Objective:To investigate the relationship between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours in primiparas using epidural analgesia.Methods:A retrospective study was conducted on the clinical data of pregnant women who delivered vaginally in the obstetrics department of the Affiliated Hospital of Jining Medical University from January 1, 2020, to December 31, 2020. The data included maternal age, pre-pregnancy body mass index (BMI), gravidity, gestational age at delivery, weight gain during pregnancy, common pregnancy complications (such as gestational hypertension, gestational diabetes, hypothyroidism, and pregnancy-related anemia), types of uterotonics, duration of each stage of labor, delivery outcomes, perineal conditions, postpartum hemorrhage within 2 hours, and neonatal birth length and weight. The exposure variable was the duration of the second stage of labor, and the outcome was the amount of postpartum hemorrhage within 2 hours. Potential risk factors were analyzed using univariate analysis. After adjusting for potential confounding factors, a generalized additive model was used for linear regression analysis, smooth curve fitting, and threshold effect analysis to observe the relationship between the duration of the second stage of labor and postpartum hemorrhage within 2 hours.Results:A total of 2 067 primiparas were included in the study. The mean age of the participants was 26.5±3.6 years, the median duration of the second stage of labor was 54 min (range: 35-81 min), and the median amount of postpartum hemorrhage within 2 hours was 230 ml (range: 200-300 ml). After adjusting for factors such as maternal age, pre-pregnancy BMI, gestational age at delivery, vaginal delivery, duration of the first and third stages of labor, perineal conditions, types of uterotonics used within 2 hours postpartum, and neonatal birth length and weight, a positive relationship was found between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours ( ?=0.20, 95% CI: 0.00-0.30, P<0.05). The smooth curve fitting results showed a non-linear relationship between the duration of the second stage of labor and postpartum hemorrhage within 2 hours. Threshold effect analysis indicated that the two-segment regression model (Model Ⅱ) was more suitable for fitting the correlation compared to the univariate linear regression model (Model Ⅰ), with a log-likelihood ratio test P-value of 0.001, and the inflection point was 115 min for the second stage of labor (95% CI: 99-125 min). Conclusions:In primiparas using epidural analgesia, there is a non-linear relationship and threshold effect between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours. When the second stage of labor exceeds 115 min, the extension of the second stage may increase the amount of postpartum hemorrhage within 2 hours.

[Objective] To investigate the effects of advanced male age on the incidence of polyspermy fertilization. [Methods] The study involved data of 4210 in vitro fertilization (IVF) cycles treated in our center during Jan.2016 and Sep.2022, including 4053 patients younger than 40 years and 157 patients above 40 years.After propensity score matching, 152 patients in the advance group and 421 in the young group were recruited.The baseline data and the difference in polyspermy fertilization rate were compared between the two groups. [Results] After propensity score matching, there were no significant differences between the two groups in terms of female age, infertility type, infertility years, infertility factors, female body mass index (BMI), male BMI, semen volume, semen pH value, sperm concentration, sperm motility, progressive motility rate, percentage of normal sperm morphology, number of fertilized eggs and number of MⅡ eggs (P>0.05). Among the 573 fresh IVF cycles, the rate of 3 PN cycles was 35.5%, and the incidence of polyspermy fertilization was 6.5%.There were no significant differences in the number of polyspermy fertilized eggs, transferable embryos, high-quality embryos, and blastocysts between the two groups. [Conclusion] Advanced male age has no significant effect on the incidence of polyspermy fertilization.

Due to the formation of scars in the local uterus during cesarean section, the subsequent natural pregnancy of these patients is affected and they receive assisted reproductive technology (ART) for pregnancy treatment. However, the impact of cesarean section on the pregnancy outcomes of ART is still controversial. Studies have shown that poor scar healing after cesarean section is related to changes in uterine anatomy, weakened endometrial receptivity, and imbalance in uterine microenvironment, which is not conducive to embryo implantation and increases the risk of recurrent implantation failure and recurrent miscarriage. Scar diverticulum repair is an effective method to improve the pregnancy outcomes of patients with scarred uterus. In recent years, uterine perfusion, inhibition of uterine contractions, and the application of antibiotics have also become new ideas to improve the uterine environment. Based on the relationship between cesarean section scarred uterus and subsequent fertility, this article reviews the possible mechanisms and treatment options that affect the pregnancy outcomes of ART, providing clinical evidence for daily practice.

