Acta Obstetricia et Gynecologica Scandinavica最新文献_第4页

Biopsy-proven residual cervical cancer at the end of combined chemoradiation predicts poor outcome—Retrospective single-center cohort study 联合放化疗结束时活检证实的残留宫颈癌预测不良预后：回顾性单中心队列研究

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-21 DOI: 10.1111/aogs.70106

Christoph Ebner, Ricarda Purtscheller, Barin Feroz, Jana Rieker, Linda Ebner, Mara Mantovan, Sergej Skvortsov, Mario Brüggl, Katharina Leitner, Verena Wieser, Irina Tsibulak, Christian Marth, Alain Gustave Zeimet

Introduction

Persistent tumor after combined chemoradiation for locally advanced cervical cancer is an established prognostic factor. Detection may include magnetic resonance imaging, positron emission tomography (PET) combined with CT scan, ultrasound, or biopsies; however, no agreement about the best method and time point has been reached. In our institution, a standardized biopsy protocol of at least four punch biopsies is routinely performed at the last brachytherapy with re-biopsies 6 weeks later in cases not showing histologic complete response (hCR). This study aims to assess the prognostic relevance of these biopsies, especially with respect to the time point of hCR.

Material and Methods

This investigation was a retrospective single-center observational cohort study that included all patients treated for locally advanced or node-positive cervical cancer with combined chemoradiation at the University Hospital Innsbruck between 2008 and 2023. Patients with a hCR at the end of radiotherapy were classified as primary negative and otherwise as primary positive. Primary positive patients that achieved complete response at a control biopsy 6 weeks later were classified as secondary negative, and the remaining patients with residual tumor as secondary positive. Progression-free survival (PFS) and overall survival (OS) were compared between all these groups.

Results

We included 184 patients in this study, from which 46 (25%) were classified as primary positive. These patients experienced a significantly worse PFS compared to primary negative patients (p = 0.008, HR = 2.03, 95% CI [1.20, 3.45]). The difference in PFS was also evidenced when comparing primary negative patients to those who had a hCR 6 weeks after radiotherapy (secondary negative) (p = 0.018, HR = 2.00, 95% CI [1.13, 3.56]). However, in primary positive patients, OS was not significantly reduced (p = 0.29, HR = 1.45, 95% CI [0.73, 2.86]).

Conclusions

Early response evaluation using punch biopsies at the time of the last brachytherapy can identify patients with residual tumor, which exhibit a statistically significant and clinically meaningful risk of disease progression. This risk was not reversed even in the case of a delayed hCR 6 weeks after completion of chemoradiation.

简介：局部晚期宫颈癌联合放化疗后肿瘤持续是一个确定的预后因素。检测可能包括磁共振成像，正电子发射断层扫描（PET）结合CT扫描，超声波或活组织检查；然而，关于最佳方法和时间点尚未达成一致意见。在我们的机构中，在最后一次近距离放射治疗时，常规进行至少四次穿孔活检的标准化活检，在未显示组织学完全缓解（hCR）的病例6周后进行再次活检。本研究旨在评估这些活检的预后相关性，特别是与hCR的时间点有关。材料和方法：本研究是一项回顾性单中心观察队列研究，纳入了2008年至2023年间在因斯布鲁克大学医院接受局部晚期或淋巴结阳性宫颈癌联合放化疗的所有患者。放疗结束时hCR患者分为原发性阴性和原发性阳性。在6周后的对照活检中获得完全缓解的原发性阳性患者被归类为继发性阴性，剩余的肿瘤残留患者被归类为继发性阳性。比较各组间的无进展生存期（PFS）和总生存期（OS）。结果：我们纳入184例患者，其中46例（25%）为原发性阳性。与原发性阴性患者相比，这些患者的PFS明显更差（p = 0.008, HR = 2.03, 95% CI[1.20, 3.45]）。原发性阴性患者与放疗后6周hCR患者（继发性阴性）的PFS差异也得到了证实（p = 0.018, HR = 2.00, 95% CI[1.13, 3.56]）。然而，在原发性阳性患者中，OS没有显著降低（p = 0.29, HR = 1.45, 95% CI[0.73, 2.86]）。结论：在最后一次近距离放射治疗时使用穿孔活检进行早期反应评估可以识别残留肿瘤患者，这些患者表现出具有统计学意义和临床意义的疾病进展风险。即使在放化疗完成后6周hCR延迟的情况下，这种风险也没有逆转。

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引用次数: 0

Menopause in nonhuman mammals—What does it mean for the gynecologist? 非人类哺乳动物的更年期——这对妇科医生意味着什么？

