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15 July 2020, Volume 39 Issue 4
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Incidence of Perinatal Congenital Heart Disease in China：A Meta-Analysis XU Wen-jing, WEI Li-li, WANG Ying, WEI Ying, WANG Jian, MAO Bao-hong, TAO Zhong-bin, YANG Ke-hu, LIU Qing 2020, 39 (4):  269-275.  Abstract ( 2328 )   PDF (1238KB) ( 11656 )   Objective: To evaluate the incidence of congenital heart disease (CHD) among perinatal kids in China. Methods：English and Chinese databases were electronically searched, to get the studies on the prevalence of COH in China from the creation of databases to January 2020. Two investigators independently reviewed those included studies, extracted data and evaluated data quality. Stata 12.0 software was used for the meta-synthesis. Results：29 original literatures were screened, reporting 8 327 724 subjects. Meta-regression analyses revealed that the total incidence of CHD among perinatal kids of China was 2.9‰ (95%CI: 2.2‰-3.8‰). The subgrouped analysis showed that ventricular septal defect was the main subtype. The incidence of CHD in male perinatal kids (2.9‰) was higher than that in female perinatal kids (2.2‰). The incidence of perinatal CHD in urban (2.5‰) was higher than that in rural (1.1‰). This incidence in the south (3.5‰) was higher than that in the north (2.1‰). The incidence of perinatal CHD of maternal age ≥35 (2.8‰) was higher than that of maternal age ＜35 (2.0‰). This incidence decreased from 2007 to 2012, and then showed an increasing trend from 2012. Conclusions：The ncidence of COH among perinatal kids of China showed an increasing trend in recent years. More targeted interventions should be provided so as to reduce the incidence of CHD. Related Articles | Metrics

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Association of Sleep Disturbances and Polycystic Ovary Syndrome: A Meta-Analysis GU Fang-yun, HOU Li-hui, XIA Xiao-yan, SUN Miao, LI Yan, HAO Song-li 2020, 39 (4):  276-279.  Abstract ( 1856 )   PDF (726KB) ( 10349 )   Objective: To review the association of sleep disturbances and polycystic ovary syndrome (PCOS). Methods：PubMed, Web of Science, The Cochrane Library, Embase, CNKI and Wan Fang Data databases were electronically searched to collect the case-control studies on the association of sleep disturbances and PCOS. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using Stata 12.0 software. Results：A total of 8 case-control studies were included, in which 1 735 patients were in the case group and 1 671 in the control group. The results of meta-analysis showed: there were significant differences between the two groups in PSQI scores (WMD=2.89, 95%CI: 0.13-5.64, P=0.040) and sleep disturbances frequency (OR=2.26, 95%CI: 1.02-4.97, P=0.044). Conclusions：The current evidence shows that sleep disturbances is associated with PCOS. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion. Related Articles | Metrics

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Analysis of the Pregnant Outcomes of Transvaginal Cervical Cerclage—MacDonald Operation in Twin Pregnancy LIU Jian-hua, WANG Yu-xian, ZHAO Hui-ling, XI Xiao-li 2020, 39 (4):  280-283.  Abstract ( 1643 )   PDF (619KB) ( 9582 )   Objective: To explore the application of transvaginal cervical cerclage-MacDonald operation in those women with twin pregnancy combined with cervical insufficiency, and follow-up visit the pregnancy outcomes. Methods：Ninety-seven women with twin pregnancy combined with cervical dysfunction who had a regular pregnancy test were included from January 2014 to June 2019. According to their medical history and follow-up results, they were divided into 2 groups. The surgical group (n=57) was treated by cervical cerclage, and the conservative group (n=40) was treated by bed-rest and symptomatic drug. Then according to different surgical timing, the surgical group was divided into 2 subgroups: the preventive cerclage subgroup (n=39) and the emergency cerclage subgroup (n=18). The mother-infant outcomes and clinical effects were compared. Results：The prolonged gestational age and delivery gestational age of the operation group were significantly higher than those of the conservative group (P＜0.05). The length of cervical before ligation, prolonged gestation week, weeks of delivery, and birth weight of newborns in the preventive cerclage subgroup were higher than those in the emergency cerclage subgroup (P＜0.05). The gestational age of circumcision in the preventive cerclage subgroup was lower than that in the emergency cerclage subgroup (P＜0.05). The operation group′s preterm birth rate ＜35 weeks, ≥35 weeks delivery rate and live birth rate were higher than the conservative group (P＜0.05). The conservative group had a higher abortion rate than the surgical group (P＜0.05). Compared with the emergency ligation group, the miscarriage rate and preterm birth rate in the preventive cerclage group were not statistically significant (P＞0.05). However, the preventive cerclage group had a higher delivery rate and live birth rate at 35 weeks. In the emergency circumcision group, the differences were statistically significant (P＜0.05). Conclusions：Compared with conservative treatment, the transvaginal cervical cerclage for pregnant women with twin pregnancies and cervical insufficiency has positive significance for improving pregnancy outcomes, and for choosing the right timing of surgery so as to prolong the gestational weeks. Related Articles | Metrics

