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

英文中文

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 : 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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引用次数: 0

Recurrence of Severe Maternal Morbidity and Transfusion During Delivery Hospitalisations: A Retrospective Cohort Study. 分娩住院期间重症孕产妇的复发和输血：一项回顾性队列研究。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-10-01 DOI: 10.1111/1471-0528.17969

Anne-Sophie van Wingerden, Yongmei Huang, Whitney Booker, Kaitlyn G Nwaba, Mary E D'Alton, Alexander Friedman

Objective: To determine risks for non-transfusion severe maternal morbidity and transfusion during a second delivery hospitalisation based on clinical risk factors and obstetric complications from an index, first delivery hospitalisation.

Design: Retrospective cohort.

Population: Delivery hospitalisations in the 2010-2017 New York State Inpatient Database.

Methods: Patients with a first index delivery hospitalisation followed by a second delivery hospitalisation during the study period were included. Clinical risk factors and obstetric complications were obtained from the first index delivery hospitalisation. Adjusted logistic regression models for non-transfusion severe maternal morbidity during the second delivery were performed with adjusted (aORs) odds ratios as measures of effect. These analyses were then repeated for the outcome of transfusion.

Results: Of 624 500 paired delivery hospitalisations to 312 250 women, severe maternal morbidity occurred among 0.85% of second deliveries (n = 2672). When adjusted analysis was performed, several clinical factors were associated with severe maternal morbidity in a subsequent pregnancy, including severe maternal morbidity during the index pregnancy (aOR 8.4, 95% CI 7.0, 9.9), transfusion (aOR 2.0, 95% CI 1.6, 2.4) and pregestational diabetes (aOR 2.2, 95% 1.6, 2.9). When analyses were repeated for transfusion, several factors were associated with increased risk, including severe maternal morbidity (aOR 1.5, 95% CI 1.2, 1.8), index transfusion (aOR 6.3, 95% CI 5.6, 7.0), chronic heart disease (aOR 1.6, 95% 1.4, 1.9) and pregestational diabetes (aOR 1.7, 95% 1.3, 2.2).

Conclusion: Many obstetric complications and chronic conditions identified during an index delivery hospitalisation are associated with severe morbidity during a second, subsequent delivery. Index severe maternal morbidity is associated with the highest odds. These findings may be of use in patient counselling and risk stratification.

目的根据第一次分娩住院的临床风险因素和产科并发症，确定第二次分娩住院期间非输血严重产妇发病率和输血风险：设计：回顾性队列：2010-2017年纽约州住院患者数据库中的分娩住院患者：方法：纳入在研究期间首次分娩住院后再次分娩住院的患者。临床风险因素和产科并发症来自首次分娩住院。以调整后（aORs）的几率比作为效果衡量标准，建立了第二次分娩期间非输血严重孕产妇发病率的调整逻辑回归模型。然后针对输血结果重复这些分析：结果：在 312 250 名产妇的 624 500 例配对分娩住院病例中，0.85% 的二胎产妇（n = 2672）发生了严重的孕产妇发病率。在进行调整分析时，一些临床因素与再次妊娠的严重产妇发病率有关，包括初次妊娠期间的严重产妇发病率（aOR 8.4，95% CI 7.0，9.9）、输血（aOR 2.0，95% CI 1.6，2.4）和妊娠期糖尿病（aOR 2.2，95% 1.6，2.9）。在对输血进行重复分析时，有几个因素与风险增加有关，包括严重的孕产妇发病率（aOR 1.5，95% CI 1.2，1.8）、指数输血（aOR 6.3，95% CI 5.6，7.0）、慢性心脏病（aOR 1.6，95% 1.4，1.9）和妊娠期糖尿病（aOR 1.7，95% 1.3，2.2）：结论：在初次分娩住院期间发现的许多产科并发症和慢性病与第二次、后续分娩期间的严重发病率有关。预产期产妇严重发病的几率最高。这些发现可能有助于对患者进行咨询和风险分层。

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引用次数: 0

Pre-Pregnancy Chronic Conditions: Mental Health is a Burgeoning Problem 孕前慢性病：心理健康是一个日益突出的问题。

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-09-30 DOI: 10.1111/1471-0528.17959

Abi Merriel

Linked article: This is a mini commentary on Lundborg et al., pp. 44–52 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17885.

