中华妇产科杂志最新文献

{"title":"[Impact of the number of cesarean deliveries on adverse pregnancy outcomes of cesarean section in a single-center cohort study].","authors":"M Hu, L Lin, L L Du, Z P Yan, S J Luo, W Sun, S Lu, Y T He, F He, D J Chen","doi":"10.3760/cma.j.cn112141-20250121-00032","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250121-00032","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the impact of the number of cesarean deliveries on adverse maternal and neonatal outcomes. <b>Methods:</b> A retrospective analysis was conducted on 11 904 singleton pregnant women who underwent cesarean delivery at the Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2019 to December 31st, 2023. The women were grouped according to the number of cesarean deliveries: those undergoing their first cesarean delivery (1CD group, 7 231 cases), those undergoing their second cesarean delivery (2CD group, 3 749 cases), those undergoing their third cesarean delivery (3CD group, 841 cases), and those undergoing their fourth or more cesarean deliveries (4CD group, 83 cases). Differences in clinical characteristics, related surgical procedures, and adverse maternal and neonatal outcomes among the groups were compared. Binary logistic regression analysis was used to assess the impact of the number of cesarean deliveries on related surgical procedures and adverse maternal and neonatal outcomes. <b>Results:</b> (1) During the 5-year period, the total number of women undergoing cesarean delivery in our hospital showed a slight downward trend, while the proportion of women undergoing three or more cesarean deliveries increased. (2) Compared with women undergoing their first cesarean delivery, women in each repeat cesarean delivery group were older, had higher proportions of advanced maternal age and pre-pregnancy body mass index, and had more pregnancies, deliveries, and induced abortions; the incidence of placenta previa, placental implantation, antepartum hemorrhage, gestational hyperglycemia, and failed trial of labor requiring conversion to surgery was higher, while the incidence of premature rupture of membranes was lower; the proportions of ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and postoperative intestinal obstruction were higher, and the amount of postpartum hemorrhage was greater; the gestational age at delivery of neonates was earlier, but the rates of preterm birth at 28-31<sup>+6</sup> and 32-33<sup>+6</sup> weeks of gestation were lower; the differences were statistically significant (<i>P</i><0.05) for all comparisons. (3) The number of cesarean deliveries was not an independent risk factor for the dose-dependent occurrence of placenta previa (a<i>OR</i>=0.99, 95%<i>CI</i>: 0.98-1.01; <i>P</i>=0.261). In women without placenta previa, the number of cesarean deliveries was not a risk factor for placental implantation (a<i>OR</i>=1.12, 95%<i>CI</i>: 0.90-1.39; <i>P</i>=0.320). However, in women with placenta previa, the number of cesarean deliveries was a risk factor for placental implantation (a<i>OR</i>=4.01, 95%<i>CI</i>: 3.08-5.22; <i>P</i><0.001). In the overall population, the number of cesarean deliveries was a risk factor for ureteral stent ","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"430-438"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endometriosis-associated ovarian mesonephric-like adenocarcinoma:a clinicopathological analysis of 9 cases].","authors":"H Wang, J Liu, Y Cheng, S N Wang, F F Zhong, W Y Gu","doi":"10.3760/cma.j.cn112141-20241217-00675","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241217-00675","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical and pathological characteristics, treatment and prognosis of endometriosis (EM)-associated ovarian mesonephric-like adenocarcinoma (MLA). <b>Methods:</b> Clinical and pathological data were collected from nine patients diagnosed with EM-associated ovarian MLA at the Obstetrics and Gynecology Hospital of Fudan University between January 2022 and December 2024. Histological slides were re-reviewed, immunohistochemical examination and molecular testing were performed, and patient follow-up was conducted. <b>Results:</b> (1) Clinical characteristics: the median age of the nine patients was 54 years (range: 38-69 years). All patients presented with a pelvic mass; five cases also reported abdominal pain. Tumor location included five cases