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    • Guidelines for Scientific Decision-Making in Labor and Delivery: Analysis of Biomechanical and Clinical Variables Affecting Conduct of Labor and Delivery

    2025-03-19

    　　The decision on the mode of delivery is one of the most complex and dynamic assessment processes in obstetrics. In this article, we systematically analyze the scientific mechanisms affecting the success rate of vaginal delivery from three dimensions: biomechanics, clinical variables and uncontrollable factors, and establish a risk prediction model. 　　I. Biomechanical optimization path of vaginal delivery　　1. Golden ratio between fetal weight and maternal pelvis　　Ideal fetal weight should be controlled in the range of 2800-3300 grams (corresponding to a biparietal diameter of 8.5-9.5 cm). The risk of cephalopelvic disproportion (CPD) rises by 12% for every 100 gram increase in weight. For pregnant women of different body types:　　Dwarf body type (height 150cm³ increases the success rate of vaginal delivery to 85%.　　3. Optimization of labor dynamics　　Efficacy of uterine contractions: contraction pressure should reach 50-60 mmHg, frequency 3-5 times/10 minutes (contraction curve score ≥200 Montevideo units)　　Abdominal muscle synergy training: daily modified crunches (30° inclination, 10 repetitions per set) from 28 weeks of gestation onwards, to improve the efficiency of intra-abdominal pressure generation by 40%　　Pelvic floor muscle elasticity remodeling: Kegel exercises combined with biofeedback therapy resulted in class II muscle fiber contraction duration of ≥6 seconds　　II. Risk stratification management of uncontrollable variables　　1. Fetal position dynamic monitoring technology　　The rate of sustained cephalic position after 35 weeks of gestation is only 78%, of which:　　Occipital anterior (OA): 92% success rate of natural rotation　　Occipital Transverse (OT): 65% success rate of hand rotation of the fetal position　　Occipital Posterior (OP): persistent OP position leads to a 3-fold increased risk of prolongation of the second stage of labor　　Magnetic resonance diffusion tensor imaging (DTI) can be used to predict the stability of the fetal position up to 6 weeks in advance.　　2. Early warning system for umbilical cord mechanical parameters　　Umbilical cord effective length 7.15　　IV. Intelligent support system for modern obstetrics　　1. Artificial intelligence prediction…

    In-depth analysis of embryonic sterilizations in surrogate mothers: a scientific perspective from mechanism to management

    2025-03-19

    　 In the fertility journey of surrogate mothers, embryonic abruption is like an unexpected barrier. Statistics show that globally, about 15-20% of clinical pregnancies end in embryonic arrest, with the risk being as high as 50% in women over 40 years of age. This phenomenon not only involves biological mechanisms, but also is closely related to lifestyle, environmental exposure and medical interventions. This article will systematically dismantle the complex causes of embryonic arrest and provide coping strategies guided by evidence-based medicine.　　I. Biological nature of embryonic arrest in surrogate mothers　　Embryonic arrest in surrogate mothers is medically referred to as an “induced abortion”, meaning that the embryo or fetus stops developing in the uterus but is not expelled naturally. Diagnosis is made by continuous ultrasound monitoring:　　Stagnation of the gestational sac: absence of yolk sac structure even though the sac is more than 25 millimeters in diameter.　　Absence of fetal buds/heart: absence of fetal heartbeat in the presence of a bud ≥ 7 mm in length or disappearance of the previously detected fetal heart.　　Time window verification: at least 7 days between retests to confirm developmental arrest　　This process is often accompanied by the sudden resolution of pregnancy symptoms (e.g., nausea, breast tenderness), but about 30% of patients do not have any obvious physical sensation, highlighting the importance of regular obstetric examination.　　Three-dimensional analysis of the causes of infertility cessation　　1. Genetic defects: fundamental errors in the blueprint of life　　About 60% of embryonic sterilizations are caused by chromosomal abnormalities. Among them:　　Autosomal trisomies predominate, such as trisomy 16 (leading to 22% of early miscarriages)　　Monosomy X syndrome (Turner syndrome) accounts for 15% of cases, with embryos mostly surviving until about 9 weeks　　The risk of chromosomal abnormalities in the offspring spikes to 30% when parents carry a balanced translocation in a recessive manner　　Sperm DNA Fragmentation Index (DFI) above 30% or mitochondrial…

    Why do IVF treatments require large amounts of luteal support medications?

