Obstetrics, Gynaecology and Reproductive Medicine最新文献

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Genomics and hereditary cancer syndromes in women's health: a focus on gynaecological management 基因组学与妇女健康中的遗传性癌症综合征：关注妇科管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-09-14 DOI: 10.1016/j.ogrm.2024.07.002

Hereditary or familial cancer syndromes are caused by inherited pathogenic variants in cancer susceptibility genes and are associated with an increased risk of developing malignancies occurring at an earlier age. BRCA-associated Hereditary Breast and Ovarian Cancer and Lynch Syndromes are the most common conditions encountered in gynaecology. Identification presents opportunities to prevent or reduce the risk of cancer, or to detect cancers at earlier stages with improved outcomes. When cancer does occur, there may be options for personalized therapeutic approaches. Cancer prevention invariably requires risk-reducing surgical treatment, which may result in irreversible loss of fertility and premature menopause; issues which must be addressed through a personalized management approach. Regular review with adjustments to plans are required as individuals pass through different reproductive life-stages. Comprehensive management requires a multi-professional approach including specialist genetics input, prevention of cancer by education, modification of risk factors and specific interventions, in addition to psychosocial support.

遗传性或家族性癌症综合征是由癌症易感基因中的遗传致病变异引起的，与较早发生恶性肿瘤的风险增加有关。BRCA 相关遗传性乳腺癌和卵巢癌以及林奇综合征是妇科最常见的疾病。通过鉴定，可以预防或降低患癌风险，或在早期发现癌症，从而改善预后。当癌症发生时，可以选择个性化的治疗方法。预防癌症必然需要降低风险的手术治疗，这可能会导致不可逆转的生育能力丧失和过早绝经；这些问题必须通过个性化的管理方法来解决。在个人经历不同的生殖生命阶段时，需要对计划进行定期审查和调整。综合管理需要多专业的方法，包括遗传学专家的投入、通过教育预防癌症、改变风险因素和具体干预措施，以及社会心理支持。

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Self-assessment questions 自我评估问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-09-11 DOI: 10.1016/j.ogrm.2024.08.005

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Adolescent gynaecology: a review of core conditions 青少年妇科：核心病症回顾

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-09-03 DOI: 10.1016/j.ogrm.2024.08.003

In adolescent gynaecology clinic, we can encounter conditions that solely occur at this specific time in development and that we otherwise do not come across in other aspects of our working life. Though a patient may present with a ‘menstrual disorder’, this may well be the first manifestation of an endocrine disease or underlying congenital abnormality. When caring for adolescent gynaecology patients, it is essential we are alert to these possibilities, equipped with the specific knowledge pertaining to this patient group and that we investigate diligently so as not to miss a potentially serious condition. This article comprises key learning points for important adolescent gynaecology conditions including genital tract anomalies such as Mayer-Rokitansky-Kuster-Hauser and OHVIRA (obstructed hemivagina, ipsilateral renal anomalies) syndromes, genetic conditions such as Turner's syndrome, endocrine disorders such as androgen insensitivity and congenital adrenal hyperplasia, as well as abnormal uterine bleeding, primary ovarian insufficiency and polycystic ovarian syndrome.

在青春期妇科门诊中，我们可能会遇到只发生在这一特殊发育时期的病症，而这些病症在我们工作生活的其他方面是不会遇到的。虽然患者可能表现为 "月经失调"，但这很可能是内分泌疾病或潜在先天性异常的最初表现。在护理青春期妇科病人时，我们必须对这些可能性保持警惕，掌握与这一病人群体相关的特殊知识，并认真调查，以免错过潜在的严重病情。本文介绍了重要的青春期妇科疾病的学习要点，包括梅尔-罗基坦斯基-卡斯特-豪泽（Mayer-Rokitansky-Kuster-Hauser）和OHVIRA（半阴道梗阻、同侧肾脏异常）综合征等生殖道异常、特纳综合征等遗传性疾病、雄激素不敏感和先天性肾上腺皮质增生症等内分泌疾病，以及异常子宫出血、原发性卵巢功能不全和多囊卵巢综合征。

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Management of antepartum haemorrhage 产前出血的处理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-09-03 DOI: 10.1016/j.ogrm.2024.08.001

Obstetrics haemorrhage is the third direct leading cause for maternal mortality as highlighted in the last Mothers and Babies: Reducing risk through Audits and Confidential Enquires across the UK (MBRRACE-UK) report published in 2023. Antepartum haemorrhage (APH) can occur at any time between the age of viability until delivery. The most significant causes of APH, though not the most common, are associated with maternal and perinatal morbidity and mortality. These are placenta praevia, placental abruption, placenta accreta, vasa praevia, and uterine rupture. This review will outline the basic management principles of APH and provide an overview for most serious APH causes.

