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Association of Acute Histological Chorioamnionitis and Other Placental Lesions With Subsequent Pregnancy Outcomes After Spontaneous Preterm Birth 急性组织学绒毛膜羊膜炎和其他胎盘病变与自然早产后妊娠结局的关系。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102715
Ludmila Porto MD, MSc , Nir Melamed MD, MSc , Jessica Liu MD , John Kingdom MD , John Snelgrove MD, MSc , Elizabeth Aztalos MD, MSc , Christopher Sherman MD , Jon Barrett MD , Stefania Ronzoni MD, PhD

Objectives

Acute histological chorioamnionitis (HCA) is detected in over 50% of spontaneous preterm birth (PTB) and is associated with worse neonatal prognosis. We aim to investigate whether the presence of HCA impacts subsequent pregnancy outcomes.

Methods

This retrospective cohort study included deliveries at a tertiary centre from 2014 to 2020. Participants were individuals with a history of spontaneous PTB or pregnancy loss >160 weeks and available placental pathology (index pregnancy) with a subsequent pregnancy followed at the same institution. Placentas were classified according to the presence of HCA, other placental lesions, or no lesions. Subsequent pregnancy outcomes were analyzed. The primary outcome was the rate of overall and spontaneous PTB (<370 weeks) in the subsequent pregnancy.

Results

A total of 292 individuals met the study criteria, of which 133 had HCA, 61 had other placental lesions, and 98 had no lesions. Individuals with HCA in the index delivery had a higher risk of PTB <280 weeks in the subsequent pregnancy, compared to the no-lesion group (10.4% vs. 1.0%, P = 0.004). Rates of PTB >280 weeks did not significantly differ. The risk of neonatal adverse composite outcomes was higher in the HCA group (13.9% vs. 4.2%, P < 0.01). In a subanalysis of different placental lesions at the index PTB, only maternal vascular malperfusion was associated with recurrent PTB (adjusted odds ratio 2.57, P = 0.01).

Conclusions

PTB with HCA is associated with higher rates of extreme PTB and adverse neonatal outcomes in the subsequent pregnancy. The inclusion of placental pathology analysis may improve individualized risk assessment in future pregnancies.
目的:急性组织学绒毛膜羊膜炎(HCA)在50%以上的自发性早产(PTB)中被检测到,并且与新生儿预后不良有关。我们的目的是调查 HCA 的存在是否会影响随后的妊娠结局:这项回顾性队列研究纳入了 2014 年至 2020 年在一家三级医疗中心的分娩情况。参与者为有自发性PTB病史或妊娠损失大于16周且有胎盘病理(指数妊娠)并在同一机构接受后续妊娠随访的个体。根据是否存在 HCA、其他胎盘病变或无病变对胎盘进行分类。对后续妊娠结果进行分析。主要结果是总体和自发性PTB的发生率(结果:共有 292 人符合研究标准,其中 133 人有 HCA,61 人有其他胎盘病变,98 人无病变。预产期为 28 周的 HCA 患儿发生 PTB 的风险较高,但无明显差异。HCA组发生新生儿不良综合结局的风险更高(13.9% vs 4.2%,P < 0.01)。在对指数PTB时不同胎盘病变的子分析中,只有母体血管灌注不良与复发性PTB相关(aOR 2.57,P = 0.01):结论:伴有HCA的PTB与较高的极端PTB发生率及后续妊娠的不良新生儿结局相关。纳入胎盘病理学分析可改善未来妊娠的个体化风险评估。
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引用次数: 0
2024 Index of SOGC Clinical Practice Guidelines
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102748
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引用次数: 0
Bilateral Salpingitis Isthmica Nodosa: A Laparoscopic Clue Supporting its Infectious Etiology 双侧结节性输卵管炎:腹腔镜线索支持其感染性病因。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102717
Konstantinos Koukoumpanis MD, MSc, Michail Panagiotopoulos MD, MSc, Athanasios Douligeris MD, MSc, Konstantinos Kypriotis MD, MSc, Nikolaos Kathopoulis MD, MSc, PhD, Athanasios Protopapas MD, PhD
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引用次数: 0
Placenta Accreta Spectrum Disorders: A Canadian Tertiary Care Centre’s Experience Over 10 years 胎盘增生谱系障碍:加拿大三级保健中心的经验超过10年。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-31 DOI: 10.1016/j.jogc.2024.102757
Catherine Lu MD , Carol Schneider MD , Caroline Corbett MD , Anet Maksymowicz MD , Devon Evans MD