链接文章：这是本期对Lundborg等人44-52页的迷你评论。要查看本文，请访问https://doi.org/10.1111/1471-0528.17885。

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 : 2024-09-30 DOI: 10.1111/1471-0528.17968

Angelo B. Hooker

引用次数: 0

PAX1/SOX1 DNA Methylation Versus Cytology and HPV16/18 Genotyping for the Triage of High-Risk HPV-Positive Women in Cervical Cancer Screening: Retrospective Analysis of Archival Samples PAX1/SOX1 DNA 甲基化与细胞学和 HPV16/18 基因分型用于宫颈癌筛查中高危 HPV 阳性女性的分流：档案样本的回顾性分析

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-09-26 DOI: 10.1111/1471-0528.17965

Karen K. L. Chan, Stephanie S. Liu, Lesley S. K. Lau, Siew Fei Ngu, Mandy M. Y. Chu, K. Y. Tse, Annie N. Y. Cheung, Hextan Y. S. Ngan

Objective

To compare the performance of cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for the triage of high-risk HPV-positive cervical samples.

Design

Retrospective analyses of archival samples collected from a large-scale prospective randomised controlled trial.

Setting/Sample

HPV-positive women recruited from the general cervical screening population.

Methods

403 HPV-positive samples including 113 normal, 173 low-grade cervical intraepithelial neoplasia (LG-CIN), 114 HG-CIN and three cervical cancers. All samples were assessed by liquid-based cytology, HPV genotyping and PAX1/SOX1 methylation.

Main Outcome Measures

AUC (area under the curve), sensitivity and specificity for cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for high-grade (HG) premalignant cervical lesions.

Results

PAX1 was more sensitive than cytology and HPV16/18 genotyping in detecting a HG lesion (CIN2+). The sensitivity for PAX1, SOX1, cytology and HPV16/18 were 73.5% (95% CI: 65.5–81.5), 41.9% (95% CI: 32.9–50.8), 48.7% (95% CI: 39.7–57.8) and 36.8% (95% CI: 28.0–45.5), respectively, and their respective specificities were 70.3% (95% CI: 65.0–75.6), 83.6% (95% CI: 79.3–87.9), 77.6% (95% CI: 72.8–82.5) and 67.1% (95% CI: 61.7–72.6), respectively. Overall, PAX1 gave the best AUC at 0.72. Adding SOX1 to PAX1 did not improve the AUC (0.68). Three hundred and twenty-two women who did not have a HG lesion at baseline were followed up for two rounds of screening. Fewer women developed a HG lesion with a normal baseline PAX1 compared to women with a normal baseline cytology or negative HPV16/18 (8.4% vs. 14.5% and 17.5%, respectively).

Conclusion

PAX1 triage for referral to colposcopy in HPV-positive women may be superior to cytology and HPV16/18 genotyping.

比较细胞学、HPV16/18 基因分型和 PAX1/SOX1 甲基化对高危 HPV 阳性宫颈样本的分流效果。

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引用次数: 0

Pregnancy Outcomes in Women With Vascular EDS Provide High Mortality Rates 血管性脑损伤妇女的妊娠结局导致高死亡率

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-09-25 DOI: 10.1111/1471-0528.17961

Matthew Cauldwell

引用次数: 0

Professor Christopher Redman MBBChir (Cantab), FRCP, FRCOG (fellowship ad eundem), 30 November 1941 to 13 August 2024 克里斯托弗-雷德曼 MB Bchir、FRCP、FRCOG 教授（临时），1941 年 11 月 30 日至 2024 年 8 月 13 日

