Obstetrics, Gynaecology and Reproductive Medicine最新文献

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Optimising endometrial preparation in frozen embryo transfer: a comprehensive review of current protocols and outcomes 优化子宫内膜准备在冷冻胚胎移植：目前的方案和结果的全面审查

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2026-01-01 DOI: 10.1016/j.ogrm.2025.09.007

Snigdha Soni, Neena Malhotra

The number of frozen embryo transfers (FET) cycles has increased significantly, largely due to the advancements in cryopreservation techniques and reassuring long-term perinatal outcomes. Synchronization between a receptive endometrium and an implantation-competent embryo is essential for successful outcomes in FET cycles. Endometrial preparation can be achieved through the natural cycle (true or modified), mild ovarian stimulation, or hormone replacement cycles. Natural cycles retain the physiological benefits of the corpus luteum, with improved obstetric outcomes, but require monitoring to identify ovulation. Hormone replacement cycles allow scheduling flexibility but are associated with an increased risk of hypertensive disorders of pregnancy and adverse perinatal outcomes. The timing of embryo transfer in relation to ovulation or progesterone exposure is critical and must align with the window of implantation. Luteal phase support is mandatory in hormone replacement cycles. Appropriate protocol selection based on patient characteristics and clinical context is essential to optimize reproductive and perinatal outcomes.

冷冻胚胎移植（FET）周期的数量显著增加，主要是由于冷冻保存技术的进步和长期围产期结局的保证。在FET周期中，接受性子宫内膜和具有着床能力的胚胎之间的同步对于成功的结果至关重要。子宫内膜准备可以通过自然周期（真实或修改）、轻度卵巢刺激或激素替代周期来实现。自然周期保留了黄体的生理益处，改善了产科结局，但需要监测以确定排卵。激素替代周期允许安排灵活性，但与妊娠高血压疾病和不良围产期结局的风险增加有关。与排卵或黄体酮暴露有关的胚胎移植时间至关重要，必须与植入窗口一致。黄体期支持在激素替代周期中是强制性的。根据患者特点和临床情况选择适当的方案对于优化生殖和围产期结果至关重要。

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引用次数: 0

Referral criteria, investigation and management of postmenopausal bleeding 绝经后出血的转诊标准、调查和处理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2026-01-01 DOI: 10.1016/j.ogrm.2025.09.009

Felicity Watson, Michaela Jewson, Ohoud AlOmar

Postmenopausal bleeding (PMB) is the most common presenting symptom of endometrial cancer. An aging population, obesity and cancer survival have contributed to increasing endometrial cancer rates. However, only 10% of women with PMB have endometrial cancer. Robust guidelines for management of PMB are essential to allow timely access to services, without exposing women to unnecessary investigation and treatment. Any woman with unexplained PMB, unscheduled bleeding on hormone replacement therapy (HRT) lasting >6 months after commencing or >3 months after a dosage change should be referred to secondary care. Clinical history, examination findings and ultrasound (USS) should be used to guide management. Endometrial thickness (ET) should be interpreted in the context of HRT use along with patient risk factors for endometrial pathologies. Women on selective estrogen receptor modulators (SERM), women who have recurrent symptoms or USS findings of irregular endometrium or obvious focal abnormality should be offered hysteroscopy.

绝经后出血是子宫内膜癌最常见的症状。人口老龄化、肥胖和癌症生存是导致子宫内膜癌发病率上升的原因。然而，只有10%的PMB女性患有子宫内膜癌。强有力的PMB管理准则对于使妇女能够及时获得服务，而不使妇女遭受不必要的调查和治疗至关重要。任何在激素替代治疗（HRT）中出现不明原因PMB、计划外出血的妇女，在开始治疗后持续6个月或剂量改变后持续3个月，都应转诊至二级护理。临床病史，检查结果和超声检查（USS）应指导管理。子宫内膜厚度（ET）应在HRT使用的背景下与子宫内膜病理的患者危险因素一起解释。服用选择性雌激素受体调节剂（SERM）的妇女，有复发症状或子宫内膜不规则或明显局灶性异常的妇女应进行宫腔镜检查。

引用次数: 0

Vulval cancer essentials: what every clinician should know 外阴癌要点：每个临床医生都应该知道的

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2026-01-01 DOI: 10.1016/j.ogrm.2025.09.006

Audrey Kwong, James Nevin, Jason Yap

Vulval cancer is uncommon and needs subspecialist management. However, because patients are usually first seen by non-gynaecological oncologists, this paper aims to provide guidance that is of particular interest to general gynaecologists. The diagnosis needs confirmation by punch biopsy. Cross sectional imaging is not always necessary. Treatment is usually surgical; that is, local and groin node resections. Sentinel node resection has replaced complete groin node resection in many patients with a consequent reduction in surgical morbidity. Prognosis is good but surveillance is important for five years.

