Obstetrics, Gynaecology and Reproductive Medicine最新文献

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Preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation: key points for counselling and management 妊娠23周前早产胎膜破裂（PPROM）：咨询与处理要点

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.ogrm.2025.07.004

Laura Goodfellow, Angharad Care

Preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation is a rare but high-risk complication. A UK-wide prospective study using the UK Obstetric Surveillance System (UKOSS) identified 364 women with PPROM between 16⁺⁰ and 22⁺⁶ weeks' gestation. Of these, 32% had a termination and 68% had expectant management. Sepsis occurred in 14% of women and there were two maternal deaths. There was a high rate of birth in the immediate period after PPROM; only 38% of women remained pregnant at 28 days. Among women who continued their pregnancies, 44% had live births and 26% had babies that survived to discharge, with 70% of survivors avoiding severe morbidity. These findings highlight the importance of sepsis vigilance, early multidisciplinary counselling, and psychological support. Outcomes vary depending on gestation at rupture and timing of delivery. As no formal guidelines currently exist, this study provides a foundation for future research and supports balanced, individualised management of early PPROM in clinical practice.

妊娠23周前的早产胎膜破裂（PPROM）是一种罕见但高风险的并发症。一项使用英国产科监测系统（UKOSS）的全英国范围的前瞻性研究确定了364名妊娠16+0至22+6周的PPROM妇女。其中，32%的人终止了妊娠，68%的人接受了预期的管理。败血症发生率为14%，产妇死亡2例。PPROM术后即刻出生率较高；只有38%的女性在第28天仍然怀孕。在继续怀孕的妇女中，44%活产，26%的婴儿存活至出院，70%的幸存者避免了严重的疾病。这些发现强调了脓毒症警惕、早期多学科咨询和心理支持的重要性。结果取决于破裂妊娠和分娩时间。由于目前没有正式的指南，本研究为未来的研究提供了基础，并支持临床实践中早期PPROM的平衡，个性化管理。

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Recent advances in laparoscopic urogynaecology 腹腔镜泌尿妇科的最新进展

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-22 DOI: 10.1016/j.ogrm.2025.09.001

Indranil Banerjee, Swati Jha

Laparoscopic urogynaecology has undergone significant advancements over the past decade, offering minimally invasive alternatives for managing complex pelvic floor disorders. This review explores recent innovations in laparoscopic procedures, focusing on improvements in surgical techniques, instrumentation, and patient outcomes. Key developments include refined approaches to laparoscopic sacrocolpopexy, the use of robotic assistance and enhanced imaging technologies that improve surgical precision. The integration of mesh materials and evolving strategies to reduce complications such as mesh erosion are also discussed in this article. These innovations have contributed to reduced morbidity, shorter recovery times, and improved quality of life for patients. However, continued evaluation through long-term studies is essential to validate the efficacy and safety of these techniques. This paper underscores the importance of multidisciplinary collaboration and ongoing surgical training in advancing laparoscopic urogynaecology practices.

腹腔镜泌尿妇科在过去十年中取得了重大进展，为治疗复杂的盆底疾病提供了微创选择。这篇综述探讨了腹腔镜手术的最新创新，重点是手术技术、器械和患者预后的改进。关键的发展包括腹腔镜骶髋固定术的改进方法，机器人辅助的使用和提高手术精度的增强成像技术。本文还讨论了网格材料的集成和减少网格侵蚀等并发症的发展策略。这些创新有助于降低发病率，缩短康复时间，提高患者的生活质量。然而，通过长期研究进行持续评估对于验证这些技术的有效性和安全性至关重要。本文强调了多学科合作和持续的外科培训在推进腹腔镜泌尿妇科实践中的重要性。

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Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-21 DOI: 10.1016/j.ogrm.2025.09.005

Anna Richmond, Georgina Smart

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The impact of the menopause on the lower urinary tract 更年期对下尿路的影响

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-20 DOI: 10.1016/j.ogrm.2025.09.003

Aysha Waheed, Angie Rantell, George Araklitis

The wide-reaching effect of the menopause is becoming increasingly understood. Oestrogen-receptive tissues of the female urogenital tract have been shown to have altered structure and function in response to decreasing oestrogen levels around the time of the menopause and beyond. This is thought to contribute to the increased incidence of lower urinary tract pathology found post-menopause, including urinary frequency, urgency, incontinence and recurrent urinary tract infections. By understanding the mechanism of these conditions in post-menopausal women, effective management options can be developed, for example replacing depleted oestrogens through topical administration. The aim of this review is to identify the current available evidence on the impact of post-menopausal oestrogen depletion on the bladder and lower urinary tract, and how this may influence the management we can offer to patients.

