Bjog-An International Journal of Obstetrics and Gynaecology最新文献

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Time to Diagnose Endometriosis: Current Status, Challenges and Regional Characteristics-A Systematic Literature Review. 诊断子宫内膜异位症的时间：现状、挑战和地区特征--系统性文献综述。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-01-01 Epub Date: 2024-10-07 DOI: 10.1111/1471-0528.17973

Pauline De Corte, Moritz Klinghardt, Sophia von Stockum, Klaas Heinemann

Background: Endometriosis diagnosis reportedly faces delays of up to 10 years. Despite growing awareness and improved guidelines, information on the current status is limited.

Objectives: To systematically assess the published evidence on the status of time to diagnosis in individuals with endometriosis, with respect to the definition of time to diagnosis, geographical location and patient characteristics.

Search strategy: MEDLINE (via PubMed) and Embase were searched for publications reporting time to diagnosing endometriosis since 2018. No restrictions to population or comparators were applied. All publications were screened by two independent reviewers.

Selection criteria: Search results were limited to primary publications of randomised controlled trials, non-randomised trials and observational studies. Case reports, secondary publications and grey literature were excluded. No restrictions were made regarding language, provided that an English title and abstract were available.

Data collection and analysis: Publications were assessed with respect to time to diagnosis, diagnostic methods, study type, study country and potential bias.

Main results: The 17 publications eligible for inclusion in this literature review were all observational studies. The publications reported diagnosis times between 0.3 and 12 years, with variations depending on the definition of time to diagnosis (overall, primary, or clinical), geographical location and characteristics of the included study population. Evidence was of poor to good quality overall.

Conclusions: Diagnostic delay is still present, primarily driven by physicians, and this review underscores the need for standardised definitions, increased awareness and targeted diagnostic interventions.

背景：据报道，子宫内膜异位症的诊断会面临长达 10 年的延误。尽管人们对子宫内膜异位症的认识在不断提高，相关指南也在不断完善，但有关其现状的信息却十分有限：系统评估已发表的有关子宫内膜异位症患者诊断时间状况的证据，包括诊断时间的定义、地理位置和患者特征：检索MEDLINE（通过PubMed）和Embase，检索2018年以来报告子宫内膜异位症诊断时间的出版物。对人群或比较对象未作限制。所有出版物均由两名独立审稿人进行筛选：搜索结果仅限于随机对照试验、非随机对照试验和观察性研究的主要出版物。病例报告、二手出版物和灰色文献均被排除在外。数据收集与分析：对出版物的诊断时间、诊断方法、研究类型、研究国家和潜在偏倚进行评估：符合纳入本次文献综述的 17 篇文献均为观察性研究。这些文献报告的诊断时间介于 0.3 年至 12 年之间，诊断时间的不同取决于诊断时间的定义（总体诊断时间、初诊诊断时间或临床诊断时间）、地理位置和纳入研究人群的特征。总体而言，证据的质量从差到好：诊断延误仍然存在，主要是由医生造成的，本综述强调了标准化定义、提高认识和有针对性的诊断干预措施的必要性。

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引用次数: 0

Evaluating waterbirth risks: A deep dive into the POOL cohort study's research gaps. 评估水中分娩风险：深入探讨 POOL 队列研究的研究空白。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-01-01 Epub Date: 2024-08-12 DOI: 10.1111/1471-0528.17934

Wei-Zhen Tang, Tai-Hang Liu, Xia Lan

引用次数: 0

Prevention of Intrauterine Adhesions: The Way to Go. 预防子宫内膜粘连：前进之路。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-01-01 Epub Date: 2024-09-30 DOI: 10.1111/1471-0528.17968

Angelo B Hooker

引用次数: 0

Congenital Cytomegalovirus Infection: Update on Screening, Diagnosis and Treatment: Scientific Impact Paper No. 56. 先天性巨细胞病毒感染：筛查、诊断和治疗的最新进展：第 56 号科学影响文件。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-01-01 Epub Date: 2024-10-21 DOI: 10.1111/1471-0528.17966

A Khalil, P T Heath, C E Jones, A Soe, Y G Ville

Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high-income countries; and 1 in 71 in low- and middle-income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non-primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene-based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2-3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2-3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28-32 weeks of gestation (and sometimes repeated 3-4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long-term brain develo