上一份《母亲与婴儿》（Mothers and Babies：2023 年发布的上一份《母亲和婴儿：通过全英审计和保密调查降低风险》（MBRRACE-UK）报告中强调了这一点。产前出血（APH）可发生在胎儿存活至分娩期间的任何时间。产前出血的最主要原因虽然不是最常见的，但却与产妇和围产期的发病率和死亡率有关。这些原因包括前置胎盘、胎盘早剥、胎盘早剥、前置血管和子宫破裂。本综述将概述 APH 的基本处理原则，并概述最严重的 APH 原因。

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Surgical approaches to hysterectomy in benign gynaecological conditions 良性妇科疾病的子宫切除手术方法

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-29 DOI: 10.1016/j.ogrm.2024.08.002

Hysterectomy is among the most frequently performed major gynaecological procedures globally. The primary indications include various benign conditions that have not responded to conservative management, including heavy menstrual bleeding, symptomatic uterine fibroids, chronic pelvic pain and uterine prolapse. Surgeons must be well-versed in surgical anatomy and the various approaches for performing a hysterectomy. The appropriate approach should be tailored for each patient whilst taking into consideration surgical risk factors as well as modern management of complications of hysterectomy.

子宫切除术是全球最常见的妇科大手术之一。主要适应症包括各种保守治疗无效的良性疾病，包括月经过多、无症状子宫肌瘤、慢性盆腔疼痛和子宫脱垂。外科医生必须精通手术解剖和各种子宫切除术的方法。应为每位患者量身定制适当的方法，同时考虑到手术风险因素以及子宫切除术并发症的现代处理方法。

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Outpatient management of severe ovarian hyperstimulation syndrome 严重卵巢过度刺激综合征的门诊治疗

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-20 DOI: 10.1016/j.ogrm.2024.08.004

Ovarian hyperstimulation (OHSS) is an iatrogenic complication, which commonly occurs after controlled ovarian stimulation (COS) in in-vitro fertilization (IVF) cycles. Most patients experience mild to moderate OHSS and can be managed safely in an outpatient setting with regular monitoring from their fertility treatment centre. However, severe OHSS has traditionally been managed on an inpatient basis to ensure regular monitoring and bloods can be performed to ensure there is no deterioration in the patient's condition. The mainstay of treatment remains supportive care even in severe cases of OHSS. This spotlight article aims to show that, with correct patient selection, most patients can be managed safely and effectively in an outpatient setting.

卵巢过度刺激（OHSS）是一种先天性并发症，通常发生在体外受精（IVF）周期中的控制性卵巢刺激（COS）之后。大多数患者都会出现轻度至中度的促排卵过多症（OHSS），可在门诊环境中通过生殖治疗中心的定期监测进行安全处理。然而，重度OHSS传统上需要住院治疗，以确保定期监测和抽血，确保患者的病情没有恶化。即使是严重的卵巢功能不全症，治疗的主要方式仍然是支持性护理。这篇聚焦文章旨在说明，只要患者选择正确，大多数患者都可以在门诊环境中得到安全有效的治疗。

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Management of connective tissue disorders and dermatological disorders in pregnancy 妊娠期结缔组织疾病和皮肤病的管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-17 DOI: 10.1016/j.ogrm.2024.07.003

Connective tissue, rheumatological and dermatological conditions affect a large proportion of the pregnant population and have important implications for women and their babies. Some conditions are chronic but may occur de novo in pregnancy whereas some are seen only during pregnancy. Multidisciplinary care is essential to maximise fetal and maternal outcomes, since many of these women require immunosuppressive treatment and close monitoring of their pregnancies. The development of biological therapies has revolutionised treatment of many connective tissue and arthritic diseases, allowing both more targeted treatments and an increase in treatment options. Their impact on fertility is minimal compared to older treatments and hence more women are able to conceive. With new treatments there will always be concerns about safety in pregnancy but concerns around neonatal immunosuppression have largely been unfounded and the benefits of continuing medication are significant. This article uses four cases to illustrate the challenges of management.

结缔组织、风湿病和皮肤病影响着很大一部分孕妇，并对妇女及其胎儿产生重要影响。有些疾病是慢性的，但可能会在怀孕期间重新出现，而有些则只在怀孕期间出现。为了最大限度地改善胎儿和母体的预后，多学科护理是必不可少的，因为其中许多妇女需要接受免疫抑制治疗并对妊娠进行密切监测。生物疗法的发展彻底改变了许多结缔组织和关节炎疾病的治疗方法，使治疗更有针对性，治疗选择也更多。与旧的治疗方法相比，生物疗法对生育能力的影响微乎其微，因此有更多的妇女能够怀孕。对于新的治疗方法，人们总是会担心妊娠的安全性，但对新生儿免疫抑制的担忧在很大程度上是没有根据的，而且继续用药的益处也很大。本文通过四个病例来说明管理方面的挑战。

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Surgical management of pelvic organ prolapse 盆腔器官脱垂的手术治疗

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.ogrm.2024.05.003

Pelvic organ prolapse (POP) is a common condition and is thought to affect approximately 40% of women over the age of 50, with prevalence increasing with age. 1 in 10 women will undergo surgery during their lifetime. Symptomatic women can be offered supervized pelvic floor exercises supported by Specialist Pelvic Floor Physiotherapists, vaginal pessary management or surgical management. This article covers comprehensive assessment, preoperative considerations to support shared decision making, and clinical governance surrounding surgical management of prolapse. It also provides a summary of different surgical techniques for both vaginal and abdominal approach for prolapse.

