Obstetrics, Gynaecology and Reproductive Medicine最新文献

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Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ogrm.2024.11.005

Anna Richmond

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The clinical impact and management of premenstrual syndrome 经前综合征的临床影响及处理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ogrm.2024.11.001

Supriya Preman Thazhath Pullayikudi, Akanksha Sood

Premenstrual syndrome (PMS) is a condition characterized by psychological, physical and behavioural symptoms occurring in the luteal phase of the normal menstrual cycle but resolves shortly after menstruation. Around 40% of women experience symptoms of PMS and of these 5–8% suffer from severe PMS including premenstrual dysphoric disorder (PMDD), a debilitating condition with severe emotional and physical symptoms and functional impairment. Premenstrual syndrome is effectively related to hormonal changes in the menstrual cycle, supported by the absence of PMS prior to puberty, during pregnancy, and after the menopause. Diagnosis is aided by reviewing symptoms in the Daily Record of Severity of Problems (DRSP) questionnaire. Management is centred around lifestyle modifications, cognitive behavioural therapy and pharmacological treatment. This article is a review of the clinical impact of premenstrual syndrome and its management strategies.

经前综合症（PMS）是一种以心理、身体和行为症状为特征的疾病，发生在正常月经周期的黄体期，但在月经后不久就会消退。大约40%的妇女有经前综合症的症状，其中5-8%患有严重的经前综合症，包括经前烦躁不安（PMDD），这是一种使人衰弱的疾病，伴有严重的情绪和身体症状以及功能障碍。经前综合症与月经周期中的激素变化有关，在青春期前、怀孕期间和绝经后没有经前综合症。诊断是通过回顾问题严重程度的每日记录（DRSP）问卷中的症状来辅助的。管理以生活方式改变、认知行为疗法和药物治疗为中心。本文就经前综合征的临床影响及其治疗策略作一综述。

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Evidence-based management of women of advanced maternal age 高龄产妇的循证管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ogrm.2024.11.002

Huda MEM Ahmed, Kate F Walker

The average age of women at childbirth in industrialised nations has been increasing steadily for approximately 30 years. Women aged 35 years or over have an increased risk of gestational hypertensive disease, gestational diabetes, placenta praevia, placental abruption, perinatal death, preterm labour, fetal macrosomia and fetal growth restriction. The risk of trisomy 21, 18 and 13, and other sex chromosome aberrations (e.g. Klinefelter syndrome) increases significantly with maternal age, especially in women aged 35 years and older but there is no age-related association with an increased risk of triploidy or monosomy X. Unsurprisingly, rates of obstetric intervention are higher among older women. Of particular concern is the increased risk of antepartum stillbirth at term in women of advanced maternal age. In all maternal age groups, the risk of stillbirth is higher among nulliparous women than among multiparous women. Women of advanced maternal age (>40 years) should be offered low dose aspirin (in the presence of an additional risk factor for pre-eclampsia) and offered serial ultrasounds for fetal growth and wellbeing; given the increased risk of antepartum stillbirth, induction of labour from 39 weeks’ gestation should be discussed with the woman. In very advanced maternal age (≥45 years of age), women who conceived via in vitro fertilization are significantly at increased risk of preterm delivery and adverse maternal outcomes compared to those who conceive naturally.

近30年来，工业化国家妇女分娩的平均年龄一直在稳步增长。35岁或以上的妇女患妊娠期高血压、妊娠期糖尿病、前置胎盘、胎盘早剥、围产期死亡、早产、胎儿巨大和胎儿生长受限的风险增加。21、18、13三体和其他性染色体畸变（如Klinefelter综合征）的风险随着母亲年龄的增加而显著增加，特别是在35岁及以上的妇女中，但与三倍体或x单体的风险增加没有年龄相关性，不出所料，老年妇女的产科干预率更高。特别值得关注的是高龄产妇足月发生产前死产的风险增加。在所有产妇年龄组中，未产妇女的死产风险高于多产妇女。高龄产妇（40岁）应给予低剂量阿司匹林（存在子痫前期的额外风险因素），并提供连续超声检查胎儿生长和健康状况；考虑到产前死产的风险增加，从妊娠39周开始引产应与妇女讨论。在高龄产妇（≥45岁）中，通过体外受精受孕的妇女与自然受孕的妇女相比，早产和不良产妇结局的风险明显增加。

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The obstetric anal sphincter injury (OASI) clinic: postnatal and subsequent antenatal management of women with a history of obstetric anal sphincter injury 产科肛门括约肌损伤（OASI）诊所：有产科肛门括约肌损伤史的妇女的产后和随后的产前管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ogrm.2024.11.004

Kathy Parsons, Matthew Parsons

Obstetric anal sphincter injuries (OASI) occur in around 6.1% of first vaginal births and around 5–7% of subsequent vaginal births. The multidisciplinary OASI clinic plays a vital role in the postnatal, and subsequent antenatal, management of women with a history of OASI. This review will outline the recommended best practice for the outpatient postnatal management of women who have sustained a recent OASI and also the current guidance on mode of birth recommendations in a subsequent pregnancy after an OASI. It will explore the evidence supporting current practice recommendations to facilitate clinicians leading mode of birth discussions for women with a previous OASI.

