Maternal Pathology Obstetrics

Maternal-Fetal Medicine

Maternal-Fetal Medicine--Yangpu Campus

Maternal-Fetal Medicine--Huangpu Campus

Fudan University Affiliated Obstetrics and Gynecology Hospital has a glorious 100-year history and is the first specialized obstetrics and gynecology hospital in the country. The hospital’s Department of Obstetrics has produced many outstanding professionals and trained many nationally renowned obstetric experts: Wang Shuzhen, Zheng Huaimei, Lu Xiangyun, Wang Juhua, Gao Xiuhui, Zhang Zhenjun, Zhuang Yiliang, Pan Mingming… Together with colleagues nationwide, they co-wrote the history of obstetrics in China. The academic achievements of the Obstetrics and Gynecology Hospital Affiliated to Fudan University are remarkable: it served as chief editor of the first textbook, “Obstetrics and Gynecology”; performed China’s first extraperitoneal cesarean section; established external pelvic measurement data for Chinese women; and established the first high-risk ward… It has witnessed the glorious development of modern obstetrics in China.

In 2010, the Department of Obstetrics was selected for the first batch of National Clinical Key Specialty construction projects; that same year, it became one of the first-batch national bases for standardized residency training; and in 2013, it became one of the first-batch national bases for standardized specialist training in obstetrics and gynecology. Beginning in 1973, a perinatal medicine research group was formed and a high-risk obstetrics ward was established, dedicated to the diagnosis, treatment, and management of high-risk pregnant and postpartum women. From May 2019 onward, the Obstetrics and Gynecology Hospital Affiliated to Fudan University established the Department of Obstetrics and Neonatology, and the high-risk obstetrics ward was renamed Maternal-Fetal Medicine.

Maternal-Fetal Medicine is a clinical department integrating clinical care, research, and teaching. Under the leadership of Professor Li Xiaotian, the discipline leader; Professor Cheng Haidong, the academic advisor; and Professor Gu Weirong, director of the Department of Obstetrics and Neonatology, a tiered professional team with pathological obstetrics at its core was formed. The department has 30 physicians: 2 chief physicians, 6 associate chief physicians, 7 attending physicians, and 15 resident physicians; among them, 10 hold doctoral degrees, 12 hold master’s degrees, and 8 hold bachelor’s degrees, with 1 doctoral supervisor and 2 master’s supervisors. It has 2 wards, 110 fixed beds, and offers a perinatal medicine outpatient clinic, specialty outpatient clinics, an expert clinic, a difficult-cases clinic, a special-needs clinic, and a postpartum clinic. The specialty outpatient clinics include a high-risk and IVF clinic, a clinic for prevention of pregnancy-induced hypertension, a diabetes nutrition clinic, a multidisciplinary joint clinic for placenta previa, a multidisciplinary joint clinic for preterm birth, and others.

High-risk pregnancies account for more than 70% of all deliveries in the Department of Obstetrics. The department implements stratified and graded case management for high-risk pregnant and postpartum women, ensuring their safety, and has developed a distinctive clinical model centered on integrated outpatient–inpatient management of high-risk pregnant women, form-based management of key stages in disease care, and multidisciplinary joint diagnosis and treatment. First, for high-risk pregnant women whose pregnancy-risk warning assessment is yellow or higher, physicians at the attending level or above, or the expert clinic, provide timely diagnosis and treatment; case-specific management is achieved by scheduling the visit time and the receiving physician. According to their different high-risk factors, patients are triaged to the relevant specialty outpatient clinics and connected with each subspecialty diagnosis-and-treatment group; senior physicians from the groups conduct outpatient visits, achieving integrated outpatient–ward management for high-risk pregnant women. Secondly, standardized, form-based management is provided for special diseases. Given the characteristics of hypertensive disorders of pregnancy—atypical clinical manifestations, rapid changes, difficult monitoring, and the tendency of severe preeclampsia to cause serious complications involving multiple organs—the department has developed a disease-monitoring form for expectant management of preeclampsia, observation scales for induction of labor in the delivery room and during labor, and others, enabling early detection of disease progression, timely symptomatic treatment, and termination of pregnancy. This facilitates thorough assessment and disease monitoring for women with hypertensive disorders of pregnancy, prolongs the duration of expectant management, encourages more patients to attempt a trial of vaginal labor, effectively lowers the cesarean section rate, and reduces severe adverse maternal and fetal outcomes. In view of the tendency of central/pernicious placenta previa to cause severe hemorrhage before, during, and after delivery, the department developed an observation scale and quality-control indicators for placenta previa, and established a multidisciplinary diagnosis-and-treatment team comprising the Departments of Ultrasound, Radiology, Anesthesiology, Neonatology, the Blood Bank, Urology, and Gynecology. It carried out prophylactic abdominal aortic balloon placement, gaining time to control hemorrhage during cesarean surgery, and greatly reduced the rates of severe postpartum hemorrhage, DIC, massive transfusion, and hysterectomy. Pregnant women with a history of preterm birth or high-risk factors for preterm birth are assessed, individualized and standardized follow-up and intervention measures are formulated, prophylactic and emergency cervical cerclage are actively performed, and multidisciplinary joint diagnosis and treatment for preterm birth has been established. For pregnant women with diabetes, a disease-specific outpatient clinic has been established; in collaboration with the Department of Nutrition, individualized dietary guidance and blood glucose monitoring and management are provided; individualized dietary records and blood glucose monitoring forms are developed; and patients are guided in diet and adjustment of insulin dosage, effectively controlling blood glucose and avoiding hypoglycemic reactions. A scale for deep vein thrombosis risk assessment and recommendations for preventive measures has been implemented; after preventive measures for perinatal venous thromboembolic disease were administered according to high-risk scores, not a single case of thromboembolic disease occurred at our hospital during the 5 years since implementation.

For a long time, the department has been responsible for teaching undergraduate students, graduate students, doctoral students, and physicians undertaking further training, as well as standardized residency training and specialty training; 4 teachers in the department have received the honorary titles of Excellent Teacher for Standardized Residency Training of Fudan University and Excellent Teaching Teacher of Shanghai. The Practical Maternal-Fetal Medicine Seminar is held every year and receives an enthusiastic response. The department has long conducted basic research on the pathogenesis of preeclampsia, the mechanisms of fetal-origin adult diseases, and the pathogenesis of preterm birth; translational medical research on the effects of preconception and pregnancy interventions on pregnancy outcomes in pregnancies complicated by hypothyroidism and on the long-term effects on offspring; randomized controlled studies of low-dose aspirin for prevention of preeclampsia; and clinical cohort studies of women of advanced maternal age, among others. Over the past 5 years, the department has received funding for more than 30 research projects, including the key special project “Research on Reproductive Health and Prevention and Control of Major Birth Defects” under the National Key R&D Program; General Program and Young Scientists Fund projects of the National Natural Science Foundation of China; and provincial- and ministerial-level scientific research projects from the Ministry of Education, the Shanghai Municipal Science and Technology Commission, and others. Over the past 5 years, it has published more than 60 papers in SCI and domestic core journals and has served as chief editor or contributing editor for 12 monographs.

Department Experts.