Objective:To analyze the impact of transcervical resection of adhesion (TCRA) on obstetric complications in patients after frozen-thawed embryo transfer (FET) and its associated factors.Methods:A retrospective cohort study was conducted by collecting clinical data from patients who underwent autologous oocyte FET treatment and gave birth to at least one live newborn at the Reproductive Medicine Center of Nanjing Women and Children's Healthcare Hospital from April 2015 to May 2022. Based on the uterine condition, patients were divided into three groups: control group with normal uterine morphology (712 cases); the intrauterine adhesion (IUA) group consisting of IUA patients who did not undergo TCRA surgery (45 cases); the TCRA group, which included IUA patients who received TCRA treatment (51 cases). The relationship between uterine conditions and obstetric complications among the three groups was investigated using propensity score matching (PSM). Multivariate logistic regression analysis was applied to identify risk factors associated with obstetric complications related to TCRA. The performance of the constructed multivariate logistic regression model was evaluated using calibration curves and receiver operating characteristic (ROC) curves.Results:1) Before PSM, statistically significant differences were observed among the three groups regarding endometrial thickness, the presence of a scarred uterus, numbers of pregnancies, deliveries, miscarriages, induced abortions, and transferred embryos (all P<0.05). After PSM, baseline characteristics were balanced across the groups. The rates of placenta accreta spectrum disorders (PAS) in the TCRA group [48.8% (20/41)] and the IUA group [45.2% (19/42)] were significantly higher than those in control group [24.7% (18/73), P=0.016; 22.8% (18/79), P=0.019]. 2) Multivariable logistic regression analysis revealed that endometrial thickness ( OR=0.79, 95% CI: 0.69-0.90, P<0.001], number of pregnancies (2 times, OR=2.25, 95% CI: 1.33-3.82, P=0.003), endometrial preparation protocol (gonadotropin-releasing hormone agonist plus hormone replacement therapy, OR=2.29, 95% CI: 1.16-4.52, P=0.017), the presence of a scarred uterus ( OR=2.19, 95% CI: 1.39-3.45, P<0.001), and uterine cavity conditions (IUA and TCRA, OR=2.11, 95% CI: 1.07-4.17, P=0.031; OR=2.70, 95% CI: 1.37-5.31, P=0.004) were independent predictors of PAS occurrence. 3) The area under the ROC curve for this model was 0.732 (95% CI: 0.686-0.778). Calibration curve results, after internal validation, showed good consistency between predicted risks and actual outcomes, demonstrating good discriminative ability and calibration ( P=0.540). Conclusion:The incidence of obstetric complications such as placenta previa, postpartum hemorrhage, and premature rupture of membranes in patients who underwent TCRA surgery was comparable to that of patients with a normal uterine morphology. However, TCRA significantly increased the risk of PAS in patients with IUA undergoing FET assisted reproductive treatment.

Due to the formation of scars in the local uterus during cesarean section, the subsequent natural pregnancy of these patients is affected and they receive assisted reproductive technology (ART) for pregnancy treatment. However, the impact of cesarean section on the pregnancy outcomes of ART is still controversial. Studies have shown that poor scar healing after cesarean section is related to changes in uterine anatomy, weakened endometrial receptivity, and imbalance in uterine microenvironment, which is not conducive to embryo implantation and increases the risk of recurrent implantation failure and recurrent miscarriage. Scar diverticulum repair is an effective method to improve the pregnancy outcomes of patients with scarred uterus. In recent years, uterine perfusion, inhibition of uterine contractions, and the application of antibiotics have also become new ideas to improve the uterine environment. Based on the relationship between cesarean section scarred uterus and subsequent fertility, this article reviews the possible mechanisms and treatment options that affect the pregnancy outcomes of ART, providing clinical evidence for daily practice.

