Supervisor: National Health Commission of the PRC
Sponsored by: Chinese Medical Doctor Association
China Medical University
Sponsored by: Chinese Medical Doctor Association
China Medical University
Maternal sepsis is one of the top three leading causes of global maternal morbidity and mortality. It is characterized by an insidious onset and rapid progression. Sepsis is fundamentally defined as life-threatening organ dysfunction caused by a dysregulated host response to infection， and its pathophysiological progression encompasses sequential cascade reactions ranging from loss of control of localized infection， a systemic inflammatory cytokine storm and immune suppression to endothelial glycocalyx degradation， microvascular thrombosis and shock. To accommodate fetal growth and parturition， the maternal body undergoes profound physiological remodeling across the immune， cardiovascular， coagulation， respiratory， and urinary systems. When sepsis occurs， pregnancy-specific Th2-biased immune tolerance，hyperdynamic and low-resistance circulation，and a physiological hypercoagulable state may mask the early clinical warning signs of septic shock， significantly increasing the difficulty in diagnosis， precise treatment， and bundle management. This article aims to elucidate the pathophysiological mechanisms of sepsis and elaborate on the unique evolution processes of maternal vasodilation， increased vascular permeability， coagulation disorders， and multiorgan hypoperfusion. The ultimate objective is to lay a solid pathophysiological theoretical foundation for understanding the severity and treatment complexity of maternal sepsis.
Maternal sepsis is a major cause of maternal mortality and poses a serious threat to the safety of both mother and baby. In the vast majority of cases， early identification and intervention can improve outcomes and even prevent death. The physiological changes during pregnancy and the postpartum period may overlap with some of the clinical manifestations of sepsis， presenting challenges for its early identification. This article systematically reviews the common pathogens， sites of infection，high-risk factors and various early warning scoring systems associated with maternal sepsis， with the aim of enhancing the understanding and early recognition of the maternal sepsis.
Emergency cervical cerclage is an invasive surgical procedure for rescue， where pre-existing occult amniotic cavity inflammation/infection serves as a significant risk factor for postoperative sepsis. Established amniotic cavity infections，suspected amniotic cavity inflammation/infection； cervical dilation exceeding 4 cm， and fetal membrane protrusion into the vagina can increase the risk of postoperative sepsis and warrant close attention. Standardized preoperative evaluation， intraoperative procedures， and postoperative monitoring protocols can reduce the incidence of postoperative sepsis. Enhanced vigilance for sepsis， early identification based on clinical manifestations and laboratory characteristics， rational use of broad-spectrum antibiotics， and timely interventions such as pregnancy termination when indicated are critical measures for preventing sepsis following emergency cerclage.
Sepsis is a significant cause of maternal mortality， yet its early identification still poses a significant challenge，and one of the primary reasons lies in the physiological changes during pregnancy and puerperium， which can cover and interfere with the clinical manifestations and laboratory indicators of sepsis. This article systematically reviews the clinical and laboratory characteristics of maternal sepsis that differ from those in the non-pregnant population， with a particular focus on the important value of early and dynamic alterations in coagulation function as a critical window for early warning of sepsis， aiming to enhance early clinical recognition and timely intervention and reduce maternal mortality and adverse perinatal outcomes.
Maternal sepsis is a severe infectious condition occurring during pregnancy and the puerperium that poses a significant threat to both maternal and fetal health. Globally， it remains one of the leading causes of maternal mortality. The unique physiological changes associated with pregnancy may obscure the early manifestations of sepsis， thereby contributing to delayed clinical diagnosis and untimely intervention.Bundle management， which integrates a series of evidence-based standardized interventions， provides a systematic framework for the standardized diagnosis and treatment of obstetric sepsis. Upon early identification of sepsis， the bundle management of obstetric sepsis should be initiated promptly. This includes the measures concerning lactate measurement， microbiological cultures， administration of broad-spectrum antibiotics， fluid resuscitation， and the use of vasopressors， with careful consideration of obstetric-specific adaptations. Particular emphasis should be placed on the timeliness of antibiotic therapy and adherence to the principle of de-escalation. Sepsis itself is not an indication for termination of pregnancy; in most cases， pregnancy can be safely continued once the underlying cause of infection is identified and appropriately managed.