人们越来越了解更年期的广泛影响。女性泌尿生殖道的雌激素接受组织已被证明在绝经前后雌激素水平下降时结构和功能发生改变。这被认为是导致绝经后发现的下尿路病理发生率增加的原因，包括尿频、尿急、尿失禁和反复尿路感染。通过了解绝经后妇女这些情况的机制，可以制定有效的管理方案，例如通过局部给药替代耗尽的雌激素。本综述的目的是确定目前可用的证据，证明绝经后雌激素消耗对膀胱和下尿路的影响，以及这可能如何影响我们为患者提供的治疗。

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Vulval pain: underdiagnosed, underestimated and under-treated 外阴疼痛：诊断不足，低估和治疗不足

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-18 DOI: 10.1016/j.ogrm.2025.09.004

Emily Wright, Rebecca Mckay

Vulval pain is a common condition which can cause significant distress to patients. Pain can be from a specific disorder affecting the vulva which presents acutely but becomes a chronic pain if left untreated. If not due to an underlying defined condition, chronic vulval pain is termed Vulvodynia, where pain can classically be described as burning in nature. Chronic vulval pain can be challenging for the gynaecologist; correct diagnosis is frequently delayed and treatment is often unsatisfactory. Management relies on a multidisciplinary approach, tailored specifically to the patient.

外阴疼痛是一种常见的情况，可引起显著痛苦的病人。疼痛可能来自影响外阴的特定疾病，这种疾病急性出现，但如果不及时治疗，就会变成慢性疼痛。如果不是由于一个潜在的定义条件，慢性外阴疼痛被称为外阴痛，其中的疼痛可以经典地描述为燃烧的性质。慢性外阴疼痛对妇科医生来说是一个挑战；正确的诊断常常被延误，治疗也常常不能令人满意。管理依赖于多学科的方法，专门为患者量身定制。

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Telemedicine and remote monitoring advancements for obstetric antenatal care 产科产前保健的远程医疗和远程监测进展

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.ogrm.2025.06.004

Jack Le Vance, Leo Gurney, R Katie Morris, Victoria Hodgetts Morton

In recent years, the proportion of pregnant women now classifying as high-risk has increased. This is primarily due to guideline changes, implementation of national initiatives and an ageing maternal population. The requirement for serial antenatal maternal-fetal monitoring has therefore increased, placing a significant strain on outpatient obstetric services to cope with the increased demand. Advancements in digital medical innovation, combined with improvements in technological infrastructure has led to increasing development of methods for telemedicine and remote monitoring in both research and clinical settings of antenatal care. The recent pandemic has had also a substantial influence on technology development, as obstetric outpatient services were required to consider alternative solutions to the provision of antenatal care. This spotlight article presents the latest research in telemedicine and remote monitoring for obstetric antenatal care.

近年来，被列为高危的孕妇比例有所增加。这主要是由于指导方针的变化、国家举措的实施以及孕产妇人口的老龄化。因此，对连续产前母胎监测的需求增加了，对产科门诊服务造成了巨大压力，以应对不断增加的需求。数字医疗创新的进步，加上技术基础设施的改进，促使在产前护理的研究和临床环境中不断开发远程医疗和远程监测方法。最近的大流行病也对技术发展产生了重大影响，因为产科门诊服务必须考虑提供产前护理的其他解决办法。这篇重点文章介绍了产科产前保健远程医疗和远程监测的最新研究。

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Placental disorders: a case-based review 胎盘疾病：一项基于病例的综述

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.ogrm.2025.06.003

Sumana Narain, Craig Platt, Gabriela Cristina Giurgiu, Luiz Cesar Peres

A well functioning placenta plays the key role in fetal growth and development, and is crucial for fetal and maternal wellbeing. Placental pathology is linked with numerous pregnancy complications, such as fetal growth restriction, preeclampsia, abruption and stillbirth. Placental pathology, although highly relevant to clinical practice, is an area of obstetric knowledge and understanding which requires further study. The diagnosis of placental disorders are mainly made after delivery, on histopathological examination of the placenta. This has impeded better understanding of how and when abnormal development occurs and makes targeting specific treatments far more difficult. Four cases are presented, covering some of the most common and well-defined placental pathologies, and illustrate the different presentations and outcomes associated with these distinct diagnoses.