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Analysis of Pregnancy Outcome of In Vitro Fertilization and Embryo Transfer in Patients after Cervical Conization WANG Pei, DING Hui, LING Xiu-feng, ZHAO Chun, XIE Qi-jun, LI Xiu-ling 2020, 39 (4):  284-286.  Abstract ( 1490 )   PDF (503KB) ( 10110 )   Objective: To investigate the effect of cervical conization on the pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with infertility. Methods：A total of 35 infertile patients with a history of cervical conization who treated with IVF-ET from January 2013 to December 2019 were selected as the case group, and 98 infertile patients without history of cervical conization and with the results of normal or inflammatory cervical curettage who treated with IVF-ET in the same period were randomly selected as the control group. The index of early pregnancy and the delivery outcome of singleton delivery were compared between the two groups. Results：There were no significant differences in age, years of infertility, times of pregnancy, parity and factors of infertility between the two groups (P＞0.05). There was no significant differences in the abortion rate and early abortion rate between the two groups (P＞0.05), but the cervical ligature rate in the study group was higher than that in the control group (P=0.001). There were no significant differences in term delivery, premature delivery, gestational age, cesarean section and low birth weight between the two groups (all P＞0.05), but the birth weight of newborns in the study group was significantly lower than that in the control group (P=0.048). Conclusions：The history of cervical conization has no significant effect on the pregnancy outcome of infertile patients undergoing IVF-ET. We can reduce the occurrence of obstetrical complications and obtain better pregnancy outcome by transferring single embryo, checking cervical function in early pregnancy and controlling body weight during pregnancy. Related Articles | Metrics

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Clinical Analysis of 128 Cases of Fetal Death in the Third Trimester of Pregnancy ZHANG Chun-xia, LIU Yan, WANG Tian, WANG Yan-yan, HUO Yan 2020, 39 (4):  287-290.  Abstract ( 1483 )   PDF (618KB) ( 10245 )   Objective: To investigate the factors of fetal death in the third trimester of pregnancy, and to discuss the matters needing attention and the effective intervention, in order to reduce the incidence of the perinatal fetal death. Methods：From January 1, 2011 to December 31, 2018, there were 128 cases of fetal death in the third trimester of pregnancy in the obstetrics department of Hebei General Hospital, including 110 cases of the age-appropriate women (aged 20-35 years) and 18 cases of the aged group (aged ≥35 years). And there were 114 cases of single pregnancy and 14 cases of twin pregnancy. The clinical data were retrospectively analyzed. Results：The main causes of fetal death in 114 cases of single pregnancy included gestational hypertension (34/114, 29.8%), umbilical cord-related factors (19/114, 16.7%), placenta or fetal membrane-related factors (16/114, 14.0%), and amniotic fluid-related factors (15/114, 13.2%). The proportion of fetal death due to the placenta- or fetal membrane-related factors in the full-term birth group was higher than that in the preterm group (25% vs. 9%, P＜0.05). The main cause of 14 cases of twin pregnancy and fetal death is the related complications of the single chorionic double amniotic sac twin pregnancy (6/14, 42.9%). Conclusions：It is possible to reduce the incidence of fetal death by the comprehensive measures, such as regular prenatal exam, to determine the chorionic status of twin pregnancy as early as possible, to detect, diagnose and treat pregnancy complications as early as possible, and to terminate pregnancy timely in high-risk pregnancy. Related Articles | Metrics

