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
Auxiliary testing for spontaneous abortion primarily includes assessment of the status of the current pregnancy and maternal safety，as well as etiological evaluation based on the number and gestational age of previous pregnancy losses and the patient’s clinical characteristics，thereby providing a basis for the management of subsequent pregnancies. In early spontaneous abortion，transvaginal ultrasonography should be the principal diagnostic modality. When necessary，dynamic changes in serum β-human chorionic gonadotropin and clinical findings should be incorporated to determine the location of the pregnancy，embryonic viability，and the number of gestational sacs. In late spontaneous abortion，in addition to assessing fetal viability，particular attention should be paid to the cervix，fetal membranes，placenta，fetal growth and development，and maternal complications. A single spontaneous abortion in the absence of specific high-risk factors generally does not warrant comprehensive etiological investigation. By contrast，patients with recurrent spontaneous abortion should undergo stratified evaluation based on their reproductive history and clinical phenotype，with attention paid to genetic factors，uterine and intrauterine structure，antiphospholipid syndrome and coagulation-related factors，endocrine and metabolic disorders，autoimmune diseases，infection-related factors，and male-related factors. Excessive testing remains common in the clinical management of spontaneous abortion at present， and may lead to overinterpretation of abnormal findings，treatment without an adequate evidence base，and increased psychological and financial burdens on patients. Auxiliary testing for spontaneous abortion should therefore be guided by evidence-based medicine，with consideration given to the reliability of the testing method，the target population，the influence of the findings on clinical decision-making，and whether the corresponding intervention can improve pregnancy outcomes. Clinical practice should shift from indiscriminate comprehensive screening to targeted，stratified evaluation，thereby reducing unnecessary testing and interventions.
Spontaneous abortion is a common pregnancy complication among women of childbearing age，which not only seriously impairs women's reproductive health，but also imposes heavy psychological and economic burdens. At present，chaos such as non-targeted laboratory tests，unclear medication indications，and overuse of combined multiple medications commonly exist in the diagnosis and treatment of threatened abortion and recurrent spontaneous abortion in various medical institutions all over China，especially the overuse of progesterone-based drugs and low molecular weight heparin. The clinical manifestations and underlying causes of the abuse of hormones and anticoagulants against the background of the current clinical reality in the treatment of threatened abortion are analyzed in this article， and the expert consensuses and clinical diagnosis and treatment guidelines for spontaneous abortion in China and abroad in recent years are sorted out. The standardized diagnosis and treatment regimens for spontaneous abortion are systematically summarized based on evidence-based medicine and clinical practice in order to standardize clinical diagnosis and treatment behaviors， curb excessive pregnancy preservation and overtreatment， and provide references for clinical practice.
Threatened preterm labor constitutes a large proportion of obstetric emergency and inpatient admissions. However，clinical practice is plagued by widespread excessive and non-standardized diagnosis and treatment due to loose diagnostic criteria and a lack of objective assessment tools. This not only imposes heavy economic burdens on the patients but also leads to iatrogenic maternal-fetal injuries. Integrating the latest guidelines and expert experiences，this review systematically sorts out the clinical misconceptions of non-standard management across five key dimensions：（1） non-standard diagnosis；（2） non-standard use of tocolytics；（3） misuse or abuse of adjuvant therapies；（4） misconception in nonpharmacological interventions；（5） deficiencies in doctor-patient communication. In the future， the management of threatened preterm labor must abandon obsolete dogmas， and establish standardized regimens of objective screening and enhanced multidisciplinary collaboration.
Cervical insufficiency is a major cause of second-trimester miscarriage and early preterm birth，and cervical cerclage is currently a surgical intervention proven to be effective. In recent years，with the widespread adoption of transvaginal ultrasound cervical length measurement and increased clinical awareness，the use of cervical cerclage has shown a tendency toward broadening indications and arbitrary selection of surgical techniques，making standardization of the entire clinical process an urgent issue in obstetrics. Based on the latest national and international guidelines，expert consensus，and evidence-based data，this article systematically elaborates on the key points of standardized implementation of cervical cerclage，focusing on critical aspects such as identification of high-risk factors， screening and diagnosis，stratification of surgical indications，timing of surgery，choice of surgical technique and suture material，perioperative management，management of special populations，and suture removal and follow-up. It emphasizes the establishment of a stratified indication system grounded in evidence grading，aiming to advance the construction of a standardized diagnosis and treatment protocol for cervical insufficiency that adheres to the principle of “cerclage only when indicated，and standardized whenever performed”.