IF 4.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology

Pub Date : 2024-09-25 DOI: 10.1111/1471-0528.17967

Manu Vatish, Aris T. Papageorghiou

<p>With profound sadness, the community mourns the loss of Professor Christopher (Chris) Redman, who passed away at the age of 82 after a distinguished career as a pioneering obstetric physician and professor. Chris' relentless pursuit of knowledge and his contributions to the health of women and newborns left an indelible mark on the field and on all who had the privilege of working alongside him.</p><p>Born in South Africa in 1941, Chris' early years were shaped by his father's work as an astronomer, leading the family to move to the United Kingdom where he attended grammar school in Cambridge. His academic journey led him from Cambridge University to Oxford's Clinical Medical School, igniting a passion for medical research that would define his career. His clinical journey took him to Johns Hopkins University in Baltimore USA, to the University of Sheffield and then back to Oxford where he joined the Regius Department of Medicine.</p><p>Chris was a trailblazing innovator in maternal and fetal medicine. His first foray into obstetric research was a clinical trial on the efficacy of methyldopa for moderate hypertension in pregnancy where he showed a reduction in fetal loss, which was not due to a reduction in preeclampsia rates. He demonstrated that the drug had no adverse effects on fetal growth confirming that this drug was safe to use in pregnancy. From here onwards, Chris' career became focussed on preeclampsia and he led groundbreaking research into the role of extracellular vesicles released from the placenta in the pathogenesis of the condition.</p><p>His improvements in outcomes for mothers were not being matched by enhanced fetal outcomes and this culminated in the creation, alongside Professor Geoffrey Dawes, of the first computerised system for antepartum fetal heart rate analysis. This system, now used worldwide, has revolutionised clinical practice and decision-making in maternal and fetal medicine and stands as a testament to his foresight and unwavering dedication to patient care.</p><p>Chris started his high-risk clinic in 1983. Such was his commitment to his patients that they founded the Silver Star Charity in 1988 to raise funds for the unit and his research work. Even after retirement in 1998, Chris retained a major interest in driving understanding of preeclampsia and improving the Dawes-Redman algorithm, resulting in the publication of over 250 papers in this period alone, the most recent in June 2024.</p><p>In parallel with his academic achievements, Chris co-founded Action on Preeclampsia in 1991 (with Isobel Walker, a preeclampsia survivor and patient advocate), a charity that has dramatically improved care and awareness of the disease. He gave countless presentations and published comprehensive patient guides. His commitment to community engagement mirrored his zest for life, demonstrated in his enthusiasm for marathon running, hiking, ballroom dancing, and cycling to work, activities that kept him vibrant and well-conn

克里斯托弗（克里斯）-雷德曼（Christopher (Chris) Redman）教授作为一名杰出的产科先驱和教授，在82岁高龄时去世，社会各界对此深表哀悼。克里斯对知识的不懈追求以及他对妇女和新生儿健康的贡献，给这一领域以及所有有幸与他并肩工作的人留下了不可磨灭的印记。克里斯1941年出生于南非，父亲是一名天文学家，这影响了他的早年生活，后来他举家迁往英国，并在剑桥的文法学校就读。从剑桥大学到牛津大学临床医学院的求学之路，点燃了他对医学研究的热情，这也决定了他的职业生涯。他的临床旅程将他带到了美国巴尔的摩的约翰霍普金斯大学、谢菲尔德大学，然后又回到了牛津大学，并加入了牛津大学Regius医学系。他首次涉足产科研究是一项关于甲基多巴治疗妊娠期中度高血压疗效的临床试验，结果显示胎儿丢失减少，而这并非由于子痫前期发病率降低所致。他证明了这种药物对胎儿生长没有不良影响，证实了在孕期使用这种药物是安全的。从那时起，克里斯的职业生涯开始专注于子痫前期，他领导了关于胎盘释放的细胞外囊泡在子痫前期发病机制中的作用的开创性研究。他在改善母亲预后的同时并没有改善胎儿的预后，最终与杰弗里-道斯（Geoffrey Dawes）教授一起创建了首个产前胎儿心率分析计算机系统。该系统现已在全球范围内使用，彻底改变了孕产妇和胎儿医学的临床实践和决策，证明了他的远见卓识和对患者护理的不懈追求。克里斯于 1983 年创办了他的高风险诊所，他对病人的承诺使他们于 1988 年成立了银星慈善机构，为该科室和他的研究工作筹集资金。在取得学术成就的同时，克里斯于1991年与先兆子痫幸存者和患者倡导者伊泽贝尔-沃克（Isobel Walker）共同创立了先兆子痫行动组织（Action on Preeclampsia），该慈善组织极大地改善了对先兆子痫的护理并提高了人们对该疾病的认识。他发表了无数演讲，并出版了全面的患者指南。他对社区参与的承诺反映了他对生活的热情，表现在他热衷于马拉松长跑、徒步旅行、交谊舞和骑自行车上班，这些活动让他保持了活力和良好的人际关系。在牛津大学，克里斯度过了他大部分的职业生涯，他不仅以敏锐的智慧和开创性的研究著称，还以热情和富有感染力的个性而闻名。在牛津大学，克里斯的大部分职业生涯都是在那里度过的，他不仅以敏锐的智慧和开创性的研究而闻名，还以热情和引人入胜的个性而闻名。他善于在科学讨论中注入幽默，因此深受同事和学生的喜爱。他的医学创新和人际交往感动了无数人，他的精神将永垂不朽。克里斯托弗-雷德曼博士的妻子科琳娜（Corinna）、他们的五个孩子和 13 个孙子孙女都健在，对他们来说，他不仅是一位学者，更是一位尽职尽责的家庭主妇。当我们向他道别时，我们为他充满智慧、激情和仁慈的美好生活而庆贺。

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