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Normal Sexual Development and Puberty 正常的性发育和青春期
Pub Date : 2021-07-27 DOI: 10.2310/obg.19112
A. French
Puberty is the hormonally mediated process of physical changes that occur during the transition of childhood to adulthood.   Activation of the hypothalamic-pituitary-gonadal axis triggers the onset of puberty. Gonadotropin hormone-releasing hormone (GnRH) is the major regulator of the reproductive axis.  GnRH stimulates the anterior pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn activate the gonads to produce sex steroids. Thelarche is stimulated by estrogen and is usually the first sign of puberty in girls. Adrenarche, although associated temporally with puberty, is mediated by the adrenal cortex and is unrelated to pubertal maturation. A growth spurt occurs mid-puberty.  Menarche, usually occurring 2-3 years after thelarche, is considered the end of puberty. After menarche, only about 1-2 additional inches of height are accrued.  Understanding what is considered the normal timeline of sexual development allows better recognition of precocious or delayed puberty, both of which may be associated with serious underlying health issuesThis review contains 4 tables, 5 figures, and 29 references.Keywords: puberty, pubertal development, hypothalamic-pituitary-gonadal axis, thelarche, menarche, normal sexual development
青春期是由激素介导的生理变化过程,发生在童年到成年的过渡时期。下丘脑-垂体-性腺轴的激活触发了青春期的开始。促性腺激素释放激素(GnRH)是生殖轴的主要调节因子。GnRH刺激垂体前叶释放促黄体生成素(LH)和促卵泡激素(FSH),进而激活性腺产生性类固醇。卵巢是由雌激素刺激的,通常是女孩青春期的第一个迹象。肾上腺素虽然与青春期有关,但它是由肾上腺皮质介导的,与青春期成熟无关。生长突增发生在青春期中期。月经初潮通常发生在月经初潮后2-3年,被认为是青春期的结束。月经初潮后,只会增加1-2英寸的身高。了解正常的性发育时间可以更好地识别性早熟或性早熟延迟,这两种情况都可能与严重的潜在健康问题有关。关键词:青春期,青春期发育,下丘脑-垂体-性腺轴,月经初潮,正常性发育
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引用次数: 0
Pre-implantation Screening and Diagnosis 植入前筛查和诊断
Pub Date : 2021-07-13 DOI: 10.2310/OBG.19132
K. O'Brien
Through cellular biopsy of a developing embryo, genetic testing can be performed as part of the embryo selection phase of an in vitro fertilization (IVF) cycle. Preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD) allow embryos to be tested for genetic conditions on a chromosome and gene level, respectively, prior to implantation in the uterus and prior to pregnancy. Included in this review are indications for PGS and PGD, the biopsy and diagnostic methods that are most frequently utilized, advances in recent non-invasive technologies, and potential impacts that PGS/PGD and IVF may have on developing embryos.This review contains 5 figures, 1 table, and 53 references. Keywords: Preimplantation genetic diagnosis, preimplantation genetic screening, blastocyst biopsy, blastomere biopsy, advances in PGS/PGD, indications for PGS/PGD, non-invasive embryo biopsy, infertility
通过对发育中的胚胎进行细胞活检,基因检测可以作为体外受精(IVF)周期中胚胎选择阶段的一部分进行。胚胎着床前遗传学筛查(PGS)和胚胎着床前遗传学诊断(PGD)允许在胚胎着床前和怀孕前分别在染色体和基因水平上检测胚胎的遗传状况。这篇综述包括PGS和PGD的适应症,最常用的活检和诊断方法,最近的非侵入性技术的进展,以及PGS/PGD和IVF可能对发育中的胚胎产生的潜在影响。本综述包含5个图,1个表,53篇参考文献。关键词:着床前遗传学诊断,着床前遗传学筛查,囊胚活检,囊胚活检,PGS/PGD进展,PGS/PGD适应症,无创胚胎活检,不孕症
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引用次数: 0
Preterm Premature Rupture of Membranes Preterm胎膜过早破裂
Pub Date : 2021-05-07 DOI: 10.2310/OBG.19056
D. Castro, E. Norwitz
