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Hypertension 高血压
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0021
L. A. Magee, P. von Dadelszen
Pregnancy hypertension is associated with an estimated annual toll of 46,000 maternal and 2 million fetal, neonatal, and infant deaths. Over 99% of these deaths occur in less developed countries. The most dangerous form of pregnancy hypertension is pre-eclampsia, which, by international consensus, is defined more broadly than solely by proteinuric gestational hypertension to include markers of systemic target organ damage. Severe pre-eclampsia is defined by adverse features that mandate delivery irrespective of gestational age. There are numerous risk factors for pre-eclampsia and low-dose aspirin and, in women with low intake, calcium replacement appear to reduce the risk of pre-eclampsia and its complications. Time-of-disease risk estimation for women and, to a lesser extent, their fetuses, is possible to guide personalized decision-making and counselling. Heavy proteinuria is not an indication for delivery. Severe pregnancy hypertension must be treated as a matter of urgency. For all women with pregnancy hypertension, blood pressure should be normalized. Magnesium sulphate is the treatment to prevent and treat the seizures of eclampsia. Beyond viability, expectant management of pregnancy hypertension should be offered until 36+6 weeks of pregnancy. Women with either pre-eclampsia or gestational hypertension at more than 37+0 weeks should be offered induction, while induction should be offered to women with chronic hypertension at 38–39 weeks. Blood pressure reaches its maximal postpartum levels on days 3–6 postpartum. All forms of pregnancy hypertension are risk factors for premature cardiovascular disease and mortality, especially if associated with either fetal growth restriction, preterm birth, and/or stillbirth.
据估计,每年有46,000名孕产妇和200万名胎儿、新生儿和婴儿死亡与妊娠高血压有关。其中99%以上的死亡发生在欠发达国家。妊娠高血压最危险的形式是先兆子痫,根据国际共识,它的定义更广泛,而不仅仅是蛋白尿妊娠高血压,包括全身靶器官损伤的标志物。严重先兆子痫的定义是,无论胎龄如何,都必须分娩。子痫前期和低剂量阿司匹林有许多危险因素,在低剂量阿司匹林的妇女中,补钙似乎可以降低子痫前期及其并发症的风险。对妇女以及在较小程度上对其胎儿进行疾病时间风险估计,可以指导个性化决策和咨询。重度蛋白尿不是分娩的指征。严重的妊娠高血压必须作为紧急事项来处理。对于所有患有妊娠期高血压的妇女,应使血压正常化。硫酸镁是预防和治疗子痫发作的药物。除生存能力外,妊娠高血压的预期管理应提供至妊娠36+6周。妊娠37+0周以上伴有先兆子痫或妊娠高血压的妇女应进行引产,而妊娠38-39周伴有慢性高血压的妇女应进行引产。产后3-6天血压达到产后最高水平。所有形式的妊娠高血压都是早期心血管疾病和死亡的危险因素,特别是如果与胎儿生长受限、早产和/或死胎有关。
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引用次数: 0
Urinary incontinence 尿失禁
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0057
J. Iyer, A. Rane
According to the most recent definition of the International Continence Society, urinary incontinence (UI), a symptom of impaired storage, is ‘the complaint of any involuntary leakage of urine’. A condition that primarily affects women, UI is not a lethal condition; however, it significantly affects quality of life. Three types of incontinence are generally distinguished: stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence, which associates with the first two. Prevalence varies significantly due to variations in definitions and measurement, methodology of data collection, lack of self-reporting, and sampling/non-response issues. Age, parity, vaginal childbirth, and body mass index are important factors that affect the prevalence of urinary incontinence. In 2005, the ‘Evaluation of the Prevalence of urinary InContinence’ (EPIC) study, which was the largest population-based survey of 19,165 individuals, was conducted in five developed countries to assess the prevalence of lower urinary tract symptoms in men and women. Prevalence of overactive bladder overall was 11.8%; rates were similar in men and women and increased with age. Overactive bladder was more prevalent than all types of UI combined (9.4%). Besides the obvious issue of hygiene, UI results in ramifications that extend to the sufferer’s social and sexual life. This chapter focuses on mainly three types of female urinary incontinence commonly encountered in clinical practice—stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence—and discusses the anatomy and physiology of the continence apparatus, and the classification, evaluation, and management of urinary incontinence.