产科肛门括约肌损伤（OASI）发生在约6.1%的首次阴道分娩和约5-7%的后续阴道分娩。多学科的OASI诊所在产后和随后的产前管理中起着至关重要的作用。这篇综述将概述最近发生OASI的妇女的门诊产后管理的推荐最佳做法，以及OASI后妊娠的分娩方式推荐的现行指南。它将探讨支持当前实践建议的证据，以促进临床医生为以前有OASI的妇女领导分娩模式的讨论。

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Endometrial cancer: an update on diagnosis, treatment and the role of molecular profiling 子宫内膜癌：诊断、治疗和分子图谱作用的最新进展

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ogrm.2024.11.003

Cathrine Holland

The incidence of endometrial cancer in the UK has risen steeply since the 1990s. Survival has improved significantly over several decades but outcomes for 25% of women remain poor. Surgery is the initial treatment approach in most cases. Sentinel node surgery has largely replaced systematic lymphadenectomy for surgical staging in apparent early-stage disease. Radiotherapy and chemotherapy are used to reduce recurrence, and for upfront primary treatment in selected cases. Different endometrial cancer sub-types have different aetiologies, histological and molecular characteristics and prognoses. Molecular classification of tumours is now indicated in all patients treated for endometrial cancer. Molecular characterization has important implications for treatment options, both at initial presentation and any subsequent recurrence, including access to new immunotherapy treatments. In addition, “mainstreaming” of genetic testing in those at risk of Lynch syndrome, will improve identification of at-risk families and help prevent future endometrial, ovarian and bowel cancers.

自20世纪90年代以来，英国子宫内膜癌的发病率急剧上升。几十年来，妇女的生存状况有了显著改善，但仍有25%的妇女生活状况不佳。在大多数情况下，手术是最初的治疗方法。前哨淋巴结手术已在很大程度上取代了系统性淋巴结切除术的手术分期在明显的早期疾病。放疗和化疗用于减少复发，并在选定的病例中进行前期初级治疗。不同的子宫内膜癌亚型具有不同的病因、组织学和分子特征及预后。肿瘤的分子分类现在在所有接受子宫内膜癌治疗的患者中都有指示。分子表征对治疗方案具有重要意义，无论是在最初的表现还是随后的任何复发，包括获得新的免疫治疗。此外，对Lynch综合征高危人群进行基因检测的“主流化”，将改善对高危家庭的识别，并有助于预防未来的子宫内膜癌、卵巢癌和肠癌。

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Modern considerations in perioperative care in gynaecology 妇科围手术期护理的现代思考

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ogrm.2024.10.001

Ee Thong Lim, Nikolaos Tsampras

Modern lifestyle has led to an increased number of surgical patients having comorbidities, often related to increased perioperative morbidity and mortality. Early recognition of risk factors and optimization of the patients can improve outcomes. The continuous trend of minimal access procedures in gynaecology and the application of enhanced recovery programmes have improved clinical and cost effectiveness. Following the COVID-19 pandemic, surgical waiting lists in Gynaecology have grown to levels not seen in a decade. Day case surgery has been promoted to reduce the pressure on hospitals and improve the patient experience. National and global organizations, as the National Institute for Health and Care Excellence (NICE), the World Health Organization (WHO), the Centre for the Perioperative Care (CPOC) and the Enhanced Recovery after Surgery Society (ERAS), are producing guidance, promoting knowledge, understanding and research regarding optimal perioperative care. In this review we summarize the current evidence and discuss its applications in modern gynaecology practice.

现代生活方式导致手术患者的合并症数量增加，通常与围手术期发病率和死亡率增加有关。早期识别危险因素和优化患者可以改善结果。妇科手术次数最少的持续趋势和加强康复方案的应用提高了临床效益和成本效益。在2019冠状病毒病大流行之后，妇科手术等候名单已增至十年来从未见过的水平。日间手术已被推广，以减轻医院的压力，改善患者的体验。国家和全球组织，如国家健康和护理卓越研究所（NICE）、世界卫生组织（WHO）、围手术期护理中心（CPOC）和术后增强恢复学会（ERAS），正在制定指导方针，促进关于最佳围手术期护理的知识、理解和研究。在这篇综述中，我们总结了目前的证据，并讨论其在现代妇科实践中的应用。

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Antenatal management of teenage pregnancy 少女怀孕的产前管理

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ogrm.2024.10.002

Emily M Frier, Marie Anne Ledingham

Teenage pregnancy has major implications for the mother and child, their wider family, and at a societal and population level. Although teenage pregnancy rates have fallen substantially over the last 30 years, they remain higher in the UK relative to other countries in Western Europe, and a high proportion of teenage pregnancies are unplanned. Teenage pregnancy is associated with major health inequalities, including lower maternal socioeconomic status and education. Furthermore, there is a lack of guidance to inform the antenatal management of teenage mothers to optimize both short- and long-term outcomes for mother and child. This review article outlines the latest trends in teenage pregnancy in the UK, the risks of teenage pregnancy for the mother, fetus and child, and presents proposed antenatal management strategies to optimize outcomes of teenage pregnancies.