in the right ovary, two in the left ovary, and two involving both ovaries. International Federation of Gynecology and Obstetrics (FIGO) staging showed 3 cases at stage Ⅰ, 4 at stage Ⅱ, and 2 at stage Ⅲ. (2) Pathological features: gross examination revealed mixed solid-cystic masses with solid areas appearing gray-white or yellow-brown; the median maximum tumor diameter was 9.0 cm (range: 2.6-13.0 cm). Microscopically, tumors exhibited various architectural patterns, including tubular, glandular, papillary, slit-like, sex cord-like, glomeruloid, and solid structures, with tubular and glandular patterns being most common. Tumor cells demonstrated mild to moderate nuclear atypia. Of the 11 tumor foci in the 9 cases, 8 showed coexistence of MLA with other tumor components, such as endometrioid carcinoma, borderline endometrioid or borderline seromucinous tumors. In 1 case of MLA mixed with a borderline endometrioid tumor, both components exhibited squamous metaplasia. Immunohistochemistry showed variable expression of GATA-binding protein 3, thyroid transcription factor-1, CD<sub>10</sub>, and calretinin, with positive rates of 9/11, 8/11, 5/11, and 3/6, respectively. Two tumor foci (2/11) exhibited focal expression of estrogen receptor and progesterone receptor. All cases displayed wild-type p53 expression. Molecular testing via next-generation sequencing in five patients revealed pathogenic mutations in the KRAS gene (5/5), with 3 cases (3/5) harboring additional pathogenic mutations in other genes. (3) Treatment and prognosis: all patients underwent surgery, supplemented by chemotherapy and (or) targeted therapy. Five patients underwent comprehensive staging surgery, four received cytoreductive surgery, and one patient received targeted therapy. The median follow-up duration was 7 months (range: 2-27 months). Three patients (3/9) experienced recurrence, and no deaths were reported during the follow-up period. <b>Conclusions:</b> EM-associated ovarian MLA demonstrates diverse morphological patterns and frequently coexists with other tumor types. Accurate diagnosis relies on an integrated evaluation of histomorphology, immunohistochemistry, and molecular testing. The pr","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"469-476"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on gynecologic laparoendoscopic single port surgery (including vNOTES) 2025 edition].","authors":"","doi":"10.3760/cma.j.cn112141-20250127-00039","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250127-00039","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"417-421"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Impact of pre-pregnancy BMI on the cumulative live birth rate and perinatal outcomes in patients with PCOS undergoing first IVF/ICSI].","authors":"X Y Wang, J N Xu, M Li, C L Zhang, S D Zhang","doi":"10.3760/cma.j.cn112141-20250312-00087","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250312-00087","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the effect of pre-pregnancy body mass index (BMI) on the cumulative live birth rate (CLBR) and perinatal outcomes in women with polycystic ovary syndrome (PCOS) undergoing first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI). <b>Methods:</b> The clinical data of 1 013 patients with PCOS who received first IVF/ICSI treatment in Reproductive Medicine Center, Henan Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. According to BMI China standard, they were divided into: normal weight group (18.5≤BMI<24.0 kg/m², 388 cases), overweight group (24.0≤BMI<28.0 kg/m², 367 cases), obese group (BMI≥28.0 kg/m², 258 cases). The effect of BMI on CLBR was analyzed by univariate analysis, multivariate logistic regression analysis and smooth curve fitting. The role of homeostasis model assessment of insulin resistance index (HOMA-IR) in the process of BMI on CLBR was analyzed by mediation analysis. <b>Results:</b> Among three groups, female age, basal level of follicle stimulating hormone, type of infertility and ovulation induction regimens were similar (all <i>P</i>>0.05). The infertility duration, basal testosterone level, HOMA-IR, the ovulation induction time and the total gonadotropin dosage increased with BMI (all <i>P</i><0.01), anti-Müllerian hormone, basal luteinizing hormone level, the number of retrieved oocytes and available embryos decreased with BMI (all <i>P</i><0.05). CLBR