Preterm premature rupture of membranes (PPROM) refers to rupture of the fetal membranes prior to 37-0/7 weeks’ gestation and prior to the onset of labor. PPROM complicates 2-4% of singleton pregnancies and 7-20% of twin pregnancies, and has been implicated in 30-40% of preterm births. Antepartum management involves confirming the diagnosis, excluding contraindications to expectant management (such as stillbirth, nonreassuring fetal testing, and intrauterine infection), and continued inpatient care with perinatology/NICU consultation, antenatal corticosteroids, broad-spectrum antibiotics (to prolong latency), and serial fetal surveillance. Delivery is indicated in the setting of nonreassuring fetal testing, intrauterine infection, excessive vaginal bleeding, preterm labor, and/or a gestational age of 34 weeks or beyond. Latency (time from rupture of membranes to delivery) depends on gestational age, severity of oligohydramnios, number of fetuses (shorter in twins), pregnancy complications (placental abruption, infection), fetal wellbeing, and use of broad-spectrum antibiotics. PPROM cannot be accurately predicted or prevented. Appropriate evidence-based management is essential to optimize outcome for both the mother and fetus in the setting of PPROM.This review contains 1 table, 2 figures and 57 references.Key words: chorioamnionitis, preterm birth, perinatal morbidity, twin pregnancies, preterm premature rupture of membranes (PPROM), fetal complications, maternal complications, labor and delivery, inpatient care, antepartum management
早产胎膜早破(PPROM)是指在妊娠37-0/7周之前和分娩前发生的胎膜破裂。PPROM导致2-4%的单胎妊娠和7-20%的双胎妊娠并发症,并与30-40%的早产有关。产前管理包括确认诊断,排除准产管理的禁忌症(如死产、不可靠的胎儿检测和宫内感染),并继续住院护理,包括围产期/新生儿重症监护病房会诊、产前皮质类固醇、广谱抗生素(延长潜伏期)和连续胎儿监测。在胎儿检查不可靠、宫内感染、阴道出血过多、早产和/或胎龄大于或等于34周的情况下,可选择分娩。潜伏期(从破膜到分娩的时间)取决于胎龄、羊水过少的严重程度、胎儿数量(双胞胎较短)、妊娠并发症(胎盘早剥、感染)、胎儿健康和使用广谱抗生素。PPROM不能准确预测或预防。适当的循证管理对于优化PPROM的母亲和胎儿的结局至关重要。本综述包含表1张,图2张,文献57篇。关键词:绒毛膜羊膜炎,早产,围产期发病率,双胎妊娠,早产早破膜(PPROM),胎儿并发症,产妇并发症,分娩,住院护理,产前管理
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引用次数: 0
Recurrent Urinary Tract Infections 复发性尿路感染
Pub Date : 2021-03-09 DOI: 10.2310/OBG.19160
L. Siff
One in three women has had at least one urinary tract infection (UTI) treated with antibiotics by the age of 24 years, and half of all women experience a UTI in their lifetime with one in four developing recurrence. Recurrent UTI is defined by two or more symptomatic infections in the past 6 months or three or more symptomatic infections in the past 12 months where each UTI follows a complete resolution of the previous UTI. This review describes the risk factors, diagnosis, work-up and treatment, and prevention of recurrent UTIs. Prevention strategies can be divided into antimicrobial and nonantimicrobial strategies. Nonantimicrobial prevention with behavioral changes, cranberry products, or probiotics did not significantly reduce the occurrence of symptomatic UTIs. Compared with placebo, oral estrogens did not reduce UTIs. However, vaginal estrogens do play a role in prevention of recurrence, particularly in postmenopausal women. There are three main strategies for antibiotic prevention: (1) low-dose daily antimicrobial prophylaxis, (2) postcoital antimicrobial prophylaxis, and (3) patient-initiated antimicrobial treatment. All of these strategies decrease infections during prophylaxis period.The choice of regimen should be based on susceptibilities and antibiotic allergy.This review contains 1 figure, 7 tables and 37 references.Keywords: antimicrobial prophylaxis, continuous antibiotics, CT urography, cystoscopy, postcoital prophylaxis, recurrent UTI, risk factors, self-directed therapy, treatment and diagnosis