Maternal sepsis， defined as infection-induced organ dysfunction occurring during pregnancy， childbirth， and the postpartum period， is a major cause of adverse pregnancy outcomes such as maternal mortality. Due to physiological， anatomical，and immunological changes associated with pregnancy， early recognition and treatment of sepsis present significant challenges. Management should follow a multidisciplinary collaboration and bundle strategy，with emphasis on early intervention. While administering etiological treatment，equal importance should be placed on supportive therapy to provide comprehensive support for damaged organs until the infection is controlled and immune homeostasis is restored. The management of maternal sepsis should be based on guidelines for the non-pregnant population， but must be combined with the pathophysiological characteristics of pregnancy in order to implement refined， dynamic， and individualized organ support treatment.
Pregnancy-associated sepsis is one of the serious complications of pregnancy； the timing and method of terminating the pregnancy have a direct impact on maternal and fetal outcomes，yet there remains considerable variation in clinical decision-making. This article reviews obstetric management strategies for pregnancy-associated sepsis， drawing on recent domestic and international guidelines and research advances. By integrating methods for assessing the severity of maternal condition and fetal viability，it clarifies the timing and methods of pregnancy termination for pregnancy-associated sepsis of different etiologies. Furthermore， it explores the decision-making criteria，timing，and key aspects of perioperative management of surgical interventions such as dilation and curettage， caesarean section， and hysterectomy. Overall， decisions regarding the termination of pregnancy in cases of pregnancy associated sepsis should be based on a dynamic assessment of the severity of the mother’s condition and the viability of the fetus， and individualized management should be implemented within a multidisciplinary framework to maximize the safety of both mother and baby.
Maternal sepsis has a insidious onset and progresses rapidly， and delayed recognition， delayed empirical antimicrobial therapy， delayed initiation of referral， and delayed inter-hospital handover in the primary hospitals may increase the risk of adverse maternal and fetal outcomes. Based on county-level practice and experience in managing critically ill obstetric patients， this article outlines a management pathway covering initial recognition， diagnostic assessment， early treatment， referral/transfer preparation， and inter-hospital handover. It emphasizes chief complaints and the present disease history and systematic assessment of vital signs and organ perfusion； prompt completion of key testing （including infection-related indexes， blood gas analysis and lactate detection） should be done with repeated measurement and reassessment； initiate empirical antibiotic therapy as soon as possible based on oxygenation and hemodynamic support and implement anti-shock and organ function support； clarify stratified referral indications and standardize pre-referral preparation and in-transfer care； increase efficacy of continuity of care through standardized structured handover and referral process. The aim is to provide referrences for the primary hospitals to establish a practical workflow of emergency management and referral of maternal sepsis， in order to reduce management delays and improve maternal and fetal outcomes.
Objective To investigate the predictive value of the CA125 elimination rate constant K（KELIM）for chemotherapy sensitivity and its clinical significance in prognostic assessment among patients with recurrent ovarian cancer（ROC）receiving standard treatment. Methods A retrospective analysis was conducted on the clinical data of 311 patients with advanced epithelial ovarian carcinoma admitted to the First Affiliated Hospital of Chongqing Medical University between January 2015 and December 2022，including 121 patients in the recurrence cohort. The optimal cut-off value of KELIM for predicting chemotherapy sensitivity was determined using the receiver operating characteristic（ROC）curve. Patients were divided into favorable and unfavorable KELIM groups. The platinum-free interval（PFI），progression-free survival（PFS），and overall survival（OS）were compared between the two groups. Independent prognostic factors were identified using the Cox regression model. Results In the recurrence cohort，the area under the ROC curve（AUC）of KELIM for predicting chemotherapy sensitivity was 0.696（P<0.001），with an optimal cut-off value of 0.82. The median PFI was significantly longer in the favorable KELIM group than in the unfavorable group（9.4 months vs. 5.0 months，P<0.001）. Both median PFS（13.4 months vs. 10.7 months，P=0.006）and median OS（77.3 months vs. 50.6 months，P<0.001）were higher in the favorable KELIM group than in the unfavorable KELIM group. Multivariate analysis confirmed that a KELIM≥0.82 was an independent predictive factor for OS. Conclusion In the population with recurrent ovarian cancer，KELIM serves as an effective indicator for predicting chemotherapy sensitivity and assessing prognosis，potentially aiding in the early identification of platinum-resistant patients.