decreased with BMI increasing [84.08% (301/358) vs 74.26% (251/338) vs 71.88% (161/224); <i>P</i><0.001]. The incidence of hypertensive disorder in pregnancy was highest in obese group, while premature rupture of membranes rate, premature delivery rate, low birth weight rate and macrosomia birth rate were the lowest in normal weight group. After adjusting for confounding factors, both smooth curve fitting and multiple logistic regression analysis revealed a significant trend: CLBR declined with increasing BMI (<i>OR</i>=0.93, 95%<i>CI</i>: 0.89-0.97; <i>P</i>=0.002), with a reduction of 41% (<i>OR</i>=0.59, 95%<i>CI</i>: 0.39-0.91; <i>P</i>=0.020) in overweight group, and a reduction of 48% (<i>OR</i>=0.52, 95%<i>CI</i>: 0.32-0.83; <i>P</i>=0.010) in obese group. HOMA-IR mediated the effect of BMI on CLBR by 27.5% (<i>P</i><0.05). <b>Conclusions:</b> High BMI before IVF/ICSI in PCOS patients negatively impacts CLBR and raises maternal and infant risks during pregnancy and the perinatal period. 27.5% of the effect of BMI on CLBR is mediated by HOMA-IR. Thus, PCOS patients should manage their BMI and enhance insulin sensitivity prior to pregnancy.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"439-449"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Association between postpartum blood loss volume and maternal adverse clinical outcomes].","authors":"S Y Liang, J X Qu, H F Shi, Y Y Zhao","doi":"10.3760/cma.j.cn112141-20241024-00572","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241024-00572","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the relationship between postpartum hemorrhage (PPH) volume and the risk of adverse clinical outcomes in pregnant women. <b>Methods:</b> This was a retrospective cohort study of 41 494 deliveries at Peking University Third Hospital from 2012 to 2020. With PPH volume as the main exposure, the outcome indicators included: (1) Severe adverse outcomes: shock or embolism, abnormal coagulation function, abnormal liver function, and kidney injury; (2) General adverse outcomes: moderate to severe anemia, hypoalbuminemia, postpartum blood transfusion. Robust Poisson regression was employed to calculate the risk of each outcome index in pregnant women with different PPH volumes under the condition of controlling confounding factors, and to analyze the risk trends of each outcome index with the change of PPH volumes. <b>Results:</b> A total of 41 494 pregnant women were included in the study, including 9 959 cases (24.00%, 9 959/41 494), 23 974 cases (57.78%, 23 974/41 494), 5 235 cases (12.62%, 5 235/41 494), 1 144 cases (2.76%, 1 144/41 494), 508 cases (1.22%, 508/41 494), 208 cases (0.50%, 208/41 494), 207 cases (0.50%, 207/41 494) and 259 cases (0.62%, 259/41 494) pregnant women with PPH volume <250, 250-499, 500-749, 750-999, 1 000-1 249, 1 250-1 499, 1 500-1 999 and ≥2 000 ml, respectively. The risk of any serious adverse outcome, such as shock or embolism, abnormal coagulation function, abnormal liver function and kidney injury, showed a \"J-shaped\" relationship with PPH volume: risks remained stable (0.26%-0.59%) below 1 500 ml but increased significantly to 3.38% (<i>RR</i>=3.43, 95%<i>CI</i>: 1.14-10.35) at 1 500-1 999 ml and 5.02% (<i>RR</i>=4.53, 95%<i>CI</i>: 1.49-13.75) at ≥2 000 ml (all <i>P</i><0.05). Moderate-to-severe anemia showed threshold effects at 750 ml (<i>RR</i> ranging from 7.21 to 8.53) and hypoalbuminemia at 1 250 ml (<i>RR</i> ranging from 3.24 to 3.83), with risks plateauing beyond these thresholds (all <i>P</i><0.05). <b>Conclusion:</b> It is suggested that 750 ml, 1 250 ml and 1 500 ml should be used as the key intervention thresholds, corresponding to the initiation thresholds of anemia, hypoalbuminemia management and multidisciplinary intensive care, respectively, so as to provide a new reference for optimizing the clinical diagnosis and treatment strategy of PPH.