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Clinical Analysis of Five Cases of Uerine Arteriovenous Malformation WANG Xiao-ye, ZHOU Ying, WANG Wei, LIANG Hua-mao 2020, 39 (4):  291-294.  Abstract ( 1559 )   PDF (12804KB) ( 9432 )   Objective: To analyze the cause and clinical manifestations of uterus arteriovenous malformations (UAVMs), and to discuss the precautions in diagnosis and treatment. Methods：Five patients (accepted from March 2014 to March 2018) were diagnosed as UAVMs by Peking University Third Hospital. The clinical data were retrospectively analyzed. Results：UAVMs were preliminarily diagnosed by ultrasound Doppler examination in five cases. One was treated with hysteroscopic curettage plus uterine balloon oppression, and the lesion disappeared 3 months later. One was treated with the ultrasound-guided curettage, and the lesion also disappeared after 3 months. Three other cases were confirmed by angiography, and treated synchronously with the selective uterine artery embolization. One patient delivered successfully after 2+ years. One had amenorrhea after 2 months. The last case had curettage after embolization, and the lesion disappeared 3 months after operation. Conclusions：Color doppler ultrasound through vagina can be adopted as the preferred examination of UAVMs, while angiography remains the golden criteria for diagnosis. Selective uterine artery embolization is an effective treatment of UAVMs. Related Articles | Metrics

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Giant Ovarian Tumor Coexisting with Pregnancy: Two Cases Report and Literature Review WANG Tian, WANG Yan-yan, ZHANG Chun-xia, LIU Yan, HUO Yan 2020, 39 (4):  295-297.  Abstract ( 1345 )   PDF (500KB) ( 9968 )   Ovarian tumors are common in clinical gynecology. However, the giant ovarian tumors during pregnancy are not common. Ovarian tumors during pregnancy have little direct effect on the fetus, but various complications and metastatic tumors can pose great threats to the maternal and child health. Common complications include pedicle twist, rupture, infection, and compression symptoms. Compression symptoms also occur when the ovarian tumor grows faster and larger in size, and some ovarian tumors may become cancerous. Combining the 2 cases of pregnant patients with giant ovarian tumors and literature review, we discussed the diagnosis and treatment of this complex disease. Related Articles | Metrics

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Acute Hepatic Failure in A Pregnant Woman with Hepatolenticular Degeneration：A Case Report and Literature Review YU Yan-chao, JIN Zhen 2020, 39 (4):  298-300.  Abstract ( 1362 )   PDF (462KB) ( 9649 )   Hepatolenticular degeneration (HLD) is an autosomal recessive disorder of congenital copper metabolism. The causative gene is the ATP7B located on chromosome 13q14.3, which leads to the functional defect of ATP7B. Those untreated female patients may cause spontaneous miscarriage or infertility. It is extremely rare that HLD patients have the natural pregnancy with a successful outcome. Symptoms of liver injury are the main clinical manifestations of HLD. However, acute hepatic failure is rare in HLD patients. Acute hepatic failure in HLD patients is characterized by rapid progression, poor prognosis and high mortality. A case of acute hepatic failure and hemolysis in a pregnant HLD women was reported, with a review of literatures, in order to explore the clinical characteristics and treatment methods. Related Articles | Metrics