根据国际尿失禁协会(International Continence Society)的最新定义,尿失禁(UI)是一种储存功能受损的症状,是“任何非自愿尿漏的抱怨”。这是一种主要影响女性的疾病,但并不致命;然而,它会显著影响生活质量。一般可以区分出三种类型的尿失禁:压力性尿失禁、急迫性尿失禁和混合性尿失禁,混合性尿失禁与前两种尿失禁有关。由于定义和测量、数据收集方法、缺乏自我报告以及抽样/无反应问题的不同,患病率差异很大。年龄、胎次、阴道分娩和体重指数是影响尿失禁患病率的重要因素。2005年,在5个发达国家开展了“尿失禁患病率评估”(EPIC)研究,这是最大规模的基于人口的调查,共有19,165人参与,目的是评估男性和女性下尿路症状的患病率。膀胱过动症总体患病率为11.8%;男性和女性的发病率相似,并且随着年龄的增长而增加。膀胱过度活动的发生率高于所有类型尿失禁的总和(9.4%)。除了明显的卫生问题外,尿路感染还会影响到患者的社交和性生活。本章主要针对临床上常见的三种类型的女性尿失禁——压力性尿失禁、迫切性尿失禁和混合性尿失禁,并讨论了尿失禁装置的解剖学和生理学,以及尿失禁的分类、评估和管理。
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引用次数: 0
Polycystic ovary syndrome 多囊卵巢综合征
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0042
Zhongwei Huang, E. Yong
Polycystic ovary syndrome (PCOS) is an enigmatic condition and its pathophysiology remains to be determined but it is likely to involve the androgen, insulin, and anti-Mullerian hormone pathways. PCOS is diagnosed in women in the reproductive age group based on the Rotterdam criteria. The spectrum of disease involves various phenotypes based on the current diagnostic criteria and this may have reproductive, metabolic, and endocrine consequences. Reproductive issues include that of irregular menstrual cycles and anovulation. Metabolic disorders such as insulin resistance, obesity, dyslipidaemia, and hypertension must be screened for in all women who are diagnosed with PCOS. Long-term risks of metabolic and endocrine disorders in women with PCOS still need further confirmation with more robust data. Reproductive ageing appears to be increased in women with PCOS and they seem to menopause at a later age. Thus far, PCOS appears to be associated with endometrial hyperplasia and cancer.
多囊卵巢综合征(PCOS)是一种神秘的疾病,其病理生理机制仍未确定,但可能涉及雄激素,胰岛素和抗苗勒管激素途径。多囊卵巢综合征是根据鹿特丹标准在育龄妇女中诊断出来的。根据目前的诊断标准,疾病谱系涉及各种表型,这可能具有生殖、代谢和内分泌方面的后果。生殖问题包括月经周期不规律和无排卵。代谢紊乱,如胰岛素抵抗、肥胖、血脂异常和高血压,必须在所有被诊断为多囊卵巢综合征的妇女中进行筛查。多囊卵巢综合征妇女的代谢和内分泌紊乱的长期风险仍需要更多可靠的数据进一步证实。多囊卵巢综合征女性的生殖老化似乎有所增加,她们绝经的年龄似乎也较晚。到目前为止,多囊卵巢综合征似乎与子宫内膜增生和癌症有关。
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引用次数: 0
Fetal growth 胎儿生长
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0010
Jane E. Hirst, A. T. Papageorghiou
Fetal growth is a complex and highly orchestrated process. Monitoring fetal growth is one of the cornerstones of the evaluation of fetal well-being. This chapter explores the global epidemiology of poor fetal growth, the controversies around the definition of the condition, and the scientific validity of the multitude of growth charts and approaches to fetal growth currently in use around the world. In 2014, the accepted approaches to fetal growth were challenged by the findings of the international INTERGROWTH-21st Project. This major international project demonstrated that the growth of babies in utero and the size of babies around the world are remarkably similar if maternal environmental, social, and medical conditions are relatively optimal. From this study, the first standards for fetal and newborn growth have been produced. The management of babies detected to be large for gestational age (LGA) also remains controversial and a clinical challenge. With increasing rates of maternal obesity and gestational diabetes, a growing proportion of babies are born LGA or detected to be LGA in utero. Other than the treatment for gestational diabetes, the evidence for effective interventions to prevent the development of LGA during pregnancy is limited. Key issues regarding the management of LGA include the most appropriate timing and mode of delivery to prevent shoulder dystocia and birth trauma.