Objectives

The placenta accreta spectrum disorders (PASD) are associated with significant maternal and neonatal morbidity and mortality worldwide. As cesarean delivery rates increase, so does the rate of PASD. PASD antepartum diagnosis and perioperative management are evolving, and we primarily aimed to share our tertiary care centre’s institutional approach and outcomes over a decade.

Methods

A retrospective medical record review of cesarean hysterectomy for suspected or confirmed PASD was conducted at a single tertiary centre in Canada from 2010 to 2021.

Results

A total of 46 records remained after applying the exclusion criteria, with a diagnosis of PASD in 94% of cases, and 20% consistent with accreta, 48% with increta, and 26% with percreta. Cesarean hysterectomies were conducted on an unscheduled emergency basis in 41% of cases. All cases had antenatal ultrasound imaging, and 57% received an antenatal MRI. Prophylactic ureteric stenting occurred in 37% of cases. Mean total operative time was 97 minutes, and 50% of cases received an intraoperative blood transfusion. Ureteric injury occurred in 2% of cases, and admission to the intensive care unit in 13% of cases.

Conclusions

PASD is a complex and highly morbid condition. We have shared our institutional experience and explored some variations in practice, including the use of prophylactic ureteric stenting. Additional research is needed to further explore the optimal methods to diagnose and manage this complex disorder.
目的:胎盘增生谱系障碍(PASD)与全球孕产妇和新生儿的发病率和死亡率相关。随着剖宫产率的增加,PASD的发生率也在增加。产前诊断和围手术期管理正在不断发展,我们的主要目标是分享我们三级护理中心十年来的机构方法和成果。方法:回顾性分析2010年至2021年XXX某三级中心剖宫产子宫切除术疑似或确诊PASD的病例。结果:在排除标准后,总共保留了46例记录,其中94%的病例诊断为PASD, 20%符合accreta, 48%符合increta, 26%符合percreta。41%的剖宫产子宫切除术是在计划外的紧急情况下进行的。所有病例进行了产前超声成像,57%的患者接受了产前MRI检查。预防性输尿管支架置入术发生率为37%。平均总手术时间为97分钟,50%的病例接受术中输血。输尿管损伤发生率为2%,住院率为13%。结论:PASD是一种复杂的、高度病态的疾病。我们分享了我们的机构经验,并探讨了实践中的一些变化,包括使用预防性输尿管支架置入。需要进一步的研究来进一步探索诊断和管理这种复杂疾病的最佳方法。
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引用次数: 0
Connaissances, équité et priorités de recherche en santé menstruelle 经期健康的知识、公平和研究重点。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102746
Paul J. Yong , Zeba Khan , Kate Wahl , Thomas P. Bouchard , Patricia K. Doyle-Baker , Jerilynn C. Prior
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引用次数: 0
SOGC Guideline Retirement Notice No. 10 公司指引退休通知书第10号
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102737
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引用次数: 0
Directive clinique no 457 : Lésions obstétricales du sphincter anal (LOSA) – Partie I : prévention, détection et prise en charge immédiate 第 457 号临床指南:产科肛门括约肌损伤(OASI)--第一部分:预防、检测和及时处理。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102720
Dobrochna Globerman M.D., Alison Carter Ramirez M.D., Maryse Larouche M.D., M. Sc. (santé publique), Dante Pascali M.D., Sinead Dufour pht, Ph. D., Maria Giroux M.D.