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Atypical Uterus Rupture at Different Locations in Four Cases WANG Bei, MA Jun-lian 2020, 39 (4):  301-303.  Abstract ( 1257 )   PDF (8119KB) ( 10046 )   More and more clinical attention has been paid to uterine rupture. The perinatal uterine rupture of cicatricial uterus such as cesarean section and myomectomy is easy to be vigilant and recognized. However, the uterine rupture of non cesarean scar sites often has a variety of medical history and atypical symptoms. It is not easy to diagnose, and easy to misdiagnose, miss diagnosis. The treatment could be delayed, which lead to the serious adverse maternal and child outcomes. In this paper, 4 cases of uterine rupture in the scar area of non-cesarean section were reported. These cases were secondary to the previous cesarean section, the natural labor and artificial separation of placenta, the traffic accident and the ectopic pregnancy after laparoscopic salpingectomy. Related Articles | Metrics

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A Case Report of Unilateral Ovarian and Unilateral Adrenal Non-Hodgkin′s Lymphoma GUO Yu-jing, WANG Hui-fei, LI Yao-qi, WANG Bi-hui, JIA Zan-hui 2020, 39 (4):  304-307.  Abstract ( 1295 )   PDF (8595KB) ( 9763 )   Non-hodgkin lymphoma (NHL) as a common malignant tumor of the immune system is a clonal and proliferative disease of B or T cell progenitor cells originating from lymph nodes or extralymph tissues. It mainly occurs in thymus, lymph nodes or spleen. The clinical and radiological manifestations of the NHL originated outside the junction were non-specific, and the morphology was similar to that of the primary tumor of the organ outside the junction. Therefore, early correct clinical and histopathological diagnosis can make patients to receive correct treatment and avoid unnecessary surgery. In this paper, we report a case of unilated ovarian and unilated adrenal NHL, with the secondary and multiple external involvement, in a perimenopausal female with pelvic mass as the first symptom, by which clinical doctors and pathologists can understand well the complicacy of this disease. Related Articles | Metrics

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Research Progress in Circular RNA in Female Reproductive System ZHANG Xue-ying, YING Xiao-yan, XU Bo-qun 2020, 39 (4):  308-313.  Abstract ( 1483 )   PDF (1498KB) ( 10371 )   Circular RNA (circRNA) is a large class of non-coding RNAs in eukaryotes which is bonded by the reverse splicing. Through binding with corresponding microRNAs or directly contacting with proteins, circRNA exerts the biological functions of cell signal transduction, gene regulation and protein translation, and plays a primarily important role in various physiological and pathological processes. Study found that the abnormality of circRNA could be related to the occurrence and development of female genital tract tumors and female endocrine-related diseases. The potential mechanism of circRNA in female reproductive system and diseases has also been gradually investigated. Owing to the biological characteristics of conservative, stability and tissue specificity, circRNA may be a class of potential diagnostic biomarkers and therapeutic targets of female reproductive system diseases. Related Articles | Metrics

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Research Progress in MicroRNAs in Ovarian Granulosa Cells WEI Chao-feng, LIAN Fang 2020, 39 (4):  314-318.  Abstract ( 1311 )   PDF (699KB) ( 10195 )   MicroRNAs (miRNAs), a kind of endogenous non-coding RNA, can affect the expression of protein by regulating the target gene at the post transcriptional level. MiRNAs involve in the regulation of biological activities of cells in all respects. The low expression, high expression or mutation of specific miRNAs can cause cell dysfunction. Ovarian granulosa cells, the most important somatic cells in follicles which surrounding the oocytes, can synthesize various hormones, growth factors and express their receptors. Those hormones and factors regulate the growth, differentiation and maturation of follicular theca cells and oocytes through gap junction, and then regulate the development of follicles. In addition to the direct effect of miRNAs on oocytes, the regulatory role of miRNAs in granulosa cells is particularly important. It has been found that miRNAs play important roles in the proliferation, differentiation and apoptosis of ovarian granulosa cells, as well as the secretion of sex hormones. In this paper, we reviewed the research progress of miRNAs in ovarian granulosa cells in recent years. Related Articles | Metrics