胎儿生长是一个复杂而高度协调的过程。监测胎儿生长是胎儿健康评估的基石之一。本章探讨了胎儿生长不良的全球流行病学,围绕该疾病定义的争议,以及目前世界各地使用的大量生长图表和胎儿生长方法的科学有效性。2014年,国际intergrowth -21项目的研究结果对公认的胎儿生长方法提出了挑战。这个重大的国际项目表明,如果母亲的环境、社会和医疗条件相对理想,世界各地婴儿在子宫内的生长和婴儿的大小是非常相似的。从这项研究中,产生了胎儿和新生儿生长的第一个标准。检测到的大胎龄(LGA)婴儿的管理也仍然存在争议和临床挑战。随着产妇肥胖率和妊娠期糖尿病的增加,越来越多的婴儿出生时患有LGA或在子宫内被检测为LGA。除了对妊娠期糖尿病的治疗外,有效干预预防妊娠期LGA发展的证据是有限的。关于LGA管理的关键问题包括最合适的分娩时间和方式,以防止肩难产和分娩创伤。
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引用次数: 0
The menstrual cycle 月经周期
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0040
L. Whitaker, K. Skorupskaite, J. Maybin, H. Critchley
The female human reproductive system comprises the hypothalamic–pituitary–ovarian axis and the reproductive tract (fallopian tubes, uterus, cervix, and vagina). The principal functions of this system are to produce an ovum, enable its fertilization and implantation, and allow growth and safe expulsion of the fetus into the external world. The menstrual cycle is critical for facilitation of the initial steps of this raison d’etre of the female reproductive system. As a greater understanding of the menstrual cycle biology is garnered, therapies that directly target pathways underpinning the regulation of normal and heavy menstrual bleeding are likely to emerge. Such future targeted therapies have the potential to offer a more personalized approach to management with minimization of undesirable side effects.
女性人类生殖系统包括下丘脑-垂体-卵巢轴和生殖道(输卵管、子宫、子宫颈和阴道)。该系统的主要功能是产生卵子,使其受精和着床,并允许胎儿生长和安全排出体外。月经周期对于促进女性生殖系统这一存在理由的初始步骤至关重要。随着对月经周期生物学的进一步了解,直接针对正常和大量月经出血调节途径的治疗方法可能会出现。这种未来的靶向治疗有可能提供一种更个性化的治疗方法,同时将不良副作用降到最低。
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引用次数: 0
Infertility 不孕不育
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0051
S. Bhatta, S. Bhattacharya
Human fertility is a complex process involving gamete production, fertilization, and implantation. Disruption of any of these key steps can result in infertility. Underlying lifestyle factors, age, or pathological conditions in either or both partners can be contributory. Traditional investigations can help to identify the nature of infertility. Management depends on modification of lifestyle factors and treatment of a specific cause—where appropriate. Assisted conception has transformed the approach to fertility treatment and is used for all cases of prolonged unresolved infertility. Individualized care, taking into account the chances of natural conception as well as the physical, emotional, and financial needs of a couple, is the basis of a successful management strategy.
人类生育是一个复杂的过程,包括配子的产生、受精和着床。这些关键步骤的任何一个中断都可能导致不孕。潜在的生活方式因素、年龄或伴侣一方或双方的病理状况都可能是原因。传统的调查可以帮助确定不孕症的性质。治疗取决于生活方式因素的改变和特定病因的治疗——在适当的情况下。辅助受孕已经改变了生育治疗的方法,并用于所有长期未解决的不孕症。个性化护理,考虑到自然受孕的机会以及夫妇的身体、情感和经济需求,是成功管理策略的基础。
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引用次数: 0
Preterm birth 早产
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0030
A. Care, Z. Alfirevic
This chapter discusses the epidemiology, prediction, prevention, and management of spontaneous preterm birth. Preterm birth is usually defined as delivery at any gestation before 37 completed weeks of pregnancy (<37+0 weeks, <259 days). The lower limit of preterm birth and upper limit of late spontaneous miscarriage are blurred as the limit of viability varies with differences in healthcare settings. This condition remains one of the biggest challenges facing obstetricians globally as a result of continuing high rates of morbidity and mortality. Spontaneous preterm birth is caused by a complex collection of pathophysiology with overlapping environmental interactions and behavioural influences that contribute to individual risk. Much debate exists regarding best prevention therapies and there remains a huge need for novel therapies and interventions for both prediction and prevention
本章讨论了自发性早产的流行病学、预测、预防和管理。早产通常定义为在妊娠37周(<37+0周,<259天)之前分娩。早产的下限和晚期自然流产的上限是模糊的,因为生存能力的限制随医疗环境的差异而变化。由于持续的高发病率和死亡率,这种情况仍然是全球产科医生面临的最大挑战之一。自发性早产是由复杂的病理生理学和重叠的环境相互作用和行为影响引起的,这些因素导致了个体风险。关于最佳预防疗法存在许多争论,对于预测和预防的新疗法和干预措施仍有巨大的需求
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引用次数: 0
Palliative care 姑息治疗
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0069
J. Cain, S. Kibel
Palliative care is an integrated approach that focuses on quality of life of ‘patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and treatment of other problems, physical, psychosocial, and spiritual’. This embraces the concept that quality care is embedded not only in individual health, but also the environment and setting of care and touches the domains included in the previous World Health Organization (WHO) definition. Palliative care focuses caregivers on the important goals of medicine—alleviating pain and suffering (at all levels), improving the experience of daily living, supporting psychological transitions with changing physical abilities, and advancing the patient’s and family’s understanding of the nature of the disease facing an individual and the outcomes. With that in mind, it represents a basic tenet of care for all patients, particularly those with diseases that lead to significant loss of quality of life and function. While this chapter focuses more on oncological palliative care, the tenets of palliative care and the research about symptom management can extend to the care of women with chronic conditions such as chronic pelvic pain, severe endometriosis, interstitial cystitis, untreatable pelvic prolapse, and other conditions. Palliative care, then, can be a focus for fatal and non-fatal diseases, and can and should be provided to address diminished quality-of-life issues as a part of ongoing treatment of a disease process, not just at the end of life.