    2025-03-18

    　　In assisted reproduction treatments, patients undergoing in vitro fertilization (IVF) often wonder why they need to take or inject large amounts of luteal support medications after embryo transfer when they have already endured frequent injections during the ovulation induction phase. Can these medications be reduced in dosage?　　The answer is very clear: they cannot be omitted! Luteal support is the cornerstone of successful pregnancy in IVF.　　I. Scientific Background of Luteal Function Defects　　In natural pregnancy, progesterone secreted by the corpus luteum is essential for maintaining endometrial tolerance. However, luteal phase deficiency (LPD) is present in more than 80% of patients undergoing IVF treatment, and the main causes include:　　Physiologic disturbances in multiple follicular development　　While only 1-2 follicles develop in a natural cycle, IVF ovulation stimulates the growth of multiple follicles simultaneously. When estrogen levels exceed 2,000 pg/mL (about 10 times that of a natural cycle), it inhibits the hypothalamic-pituitary axis through negative feedback, resulting in a shortened luteal phase to 9-11 days (normal is 14 days).　　After-effects of gonadotropin-releasing hormone agonists (GnRH-a)　　Recovery of pituitary function after the use of down-regulating drugs such as leuprolide takes 4-6 weeks. Studies have shown a 60% reduction in the amplitude of pulsatile LH secretion within 7 days of GnRH-a withdrawal, which directly affects the ability of luteal cells to synthesize progesterone.　　Mechanical injury during egg retrieval procedure　　During follicular aspiration, approximately 35% of the granulosa cells are lost with the follicular fluid. These cells should have differentiated into luteal cells, and their absence leads to a 40%-50% reduction in progesterone secretion.　　II. Pharmacologic panorama of luteal support　　Luteal support regimens currently in clinical use include four major categories:　　Natural progesterone preparations　　Intramuscular injections (oils): bioavailability >95%, but the incidence of pain at the injection site is as high as 67%, and aseptic nodules occur in about 5% of patients　　Vaginal gels (e.g., Crinone 8%): uterine…

    International consensus on perioperative management of testicular microtesticular sperm extraction (micro-TESE)

    2025-03-18

    　　I. Background and clinical significance　　Non-obstructive azoospermia (NOA) is the most serious type of male infertility. Microtesticular sperm extraction (micro-TESE) has been widely used worldwide as the primary means of obtaining sperm in patients with NOA. Its perioperative management covers key aspects such as patient education, endocrine evaluation, microsurgical operation, enhanced recovery after surgery (ERAS), testicular sperm freezing and thawing technique, and long-term follow-up. Standardized perioperative management is essential to improve sperm retrieval rate (SRR) and assisted reproductive technology (ART) outcomes. 　　History of technology development　　Origin: First proposed by Schlegel’s team in 1999, the technique identifies and extracts spermatozoa from focal seminiferous tubules by microscopic manipulation.　　Recommended by international guidelines:　　American Society for Reproductive Medicine (ASRM): micro-TESE is the procedure with the highest SRR in patients with NOA (Level of evidence: 1A).　　European Association of Urology (EAU): 2022 guidelines clearly recommend micro-TESE as the procedure of choice.　　Evidence-based: 2022 randomized controlled trial by Jensen et al. confirmed that micro-TESE has significantly better SRR than conventional testicular biopsy (cTESE).　　III. Indications and contraindications　　Indications:　　Idiopathic NOA, Creutzfeldt-Jakob syndrome (47,XXY), Y chromosome AZFc deletion, azoospermia after cryptorchidism.　　Azoospermia after radiotherapy, hypogonadotropic hypogonadism (HH) for which endocrine therapy is ineffective.　　Contraindications:　　Genetic: AZFa/AZFb deletion, 46,XX sex reversal syndrome, TEX11 gene mutation.　　Systemic contraindications: coagulation disorders, acute reproductive infections, severe cardiopulmonary diseases.　　IV. Preoperative assessment and optimization　　Multidimensional assessment:　　Male examination: testicular volume (ultrasound measurement), sex hormones (FSH, LH, testosterone).　　Genetic testing: karyotype, Y chromosome microdeletion, male infertility gene Panel.　　Spousal fertility: ovarian reserve function (AMH, AFC) and ART feasibility.　　Preoperative medication:　　Gonadotropins (hCG/hMG): stimulate testosterone synthesis in the testes.　　Estrogen receptor modulators (SERMs): clomiphene or tamoxifen upregulate FSH/LH levels.　　Aromatase inhibitors (AIs): Letrozole reduces the conversion of testosterone to estrogen.　　V. Surgical Practice　　Anesthesia and incision:　　General anesthesia is preferred, with a midline or bilateral longitudinal incision in the scrotum to expose the testis.　　Key points of microscopic operation:　　Identification of spermatogenic tubules: full tubules with a diameter of >300…