外阴癌不常见，需要专科治疗。然而，由于患者通常首先由非妇科肿瘤学家看到，本文旨在提供一般妇科医生特别感兴趣的指导。诊断需要穿孔活检证实。横断面成像并不总是必要的。治疗通常是手术；即局部和腹股沟淋巴结切除术。在许多患者中，前哨淋巴结切除术已经取代了完全的腹股沟淋巴结切除术，从而降低了手术发病率。预后良好，但5年的监测很重要。

引用次数: 0

Urogynaecological complications in pregnancy 妊娠期泌尿妇科并发症

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2026-01-01 DOI: 10.1016/j.ogrm.2025.09.008

Mosab Mahadi, Aethele Khunda, Victoria Kershaw, Paul Ballard, Sami Shawer

Various urogynaecological symptoms can arise or change during pregnancy and the postpartum period. Alterations in body physiology during pregnancy and after childbirth can affect excretory function, making women more susceptible to urological complications, such as acute urinary tract infections and urinary retention, and to constipation, whilst alterations in anatomy can affect continence. The anatomical proximity of the uterus to the urinary system renders the bladder and ureters vulnerable to iatrogenic injury during caesarean sections. Similarly, the proximity of the vagina to the anus increases the risk of anal sphincter injury during vaginal delivery. Pelvic floor function may become compromised during pregnancy and the postpartum period. Patients may encounter problems with urinary and faecal continence as well as pelvic organ support, which can significantly impact their quality of life. This review article provides an overview of the presentation and management of common urogynaecological conditions encountered during pregnancy and the postpartum periods.

在怀孕和产后期间，各种泌尿妇科症状可能出现或改变。怀孕期间和分娩后身体生理的改变会影响排泄功能，使女性更容易出现泌尿系统并发症，如急性尿路感染和尿潴留，以及便秘，而解剖结构的改变会影响尿失禁。子宫与泌尿系统的解剖接近使得膀胱和输尿管在剖宫产时容易受到医源性损伤。同样，阴道靠近肛门也会增加阴道分娩时肛门括约肌损伤的风险。在怀孕和产后期间，盆底功能可能会受到损害。患者可能会遇到尿和大便失禁以及盆腔器官支持的问题，这可能会严重影响他们的生活质量。这篇综述文章提供了在妊娠和产后期间遇到的常见泌尿妇科疾病的表现和管理的概述。

引用次数: 0

Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2026-01-01 DOI: 10.1016/j.ogrm.2025.09.010

Richmond Anna, Smart Georgina

引用次数: 0

Amniotic fluid in fetal life: physiology and pathophysiology 羊水在胎儿生命中的作用：生理学和病理生理学

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-12-11 DOI: 10.1016/j.ogrm.2025.11.001

Nashwa Anwar, Leo Gurney

Amniotic fluid is the fluid surrounding the growing fetus during the intra-uterine life. It is an essential component of the intrauterine environment, playing a vital role not only in fetal growth and musculoskeletal development but also in the organogenesis of important fetal organs, such as the lungs, brain, and gastrointestinal tract. The amount of amniotic fluid is maintained because of the balance between the fluid produced by the placenta, fetal lungs and kidneys, versus the amount of fluid cleared by fetal swallowing. Any disruption in this mechanism can lead to either an increase in the fluid volume (polyhydramnios) or a decrease in the fluid volume (oligohydramnios). Abnormalities in the fluid volume can potentially impact the perinatal outcomes. This manuscript aims to provide an in-depth explanation of how amniotic fluid is produced, the normal parameters of amniotic volume during each gestational period, abnormalities of amniotic fluid volume, and the clinical impact of each scenario.

羊水是在子宫内生长的胎儿周围的液体。它是宫内环境的重要组成部分，不仅在胎儿生长和肌肉骨骼发育中起着至关重要的作用，而且在重要胎儿器官（如肺、脑和胃肠道）的器官发生中起着至关重要的作用。羊水的量是由于胎盘、胎儿肺和肾脏产生的液体与胎儿吞咽清除的液体量之间的平衡而维持的。这种机制的任何破坏都可能导致液体体积增加（羊水过多）或液体体积减少（羊水过少）。异常的液体量可以潜在地影响围产期结局。本文旨在深入解释羊水是如何产生的，每个妊娠期羊水体积的正常参数，羊水体积的异常，以及每种情况的临床影响。

引用次数: 0

Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-12-08 DOI: 10.1016/j.ogrm.2025.11.005

Anna Richmond, Georgina Smart

引用次数: 0

From booking to baby: a comprehensive review of the UK Maternity Care Pathway 从预订到婴儿：英国产科护理途径的全面审查

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-11-26 DOI: 10.1016/j.ogrm.2025.11.002

Rajangam Akshaya, Roy Chandrima

Antenatal care in the UK has evolved since the late 20th century, following a structured, evidence-based pathway, with early booking by 10 weeks' gestation recommended to optimise maternal and fetal outcomes. The initial midwifery-led booking appointment identifies clinical and social risk factors, directing women into either standard or high-risk pathways. Those identified as high risk are referred to consultant-led or multidisciplinary clinics and undergo additional scans and monitoring throughout pregnancy. Universal antenatal care includes basic blood tests with offering of screening tests, first trimester dating and second trimester anomaly scans, with further investigations arranged as indicated. A minimum of 6–8 appointments with a named midwife supports continuity, holistic care and informed decision-making. Women are empowered to create personalised birth plans, supported by counselling on delivery options and associated risks. The pathway has evolved to incorporate targeted support for vulnerable women and late bookers. Postnatal care includes structured follow-up, contraceptive counselling, and transition to primary care. Increasingly, pre-conception and equity-focused models, such as the inverted care pyramid, are being explored to improve long-term outcomes.