<div><h3>Objectif</h3><div>La présente directive vise à promouvoir la détection et les stratégies de prévention des lésions obstétricales du sphincter anal. Elle fournit aussi des conseils sur la réparation primaire des lésions obstétricales du sphincter anal et leur prise en charge post-partum immédiate afin de limiter les séquelles indésirables.</div></div><div><h3>Population cible</h3><div>Toutes les patientes ayant subi une lésion obstétricale du sphincter anal à l’accouchement vaginal.</div></div><div><h3>Résultats</h3><div>Certaines stratégies préventives sont associées à une diminution de l’incidence des lésions obstétricales du sphincter anal (p. ex., flexion et contrôle de la tête fœtale, utilisation avisée de l’épisiotomie médio-latérale). Les stratégies de prise en charge, telles que le diagnostic et la réparation appropriés des lésions obstétricales du sphincter anal, l’antibioprophylaxie ainsi que la prise en charge du transit intestinal et de la fonction vésicale post-partum, peuvent réduire les séquelles à court et à long terme.</div></div><div><h3>Bénéfices, risques et coûts</h3><div>La mise en application des recommandations de cette directive peut améliorer la détection, la prévention et la prise en charge adéquate des lésions anales obstétricales, ce qui aura pour effet de limiter le fardeau associé à ces lésions. L’adoption de la classification recommandée des lésions obstétricales du sphincter anal améliorera les efforts de recherche nationaux et internationaux.</div></div><div><h3>Données probantes</h3><div>La littérature publiée dans la période du 1<sup>er</sup> septembre 2014 au 30 novembre 2023 a été colligée par des recherches dans les bases de données PubMed, Ovid, Medline, Embase, Scopus et Cochrane Library au moyen de termes MeSH (<em>delivery</em>, <em>obstetrics</em>, <em>obstetric surgical procedures</em>, <em>obstetric labor complications</em>, <em>anal canal</em>, <em>episiotomy</em>) et mots clés pertinents (<em>OASIS</em>, <em>obstetrical anal sphincter injury</em>, <em>anal injury</em>, <em>anal sphincter</em>, <em>vaginal delivery</em>, <em>suture</em>, <em>fecal incontinence</em>, <em>anal incontinence</em>, <em>overlap repair</em>, <em>end-to-end repair</em>, <em>bladder protocol</em>, <em>analgesia</em>). Seuls les résultats de revues systématiques, de méta-analyses, d’essais cliniques randomisés, d’essais cliniques comparatifs, d’études observationnelles et de lignes directrices de pratique clinique ont été retenus. Les recherches se sont limitées aux publications en anglais ou en français. Les données probantes ont été étayées par des références à la directive n<sup>o</sup> 330 de la Société des obstétriciens et gynécologues du Canada, publiée en 2015.</div></div><div><h3>Méthodes de validation</h3><div>Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Vo
目的:本指南旨在推广产科肛门括约肌损伤的检测和预防策略。目标人群:所有经阴道分娩时发生产科肛门括约肌损伤的患者。结果:某些预防策略可降低产科肛门括约肌损伤的发生率(如胎头屈曲和控制、合理使用内外侧切开术)。管理策略,如产科肛门括约肌损伤的适当诊断和修复、抗生素预防以及产后肠道和膀胱功能管理,可减少短期和长期后遗症。收益、风险和成本:实施本指南中的建议可改善产科肛门损伤的检测、预防和适当管理,从而减轻与这些损伤相关的负担。采用建议的产科肛门括约肌损伤分类方法将加强国内和国际研究工作。准备数据:通过检索 PubMed、Ovid、Medline、Embase、Scopus 和 Cochrane 图书馆数据库,使用 MeSH 术语(分娩、产科、产科外科手术、产科分娩并发症、肛管、外阴切开术)和相关关键词(OASIS、产科肛门括约肌损伤、肛门损伤、肛门括约肌、阴道分娩、缝合、大便失禁、肛门失禁、重叠修复、端对端修复、膀胱方案、镇痛)。只有系统综述、荟萃分析、随机临床试验、对照临床试验、观察性研究和临床实践指南的结果才被纳入。检索仅限于英语或法语出版物。参考了 2015 年发布的加拿大妇产科医师协会第 330 号指南,为证据提供支持。验证方法:作者采用 GRADE(建议、评估、发展和评价分级)方法框架评估了证据的质量和建议的力度。参见附录 A(表 A1 为定义,表 A2 为强建议和弱建议的解释)。相关专业人员:产科护理人员。社会媒体摘要:加拿大产科肛门括约肌损伤(OSHA)检测、预防和管理指南更新版。