到24岁时,三分之一的女性至少有一次接受过抗生素治疗的尿路感染,一半的女性一生中经历过尿路感染,四分之一的女性复发。复发性尿路感染的定义是在过去6个月内有两次或两次以上的症状性感染,或在过去12个月内有三次或三次以上的症状性感染,并且每次尿路感染都是在上一次尿路感染完全消退之后发生的。本文综述了尿路感染复发的危险因素、诊断、检查和治疗以及预防。预防策略可分为抗菌素和非抗菌素策略。通过行为改变、蔓越莓产品或益生菌进行非抗菌预防并不能显著减少症状性尿路感染的发生。与安慰剂相比,口服雌激素不能减少尿路感染。然而,阴道雌激素确实在预防复发中起作用,特别是在绝经后妇女中。有三种主要的抗生素预防策略:(1)每日低剂量抗菌预防,(2)性交后抗菌预防,(3)患者主动抗菌治疗。所有这些策略都减少了预防期间的感染。治疗方案的选择应基于药物敏感性和抗生素过敏。本综述包含图1张,表7张,参考文献37篇。关键词:抗菌药物预防,持续抗生素,CT尿路造影,膀胱镜检查,性交后预防,复发性尿路感染,危险因素,自我指导治疗,治疗和诊断
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引用次数: 1
The Puerperium
Pub Date : 2021-02-12 DOI: 10.2310/obg.19030
S. Kleinman, H. Ricciotti
The puerperium starts after the birth of a baby and continues until 6 to 8 weeks postpartum. Several recent interventions in management have been shown to improve outcomes. Delayed cord clamping, the practice of waiting for a period of time after a baby is born before clamping and cutting the umbilical cord, can increase hemoglobin levels, improve iron stores, and increase birth weight in newborns. Rooming in, the practice of mothers and newborns staying together, improves infant sleep and breast-feeding without affecting maternal sleep. Immediately after birth, significant physiologic and anatomic changes occur. Thromboembolic events are more common in the postpartum state than during pregnancy, but the majority of women do not require specific thromboprophylaxis but should be encouraged to walk after birth. Women who have not been previously immunized for influenza; tetanus, diphtheria, pertussis (Tdap); and rubella should be offered these immunizations. Women with uncomplicated pregnancies may engage in exercise within days after delivery. Pelvic floor physical therapy performed during pregnancy and postpartum may assist in maintaining or regaining muscle tone of the pelvic floor and may prevent or treat urinary incontinence. Perinatal depression affects one in seven women. Baby blues, which include mood swings, anxiety, tearfulness, and insomnia, should resolve by 2 weeks after delivery. Patients should be screened for depression using a standardized, validated tool and appropriate treatment initiated. All women should undergo a comprehensive postpartum visit within 6 weeks of delivery. This review contains 2 figures, 4 tables and 34 referencesKey words: delayed cord clamping, hemodynamic changes, perinatal depression, postpartum, puerperium, rooming in, skin-to-skin contact 
产褥期从婴儿出生后开始,一直持续到产后6 - 8周。最近在管理方面的一些干预措施已被证明可以改善结果。延迟脐带夹紧,即在婴儿出生后等待一段时间再夹紧和切断脐带的做法,可以增加血红蛋白水平,改善铁储存,并增加新生儿的出生体重。母亲和新生儿住在一起的做法,在不影响母亲睡眠的情况下,改善了婴儿睡眠和母乳喂养。出生后立即发生显著的生理和解剖变化。血栓栓塞事件在产后比怀孕期间更常见,但大多数妇女不需要特殊的血栓预防,但应鼓励出生后走路。以前未接种过流感疫苗的妇女;破伤风、白喉、百日咳(Tdap);风疹患者应该接受这些免疫接种。没有并发症的孕妇可以在产后几天内进行锻炼。妊娠期和产后盆底物理治疗有助于维持或恢复盆底肌张力,预防或治疗尿失禁。七分之一的妇女患有围产期抑郁症。产后忧郁,包括情绪波动、焦虑、流泪和失眠,应该在产后两周内消失。患者应使用标准化、有效的工具进行抑郁症筛查,并开始适当的治疗。所有妇女应在分娩6周内进行全面的产后检查。关键词:延迟脐带夹紧,血流动力学改变,围产期抑郁,产后,产褥期,合住,皮肤接触