Preeclampsia（PE）is a severe pregnancy-specific complication with complex pathological mechanisms，and no etiological treatment is currently available. Therefore，standardized screening and precision prevention are critical to improving maternal and neonatal outcomes. However，in clinical practice，standardization is frequently misinterpreted as comprehensiveness，leading to overtreatment of costly testing in low-risk populations and overuse of drugs that increase risks and strain healthcare resources.This article integrates domestic and international guidelines and evidence-based data to review a standardized screening pathway and stratified prevention strategy，emphasizing that the cornerstone of precise prevention and control of PE lies in strictly defining intervention boundaries and avoiding overscreening and unnecessary prevention without clear indications，thus ensuring that medical resources are genuinely directed toward high-risk populations.
Fetal growth restriction （FGR） is a major clinical concern in perinatal medicine，closely related to intrauterine fetal death，neonatal asphyxia，hypoglycemia，neonatal necrotizing enterocolitis，and long-term metabolic and neurodevelopmental abnormalities. With the widespread adoption of prenatal ultrasound and perinatal surveillance，the antenatal detection rate of FGR has steadily improved. Nevertheless，two opposing extremes-overtreatment and undertreatment-persist in clinical practice. On one hand，a proportion of constitutionally small but healthy fetuses are simplistically equated with FGR，resulting in overdiagnosis followed by high-frequency monitoring，hospital admission for observation，iatrogenic preterm birth，and even unnecessary cesarean section. On the other hand，some truly high-risk FGR cases，especially early-onset severe FGR，those accompanied by abnormal blood fow，or late-onset occult FGR，may fail to receive timely and appropriate management because of inadequate dynamic assessment，nonstandardized ultrasound surveillance，delayed referral，or insufficient perinatal preparation. The core of FGR management is not simply to detect all fetuses below the 10th percentile，but to identify those at high risk due to genuine placental insufficiency，fetal hypoxia，or progressive growth impairment，and to strike a balance between the risk of intrauterine fetal death and the harms associated with preterm birth. This commentary discusses the overtreatment and undertreatment in FGR diagnosis and management，and proposes the establishment of a continuous，stratified，and interpretable precision management system based on accurate gestational age dating，standardized ultrasound measurements，appropriate growth chart selection，dynamic growth velocity assessment，Doppler blood flow evaluation，and comprehensive maternal-fetal etiological investigation，thus shifting FGR management from a "single-threshold-driven" approach to a "risk-evidence-driven" paradigm.
Thrombophilia serves as a critical pathological basis for multiple adverse pregnancy outcomes，including venous thromboembolism （VTE） in pregnancy，recurrent spontaneous abortion，preeclampsia，and fetal growth restriction. Auxiliary examinations represent the core modality for identifying thrombophilic states and guiding clinical interventions. Nevertheless，thrombophilia-related testing in current clinical practice is plagued by extensive over-indication，excessive selection of test panels，and biased interpretation of laboratory results. These issues not only waste medical resources but also predispose patients to overdiagnosis and overtreatment，increasing pregnancy-related risks and imposing psychological burden on pregnant women. This article sorts out the stratified framework and applicable indications of standardized auxiliary testing for obstetric thrombophilia，clarifies the criteria defining excessive testing alongside prevalent clinical misconceptions，analyzes the multifaceted hazards stemming from redundant examinations，and proposes a rational testing approach based on risk stratification，so as to provide references for standardized diagnosis and management of obstetric thrombophilia.
Aspirin， the main drug used to prevent platelet aggregation， and low-molecular-weight heparin （LMWH）， the main anticoagulant， have been widely used in pregnant and postpartum women. Through population screening， aspirin is used to prevent preeclampsia in high-risk groups， while LMWH is used to prevent thromboembolism in high-risk groups. In addition， combining aspirin with LMWH in patients with autoimmune diseases like antiphospholipid syndrome or systemic lupus erythematosus can reduce adverse pregnancy outcomes. Whether using aspirin and LMWH during pregnancy increases the risk of obstetric bleeding is still worth paying attention to.
Prenatal genetic diagnostic technologies have now formed a system consisting of karyotyping，fluorescence in situ hybridization （FISH），chromosomal microarray analysis （CMA） and copy number variation sequencing （CNV-seq）， as well as whole exome sequencing （WES），whole genome sequencing （WGS） and optical genome mapping （OGM）. Each technology differs in its diagnostic target and intrinsic blind spots，and a higher resolution does not translate into a proportional increase in clinical diagnostic value. Currently， there are such issues as indication creep，technology escalation beyond the evidence-supported tier，bundled ordering of multiple tests and excessive reporting of variants of uncertain significance （VUS） in prenatal diagnostic practice in China. This article systematically reviews the diagnostic targets，effectiveness and limitations of the available prenatal genetic detection technologies，analyzes the main manifestations and costs of overuse，proposes a selection principle centred on phenotype-driven，indication-stratified and tier-matched testing，and puts forward recommendations for standardizing pre- and post-testing genetic counselling，with the aim of providing a reference for the standardized clinical application of prenatal genetic diagnostic technologies.