{"title":"Directive clinique no 457 : Lésions obstétricales du sphincter anal (LOSA) – Partie I : prévention, détection et prise en charge immédiate","authors":"Dobrochna Globerman M.D.,&nbsp;Alison Carter Ramirez M.D.,&nbsp;Maryse Larouche M.D., M. Sc. (santé publique),&nbsp;Dante Pascali M.D.,&nbsp;Sinead Dufour pht, Ph. D.,&nbsp;Maria Giroux M.D.","doi":"10.1016/j.jogc.2024.102720","DOIUrl":"10.1016/j.jogc.2024.102720","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectif&lt;/h3&gt;&lt;div&gt;La présente directive vise à promouvoir la détection et les stratégies de prévention des lésions obstétricales du sphincter anal. Elle fournit aussi des conseils sur la réparation primaire des lésions obstétricales du sphincter anal et leur prise en charge post-partum immédiate afin de limiter les séquelles indésirables.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Population cible&lt;/h3&gt;&lt;div&gt;Toutes les patientes ayant subi une lésion obstétricale du sphincter anal à l’accouchement vaginal.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Résultats&lt;/h3&gt;&lt;div&gt;Certaines stratégies préventives sont associées à une diminution de l’incidence des lésions obstétricales du sphincter anal (p. ex., flexion et contrôle de la tête fœtale, utilisation avisée de l’épisiotomie médio-latérale). Les stratégies de prise en charge, telles que le diagnostic et la réparation appropriés des lésions obstétricales du sphincter anal, l’antibioprophylaxie ainsi que la prise en charge du transit intestinal et de la fonction vésicale post-partum, peuvent réduire les séquelles à court et à long terme.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Bénéfices, risques et coûts&lt;/h3&gt;&lt;div&gt;La mise en application des recommandations de cette directive peut améliorer la détection, la prévention et la prise en charge adéquate des lésions anales obstétricales, ce qui aura pour effet de limiter le fardeau associé à ces lésions. L’adoption de la classification recommandée des lésions obstétricales du sphincter anal améliorera les efforts de recherche nationaux et internationaux.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Données probantes&lt;/h3&gt;&lt;div&gt;La littérature publiée dans la période du 1&lt;sup&gt;er&lt;/sup&gt; septembre 2014 au 30 novembre 2023 a été colligée par des recherches dans les bases de données PubMed, Ovid, Medline, Embase, Scopus et Cochrane Library au moyen de termes MeSH (&lt;em&gt;delivery&lt;/em&gt;, &lt;em&gt;obstetrics&lt;/em&gt;, &lt;em&gt;obstetric surgical procedures&lt;/em&gt;, &lt;em&gt;obstetric labor complications&lt;/em&gt;, &lt;em&gt;anal canal&lt;/em&gt;, &lt;em&gt;episiotomy&lt;/em&gt;) et mots clés pertinents (&lt;em&gt;OASIS&lt;/em&gt;, &lt;em&gt;obstetrical anal sphincter injury&lt;/em&gt;, &lt;em&gt;anal injury&lt;/em&gt;, &lt;em&gt;anal sphincter&lt;/em&gt;, &lt;em&gt;vaginal delivery&lt;/em&gt;, &lt;em&gt;suture&lt;/em&gt;, &lt;em&gt;fecal incontinence&lt;/em&gt;, &lt;em&gt;anal incontinence&lt;/em&gt;, &lt;em&gt;overlap repair&lt;/em&gt;, &lt;em&gt;end-to-end repair&lt;/em&gt;, &lt;em&gt;bladder protocol&lt;/em&gt;, &lt;em&gt;analgesia&lt;/em&gt;). Seuls les résultats de revues systématiques, de méta-analyses, d’essais cliniques randomisés, d’essais cliniques comparatifs, d’études observationnelles et de lignes directrices de pratique clinique ont été retenus. Les recherches se sont limitées aux publications en anglais ou en français. Les données probantes ont été étayées par des références à la directive n&lt;sup&gt;o&lt;/sup&gt; 330 de la Société des obstétriciens et gynécologues du Canada, publiée en 2015.