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引用次数: 0
Uterine Fibroids 子宫肌瘤
Pub Date : 2021-01-05 DOI: 10.2310/obg.19013
K. Plewniak, H. Hur
Uterine fibroids may be present in up to 80% of women and are the most common benign indication for hysterectomy. Symptoms related to fibroids can vary tremendously and depend on the number, size, and location of fibroids, as well as the patient’s hormonal status. Several different treatment options are available for fibroids. A variety of factors, such as a patient’s symptoms, age, reproductive goals, and medical comorbidities, help determine which treatment is best for each patient. This review contains 11 figures, 4 tables and 55 referencesKey Words: abnormal uterine bleeding, fibroids, FIGO fibroid classification, hysterectomy, leiomyoma, myomectomy, uterine artery embolization
子宫肌瘤可能存在于高达80%的妇女,是子宫切除术最常见的良性指征。与肌瘤有关的症状可能有很大的不同,这取决于肌瘤的数量、大小和位置,以及患者的激素状况。肌瘤有几种不同的治疗选择。各种因素,如患者的症状、年龄、生育目标和医疗合并症,有助于确定哪种治疗方法最适合每位患者。关键词:子宫异常出血,肌瘤,FIGO肌瘤分类,子宫切除术,平滑肌瘤,子宫肌瘤切除术,子宫动脉栓塞术
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引用次数: 0
Polycystic Ovary Syndrome 多囊卵巢综合征
Pub Date : 2020-12-23 DOI: 10.2310/obg.19096
Snigdha Alur-Gupta, A. Dokras
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. In this review, the pathophysiology and current diagnostic criteria for PCOS are reviewed. Treatment options for symptoms commonly associated with PCOS such as hirsutism, acne, and menstrual irregularity are reviewed. Combined hormonal contraceptives are the first line of therapy in women not attempting pregnancy. The metabolic complications commonly associated with PCOS are impaired glucose tolerance and dyslipidemia. A summary of the current guidelines on screening and prevention of these complications is presented. In addition, PCOS is associated with an increased risk of depressive symptoms and anxiety disorders for which patients should be monitored.This review contains 7 tables and 59 references. Keywords: Polycystic ovary syndrome, PCOS 
多囊卵巢综合征(PCOS)是一种常见于育龄妇女的内分泌疾病。本文就多囊卵巢综合征的病理生理学和目前的诊断标准进行综述。治疗方案通常与多囊卵巢综合征相关的症状,如多毛症,痤疮,和月经不规律进行审查。联合激素避孕药是不打算怀孕妇女的首选治疗方法。通常与多囊卵巢综合征相关的代谢并发症是糖耐量受损和血脂异常。现对这些并发症的筛查和预防的现行指南作一总结。此外,多囊卵巢综合征与抑郁症状和焦虑症的风险增加有关,患者应对此进行监测。本综述包含7个表格和59篇参考文献。关键词:多囊卵巢综合征;多囊卵巢综合征
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引用次数: 0
Intrauterine Fetal Demise 宫内胎儿死亡
Pub Date : 2020-12-10 DOI: 10.2310/obg.19074
G. Wilkie, S. Little
Intrauterine fetal demise (IUFD) and stillbirth are interchangeable terms to describe a fetal death in the second half of pregnancy. IUFD is defined as the delivery of a fetus showing no signs of life as indicated by the absence of heart rate, breathing, umbilical cord pulsation, or voluntary muscle movements. A thorough evaluation of maternal history and risk factors, fetal evaluation involving autopsy and genetic evaluation, and placental pathology should be offered at the time of IUFD diagnosis. Significant counseling should be provided to patients regarding future pregnancies and the risk of recurrence as well as the need for increased antenatal testing and delivery planning in subsequent pregnancies. This review contains 5 tables, 10 figures and 55 references. Keywords: fetal kick counts, intrauterine fetal demise (IUFD), management of intrauterine fetal demise, microarray, placental pathology, risk factors for intrauterine fetal demise
