Objective To explore the association between levels of peripheral blood systemic im-mune-inflammatory indicators in early pregnancy and the risk of gestational diabetes mellitus(GDM).Methods A total of 348 pregnant women in early pregnancy who underwent regular prenatal exami-nations and established medical records were enrolled as subjects.According to whether they devel-oped GDM,the participants were divided into GDM group(n=76)and non-GDM group(n=272).General characteristics,glycemic parameters and peripheral blood systemic immune-inflammatory in-dices were compared between two groups.The predictive value of peripheral blood systemic immune-inflammatory indicators for GDM was analyzed using receiver operating characteristic(ROC)curves and binary Logistic regression analysis.Results Among 348 pregnant women in early pregnancy,76 were diagnosed with GDM,with an incidence rate of 21.84％.The gestational weight gain,hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),fasting insulin(FINS)and homeostasis model assessment-insulin resistance(HOMA-IR)were significantly higher in the GDM group than those in the non-GDM group(P＜0.05).The monocyte-to-lymphocyte ratio(MLR),systemic im-mune-inflammation index(SII),systemic inflammation response index(SIRI)and C-reactive protein(CRP)levels were sig-nificantly elevated in the GDM group compared with the non-GDM group(P＜0.05).Increased levels of MLR,SII,SIRI,aggregate index of systemic inflammation(AISI)and CRP were all inde-pendent risk factors for GDM in early pregnancy(P＜0.05).The areas under the curve(AUC)of MLR,SII,SIRI,AISI and CRP levels alone and their combination for detecting the risk of GDM in the first trimester of pregnancy were 0.918,0.932,0.700,0.918,0.767 and 0.995,respective-ly.The combined detection of each index had the highest predictive value.Conclusion The ele-vated levels of MLR,SII,SIRI,AISI and CRP in peripheral blood during the first trimester of preg-nancy are associated with an increased risk of GDM,and the combined detection of the above indi-cators has higher predictive value for the occurrence of GDM.

Objective:To compare surgical methods and clinical efficacy among different types of cesarean scar pregnancy (CSP).Methods:A total of 158 patients with CSP who received treatment in Yuncheng Central Hospital from January 2016 to June 2019 were included in this study. According to Expert Consensus on Diagnosis and Treatment of Cesarean Scar Pregnancy (2016 version), type I CSP was found in 55 patients, type II in 86 patients and type III in 17 patients. These patients were divided into groups A (ultrasound-guided suction curettage), B (uterine artery chemoembolization + ultrasound-guided suction curettage) and C (laparoscopic scar pregnancy lesion resection + scar repair) according to different surgical methods. The amount of intraoperative blood loss, the difference in human chorionic gonadotropin (HCG) level between before and after surgery, the time to postoperative HCG level returning to normal level, menstruation recovery, and re-pregnancy were compared between groups.Results:The amount of intraoperative blood loss in the groups A, B and C was (43.33 ± 72.31) mL, (34.41 ± 17.16) mL, (65.71 ± 70.52) mL, respectively. There was significant difference between groups ( F = 8.51, P = 0.014]. The difference in HCG level between before and after surgery in groups A, B and C was (0.64 ± 0.18), (0.79 ± 0.10), (0.76 ± 0.19), respectively. There was significant difference in the difference in HCG level between groups ( F = 19.21, P < 0.001). There was significant difference in the incidence of postoperative menstrual volume reduction between group B and the other two groups ( χ2 = 6.73, P = 0.003). After surgery, intrauterine pregnancy occurred in 12 patients, including 8 patients in group A (type I CSP in 2 patients, type II CSP in 3 patients, type III CSP in 3 patients), 4 patients in group B (type I CSP in 3 patients, type II CSP in 1 patient). Finally, full-term fetus delivery by cesarean section was performed in 6 patients (4 patients in group A and 2 patients in group B). Conclusion:Uterine artery chemoembolization combined with uterine curettage had less blood loss, during surgery and leads to an obvious decrease in HCG level, but it can result in reduction of menstrual volume. Ultrasound-guided suction curettage is preferred for type I and type II CSP. Balloon compression can be used to stop bleeding if massive bleeding occurs. Laparoscopic scar pregnancy lesion resection plus scar repair is recommended for type III CSP.