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"422-429"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of CA₁₂₅ elimination rate constant K score in prognostic forecast of patients undergoing interval debulking surgery for high grade serous ovarian cancer].","authors":"H D Liu, H L Wu, L L Ma, Y Cui, S W Wang, G H Shen","doi":"10.3760/cma.j.cn112141-20250102-00001","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250102-00001","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the predictive value of the cancer antigen 125 (CA₁₂₅) elimination rate constant K (KELIM) score for no visible residual disease (R0) and prognosis in high-grade serous ovarian carcinoma (HGSOC) patients undergoing neoadjuvant chemotherapy (NACT)+interval debulking surgery (IDS). <b>Methods:</b> A retrospective analysis was conducted on 78 HGSOC patients treated with NACT+IDS at Beijing Hospital, from June 2014 to June 2024. The KELIM score was calculated, and its predictive value for R0 resection, chemotherapy response score (CRS), platinum-free interval (PFI), progression-free survival (PFS) time, and overall survival (OS) time was analyzed. <b>Results:</b> (1) The mean age at diagnosis was (61.9±9.9) years. The mean KELIM score was 1.1±0.4, with 44 patients having KELIM score≥1 and 34 having KELIM score <1. (2) Patients with KELIM score ≥1 had significantly higher rates of R0 resection (84% vs 56%; <i>P</i>=0.006), CRS3 grading (41% vs 0; <i>P</i><0.001), and PFI ≥6 months (84% vs 53%; <i>P</i>=0.04) compared to those with KELIM score <1. Additionally, the median PFS time (18.7 vs 13.2 months; <i>P</i><0.001) and OS time (34.8 vs 29.9 months; <i>P</i>=0.007) were significantly longer in the KELIM score ≥1 group. Chemosensitivity: patients with PFI <6 months had a significantly lower median KELIM score than those with PFI ≥6 months (0.8 vs 1.2; <i>P</i>=0.005). Surgical outcome: patients achieving R0 resection had a significantly higher median KELIM score than those without R0 (1.2 vs 0.7; <i>P</i><0.001). (3) Univariate analysis identified non-R0 resection, CRS3 grading, lack of poly adenosine diphosphate ribose polymerase (PARP) inhibitor maintenance therapy, and KELIM score <1 as significant risk factors for OS time (all <i>P</i><0.05). Multivariate analysis confirmed non-R0 resection (<i>HR</i>=3.78,95%<i>CI</i>: 1.13-12.66; <i>P</i>=0.031), no PARP inhibitor maintenance (<i>HR</i>=7.41,95%<i>CI</i>:1.82-30.15; <i>P</i>=0.005), and KELIM score <1 (<i>HR</i>=5.14,95%<i>CI</i>:1.41-18.72; <i>P</i>=0.013) as independent risk factors for OS time. <b>Conclusions:</b> The KELIM score may serve as a predictive marker for chemosensitivity, R0 resection, PFS time, and OS time in HGSOC patients undergoing NACT+IDS. KELIM score<1 is an independent risk factor for OS.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"461-468"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinicopathological features and prognosis of 117 cases of fumarate hydratase-deficient uterine leiomyomas].","authors":"W N Yu, S Y Pan, C Wang, Z D Huang, X L Wang, S Zhu, Y Ding, X L Wang","doi":"10.3760/cma.j.cn112141-20250205-00040","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250205-00040","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the clinicopathological characteristics and prognosis of fumarate hydratase-deficient uterine leiomyoma (FH-dUL). &lt;b&gt;Methods:&lt;/b&gt; Clinical data and follow-up information for 117 patients with FH-dUL diagnosed through surgical pathology and immunohistochemistry in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2024, were collected. A control group of 130 patients with common uterine leiomyomas was also included. The differences between the two groups in clinical, imaging, and pathological characteristics were compared. Additionally, recurrence rates, fertility outcomes for FH-dUL patients, and the incidence of renal cancer in FH germline mutation carriers were monitored. &lt;b&gt;Results:&lt;/b&gt; (1) Comparison of clinicopathological characteristics: the median age of 117 FH-dUL patients was 35 years, and the median age at first diagnosis of uterine leiomyomas was 29 years, both significantly younger than the control group (41 and 36 years; both &lt;i&gt;P&lt;/i&gt;&lt;0.01). The FH-dUL group showed significantly higher incidences of uterine myomectomy, multiple leiomyomas, diffusion restriction on pelvic magnetic resonance imaging diffusion weighted imaging, and typical pathological features (candelabra-like vessels, bizarre nuclei, cytoplasmic eosinophilic globules, perinuclear halo, cellular atypia) and higher ultrasound blood flow score (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Of the 30 FH-dUL patients who underwent genetic testing, 9 had germline mutations, 3 had somatic mutations, and 6 had mutations of unclear origin. Among the 9 FH gene germline mutation patients, 2 had already developed renal cell