宫内胎儿死亡(IUFD)和死胎是可互换的术语,用来描述妊娠后半期胎儿死亡。IUFD被定义为胎儿分娩时没有生命迹象,表现为没有心率、呼吸、脐带搏动或随意肌肉运动。在宫内节育器诊断时,应提供对母体病史和危险因素的全面评估,包括尸检和遗传评估的胎儿评估以及胎盘病理。应向患者提供有关未来妊娠和复发风险的重要咨询,以及在后续妊娠中增加产前检查和分娩计划的必要性。本综述包含5张表格,10张图,55篇参考文献。关键词:胎儿踢腿计数,宫内死胎(IUFD),宫内死胎处理,微阵列,胎盘病理,宫内死胎的危险因素
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引用次数: 0
Viral Infections in Pregnancy – Part 1: CMV, Ebola Virus, Viral Hepatitis, HSV, and HIV 病毒感染在怀孕-第1部分:巨细胞病毒,埃博拉病毒,病毒性肝炎,HSV,和艾滋病毒
Pub Date : 2020-12-03 DOI: 10.2310/obg.19048
P. Duff
A number of viral etiologies contribute to morbidity and mortality in pregnancy and the perinatal period. Here we discuss some of the major viral infections that occur in pregnancy. This review focuses on infections of cytomegalovirus (CMV), viral hepatitis, herpes simplex virus (HSV), and human immunodeficiency virus (HIV); other viral etiologies are discussed in part 2 of this topic. It is imperative to understand the risks, clinical course, diagnostic methodology, and management of these illnesses.This review contains 1 figure, 12 tables, and 71 references.Keywords: viral infection, pregnancy, prenatal, perinatal, cytomegalovirus, Ebola virus, viral hepatitis, herpes simplex virus, HIV, management
许多病毒病因导致怀孕和围产期的发病率和死亡率。在这里,我们讨论一些主要的病毒感染发生在怀孕。本文综述了巨细胞病毒(CMV)、病毒性肝炎、单纯疱疹病毒(HSV)和人类免疫缺陷病毒(HIV)的感染;其他病毒病因将在本主题的第2部分讨论。必须了解这些疾病的风险、临床过程、诊断方法和管理。本综述包含1张图,12张表,71篇参考文献。关键词:病毒感染,妊娠,产前,围产期,巨细胞病毒,埃博拉病毒,病毒性肝炎,单纯疱疹病毒,HIV,管理
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引用次数: 0
Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19
Pub Date : 2020-11-30 DOI: 10.2310/anes.1422
M. Ison
Coronaviruses (CoVs) are a group of viral pathogens that infect mammals and birds. The presentation in humans is typically that of a mild upper respiratory tract infection, similar to the common cold. However, in recent years, dramatic attention has arisen for more lethal members of this viral family (e.g., severe acute respiratory syndrome [SARS-CoV], Middle East respiratory syndrome [MERS-CoV], and coronavirus disease 2019 [COVID-19]). The epidemiology, clinical presentation, diagnosis, and management of these viruses are discussed in this review. Importantly, new guideline tables from the Centers for Disease Control and Prevention, as well as the World Health Organization are provided at the conclusion of the review.This review contains 12 tables, 3 figure and 48 references.Keywords: Coronavirus, severe acute respiratory distress syndrome (SARS), Middle East respiratory syndrome (MERS), COVID-19, respiratory infection, antiviral, real-time polymerase chain reaction
冠状病毒(CoVs)是一组感染哺乳动物和鸟类的病毒性病原体。人类的表现通常是轻微的上呼吸道感染,类似于普通感冒。然而,近年来,该病毒家族中更致命的成员(如严重急性呼吸综合征[SARS-CoV]、中东呼吸综合征[MERS-CoV]和2019年冠状病毒病[COVID-19])引起了人们的极大关注。本文就这些病毒的流行病学、临床表现、诊断和治疗进行综述。重要的是,在审查结束时提供了来自疾病控制和预防中心以及世界卫生组织的新指南表。本综述共包含表格12张,图3张,文献48篇。关键词:冠状病毒,严重急性呼吸窘迫综合征(SARS),中东呼吸综合征(MERS), COVID-19,呼吸道感染,抗病毒药物,实时聚合酶链反应
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引用次数: 0
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DeckerMed Obstetrics and Gynecology
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