta previa (adjusted odds ratio (aOR) = 17.54, 95% confidence interval (CI): 5.01-61.41), placenta accreta spectrum (aOR = 5.25, 95% CI: 3.14-8.77), thrombocytopenia (aOR = 5.37, 95% CI: 1.12-25.78), precipitate labor (aOR = 3.35, 95% CI: 1.68-6.66), and episiotomy (aOR = 2.16, 95% CI: 1.20-3.90) were identified as independent risk factors for SPPH. Gestational age at delivery, use of assisted reproductive technology, neonatal birth weight, induction of labor or cervical ripening with prostaglandins, instrumental delivery, and duration of the second or third stage of labor showed statistical significance in the univariate analysis but not in the multivariate analysis. Conclusion: Placenta-related factors (placenta accreta spectrum, low-lying placenta, or placenta previa), thrombocytopenia, episiotomy, and precipitate labor were identified as factors potentially associated with SPPH in vaginal delivery. These findings should be interpreted with caution, given the limited number of events, and further validation through larger, multicenter studies is warranted.

Objective: To investigate the effectiveness and efficiency of different evaluation indices in assessing adequate prenatal care (PNC) in relation to maternal and fetal outcomes. Methods: A secondary data analysis of multiple cross-sectional surveys of 221,381 new mothers (weighted estimate 10,932,150) from Phase 8 Pregnancy Risk Assessment Monitoring System between 2016 and 2021. PNC adequacy was assessed using the Kessner, Kotelchuck, and Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) indices. Descriptive, bi-variate, and multivariate analyses were performed to evaluate the impact of each index on maternal and fetal outcomes, with the level of statistical significance set at P < 0.010 and 95% confidence interval (CI). Results: The prevalence of adequate PNC using the Kessner, Kotelchuck, and MiPATH indices was 74.1% (7,675,029/10,361,625), 77.1% (8,218,603/10,664,993) and 20.1% (2,131,242/10,597,981), respectively. Women with adequate PNC, according to all three indices, showed lower rates of adverse fetal and maternal outcomes. Each index was significantly associated with fetal outcomes (neonatal infant care unit admission, small for gestational age, and preterm birth) and mode of delivery (P < 0.010). In multivariate analysis, MiPATH index consistently predicted lower odds of neonatal intensive care unit admission (odds ratio (OR): 0.475, 95% CI: 0.417-0.541), cesarean delivery (OR: 0.786, 95% CI: 0.757-0.816), and preterm birth (OR: 0.285, 95% CI: 0.263-0.309). Adequate PNC as defined by Kessner was associated with decreased the odds of neonatal intensive care unit admission (OR: 0.890, 95% CI: 0.821-0.965), small for gestational age (OR: 0.849, 95% CI: 0.729-0.990), and preterm birth (OR: 0.453, 95% CI: 0.430-0.476), while Kotelchuck was associated with increased odds of preterm birth (OR: 2.820, 95% CI: 2.661-2.989), and cesarean delivery (OR: 1.231, 95% CI: 1.187-1.277). Conclusion: While all indices effectively assessed adequate PNC, the MiPATH index proved to be the most effective, considering its criteria for flexibility and individualized care, along with its association with improved fetal and maternal outcomes among women with adequate PNC.

Objective: To evaluate the associations between pregnancy-associated plasma protein A (PAPP-A) levels and pregnancy-associated conditions, perinatal outcomes, and placental histopathology. Methods: This retrospective, single-center cohort analysis included cases of preterm and term deliveries from pregnancies complicated by preeclampsia and fetal growth restriction or gestational hypertension. A correlation analysis was performed to assess the relationship between PAPP-A levels and neonatal parameters, the prevalence of various pregnancy complications, and placental and birth weight percentiles and ratios. Associations between placental histopathological entities and PAPP-A were explored in different subgroups defined by PAPP-A multiple of the median (MoM) ranges. Potential associations between PAPP-A levels and placental capillarization were also investigated. Results: A total of 74 pregnancies were investigated. PAPP-A levels were significantly lower in cases involving cesarean section (P = 0.002), preterm birth (P = 0.030), and/or preeclampsia (P = 0.002). Among the preeclamptic cases, early-onset preeclampsia was associated with a significantly lower PAPP-A level (P < 0.001). No significant associations were identified between first-trimester PAPP-A levels and placental weight percentile, birth weight percentile, villous capillarization, or the percentage of intact terminal villi; however, correlations were found between low PAPP-A levels and placental weight-to-birth weight ratios of < 1:8 (Kruskal-Wallis test P = 0.004; Spearman’s correlation P = 0.011). PAPP-A levels were also significantly lower in the presence of distal villous hypoplasia (P < 0.001), accelerated villous maturation (P < 0.001), or avascular villi (P < 0.001) in the placenta. Conclusion: Lower PAPP-A levels may represent an early marker of pathological placentation in the background of preeclampsia and fetal growth restriction—especially in early-onset cases—which are characterized by villous underdevelopment and a non-branching villous tree pattern on placental histopathology. From a clinical translation perspective, PAPP-A levels may serve as a potential early indicator of pregnancies that warrant close monitoring during clinical management.