盆腔器官脱垂（POP）是一种常见疾病，据认为约有 40% 的 50 岁以上女性会受到影响，而且患病率会随着年龄的增长而增加。每 10 位女性中就有 1 位会在一生中接受手术治疗。有症状的妇女可在专业盆底物理治疗师的支持下进行有指导的盆底锻炼、阴道栓剂治疗或手术治疗。本文介绍了综合评估、支持共同决策的术前注意事项以及围绕脱垂手术治疗的临床管理。文章还总结了阴道和腹部治疗脱垂的不同手术技巧。

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Self-management of vaginal pessaries for prolapse: the TOPSY trial key findings 阴道塞药治疗脱垂的自我管理：TOPSY 试验的主要发现

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.ogrm.2024.05.004

Women with symptomatic pelvic organ prolapse are offered a choice of conservative and surgical treatment options. Two thirds of women choose a vaginal pessary, a support device inserted in the vagina. This article reports the finding of a randomized controlled trial published in 2023 evaluating the cost-effectiveness of self-management of pessary compared to clinic-based care. Women were recruited in 21 centres across the UK and 340 women were randomized to pessary self-management or clinic-based care. The primary outcome measure was prolapse-specific quality of life and secondary outcomes were generic quality of life, pelvic floor symptoms, sexual function, self-efficacy, pessary complications, pessary use and pessary confidence. Participants’ health care resource use was measured. The trial showed that at 18 month follow-up self-management was not associated with better or worse quality of life than clinic-based care. Women in the self-management group reported fewer pessary complications and lower healthcare resource use.

有症状的盆腔器官脱垂妇女可以选择保守治疗和手术治疗。三分之二的妇女会选择阴道栓，一种插入阴道的支撑装置。本文报告了 2023 年发表的一项随机对照试验的结果，该试验评估了自我管理膀胱塞与诊所护理相比的成本效益。英国 21 个中心招募了 340 名妇女，并随机分配她们接受泌尿器自我管理或诊所护理。主要结果是脱垂特异性生活质量，次要结果是一般生活质量、盆底症状、性功能、自我效能、栓剂并发症、栓剂使用和栓剂信心。对参与者的医疗资源使用情况进行了测量。试验结果表明，在 18 个月的随访中，与诊所护理相比，自我管理与更好或更差的生活质量并无关联。自我管理组的妇女报告的阴道塞并发症较少，使用的医疗资源也较少。

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The fetal anomaly screening scan: an international perspective 胎儿异常筛查扫描：国际视角

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.ogrm.2024.05.002

Fetal structural anomalies, affecting up to 3% of pregnancies, can be a major concern for expectant parents. Ultrasound screening has become an essential part of prenatal care, offering early detection of birth defects and empowering parents with information for reproductive decision making. While first-trimester scans are becoming more informative, the second-trimester scan remains the cornerstone of anomaly detection. Technological advancements, and the use of additional tools like MRI, are further enhancing our ability to ensure a healthy outcome for both mother and baby. Advancements have enabled detection of around half of all major anomalies in the first trimester (11–13+6) weeks. Professional societies recommend the second-trimester anatomy scan (18–22 weeks) as the gold standard for anomaly detection. The fetal anomaly scan boasts a high detection rate for major structural malformations, ranging from 15% to exceeding 90% in some cases. Detection rates vary depending on the organ system being examined. Equipment settings and sonographer experience play a role in accuracy. Whilst not 100% effective, the scan is safe and valuable. It empowers informed decision-making and can improve some pregnancy outcomes by enabling early detection and management. This allows for interventions, planning for delivery at the right time and place, and emotional preparation for parents. However, it is crucial to understand the limitations of the scan and the possibility of false positives or missed anomalies.

多达 3% 的孕妇会出现胎儿结构异常，这可能是准父母们最担心的问题。超声波筛查已成为产前保健的重要组成部分，它能及早发现先天缺陷，并为父母提供有关生育决策的信息。虽然第一孕期扫描的信息量越来越大，但第二孕期扫描仍是异常检测的基石。技术的进步以及核磁共振成像等其他工具的使用，进一步提高了我们确保母婴健康的能力。技术的进步使我们能够在妊娠头三个月（11-13+6）周检测出大约一半的重大异常。专业协会建议将第二孕期解剖扫描（18-22 周）作为异常检测的黄金标准。胎儿异常扫描对主要结构畸形的检出率很高，从 15%到超过 90%不等。检测率因检查的器官系统而异。设备设置和超声技师的经验对准确率也有影响。虽然不是百分之百有效，但扫描是安全和有价值的。它有助于做出明智的决策，并能通过早期检测和管理改善某些妊娠结局。这样就可以进行干预，在正确的时间和地点计划分娩，并为父母做好情感准备。然而，了解扫描的局限性以及出现假阳性或遗漏异常的可能性至关重要。

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