一个功能良好的胎盘在胎儿生长发育中起着关键作用，对胎儿和母亲的健康至关重要。胎盘病理与许多妊娠并发症有关，如胎儿生长受限、先兆子痫、早剥和死产。胎盘病理学，虽然高度相关的临床实践，是一个领域的产科知识和理解，需要进一步研究。胎盘疾病的诊断主要是在分娩后对胎盘进行组织病理学检查。这阻碍了更好地理解异常发育是如何以及何时发生的，并使靶向特异性治疗变得更加困难。提出了四个病例，涵盖了一些最常见和明确的胎盘病理，并说明了不同的表现和结果与这些不同的诊断。

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Her cup runneth over: the clinical impact of heavy menstrual bleeding, investigations and management 她的杯子溢出：大量月经出血的临床影响，调查和管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.ogrm.2025.06.001

Hannah Mackereth, Carolann Vezza, Felicity Watson

Heavy menstrual bleeding is defined as heavy menstrual blood loss that affects a woman's physical or mental health in addition to their social and/or quality of life. Around 25% of women aged 25–30 are affected by heavy menstrual bleeding (HMB). It accounts for 20% of outpatient referrals to Gynaecology. Initial assessment includes a combination of history taking, transvaginal ultrasound, hysteroscopy and endometrial biopsy. Management is historically split into two categories: medical and surgical. The focus should be on improving the patient's quality of life rather than reducing the amount of blood lost. Medical management ranges from analgesia, hormonal medication, intrauterine devices to medication that will arrest the menstrual cycle and ensue an early menopause. One third of patients will undergo surgical management as definitive treatment for heavy menstrual bleeding. Surgical options include endometrial ablation, hysteroscopic removal of fibroids or polyps, myomectomy and hysterectomy.

月经大量出血被定义为月经大量失血，影响妇女的身体或精神健康以及她们的社交和/或生活质量。在25-30岁的女性中，约有25%的人受到月经大出血（HMB）的影响。它占妇科门诊转诊的20%。初步评估包括病史记录、经阴道超声、宫腔镜检查和子宫内膜活检。从历史上看，管理分为两类：内科和外科。重点应该放在提高病人的生活质量上，而不是减少失血量。医疗管理范围从镇痛、激素药物、宫内节育器到阻止月经周期和随后提前绝经的药物。三分之一的患者将接受手术治疗作为大量月经出血的最终治疗方法。手术选择包括子宫内膜切除术、宫腔镜切除肌瘤或息肉、子宫肌瘤切除术和子宫切除术。

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Cancer in pregnancy: a practical guide for obstetricians and gynaecologists, with a focus on women's malignancies 妊娠期癌症：产科医生和妇科医生的实用指南，重点是妇女恶性肿瘤

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.ogrm.2025.06.002

Helen Bolton

Cancer is uncommon in pregnancy. Diagnosis may be delayed due to symptoms being incorrectly attributed to pregnancy. The management of cancer in pregnancy requires a multi-disciplinary approach, with obstetricians and oncologists sharing expertize to ensure the optimal outcome from the cancer, whilst minimizing the impact on the pregnancy wherever possible. When planning treatment, the oncologist must first consider what standard treatment would be recommended in the non-pregnant patient and then work with the obstetrician to modify the treatment approach if the treatment cannot be administered during pregnancy. Treatment modifications may require deferring treatment until later gestations, delivering earlier to expedite treatment in the post-partum period, or even offering a different treatment approach altogether during pregnancy. Termination of pregnancy may need to be considered in early pregnancy for some cancers. This review provides an overview of general approaches to managing cancer in pregnancy, followed by a more detailed discussion of the principles of managing breast, cervical and ovarian cancer presenting in pregnancy. Healthcare professionals should aspire to avoid compromising oncological outcome due to pregnancy wherever possible. Many newer drug treatments are now being incorporated into standard care for many cancer types, such that there is a risk that pregnancy may now be more likely to be associated with compromised outcomes as most of the non-cytotoxic systemic treatments are absolutely contra-indicated in pregnancy.

癌症在怀孕期间并不常见。由于症状被错误地归因于怀孕，诊断可能会延迟。妊娠期癌症的管理需要多学科的方法，产科医生和肿瘤学家分享专业知识，以确保癌症的最佳结果，同时尽可能减少对妊娠的影响。当计划治疗时，肿瘤学家必须首先考虑在非怀孕患者中推荐什么标准治疗，然后与产科医生一起修改治疗方法，如果治疗不能在怀孕期间实施。治疗方法的改进可能需要将治疗推迟到妊娠后期，提前分娩以加快产后治疗，甚至在怀孕期间提供完全不同的治疗方法。对于某些癌症，可能需要在妊娠早期考虑终止妊娠。本综述概述了妊娠期癌症治疗的一般方法，然后更详细地讨论了妊娠期乳腺癌、宫颈癌和卵巢癌的治疗原则。医疗保健专业人员应尽可能避免因怀孕而损害肿瘤结果。许多新的药物治疗现在被纳入许多癌症类型的标准治疗中，因此，由于大多数非细胞毒性全身治疗在怀孕期间是绝对禁忌的，因此怀孕可能更有可能与不良结果相关。

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引用次数: 0

Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.ogrm.2025.06.005

Anna Richmond

引用次数: 0

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