Objective:To analyze the impact of transcervical resection of adhesion (TCRA) on obstetric complications in patients after frozen-thawed embryo transfer (FET) and its associated factors.Methods:A retrospective cohort study was conducted by collecting clinical data from patients who underwent autologous oocyte FET treatment and gave birth to at least one live newborn at the Reproductive Medicine Center of Nanjing Women and Children's Healthcare Hospital from April 2015 to May 2022. Based on the uterine condition, patients were divided into three groups: control group with normal uterine morphology (712 cases); the intrauterine adhesion (IUA) group consisting of IUA patients who did not undergo TCRA surgery (45 cases); the TCRA group, which included IUA patients who received TCRA treatment (51 cases). The relationship between uterine conditions and obstetric complications among the three groups was investigated using propensity score matching (PSM). Multivariate logistic regression analysis was applied to identify risk factors associated with obstetric complications related to TCRA. The performance of the constructed multivariate logistic regression model was evaluated using calibration curves and receiver operating characteristic (ROC) curves.Results:1) Before PSM, statistically significant differences were observed among the three groups regarding endometrial thickness, the presence of a scarred uterus, numbers of pregnancies, deliveries, miscarriages, induced abortions, and transferred embryos (all P<0.05). After PSM, baseline characteristics were balanced across the groups. The rates of placenta accreta spectrum disorders (PAS) in the TCRA group [48.8% (20/41)] and the IUA group [45.2% (19/42)] were significantly higher than those in control group [24.7% (18/73), P=0.016; 22.8% (18/79), P=0.019]. 2) Multivariable logistic regression analysis revealed that endometrial thickness ( OR=0.79, 95% CI: 0.69-0.90, P<0.001], number of pregnancies (2 times, OR=2.25, 95% CI: 1.33-3.82, P=0.003), endometrial preparation protocol (gonadotropin-releasing hormone agonist plus hormone replacement therapy, OR=2.29, 95% CI: 1.16-4.52, P=0.017), the presence of a scarred uterus ( OR=2.19, 95% CI: 1.39-3.45, P<0.001), and uterine cavity conditions (IUA and TCRA, OR=2.11, 95% CI: 1.07-4.17, P=0.031; OR=2.70, 95% CI: 1.37-5.31, P=0.004) were independent predictors of PAS occurrence. 3) The area under the ROC curve for this model was 0.732 (95% CI: 0.686-0.778). Calibration curve results, after internal validation, showed good consistency between predicted risks and actual outcomes, demonstrating good discriminative ability and calibration ( P=0.540). Conclusion:The incidence of obstetric complications such as placenta previa, postpartum hemorrhage, and premature rupture of membranes in patients who underwent TCRA surgery was comparable to that of patients with a normal uterine morphology. However, TCRA significantly increased the risk of PAS in patients with IUA undergoing FET assisted reproductive treatment.

Objective:To investigate the relationship between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours in primiparas using epidural analgesia.Methods:A retrospective study was conducted on the clinical data of pregnant women who delivered vaginally in the obstetrics department of the Affiliated Hospital of Jining Medical University from January 1, 2020, to December 31, 2020. The data included maternal age, pre-pregnancy body mass index (BMI), gravidity, gestational age at delivery, weight gain during pregnancy, common pregnancy complications (such as gestational hypertension, gestational diabetes, hypothyroidism, and pregnancy-related anemia), types of uterotonics, duration of each stage of labor, delivery outcomes, perineal conditions, postpartum hemorrhage within 2 hours, and neonatal birth length and weight. The exposure variable was the duration of the second stage of labor, and the outcome was the amount of postpartum hemorrhage within 2 hours. Potential risk factors were analyzed using univariate analysis. After adjusting for potential confounding factors, a generalized additive model was used for linear regression analysis, smooth curve fitting, and threshold effect analysis to observe the relationship between the duration of the second stage of labor and postpartum hemorrhage within 2 hours.Results:A total of 2 067 primiparas were included in the study. The mean age of the participants was 26.5±3.6 years, the median duration of the second stage of labor was 54 min (range: 35-81 min), and the median amount of postpartum hemorrhage within 2 hours was 230 ml (range: 200-300 ml). After adjusting for factors such as maternal age, pre-pregnancy BMI, gestational age at delivery, vaginal delivery, duration of the first and third stages of labor, perineal conditions, types of uterotonics used within 2 hours postpartum, and neonatal birth length and weight, a positive relationship was found between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours ( ?=0.20, 95% CI: 0.00-0.30, P<0.05). The smooth curve fitting results showed a non-linear relationship between the duration of the second stage of labor and postpartum hemorrhage within 2 hours. Threshold effect analysis indicated that the two-segment regression model (Model Ⅱ) was more suitable for fitting the correlation compared to the univariate linear regression model (Model Ⅰ), with a log-likelihood ratio test P-value of 0.001, and the inflection point was 115 min for the second stage of labor (95% CI: 99-125 min). Conclusions:In primiparas using epidural analgesia, there is a non-linear relationship and threshold effect between the duration of the second stage of labor and the amount of postpartum hemorrhage within 2 hours. When the second stage of labor exceeds 115 min, the extension of the second stage may increase the amount of postpartum hemorrhage within 2 hours.