自20世纪末以来，英国的产前保健已经发展起来，遵循结构化的循证途径，建议在妊娠10周前提前预约，以优化母婴结局。最初由助产士主导的预约确定临床和社会风险因素，引导妇女进入标准或高风险途径。那些被确定为高风险的人被转介到顾问领导的或多学科诊所，并在整个怀孕期间接受额外的扫描和监测。普遍产前保健包括基本的血液检查，并提供筛检、妊娠早期确定日期和妊娠中期异常扫描，并根据指示安排进一步调查。与指定助产士至少进行6-8次预约，以支持连续性、整体护理和知情决策。妇女有权制定个性化的生育计划，并得到有关分娩选择和相关风险的咨询支持。该途径已发展为包括对弱势妇女和晚登记者的有针对性的支持。产后护理包括有组织的随访、避孕咨询和向初级保健的过渡。人们正在越来越多地探索孕前和以公平为中心的模式，如倒置的护理金字塔，以改善长期结果。

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引用次数: 0

Management of pre-existing diabetes in pregnancy 妊娠期糖尿病的管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.ogrm.2025.11.003

Anna K Richmond, Amy E Morrison, Claire L Meek

Maternal diabetes is the most common medical complication encountered in pregnancy and therefore knowledge of the pre-conceptual, antenatal, intrapartum and post-natal management is vital for the specialist and generalist. In recent times, technology to assist management of diabetes has increased significantly, most notably in the introduction of continuous glucose monitoring (CGM) and insulin pump therapy in type 1 diabetes, which has improved maternal and neonatal outcomes. Research is ongoing into the use of these technologies in type 2 diabetes. An understanding amongst the entire multi-disciplinary team in the use of these technologies is important to providing safe and best care. Pre-conception care is variably accessed by women with pre-existing diabetes and demonstrates that pregnancy should be considered by all healthcare professionals even if they do not have regular roles within obstetric care, as pre-conceptual diabetes optimization is vital to improve pregnancy outcomes. The postnatal period is also an opportunity to optimize glycaemic control for the future, whether or not the women desires a future pregnancy, and to provide appropriate advice on both contraception and risk reduction of diabetes related complications.

产妇糖尿病是妊娠期间最常见的医学并发症，因此对专科医生和全科医生来说，了解孕前、产前、产中和产后管理至关重要。近年来，辅助糖尿病管理的技术显著增加，最显著的是在1型糖尿病中引入连续血糖监测（CGM）和胰岛素泵治疗，这改善了孕产妇和新生儿的预后。目前正在研究这些技术在2型糖尿病中的应用。整个多学科团队在使用这些技术方面的理解对于提供安全和最佳护理非常重要。怀孕前糖尿病妇女获得孕前护理的情况各不相同，这表明，所有医疗保健专业人员都应考虑怀孕，即使他们在产科护理中没有常规角色，因为孕前糖尿病优化对改善妊娠结局至关重要。产后也是一个为将来优化血糖控制的机会，无论妇女是否希望将来怀孕，并在避孕和减少糖尿病相关并发症风险方面提供适当的建议。

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引用次数: 0

A placenta accreta spectrum review: focusing on antenatal care and surgical approach 胎盘增生谱回顾：重点产前护理和手术方法

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.ogrm.2025.11.004

Lucy Blanks, Nia Wyn Jones

The primary risk factor for a morbidly adherent placenta (placenta accreta spectrum) is a previous caesarean birth. It is estimated that by 2030 28.5% of births worldwide will be performed by caesarean birth. The extensive remodelling which the lower uterine segment undergoes post caesarean birth causes disruption of the normal histological boundaries between uterus and a low-lying placenta in any subsequent pregnancy. We know that placenta accreta spectrum (PAS) is a condition which carries a high risk of maternal morbidity and mortality. There is a limited amount of research concerning PAS and there is wide variation in the management worldwide. This article aims to summarize current guidance and research, whilst introducing exciting areas of research, discussion and debate; it will focus on antenatal care, diagnosis, surgical staging and the surgery itself.

病态附着性胎盘（胎盘增生谱）的主要危险因素是以前的剖腹产。据估计，到2030年，全世界28.5%的分娩将通过剖腹产进行。剖宫产后子宫下部段的广泛重构导致子宫与胎盘之间的正常组织学边界在任何后续妊娠中被破坏。我们知道，胎盘增生谱（PAS）是一种具有产妇发病率和死亡率高风险的疾病。关于PAS的研究数量有限，世界范围内的管理存在很大差异。本文旨在总结当前的指导和研究，同时介绍令人兴奋的研究、讨论和辩论领域；它将侧重于产前护理，诊断，手术分期和手术本身。

引用次数: 0

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