carcinoma. (2) Recurrence analysis: among the 56 patients who underwent uterine myomectomy, 22 (39.3%, 22/56) experienced recurrence during follow-up, compared to 12 (21.8%, 12/55) of the 55 patients in the control group, the difference between the two groups was statistically significant (&lt;i&gt;P&lt;/i&gt;=0.046). Multivariate binary logistic regression analysis showed that cellular leiomyomas (&lt;i&gt;OR&lt;/i&gt;=9.489, 95%&lt;i&gt;CI&lt;/i&gt;: 1.740-51.755; &lt;i&gt;P&lt;/i&gt;=0.009) and multiple uterine leiomyomas (&lt;i&gt;OR&lt;/i&gt;=10.709, 95%&lt;i&gt;CI&lt;/i&gt;: 1.354-84.683; &lt;i&gt;P&lt;/i&gt;=0.025) were significant risk factors for recurrence in FH-dUL. (3) Fertility analysis: among the 66 FH-dUL patients who underwent fertility-preserving surgery, 16 had the intention to have fertility desire, only 2 (2/16) completed their fertility plans during follow-up. &lt;b&gt;Conclusions:&lt;/b&gt; Clinicopathological features and imaging features help to differentiate FH-dUL from common type uterine fibroids, but lack specificity, and the diagnosis of FH-dUL is based on immunohistochemistry. The recurrence rate after resection of FH-dUL is high, and cellular and multiple leiomyomas are important predictors of recurrence. It is crucial to perform genetic testing, genetic counseling, drug treatment to prevent recurrence, fertility guidance, and long-term comprehensive management after surgery f","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"450-460"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical application value of combined focused ultrasound ablation surgery and hysteroscopy in the treatment of solitary type Ⅱ submucosal uterine fibroids with maximum diameter more than 5 cm].","authors":"H Y Cheng, C M Sang, Y J Kang, L Zhao, K Ding, S P Zhao","doi":"10.3760/cma.j.cn112141-20241022-00566","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241022-00566","url":null,"abstract":"<p><p><b>Objective:</b> To explore the effectiveness and application value of focused ultrasound ablation surgery (FUAS) combined with hysteroscopic surgery in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm. <b>Methods:</b> Clinical data of 35 patients with a single type Ⅱ submucosal uterine fibroid with maximum diameter greater than 5 cm who underwent FUAS combined with hysteroscopic surgery at Qingdao Women and Children's Hospital from June 2020 to December 2023 were collected. The clinical characteristics, treatments and treatment outcomes were retrospectively analyzed. <b>Results:</b> (1) Clinical characteristics: the mean age of the 35 patients was (36.7±6.6) years, with a median maximum diameter of fibroids of 56 mm (range: 51-80 mm). All patients presented with symptoms of menorrhagia, median menstrual bleeding score was 5 points (ranged from 3 to 5 points), and 34 cases (97.1%, 34/35) had concomitant anemia, the mean hemoglobin was (83.1±13.8) g/L of 35 patients. (2) Treatments: all 35 patients underwent FUAS treatment initially, with a lesion ablation rate ranging from 69.7% to 97.9% (median:90.7%), and no complications occurred. After FUAS treatment, the volume of fibroids decreased in all patients, with a volume reduction rate ranging from 30.57% to 87.22% (median:76.03%). Hysteroscopic surgery was performed 3-14 months (median: 5 months) after FUAS to remove the necrotic fibroid tissue, achieving a 100.0% (35/35) fibroid resection rate. Only 1 patient developed complications of hyperhyderation syndrome during hysteroscopic surgery, and no complications occurred in the remaining patients. (3) Evaluation of efficacy: after FUAS pretreatment, the maximum diameter of fibroids in the 35 patients decreased significantly (<i>Z</i>=-5.171, <i>P</i><0.001), as did the volume of fibroids (<i>Z</i>=-5.159, <i>P</i><0.001). The hemoglobin level increased significantly compared to the level before FUAS in all cases (<i>t</i>=-8.657, <i>P</i><0.001), and median menstrual bleeding score decreased to 2 points (range: 1-3 points), significantly lower than original level (<i>Z</i>=-5.292, <i>P</i><0.001). At the 3-month follow-up after hysteroscopic surgery, all patients were free of anemia symptoms, with menstrual bleeding scores totally decreased to 1 point, significantly lower than that before hysteroscopic surgery (<i>Z</i>=-4.786, <i>P</i><0.001); hemoglobin level [(118.7±5.6) g/L] significantly increased compared to that before hysteroscopic surgery (<i>t</i>=-9.258, <i>P</i><0.001). All patients underwent gynecological transvaginal ultrasound re-examination, which did not reveal any residual fibroids. <b>Conclusion:</b> FUAS combined with hysteroscopic surgery is effective in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm, providing a new treatment option for patients.