【Objective】 To observe the effects of paternal age on the pregnancy outcomes in frozen embryo transfer (FET) cycles. 【Methods】 The clinical data of two groups after propensity score matching (PSM) were retrospectively analyzed, including 738 cycles in the <40 year group and 387 cycles in the 40-60 year group. The differences in general information and pregnancy outcomes were compared between the two groups, and logistic regression analysis of pregnancy outcomes were conducted. 【Results】 There were no statistical differences in age, duration of infertility, female body mass index (BMI), infertility factors, fertilization method, endometrial preparation methods, endometrial thickness on the day of transformation, stage of embryo transfer, number of embryos transferred, and number of high-quality embryos between the two groups after PSM (P>0.05). The clinical pregnancy rate (52.2%vs. 67.2%) and live birth rate (41.1% vs. 57.2%) decreased in the 40-60 year group compared with those in the <40 year group (P<0.001), but there was no statistical difference in abortion rate (19.8% vs. 13.7%) (P>0.05). 【Conclusion】 Advanced paternal age decreases clinical pregnancy rate and live birth rate.

Objective:To evaluate the association between polycystic ovary syndrome (PCOS)-related symptom combinations and ovarian stimulation high response in infertile patients with PCOS symptoms and controlled ovarian stimulation treatment by recombinant Human Follitropin Alfa (r-hFSHα) solution for injection, and to evaluate the efficacy and safety outcomes of using the r-hFSHα prefilled injection pen in high-risk patients with ovarian hyperstimulation syndrome (OHSS).Methods:This prospective, observational, phase Ⅳ study enrolled 1055 patients with at least one symptom/sign of PCOS using the r-hFSHα prefilled pen for over 4 months follow-up observation from December 2015 to September 2017 in the Second Hospital of Hebei Medical University, Center for Reproductive Medicine, Shandong University, Tangdu Hospital of the Air Force Military Medical University, Dalian Maternity and Child Health Care Hospital, Nanjing Maternity and Child Health Care Hospital, Jiangxi Maternity and Child Health Care Hospital, the First Affiliated Hospital of Xinjiang Medical University, the First Affiliated Hospital of Anhui Medical University, the Affiliated Hospital of Inner Mongolia Medical University. The primary endpoints assessed included the development of polycystic ovaries, elevated serum testosterone levels, menstrual cycle disturbances, development of hirsutism, and completion of egg retrieval. The efficacy endpoints of the study included the number of ocoytes retrieved, the number of M Ⅱ oocyte, the biochemical pregnancy rate, the clinical pregnancy rate, and the implantation rate. Results:In the full analysis set ( n=997), polycystic ovary rate was 54.5% (543/997), serum testosterone level was (0.4±0.2) μg/L, menstrual cycle disorder rate was 45.0% (449/997), hirsutism rate was 10.5% (105/997). The average number of oocytes retrieved after ovarian stimulation was 14.4. The clinical pregnancy rate per transfer cycle was 53.6% (251/468), the live birth rate was 45.3% (212/468), the biochemical pregnancy rate was 60.9% (285/468), the implantation rate was 39.1% (349/893), and the fresh embryo transfer cancellation rate was 24.0% (239/997). OHSS incidence was diagnosed in 1.8% (19/1054) of patients (safety set, n=1054), including 8 (0.8%) mild cases, 10 (0.9%) moderate cases and 1 (0.1%) severe case. According to the results of exploratory analysis, a decrease in body mass index (BMI) was associated with an increased risk of high response. For every 1 kg/m 2 decrease in BMI, the risk of high response (number of retrieved oocytes >15) increased by approximately 9%, the risk of high response (number of retrieved oocytes >20) increased by approximately 9%. For every 1 increase in antral follicle count (AFC), the risk of high response(number of retrieved oocytes >15) increased by approximately 6% and the risk of high response (number of retrieved oocytes >20) by approximately 4%. Conclusion:Patients with at least one symptom/sign of ovarian hyperstimulation achieved good clinical outcomes with the use of the r-hFSHα prefilled pen, and high response was associated with lower BMI and AFC.