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Research Progress in In Vitro Activation Therapy for Premature Ovarian Insufficiency YIN Lan-lan, WANG Chen-xi, MA Tian-zhong 2020, 39 (4):  319-323.  Abstract ( 1437 )   PDF (696KB) ( 9861 )   Premature ovarian insufficiency (POI) is an essential cause of female ovarian hormone deficiency and infertility. About 1% of women in childbearing age suffer from POI, and there is no optimal solution to improve ovarian function in patients with POI. Recently, in vitro activation (IVA) has been tried to treat the infertility of POI patients. It is well known that a certain number of dormant primordial follicles remain in the ovarian cortex of POI patients. IVA is to activate the dormant primordial follicles by blocking the Hippo signaling pathway through the fragmentation of the ovarian cortex, and activating the phosphatidylinositol 3 kinase-protein kinase B (PI3K-AKT) signaling pathway with AKT stimulators, so that the dormant primordial follicles can grow and develop into mature oocytes that can be used to assisted reproductive technology. It has been reported that follicle growth, and successful pregnancy and birth, are effectively induced via IVA. In this paper, we describe the regulatory effects of PI3K-AKT and Hippo signaling pathways on primordial follicle activation, and review the research progress of IVA treatment for POI. Related Articles | Metrics

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The Correlation between Maternal Obesity and Offspring Obesity LIN Jing, CHEN Lei, JIA Xiao-ning 2020, 39 (4):  324-328.  Abstract ( 1407 )   PDF (742KB) ( 10333 )   Obesity as an important risk factor of chronic and metabolic diseases is a global serious public health issue. Recently, it has been found that obesity can cause intergenerational transmission. With the theory of "developmental origins of health and disease", more and more studies have found that offspring obesity is closely related to maternal obesity. However, its mechanism is still not very clear. The possible mechanisms include chronic inflammatory reaction, fat tissue endocrine function, hypothalamus-adipose axis dysfunction, epigenetic changes, hereditary，gut microbial alternation and placental function changes. To clarify the relationship and the mechanisms between maternal obesity/diabetes and offspring obesity, and to block the intergenerational transmission of obesity, could lower the rate of obesity and related chronic diseases. This review describes the relationship between maternal obesity and offspring obesity and its mechanism. Related Articles | Metrics

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Effect of Obesity on Fertility and Infertility KANG Gui-juan, KONG Xiang-ling 2020, 39 (4):  329-335.  Abstract ( 1452 )   PDF (1023KB) ( 10464 )   The sharp increase of the prevalence of obesity is accompanied with the decline of reproductive health index in both sexes. Obese is associated with the changes of reproductive regulatory mechanisms. The level of estrogen in obesity males is increased due to the over-expression of aromatase in the adipose tissue, and followed by hypogonadism due to the negative feedback regulation of estrogen. These hormonal changes, along with the increased oxidative stress, directly affect the functions of testes and sex, and even lead to male infertility. Clinical evidence showed worse semen parameters and higher incidence of erectile dysfunction. In the cycles of assisted reproductive technology, the dose of ovulation induction is increased in obesity females, and the live birth rate is decreased. The clinical outcomes in PCOS patients with insulin resistance are similar to the outcomes in obesity women. The lifestyle changes, medical therapy and bariatric surgery may improve the reproductive outcomes, although the evidence remains inconclusive. In this review, we discuss the association between obesity and fertility, and the effect of weight-loss interventions on reproductive potential in obesity individuals. Related Articles | Metrics

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Research Progress in the Mechanism of Mechanical Stimulation to Improve Endometrial Receptivity in Patients with Repeated Implantation Failure HOU Zhi-jin, MENG Yu-shi 2020, 39 (4):  336-340.  Abstract ( 1563 )   PDF (715KB) ( 10172 )   Endometrial receptivity, the acceptability of endometrium to embryo, is one of the key factors of successful embryo transfer. The poor endometrial receptivity is a big problem that leads to the low success rate of embryo transfer in those patients with repeated implantation failure. Recently, many experts and scholars have explored various methods to improve endometrial receptivity. A number of studies have shown that mechanical stimulation can improve endometrial receptivity in patients with repeated implantation failure and thus increase the pregnancy rate. Mechanical stimulation of endometrium is a method to induce a series of changes of endometrium in the process of self-healing by artificial injury using curette, biopsy tube or hysteroscopy before embryo transfer, by which improve the endometrial receptivity. Many scholars have studied the mechanism of improving endometrial receptivity by mechanical stimulation from different perspectives, but they have not reached a consistent understanding. In this paper, we discussed the possible mechanism of endometrial mechanical stimulation and research progress, including the changes of ion channels, gene expression, angiogenesis, inflammation and the repair of stem cells. Related Articles | Metrics