姑息治疗是一种综合方法,重点关注“面临与威胁生命的疾病有关的问题的患者及其家属,通过早期发现和治疗其他身体、社会心理和精神问题来预防和减轻痛苦”的生活质量。这包括这样一个概念,即优质护理不仅包含在个人健康中,也包含在护理的环境和环境中,并涉及世界卫生组织(世卫组织)先前定义所包括的领域。姑息治疗将护理人员的重点放在医学的重要目标上——减轻疼痛和痛苦(各个层面),改善日常生活体验,支持身体能力变化带来的心理转变,并促进患者和家属对个体面临的疾病性质及其结果的理解。考虑到这一点,它代表了对所有患者,特别是那些患有导致生活质量和功能严重丧失的疾病的患者的护理的基本原则。虽然本章更多地关注肿瘤姑息治疗,但姑息治疗的原则和症状管理的研究可以扩展到患有慢性盆腔疼痛、严重子宫内膜异位症、间质性膀胱炎、无法治疗的盆腔脱垂等慢性疾病的妇女的护理。因此,姑息治疗可以成为致命和非致命疾病的重点,并且可以而且应该作为疾病持续治疗过程的一部分来解决生活质量下降问题,而不仅仅是在生命结束时提供。
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引用次数: 0
Obstetric analgesia and anaesthesia 产科镇痛与麻醉
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0028
S. Bampoe, A. Addei
This chapter is based on the current core curriculum of the Royal College of Obstetricians and Gynaecologists training programme. It covers the relevant anaesthesia knowledge criteria in the management of labour and delivery. The chapter provides succinct and important pieces of information on the following: (1) types and methods of action of analgesia and sedation including narcotics, hypnotics, and non-steroidal anti-inflammatory drugs and their indications and contraindications; (2) types and methods of action of regional anaesthesia including epidural, spinal, and pudendal nerve block and their indications and contraindications; (3) complications of anaesthesia and analgesia including cardiac arrest, respiratory arrest, aspiration, and drug reactions; (4) anaesthesia agents—induction, inhalational, and prophylactic measures; and (5) advice on pain relief.
本章是基于当前的核心课程的皇家学院妇产科医生培训计划。它涵盖了劳动和分娩管理中相关的麻醉知识标准。本章提供了以下简明而重要的信息:(1)镇痛和镇静的类型和作用方法,包括麻醉药、催眠药和非甾体抗炎药及其适应症和禁忌症;(2)硬膜外阻滞、脊髓阻滞、阴部神经阻滞等区域麻醉的种类和作用方法及其适应症和禁忌症;(3)麻醉和镇痛并发症,包括心脏骤停、呼吸骤停、误吸和药物反应;(4)麻醉药物——诱导、吸入和预防措施;(5)缓解疼痛的建议。
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引用次数: 0
Obstetric procedures 产科手术
Pub Date : 2020-01-01 DOI: 10.1093/med/9780198766360.003.0033
Y. Cheng, T. Leung
Human childbirth is a natural process but it is not always smooth and successful. Hence, several important obstetric surgical procedures and instruments were invented to assist difficult childbirth, such as caesarean section, forceps and vacuum vaginal delivery, external cephalic version, and vaginal breech delivery. The indications, the procedures, and the complications of these commonly practised obstetric surgeries are reviewed in this chapter. Other commonly performed procedures for normal labour such as episiotomy, repair of perineal tear, routine controlled cord traction for the delivery of the placenta in the third stage of labour, and manual removal of retained placenta will also be discussed.
人类分娩是一个自然的过程,但它并不总是顺利和成功的。因此,发明了一些重要的产科外科手术和器械来辅助难产,如剖腹产、产钳和真空阴道分娩、头外分娩和阴道臀位分娩。适应症,程序,和这些常见的产科手术并发症的审查,在本章。其他常用的正常分娩程序,如会阴切开术、会阴撕裂修复、常规控制脐带牵引在分娩第三阶段胎盘的分娩,以及人工清除残留胎盘也将被讨论。
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引用次数: 2
期刊
Oxford Textbook of Obstetrics and Gynaecology
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