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Méthodes de validation&lt;/h3&gt;&lt;div&gt;Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Vo","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102720"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guideline No. 457: Obstetrical Anal Sphincter Injuries (OASIS) Part I: Prevention, Recognition, and Immediate Management 第 457 号指南:产科肛门括约肌损伤 (OASIS) 第一部分:预防、识别和即时处理。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102719
Dobrochna Globerman MD, Alison Carter Ramirez MD, Maryse Larouche MD, MPH, Dante Pascali MD, Sinead Dufour PT, PhD, Maria Giroux MD
<div><h3>Objective</h3><div>The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae.</div></div><div><h3>Target Population</h3><div>All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury.</div></div><div><h3>Outcomes</h3><div>Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications.</div></div><div><h3>Benefits, Harms, and Costs</h3><div>Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts.</div></div><div><h3>Evidence</h3><div>Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no. 330.</div></div><div><h3>Validation Methods</h3><div>The authors rated the quality of evidence and strength of recommendations using the <span><span>Grading of Recommendations Assessment, Development and Evaluation</span><svg><path></path></svg></span> (GRADE) approach. See online <span><span>Appendix A</span></span> (<span><span>Tables A1</span></span> for definitions and <span><span>A2</span></span> for interpretations of strong and conditional recommendations).</div></div><div><h3>Intended Audience</h3><div>Obstetrical care providers.</div></div><div><h3>Tweetable Abstract</h3><div>Updated Canadian guideline on recognition, prevention and management of obstetrical anal sphincter injuries (OASIS).</div></div><di
目的:本指南旨在促进产科肛门括约肌损伤的识别和预防策略。此外,它还为产科肛门括约肌撕裂的初级修复和产后即刻处理提供指导,以尽量减少进一步的负面后遗症:目标人群:所有阴道分娩患者和产科肛门括约肌损伤患者:结果:某些预防策略与产科肛门括约肌损伤发生率降低有关(如胎头屈曲和控制、适当使用内外侧切开术)。包括产科肛门括约肌损伤的适当诊断和修复、抗生素预防以及肠道和膀胱功能管理在内的管理策略可减少相关的短期和长期并发症:实施本指南中的建议可提高产科肛门损伤的检测、预防和适当管理,从而限制与这些损伤相关的未来负担。实施产科肛门括约肌损伤的建议分类将改善国内和国际研究工作:通过检索 PubMed、Ovid、Medline、Embase、Scopus 和 Cochrane 图书馆,使用适当的 MeSH 术语(分娩、产科、产科外科手术、产科分娩并发症、肛管、外阴切开术)和关键词(OASIS、产科肛门括约肌损伤、肛门损伤、肛门括约肌、阴道分娩、缝合、大便失禁、肛门失禁、重叠修复、端对端修复、膀胱方案、镇痛)。研究结果仅限于系统综述、荟萃分析、随机对照试验/临床对照试验、观察性研究和临床实践指南。结果仅限于英语或法语材料。2015年加拿大妇产科医师协会指南第330号中的参考文献对证据进行了补充。验证方法作者采用建议评估、发展和评价分级法(GRADE)对证据质量和建议力度进行了评级。参见在线附录 A(表 A1 为定义,表 A2 为强建议和有条件建议的解释)。
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引用次数: 0
Bilateral Multiple Mature Cystic Teratoma: An Unusual Case Report 双侧多发性成熟囊性畸胎瘤:一个不寻常的病例报告。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102712
Priyanka Mathe MBBS, MS, Priya Samanta MBBS, Richa Aggarwal MBBS, MS
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引用次数: 0
Menstrual Health Literacy, Equity and Research Priorities 经期健康知识、公平和研究重点。
IF 2 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.jogc.2024.102711
Paul J. Yong , Zeba Khan , Kate Wahl , Thomas P. Bouchard , Patricia K. Doyle-Baker , Jerilynn C. Prior
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引用次数: 0
期刊
Journal of obstetrics and gynaecology Canada
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