Objective:To evaluate the association between polycystic ovary syndrome (PCOS)-related symptom combinations and ovarian stimulation high response in infertile patients with PCOS symptoms and controlled ovarian stimulation treatment by recombinant Human Follitropin Alfa (r-hFSHα) solution for injection, and to evaluate the efficacy and safety outcomes of using the r-hFSHα prefilled injection pen in high-risk patients with ovarian hyperstimulation syndrome (OHSS).Methods:This prospective, observational, phase Ⅳ study enrolled 1055 patients with at least one symptom/sign of PCOS using the r-hFSHα prefilled pen for over 4 months follow-up observation from December 2015 to September 2017 in the Second Hospital of Hebei Medical University, Center for Reproductive Medicine, Shandong University, Tangdu Hospital of the Air Force Military Medical University, Dalian Maternity and Child Health Care Hospital, Nanjing Maternity and Child Health Care Hospital, Jiangxi Maternity and Child Health Care Hospital, the First Affiliated Hospital of Xinjiang Medical University, the First Affiliated Hospital of Anhui Medical University, the Affiliated Hospital of Inner Mongolia Medical University. The primary endpoints assessed included the development of polycystic ovaries, elevated serum testosterone levels, menstrual cycle disturbances, development of hirsutism, and completion of egg retrieval. The efficacy endpoints of the study included the number of ocoytes retrieved, the number of M Ⅱ oocyte, the biochemical pregnancy rate, the clinical pregnancy rate, and the implantation rate. Results:In the full analysis set ( n=997), polycystic ovary rate was 54.5% (543/997), serum testosterone level was (0.4±0.2) μg/L, menstrual cycle disorder rate was 45.0% (449/997), hirsutism rate was 10.5% (105/997). The average number of oocytes retrieved after ovarian stimulation was 14.4. The clinical pregnancy rate per transfer cycle was 53.6% (251/468), the live birth rate was 45.3% (212/468), the biochemical pregnancy rate was 60.9% (285/468), the implantation rate was 39.1% (349/893), and the fresh embryo transfer cancellation rate was 24.0% (239/997). OHSS incidence was diagnosed in 1.8% (19/1054) of patients (safety set, n=1054), including 8 (0.8%) mild cases, 10 (0.9%) moderate cases and 1 (0.1%) severe case. According to the results of exploratory analysis, a decrease in body mass index (BMI) was associated with an increased risk of high response. For every 1 kg/m 2 decrease in BMI, the risk of high response (number of retrieved oocytes >15) increased by approximately 9%, the risk of high response (number of retrieved oocytes >20) increased by approximately 9%. For every 1 increase in antral follicle count (AFC), the risk of high response(number of retrieved oocytes >15) increased by approximately 6% and the risk of high response (number of retrieved oocytes >20) by approximately 4%. Conclusion:Patients with at least one symptom/sign of ovarian hyperstimulation achieved good clinical outcomes with the use of the r-hFSHα prefilled pen, and high response was associated with lower BMI and AFC.