巨细胞病毒（CMV）是导致新生儿病毒感染的最常见原因，在高收入国家，每 200 个活产婴儿中就有 1 人感染；在中低收入国家，每 71 个活产婴儿中就有 1 人感染。它是造成听力损失和脑损伤的主要原因。妇女可能在怀孕期间首次感染 CMV（原发性感染），也可能经历 "非原发性 "感染，可能是以前的 CMV 感染再次活化，也可能是新感染了不同的病毒株。孕妇最常见的感染源是幼儿的唾液和尿液。因此，所有孕妇，尤其是经常与幼儿接触的孕妇，都应了解减少风险的卫生措施，如洗手。英国国家筛查委员会建议不要进行普遍的产前或新生儿 CMV 筛查。通常只有在怀孕期间出现流感、传染性单核细胞增多症或肝炎（肝脏炎症）症状的妇女，或在常规超声波扫描中发现胎儿异常并提示可能感染 CMV 的妇女，才会进行 CMV 检测。妇女在孕早期初次感染 CMV 后，胎儿受到伤害的风险最大，而在怀孕 12 周后感染 CMV，胎儿受到伤害的风险似乎很低。出生时感染 CMV 的婴儿可能会有黄疸、皮疹、肝脏或脾脏肿大、小脑或胎龄小。大约每 8 个感染 CMV 的婴儿中就有 1 个会在出生时出现可被临床检测到的体征。其余的婴儿则无法仅通过临床检查发现任何特征。因此，所有出生时感染 CMV 的婴儿都应根据病情至少在 2 岁或 2 岁以后接受随访，以检查听力和大脑发育情况。在怀孕前 12 周感染原发性 CMV 后，如果孕妇开始服用抗病毒药物伐昔洛韦（valacyclovir），就会降低婴儿受感染的风险。如果子宫内的胎儿已确诊感染了 CMV（例如通过羊膜穿刺术），则应每 2-3 周定期进行超声波扫描，直至胎儿出生。对胎儿大脑的详细评估是这些扫描的重要组成部分。如果母体感染了 CMV，但胎儿未确诊感染，则应每 2-3 周对胎儿进行一次重复的超声波扫描，直至出生。对于受感染的胎儿，除了超声波扫描外，还应在妊娠 28-32 周时进行脑部核磁共振成像扫描（有时 3-4 周后会重复扫描），以评估胎儿脑部是否有受到伤害的迹象。所有确诊或疑似感染 CMV 的妇女所生的婴儿都应在出生后 21 天内接受尿液或唾液样本的 CMV 检测。对于出生时患有无症状 CMV 感染的新生儿，使用抗病毒药物（缬更昔洛韦或更昔洛韦）治疗可减少六分之五婴儿的听力损失，并改善部分婴儿的长期脑发育结果。目前还没有获得许可的 CMV 疫苗。

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引用次数: 0

Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology. 保留基本技能：泌尿妇科阴道子宫切除术培训的未来。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2025-01-01 Epub Date: 2024-10-02 DOI: 10.1111/1471-0528.17974

Reut Rotem, Michael O Carey, Claire M McCarthy, Barry A O'Reilly, Yair Daykan, Orfhlaith E O'Sullivan

Objectives: This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications.

Design: A cross-sectional survey.

Setting: An electronic questionnaire.

Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members.

Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries.

Main outcome measures: Demographics, surgical selection, proficiency and technique, and training methods.

Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10-30 cases were needed to achieve and maintain proficiency.

Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques.

研究目的本研究旨在评估外科医生在盆腔器官脱垂（POP）手术治疗方面接受的培训和自我评估的熟练程度。我们重点关注影响决策的因素、采用的手术技术、接受的培训以及并发症的处理：设计：横断面调查：人群：欧洲泌尿妇科协会人群：欧洲泌尿妇科协会（EUGA）和国际泌尿妇科协会（IUGA）会员：方法：共33个问题，评估外科医生对阴道手术的偏好：主要结果测量：人口统计学、手术选择、熟练程度和技术以及培训方法：共有 471 名受访者，其中 273 人（58%）每周有 50% 以上的时间从事泌尿妇科工作。250人（53%）完成了研究金课程，其中215人（86%）的研究金课程是泌尿妇科和盆底重建。297名受访者（63%）表示在子宫下垂的病例中更倾向于子宫切除术，这主要是受患者偏好、年龄和脱垂解剖学评分的影响。共有 443 名受访者（94%）精通阴道子宫切除术，其中三分之二的受访者每年进行 30 例或更少手术；212 名受访者（45%）表示在过去十年中手术数量有所减少。此外，373 名受访者（79%）认为需要 10-30 例手术才能达到并保持熟练程度：结论：阴道子宫切除术仍是子宫脱垂修复术的关键组成部分。然而，随着保全子宫的子宫脱垂修复术的兴起，决策过程可能会受到多种因素的影响，包括手术培训。应重视传统和新技术的培训并保持熟练程度。