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Research Progress in Etiology of Female Genital Tract Malformation MENG Ge, DUAN Hua, MA Xiao-li 2020, 39 (4):  341-344.  Abstract ( 1509 )   PDF (534KB) ( 10214 )   The malformation of female genital tract is a common type of disease in female population, which is characterized by morphological abnormalities of reproductive system due to the developmental disorders of female genital tract during the embryonic period. Common clinical symptoms include amenorrhea, dyspareunia, infertility, recurrent abortion, dysmenorrhea, et al. The development of female genital tract is a continuous dynamic process of multifactorial, multistage and multi-gene interaction with the extremely fine temporal order and complex spatial relationships, suggesting that this developmental process is regulated by many genes and molecules, and signaling pathways. However, the exact pathogenesis of female genital tract malformation is not very clear. With the development of high-throughput gene sequencing technology and the extensive application of animal experimental models such as knockout mice in recent years, scholars at home and abroad have made great progress in the etiology of female genital malformations. In this article, we review the research progress of the etiology of female genital tract malformation. Related Articles | Metrics

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The Role of Placental Exosomes in Preeclampsia FENG Xiao-ling, GUO Lu-qin, LI Na 2020, 39 (4):  345-348.  Abstract ( 1517 )   PDF (564KB) ( 10205 )   Preeclampsia (PE) is one of the most serious complications of pregnancy, and there is no effective treatment at present. Exosomes interact with recipient cells and pass proteins, lipids and RNA to these recipient cells. Placental exosomes, as a kind of specific exosomes during pregnancy, play an important role in maintaining normal pregnancy. It is necessary to study the effect of placental exosomes and mechanism in pathological pregnancy. In this article, we review the recent PE-related literatures and summarize the possible roles of placental exosomes in normal pregnancy and the pathogenesis of PE, including the quantity and content feature of placental exosomes, the maternal immune tolerance and related pathways. It is demonstrated that placental exosomes can contribute to the pathogenesis of PE by multiple signaling pathways and immune-mediated mechanisms. The blood-borne biomarkers and microRNAs from placental exosomes could be developed as the biomarkers of PE. We discuss the possible roles of placental exosomes in the early detection and treatment of PE, in order to provide some reference for future research and treatment of PE. Related Articles | Metrics

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Research Progress in Tumor Endothelial Cell Marker 1 in Diagnosis and Treatment of Ovarian Cancer BAO Hui-jing, XU Chen 2020, 39 (4):  349-352.  Abstract ( 1496 )   PDF (542KB) ( 10162 )   Ovarian cancer is a gynecological genital malignancy, with high incidence and high mortality. Because of the concealment of ovarian cancer and the lack of effective detection methods, the patients were found in the middle and late stage of the disease. Therefore, to improve the early diagnosis of ovarian cancer can effectively improve the prognosis and survival rate of patients. Tumor endothelial marker 1 (TEM1) is a newly-found tumor specific marker of ovarian cancer. TEM1 can be expressed on the surface of ovarian cancer cells, but not expressed or lowly expressed in normal tissues, suggesting that TEM1 is a potential target for the diagnosis and treatment of ovarian cancer. The specific antibody of TEM1 combined with imaging technology and genetic engineering technology has shown the excellent anti-tumor effect on ovarian cancer. At the same time, a large number of clinical trials based on the targeted TEM1 are being in progress. In this article, we review the discovery, structure and tissue expression of TEM1, and its research progress, in the diagnosis and treatment of ovarian cancer, in order to provide new ideas for the future treatment of ovarian cancer. Related Articles | Metrics