Objective To investigate the clinicopathological features and short-term outcomes of invasive stratified mucin-producing carcinoma （ISMC） of the cervix，and to compare the clinicopathological characteristics between pure adenocarcinoma-type ISMC and mixed non-glandular-type ISMC. Methods A retrospective analysis was conducted on 62 patients with ISMC treated at Peking Union Medical College Hospital，Chinese Academy of Medical Sciences between January 1，2018 and December 31，2025. Among them，53 patients were included in the treatment and outcome analysis cohort. Results The median age was 44.5 years （range：25-64 years）. High-risk human papillomavirus （HPV） was detected in 96.4% （53/55） of tested patients，with HPV 16/18 being the predominant subtypes （87.3%，48/55）. According to the 2018 FIGO staging system，66.1% （41/62） of patients had stage Ⅰ disease，while 21.0% （13/62） had stage Ⅲ or higher disease. Based on the presence of malignant components other than adenocarcinoma，40 cases （64.5%） were classified as pure adenocarcinoma type and 22 cases （35.5%） as mixed non-glandular type. Among evaluable cases，the positive rate of lymphovascular space invasion （LVSI） was 48.0% （24/50），and pelvic lymph node metastasis was found in 20.0% （10/50） of surgically treated patients. In the treatment and outcome cohort，the median follow-up was 13.0 months （range：2.2-65.9 months），and the recurrence rate was 11.3% （6/53）.The mixed non-glandular type was more frequently associated with FIGO stage ⅡB or higher （45.5% vs. 17.5%，P=0.018）. Among evaluable cases，the LVSI-positive rate increased significantly in the mixed non-glandular type （80.0% vs. 34.3%，P=0.003）. Conclusions ISMC is closely associated with high-risk HPV infection，and both LVSI and lymph node metastasis are not uncommon. The mixed non-glandular type is associated with more advanced stage and a higher LVSI-positive rate. Its impact on prognosis requires further validation through longer follow-up and multicenter studies.
Objective To explore the predictive value of five machine learning models based on clinical characteristics and integrated inflammatory biomarkers for preterm birth，and to compare the predictive performance of different models in order to provide evidence for their clinical application. Methods A retrospective cohort study was conducted，including 1335 pregnant women who delivered in the Department of Obstetrics and Gynecology at the Fifth Affiliated Hospital of Sun Yat-sen University between January 1， 2022， and December 31， 2022，with all types of preterm birth included （spontaneous preterm birth and indicated preterm birth）. Totally 20 clinical characteristics，10 laboratory testing indexes，and 4 integrated inflammatory biomarkers（Neutrophil-to-Lymphocyte Ratio，Platelet-to-Lymphocyte Ratio，Aggregate Index of Systemic Inflammation，and Albumin-to-Lymphocyte Ratio）we screened out via literature review and clinical observation，and five machine learning models（Random Forest，XGBoost，Support Vector Machine，Lasso Regression，and Logistic Regression）were constructed. Hyperparameters were optimized via repeated 5-fold cross-validation，and the models were evaluated from 3 dimensions of discrimination，calibration，and clinical utility. Results The discrimination among the five models，the XGBoost model achieved the highest AUC（0.763），significantly higher than that of Logistic Regression（AUC=0.683）（P<0.05），followed by Random Forest（AUC=0.730），Support Vector Machine（AUC=0.707），and Lasso Regression（AUC=0.696）. In terms of calibration，the XGBoost model had the lowest Brier score（0.182），indicating the best calibration performance. Decision curve analysis showed that the XGBoost model had the highest standardized net benefit around the 20% risk threshold，indicating significant clinical value in practice.After adding integrated inflammatory biomarkers，the AUC of the model decreased from 0.763 to 0.730（ΔAUC=-0.034，P=0.0033），which did not improve predictive performance of the model. Conclusions All five machine learning models constructed in this study can be applied to preterm birth risk prediction， among which the XGBoost model demonstrates the best performance across the three dimensions of discrimination， calibration， and clinical utility. Owing to its extremely high specificity （97.2%）， it can serve as a tool for secondary confirmation and refined risk stratification in high-risk populations， rather than as a first-line universal screening tool. Integrated inflammatory biomarkers failed to provide incremental predictive value in the population included in this study.