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IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-12-09 DOI: 10.1111/1471-0528.18033

Danielle L Wilson, Carley Whenn, Maree Barnes, Susan P Walker, Mark E Howard

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IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-12-01 DOI: 10.1111/1471-0528.18034

Abdalla Fayyad

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IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-11-25 DOI: 10.1111/1471-0528.18013

Berit Rein Solhaug, Rune Svenningsen, Maria Øyasæter Nyhus, Ingrid Volløyhaug

引用次数: 0

Maternal Cannabis Use Disorder and Neonatal Health Outcomes: A Data Linkage Study. 产妇大麻使用障碍与新生儿健康结果：数据关联研究。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-11-25 DOI: 10.1111/1471-0528.18024

Abay Woday Tadesse, Kim Betts, Berihun Assefa Dachew, Getinet Ayano, Rosa Alati

Objective: We tested for the potential associations between maternal antenatal cannabis use disorders (CUD) and neonatal health outcomes using large linked administrative data.

Design: Population-based retrospective cohort study.

Setting: The study was conducted in New South Wales, Australia.

Population or sample: A total of 215 879 singleton live births.

Methods: Generalised linear models (GLMs) fitted using log-binomial regression to estimate risk ratios (RRs) with the corresponding 95% confidence intervals (95% CI). Additionally, we conducted a propensity score matching (PSM) analysis.

Main outcome measures: The outcomes include preterm births (PTB), low birth weight (LBW), small for gestational age (SGA), 5-min lower Apgar scores and admission to the neonatal intensive care unit (NICU).

Results: In unmatched analyses, antenatal CUD was associated with increased risks for all adverse neonatal outcomes (adjusted risk ratio [RR] ranging from 1.47 [95% CI: 1.01, 2.14] for 5-min lower APGAR scores to 2.58 [95% CI 2.28, 2.91] for PTB). In PSM analyses, we observed slightly attenuated risks of PTB (RR = 1.98 [1.70, 2.31]), LBW (RR = 2.46 [2.13, 2.84]), SGA (RR = 1.84 [1.44, 2.35]) and admission to NICU (RR = 1.91 [1.49, 2.45]) after matching by covariates. However, we found no significant association between antenatal CUD and 5-min low APGAR scores (RR = 1.47 [0.94, 2.30]).

Conclusion: We found that maternal antenatal exposure to CUD is associated with a range of adverse neonatal outcomes. This study highlights that targeted interventions focusing on antenatal counselling are recommended to mitigate risks associated with maternal cannabis use.

目的我们利用大型关联管理数据，测试了产妇产前大麻使用障碍（CUD）与新生儿健康结果之间的潜在关联：设计：基于人群的回顾性队列研究：研究在澳大利亚新南威尔士州进行：方法：广义线性模型（GLM）：采用对数二叉回归拟合广义线性模型 (GLM)，估算风险比 (RR) 及相应的 95% 置信区间 (95%CI)。此外，我们还进行了倾向得分匹配（PSM）分析：结果包括早产（PTB）、低出生体重（LBW）、胎龄小（SGA）、5 分钟较低 Apgar 评分和入住新生儿重症监护室（NICU）：在非匹配分析中，产前 CUD 与新生儿所有不良结局的风险增加有关（调整风险比 [RR] 从 5 分钟较低 APGAR 评分的 1.47 [95% CI: 1.01, 2.14] 到 PTB 的 2.58 [95% CI 2.28, 2.91]）。在 PSM 分析中，经过协变量匹配后，我们观察到 PTB（RR = 1.98 [1.70, 2.31]）、LBW（RR = 2.46 [2.13, 2.84]）、SGA（RR = 1.84 [1.44, 2.35]）和入住 NICU（RR = 1.91 [1.49, 2.45]）的风险略有降低。然而，我们发现产前 CUD 与 5 分钟低 APGAR 评分（RR = 1.47 [0.94, 2.30]）之间无明显关联：我们发现，产妇产前接触 CUD 与新生儿的一系列不良结局有关。本研究强调，建议采取以产前咨询为重点的针对性干预措施，以降低产妇使用大麻的相关风险。

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引用次数: 0

Enhanced Recovery After Gynaecological Surgery: Insights and Future Directions. 加强妇科手术后的恢复：见解与未来方向。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-11-19 DOI: 10.1111/1471-0528.18012

Jiayu Yan, Bilan Li

引用次数: 0

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