Objective: To identify, evaluate, and summarize evidence on the effects of prenatal exposure to organochlorine compounds (OCCs) and other pesticides on neonatal growth parameters. Methods: Keywords were identified through systematic reviews and expert consultation, then finalized with an academic librarian. A comprehensive search was conducted in PubMed, Cochrane Library, MEDLINE (OVID), Scopus, Web of Science, and CINAHL from inception to February 26, 2024. Retrieved records were managed using EndNote 20. Two independent reviewers screened titles and abstracts based on predefined eligibility criteria. Full-text articles were further assessed for inclusion, with disagreements resolved by a third reviewer. A standardized process was followed during the full-text review. Studies were included if they involved pregnant women and their neonates, assessed prenatal exposure to OCCs, and reported at least one neonatal growth parameter. Data were extracted using Microsoft Excel® and included study design, sample characteristics, exposure details (timing, route, and measurement), and neonatal growth outcomes. Methodological quality was assessed using the National Institutes of Health Quality Assessment Tool. Results: This systematic review included 16 studies conducted between 1997 and 2023 across various countries, with the majority from the United States (n = 6). The studies employed diverse designs, including cohort, case-control, longitudinal cohort, and cross-sectional studies, to investigate the impact of prenatal pesticide exposure on neonatal health outcomes. Key neonatal growth parameters assessed were birth weight, length, head circumference, and gestational age. The quality of the included studies varied, with overall scores ranging between 64.28%-91.66%. Conclusion: The findings demonstrate significant associations between prenatal exposure to OCCs and adverse neonatal growth outcomes. Frequently reported effects included reduced birth weight, smaller head circumference, shorter gestational age, and increased risk of growth restriction. These results underscore the importance of minimizing maternal exposure to persistent organic pollutants during pregnancy and highlight the need for targeted public health policies and preventive strategies.

Augmentation of labor remains the cornerstone of intrapartum care, typically employed to expedite delivery by enhancing the frequency, strength, and duration of uterine contractions. The decision to augment depends on the stage of labor and the woman’s obstetric history. While up to half of all women who enter spontaneous or induced labor may require augmentation, its use is not without risk. Although augmentation in nulliparous women during the first stage of labor is generally uncontroversial, its application in multiparous women, during the second stage of labor, in breech presentation, or in women who have had a previous cesarean section remains contentious. Emerging debate also surrounds whether oxytocin should be routinely discontinued once active labor is established. In this review, we appraise contemporary evidence on the diagnosis of labor dystocia, indications, and methods for labor augmentation, outcomes, complications, and areas of clinical uncertainty. Current international guidelines are compared, and evidence-based recommendations are provided. We conclude by highlighting unresolved areas that warrant further research to inform future policy and clinical practice.

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. The incidence of PPH continues to rise. PPH is often responsive to both medical and surgical treatment. A stepwise multidisciplinary approach to PPH treatment has been shown to reduce maternal morbidity. Massive transfusion protocols are critical to any obstetrics unit. Intrauterine devices are often employed in the treatment of PPH. Placenta accreta spectrum greatly contributes to the PPH burden. Hysterectomy remains the definitive treatment of PPH; however, medical and surgical options are often successfully employed, avoiding the need for hysterectomy. Advances in interventional radiology have been shown to successfully treat PPH in the majority of cases. Clinical simulation has been shown to improve teamwork and outcomes in the treatment of PPH. Novel approaches to PPH show additional promise in reducing maternal morbidity.

Breech presentation is a relatively common fetal malposition, affecting 3% to 5% of fetuses at term. Although various clinical conditions are associated with breech presentation, its prevalence decreases as gestational age progresses toward term. Despite ongoing global academic and clinical debates on the management of breech presentation, there is a growing recognition that the decision on the mode of delivery should consider the patient’s preferences. Adequate counseling on available options is crucial. For patients with a term singleton fetus in a breech position who prefer a planned vaginal delivery, the external cephalic version (ECV) serves as an alternative to planned cesarean section (CS). ECV involves gently manipulating the fetus on the mother’s abdomen to achieve a cephalic presentation, with a reported success rate of 58%. The procedure is typically performed at or after 37 weeks, and a thorough assessment of fetal well-being is mandatory. While short-term benefits of planned CS for term breech presentation have been demonstrated in neonatal and maternal outcomes, a trial of breech vaginal delivery can be considered in the absence of contraindications and based on the patient’s preference. It is crucial for an experienced healthcare provider to offer appropriate assistance to ensure maternal and child well-being and minimize complications, whether attempting a vaginal birth or opting for a CS for breech presentation. Ultrasonography plays a crucial role in diagnosing breech presentation, and transabdominal ultrasound can offer valuable information for predicting ECV success, including placental location and amniotic fluid quantity. Emerging techniques in ultrasonography, such as transperineal ultrasound to assess fetal presenting part engagement and transabdominal ultrasound to evaluate fetal head flexion and position, are increasingly employed in labor ward evaluations. The recently introduced breech progression angle, a transperineal sonographic parameter, holds promise as a reliable tool not only for predicting ECV success but also for assessing the risk of cesarean delivery in patients who will undergo a trial of breech vaginal delivery.