Objective To investigate the species and distribution of vaginal Lactobacillus in women of childbearing age， analyze the correlation between vaginal Lactobacillus and vaginal microecology， and provide a theoretical basis for the microecological therapy of vaginal infectious diseases. Methods From September to December 2021， a total of 114 women aged 19-54 years who attended the Gynecology Clinic of Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University were enrolled. All participants underwent vaginal microecological testing and Lactobacillus identification. Results （1）Vaginal Lactobacillus identification showed that a total of 8 strains were detected， among which Lactobacillus crispatus （18.4%） and Lactobacillus jensenii （14.9%） were the dominant strains. （2）Lactobacillus was isolated from 67.1% of the subjects in the normal vaginal microecology group， while the detection rate of Lactobacillus in the abnormal microecology group was only 24.4% （P<0.001）. The dominant strains in the normal microecology group were mainly Lactobacillus crispatus （28.8%） and Lactobacillus jensenii （19.2%）； in the abnormal microecology group， the dominant strains were Lactobacillus jensenii， Lactobacillus gasseri and Lactobacillus fermentum， each accounting for 7.3%. （3）Among the vaginal microecological indicators， pH value， bacterial density， Lactobacillus grade and hydrogen peroxide were found to be correlated with the detection of Lactobacillus （P<0.05）. Conclusions The normal vaginal microecology of women of childbearing age is mainly dominated by Lactobacillus crispatus and Lactobacillus jensenii. Abnormal vaginal microecology is associated with vaginal Lactobacillus status.
Objective To investigate the clinical characteristics of different types of Caesarean scar pregnancy （CSP）， compare the efficacy of corresponding surgical treatment approaches， and assess the impact of various treatments on subsequent pregnancy outcomes. Methods A total of 943 CSP patients undergoing surgery at Shengjing Hospital of CMU from Jan. 1，2016 to Dec. 31， 2022 were included and their clinical data were retrospectively analyzed. Patients were classified by 2016 CMA criteria into types Ⅰ， Ⅱand Ⅲ (mass/non-mass). Clinical differences， surgical outcomes， and risk factors for intraoperative bleeding were compared among the groups. Follow-up was used to assess the subsequent pregnancy outcomes. Statistical methods were adopted to describe the differences in clinical variables. Results Among the 943 CSP patients， typeⅠaccounted for 38.5% (363 cases)， typeⅡ41.1% (387 cases)， non-mass type Ⅲ 13.1% (124 cases)， and mass typeⅢ 7.3% (69 cases). Significant differences were observed in amenorrhea duration and maximum gestational sac diameter among different types. There were differences in intraoperative blood loss and hospitalization costs among different surgical approaches， with a high overall success rate. In non-mass typeⅢpatients， amenorrhea duration was an independent influencing factor for the change from TCR ± suction curettage to other surgical approaches， while the largest gestational sac diameter was a risk factor for increased blood loss during surgery. Follow-up of 78 patients with subsequent pregnancies revealed 22 cases of CSP. Intraoperative repair of scar myometrium was associated with subsequent pregnancy outcomes， and those without repair had a higher risk. Conclusions TCR ± suction curettage is suitable for type I and typeⅡCSP；for non-mass typeⅢCSP， surgical approach should be chosen with caution.IntIraoperative repair of scar myometrium helps to improve subsequent pregnancy outcomes.
Objective To summarize and analyze clinical features， management， and outcomes of patients with adnexal torsion during pregnancy. Methods Retrospective analysis was conducted regarding the clinical data of 29 patients with adnexal torsion who were surgically confirmed at Beijing Chaoyang Hospital （March 2012-July 2024）. Results Median age was 29 years （22-36）， median gestational age at onset was 14 weeks （6-38）， and the pregnancy trimesters were as follows： first 51.7%， second 24.1%， third 24.1%. The main symptoms included sudden abdominal pain （100.0%） and pelvic mass （86.2%）， often accompanied by nausea （75.9%） and/or vomiting （55.2%）. Laparoscopy accounted for 34.5% and laparotomy 65.5%. Conservative procedures （ovarian cyst enucleation， adnexal detorsion） accounted for 65.5% and adnexectomy 34.5%. There was no postoperative thrombosis or recurrence. There were 11 cases of full-term delivery， 3 abortions and 1 embryonic arrest at first trimester， 6 full-term and 1 preterm （14.3%） at second trimester， and 2 full-term and 5 preterm （71.4%） at third trimester. Conclusions Adnexal torsion during pregnancy mainly occurs in early-to-mid pregnancy， with sudden pain and nausea/vomiting as the typical symptoms， which requires prompt surgery. Conservative surgery is safe and ovary should be preserved as much as possible. Preterm risk is highest in third trimester.