    A Review of Cardiovascular Health and Factors Influencing Assisted Reproductive Technology (ART) Offspring

    2025-03-18

    　　Background and Importance　　Assisted Reproductive Technology (ART) has provided fertility hope to infertile families worldwide, but there is growing concern about the long-term health of its offspring. Available evidence suggests that there is some variation in cardiovascular developmental markers in ART offspring, which may be associated with epigenetic mechanisms, technology manipulation, and environmental factors. This article systematically reviews the current status of cardiovascular health of ART offspring, the influencing factors and potential mechanisms, aiming to provide a scientific basis for clinical optimization of ART technology and improvement of offspring health. 　　I. Markers of cardiovascular health in ART offspring　　1. Blood pressure performance　　Divergent findings: Most studies showed no significant difference in blood pressure between ART offspring in childhood and adolescence and offspring from natural pregnancy, but some found high blood pressure in infancy and early childhood, which may be related to ovarian stimulation or embryo culture techniques.　　LONG-TERM TRENDS: Differences tend to disappear with age; data for adulthood remain to be added.　　Clinical significance: no pathological associations such as carotid intima-media thickening in ART offspring have been observed.　　2. Cardiac Structure and Function　　Early differences: ART fetuses and children show subclinical changes such as enlargement of the right ventricle, increased left ventricular mass, and decreased ejection fraction, but do not reach the diagnostic threshold for disease.　　ENVIRONMENTAL SENSITIVITY: High altitude exposure may amplify the risk of abnormal right heart function.　　LONG-TERM SAFETY: Resting cardiac function in adolescence is comparable to that of naturally conceived offspring, and there is no significant elevation in the incidence of cardiovascular events.　　3. Vascular Health　　Endothelial function and stiffness: Some studies have shown reduced vascular endothelial function (FMD) and increased arterial stiffness (PWV) in children with ART, but the differences are not significant in adulthood. 　II. Influencing factors and mechanisms　　1. Influence of ART technical operation　　Superovulation (COS):　　Animal models show abnormal maternal gene imprinting and elevated blood pressure…

    Why do we need to do four-dimensional ultrasound?

    2025-03-12

    　　　　Obstetric examination is the necessary homework of pregnant mothers during pregnancy, many pregnant mothers pregnant to a certain period of time the doctor will let pregnant mothers go to do four-dimensional ultrasound, perhaps some pregnant mothers will think that usually have been regularly go to do the examination, four-dimensional ultrasound is not necessary to go to do it again, but in the birth of an unhealthy baby after the repentance of the beginning.　　Some pregnant mothers are wondering, what is 4D ultrasound? Why is it necessary to go for a 4D ultrasound during pregnancy and what are its functions? What should I pay attention to when I go to do ultrasound? Below, I will give you a detailed introduction. 　　What is four-dimensional color ultrasound　　The full name of four-dimensional color ultrasound is four-dimensional color ultrasound diagnostic instrument, is a modern advanced color ultrasound equipment. Four-dimensional color ultrasound is able to surface imaging, more clear screening of fetal limb development whether malformation, meningeal bulge, whether cleft lip and palate, spina bifida and other congenital anomalies, early detection and early solutions.　　The role of four-dimensional ultrasound for pregnant mothers and babies　　Determine the due date　　The best 4D ultrasound examination is recommended around the 22nd to 28th week of pregnancy, because during this period the structure of the fetus has been basically formed, the amniotic fluid is also well stocked, and the size of the fetus is developing just right, with more room for intrauterine activities, it is relatively easy for 4D ultrasound to capture, and the images are clearer, which makes it easier for the doctor to discover more developmental problems of the fetus in a timely manner.　　Checking the activity of the fetus　　It can check whether the fetus lacks oxygen in the uterus, limb movement, swallowing movement of the fetus, etc. It can see the activity…