少女怀孕对母亲和儿童、其更广泛的家庭以及社会和人口层面都有重大影响。尽管在过去的30年里，英国的少女怀孕率大幅下降，但与西欧其他国家相比，英国的少女怀孕率仍然较高，而且很大一部分少女怀孕是计划外的。少女怀孕与严重的保健不平等有关，包括产妇社会经济地位和教育水平较低。此外，缺乏指导，以告知少女母亲的产前管理，以优化母亲和儿童的短期和长期结果。这篇综述文章概述了英国青少年怀孕的最新趋势，青少年怀孕对母亲、胎儿和儿童的风险，并提出了产前管理策略，以优化青少年怀孕的结果。

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Fertility treatment in women over 50: clinical and ethical considerations 50岁以上妇女的生育治疗：临床和伦理考虑

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ogrm.2024.10.004

Sharon Tay, Peter Kerecsenyi, Raj Mathur

As more women prioritize education, career growth, and personal milestones, family planning is increasingly postponed until later in life. Contributing factors such as advanced education, career ambitions, highly effective contraceptive methods, and finding life partners at later stages have led to a growing interest in fertility treatments for women over 50. However, pursuing pregnancy at this age comes with significant clinical and ethical challenges. Women over 50 face elevated risks of aneuploidy, miscarriage, pre-eclampsia, gestational diabetes, and preterm delivery. These complications necessitate rigorous pre-treatment evaluations, enhanced monitoring protocols, and comprehensive care throughout pregnancy. Additionally, ethical concerns arise regarding the welfare of both mother and child, as well as the societal implications of offering fertility treatments to this demographic. This spotlight article explores the clinical risks, ethical considerations, and practical approaches to managing fertility treatment in women over 50.

随着越来越多的女性优先考虑教育、事业发展和个人里程碑，计划生育越来越被推迟到生命的后期。高等教育、事业抱负、高效避孕方法以及在晚年找到生活伴侣等因素导致50岁以上女性对生育治疗的兴趣日益浓厚。然而，在这个年龄继续怀孕会面临重大的临床和伦理挑战。50岁以上的女性患非整倍体、流产、先兆子痫、妊娠糖尿病和早产的风险较高。这些并发症需要严格的治疗前评估，加强监测方案，并在整个妊娠期间进行全面护理。此外，关于母亲和儿童的福利以及向这一人口提供生育治疗的社会影响的伦理问题也出现了。这篇重点文章探讨了50岁以上妇女生育治疗的临床风险、伦理考虑和实用方法。

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Benign ovarian cysts in premenopausal women 绝经前妇女良性卵巢囊肿

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ogrm.2024.10.003

Navneet Kaur, Kenneth Ma

Benign ovarian cysts are a common gynaecological presentation. Up to 10% of women will have surgery for an ovarian cyst in their lifetime. When an adnexal mass is diagnosed, the differential diagnosis is wide and up to 10% may be non-ovarian in origin. The goal of management is to determine the underlying pathology and to risk stratify patients to guide further management. Transvaginal ultrasound scanning remains the imaging modality of choice and the use of simple rules as well as benign and malignant features should form the basis for diagnosis, with serum markers used as an adjunct. Cross-sectional imaging with other modalities including magnetic resonance imaging are useful in the management of indeterminate masses. Most ovarian cysts are benign in nature and most functional and simple cysts are likely to resolve spontaneously without intervention. This review will demonstrate four clinical scenarios with different underlying pathology and their management.

良性卵巢囊肿是一种常见的妇科表现。多达10%的女性一生中会因卵巢囊肿接受手术治疗。当诊断出附件肿块时，鉴别诊断范围很广，高达10%可能是非卵巢起源的。管理的目标是确定潜在的病理和患者的风险分层，以指导进一步的管理。经阴道超声扫描仍然是首选的成像方式，使用简单的规则以及良性和恶性特征应构成诊断的基础，血清标志物用作辅助。包括磁共振成像在内的其他方式的横断成像在不确定肿块的处理中是有用的。大多数卵巢囊肿本质上是良性的，大多数功能性和单纯性囊肿很可能在没有干预的情况下自行消退。这篇综述将展示四种具有不同基础病理的临床情况及其处理。

引用次数: 0

Self-assessment questions 自我评估的问题

Q3 Medicine

Obstetrics, Gynaecology and Reproductive Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ogrm.2024.10.005

Anna Richmond

引用次数: 0

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