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"363-371"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Feasibility analysis of laparoscopic total hysterectomy in patients with obliterated rectouterine pouch].","authors":"E N Liu, F Miao, Y F Zhou, Y Huang, L Zhang, C Peng","doi":"10.3760/cma.j.cn112141-20241118-00609","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241118-00609","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To analysis the safety and feasibility of laparoscopic total hysterectomy in patients with obliterated rectouterine pouch. &lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was conducted on 197 patients who underwent laparoscopic total hysterectomy at Peking University First Hospital, from July 2022 to July 2024. According to intraoperative observations, 197 patients were categorized into two groups: 58 cases with completely obliterated rectouterine pouch (obliterated group) and 139 cases with non-obliterated pouch (control group). General clinical characteristics, perioperative outcomes and 3-month follow-up after surgery were compared between two groups. &lt;b&gt;Results:&lt;/b&gt; (1) Baseline characteristics: the age of the obliterated group was (45.7±3.7) years, and the control group was (48.0±3.8) years (&lt;i&gt;P&lt;/i&gt;&lt;0.001). Primary complaint: dysmenorrhea prevalence was 53.4% (31/58) in the obliterated group, and was 35.3% (49/139; &lt;i&gt;P&lt;/i&gt;&lt;0.05) in the control group. Surgical indications: the proportion of adenomyosis and ovarian endometrioma was 77.6% (45/58) in the obliterated group, and was 51.1% (71/139; &lt;i&gt;P&lt;/i&gt;&lt;0.001) in the control group. No significant differences in body mass index, pelvic surgical history, or preoperative medication between the two groups (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). (2) Intraoperative outcomes: the obliterated group demonstrated significantly higher rates of surgical interventions compared to the control group. Superficial endometriosis resection was performed in 91.4% (53/58) of the obliterated group versus 33.8% (47/139) in the control group (&lt;i&gt;P&lt;/i&gt;&lt;0.001). Deep infiltrating endometriosis excision was required in 82.8% (48/58) of the obliterated group, contrasting sharply with 10.1% (14/139) in the control group (&lt;i&gt;P&lt;/i&gt;&lt;0.001). Ureterolysis procedures were similarly elevated in the obliterated group (77.6%, 45/58) compared to the control group (7.9%, 11/139; &lt;i&gt;P&lt;/i&gt;&lt;0.001). Operative metrics revealed substantial intergroup disparities: the obliterated group exhibited a median surgical duration of 149.0 minutes (interquartile range: 114.0, 180.0 minutes), significantly prolonged relative to the control group's 91.0 minutes (77.0, 107.0 minutes; &lt;i&gt;P&lt;/i&gt;&lt;0.001). Estimated blood loss followed a parallel pattern, with median volumes of 50.0 ml (20.0, 100.0 ml) in the obliterated group versus 20.0 ml (10.0, 20.0 ml) in the control group (&lt;i&gt;P&lt;/i&gt;&lt;0.001). (3) Postoperative outcomes: the uterine weight of the obliterated group was 200.0 g (132.5, 260.0 g), and the control group was 240.0 g (180.0, 336.0 g; &lt;i&gt;P&lt;/i&gt;&lt;0.05). Hospital stay was prolonged in the obliterated group compared with the control group [7.0 days (6.0, 8.3 days) vs 6.0 days (5.0, 7.0 days); &lt;i&gt;P&lt;/i&gt;&lt;0.001]. The incidences of postoperative fever in the obliterated group and the control group were 20.7% (12/58) vs 12.2% (17/139; &lt;i&gt;P&lt;/i&gt;&gt;0.05). The incidences of minor complications in the obliterated group and the control group were 3.4% (2/58) vs 0 (0/","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"355-362"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Guideline for the prediction and prevention of pre‑eclampsia (2025)].","authors":"","doi":"10.3760/cma.j.cn112141-20241130-00636","DOIUrl":"10.3760/cma.j.cn112141-20241130-00636","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"329-342"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}