    Ways to Keep Your Ovaries and Eggs Youthful

    2025-03-12

    　　　　Just as the body ages with age, so do the ovaries and eggs. So you should take care to maintain a regular routine in your daily life to keep your ovaries rejuvenated.　　When do women start to have eggs?　　Women are born with primordial follicles (cells that produce eggs) that are part of the ovaries, and most of these follicles die before they mature. A woman is born with about 2 million primordial follicles, but by the time she has her first menstrual period, only 200,000 to 300,000 follicles are left. Since then, the number of primordial follicles decreases by a few hundred each month, and by the age of 45, there are only a few thousand left. Only about 500 eggs are produced in a woman’s lifetime, and most of them die before they reach maturity. 　　Ovaries and eggs age as we get older　　As the primordial follicles age, the ovaries age with them, and the quality of the eggs declines. As a result, it becomes difficult to produce eggs that are capable of being fertilized and for the ovaries to ovulate.　　After the age of 38, the number of primordial follicles decreases to less than 25,000, and aging accelerates dramatically. As a result, the hope of pregnancy becomes very slim after the age of 46.　　The difference between the age of the ovaries and the actual age　　Recently, the medical community has begun to take note of the age of the ovaries, which is obtained by calculating the value of the anti-mullerian hormone in the blood. This hormone is secreted by immature follicles, so the more immature follicles in the ovary that have the ability to fertilize, the higher the value, and a low value indicates an older ovary. Typically, ovarian age increases with age, but there are some people who have younger ovaries…

    Why do some surrogate mothers fail to fertilize their eggs?

    2025-03-12

    　　　　For surrogate mothers who want to get pregnant quickly, they are very eager to be the first to know the good news, but it takes time for the fertilized egg to implant, so how long is this time? If the fertilization fails, what causes it?　　“How many days does it take for a fertilized egg to implant?　　● During pregnancy preparation, the time for the fertilized egg to bed is the time for the pregnancy test. The fertilized egg bed means that they start to settle in the uterus, which takes 6 – 7 days.　　It takes 6-7 days for the egg to settle in the uterus. Normally, the egg starts to lay on the uterus around day 6-7 after fertilization, but it is still too small to be seen on an ultrasound, and a small sac may not be visible on an ultrasound until about 20-30 days after it has laid.　　Usually, there is slightly more implantation in the posterior wall of the uterine body than in the anterior wall, and more in the midline than in the lateral wall.　　●The entire process of the fertilized egg moving through the fallopian tube towards the uterus is slow and the woman’s body does not feel anything.　　The fertilized egg is pushed by peristalsis and cilia, and then moves gradually towards the uterine cavity. Usually, on the third day after fertilization, a solid mass of 16 cells called a mulberry embryo, or an early blastocyst, is formed.　　● When the early blastocyst enters the uterine cavity on day 4 after fertilization and continues to divide and develop into the late blastocyst.　　● On day 6-7 after egg fertilization, the late blastocyst is the process of invading the endometrium after the zona pellucida has disappeared and is called fertilized egg implantation.　　“How many sperms are needed to fertilize an egg?　　A normal…

    Heavy research: in vitro resuscitation transfer, just need to add this drug surrogate mother live birth rate increased by 42%!

    2025-03-11

    　　　　With the resuscitation transplantation success rate increasing across the board, many surrogate mothers in IVF cycles prefer frozen embryo resuscitation transplantation, and in general for surrogate mothers who are able to ovulate on their own, doctors are more inclined to recommend the natural cycle.　　The natural cycle is more in line with the human body’s natural state of pregnancy, with a short medication time and very low dosage of medication. This programme is also particularly suitable for our circle sisters, as the reduction in the use of oestrogen can significantly reduce the risk of hypercoagulability. 　　Improving the live birth rate has always been a pain point for our surrogate mothers, Circle Sisters turned to a heavyweight study in Human and Reproduction last year, where they added only one drug to increase the live birth rate of surrogate mothers by 42%.　　I can’t wait to share it with you in hopes that it will help you who are entering your recovery cycle soon!　　01 Luteal Support Boosts Live Birth Rate Randomised Controlled Study　　It’s an already known fact that progesterone boosts live birth rates in surrogate mothers with early pregnancy preeclampsia, and progesterone is also required for frozen embryo transfers, but it’s generally used in artificial cycles.　　Generally natural cycles mimic the natural process of pregnancy and progesterone is not usually given for IVF, will natural cycle use boost pregnancy rates? This is the question this article is trying to answer. Between February 2013 and March 2018, a total of 500 subjects were randomly assigned to two 1:1 groups.　　Randomisation was carried out using opaque sealed envelopes after transfer of frozen embryos in natural cycles.　　The primary outcome was live birth rate; secondary outcomes were pregnancy, biochemical pregnancy, clinical pregnancy and miscarriage rates.　　From the date of embryo transfer, half of the subjects received vaginal progesterone administration at 100…

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