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-21 DOI: 10.1111/aogs.70131

Sebastian Gidlöf, Hedvig Engberg, Ivika Jakson

<p>Menopause has historically been regarded as a specific human phenomenon, but new research in comparative and evolutionary biology suggests that reproductive aging and reduced ovarian hormone production are not entirely unique to humans.</p><p>It has previously been shown that some species of toothed whales display a clear postreproductive life phase meaning that reproduction is haltered well before death.<span><sup>1</sup></span> Toothed whales represent the first of the two living groups of cetaceans and include species like dolphins, killer-whales, beluga, etc. The other group of cetaceans includes whales that have baleen instead of teeth, such as blue whales, gray whales, humpback whales, etc. Walker and Herndon<span><sup>2</sup></span> reviewed the topic and found that although some nonhuman primates seem to encounter menopause, the most compelling evidence comes from whales.</p><p>Later reports have shed new light and a study in wild populations of chimpanzees (<i>Pan troglodytes</i>) found evidence for a postreproductive phase in females. However, this phase does not seem to have such a sharp onset as menopause in the human sense.<span><sup>3</sup></span></p><p>Studies in the African elephant (<i>Elaphas maximus</i>) suggest that many females live many years after their last reproduction even though fertility in this species seem to gradually decline over several decades rather than ending within a few years.<span><sup>4</sup></span></p><p>The term <i>menopause</i>, referring to the last menstruation in life, is actually misleading as only a few mammals do have a menstrual cycle. Winkler and Goncalves have therefore advocated the use of <i>oopause</i> to allow for better comparison between mammal species.<span><sup>5</sup></span> Such a definition would include a broader understanding of the permanent cessation of ovulations, which may be more common in mammals than we have previously thought.</p><p>In humans, the perimenopause surrounding menopause is accompanied not only by the cessation of ovulations but also hormonal changes (declining levels of estrogen and progesterone and the reciprocal elevation of gonadotrophins), symptoms (such as hot flushes and vaginal atrophy), and physical changes (reduced bone mineral density and cardiovascular changes). Data from other species are scarce.</p><p>Studies from toothed whales are based on demographics, morphology, and lifespan markers. Photopoulou et al. found morphological signs of ovarian inactivity in older individuals of false killer whales (<i>Pseudorca crassidens</i>). By comparing the age of the whales to ovarian morphology, they could draw the conclusion that the species displays a postreproductive life phase.<span><sup>6</sup></span></p><p>In chimpanzees, evidence is based on behavioral studies, demographic data, and hormonal analyses. In the Ngogo population in Uganda, females older than 50 years did not have any offspring, and hormonal urinary samples indicated reduced ovulatory cy

历史上，更年期一直被认为是人类特有的现象，但比较和进化生物学的新研究表明，生殖老化和卵巢激素分泌减少并不完全是人类独有的。先前有研究表明，一些齿鲸物种表现出明显的生殖后生命阶段，这意味着在死亡之前很久就停止了繁殖齿鲸是现存的两种鲸目动物中的第一种，包括海豚、虎鲸、白鲸等。另一类鲸目动物包括有须而不是牙齿的鲸鱼，如蓝鲸、灰鲸、座头鲸等。沃克和赫恩顿回顾了这个话题，发现尽管一些非人类灵长类动物似乎也会经历更年期，但最令人信服的证据来自鲸鱼。后来的报告给我们带来了新的启示，一项对野生黑猩猩（泛穴居人）的研究发现了雌性黑猩猩有繁殖后期的证据。然而，这个阶段似乎没有像人类意义上的更年期那样急剧发作。对非洲象（Elaphas maximus）的研究表明，尽管该物种的生育能力似乎在几十年内逐渐下降，而不是在几年内结束，但许多雌性大象在最后一次繁殖后仍能存活多年。更年期一词指的是生命中的最后一次月经，实际上是一种误导，因为只有少数哺乳动物有月经周期。因此，Winkler和Goncalves提倡使用卵子来更好地比较哺乳动物物种这样的定义将包括对永久停止排卵的更广泛的理解，这可能比我们之前认为的在哺乳动物中更常见。在人类中，围绝经期不仅伴随着排卵的停止，还伴随着激素的变化（雌激素和黄体酮水平的下降以及促性腺激素的相互升高）、症状（如潮热和阴道萎缩）和身体变化（骨密度降低和心血管变化）。来自其他物种的数据很少。对齿鲸的研究是基于人口统计学、形态学和寿命标记。Photopoulou等人发现老年假虎鲸（伪虎鲸）个体卵巢不活动的形态学迹象。通过将鲸鱼的年龄与卵巢形态进行比较，他们可以得出这样的结论：该物种正处于繁殖后期。在黑猩猩身上，证据是基于行为研究、人口统计数据和荷尔蒙分析。在乌干达的Ngogo种群中，50岁以上的女性没有任何后代，激素尿液样本显示排卵周期减少。大象数量的减少是逐渐的，在50岁以上的时候，大象的生育能力开始下降。尽管如此，许多女性在60多岁的时候还能继续生育。因此没有明显的上限。众所周知，在野生哺乳动物身上研究潮热、情绪紊乱或其他更年期症状是非常困难的。因此，重点是生殖测量，如最后一次分娩的年龄、排卵的迹象和生育后的存活率。实验动物模型的实验研究（如卵巢切除的啮齿动物或化学诱导的卵泡衰竭）跳过了更年期或更年期的自然情况，也没有考虑到生活史的角度。为什么雌性个体在死亡前很久就会停止繁殖？进化论需要答案，人们提出了许多假设。在齿鲸中，祖母假说有强有力的证据。Ellis等人发现，齿鲸的更年期是在雌性寿命延长而没有生殖期延长的情况下发生的。这增加了代际之间的差距，使在狩猎和迁徙等重要方面的合作和知识传递成为可能，并减少了代际之间的生殖冲突这一理论符合该物种的自然历史，即雌性一生都与母亲呆在家庭群体中，形成母系豆荚。通过停止繁殖，年长的母亲避免了与女儿的竞争，同时也有助于整个家庭的生存。从进化的角度来看，生育能力较强的雌性提高了物种的进化适应性，并增加了她的基因传递给下游后代的机会。此外，对黑猩猩的研究表明，尽管黑猩猩的社会结构与鲸鱼不同，但某些雌性在最后一次分娩后仍能活很多年，年龄越大可能会带来知识和照顾等优势，这使得祖母效应有所减弱。大象也有类似祖母的结构，但没有明显的更年期，这表明在年老时继续繁殖的好处可能大于成本。生育率逐渐下降，但繁殖不会在一定时间内停止。在一项将工业化前的人类与大象进行比较的研究中，Lahdenperä及其同事得出结论，尽管一些物种的寿命很长，但它们不一定会进入更年期。要理解为什么年长的非人类女性停止繁殖，但继续生活下去，可能会提供比围绝经期更深入的知识。一个漫长的生育后生命阶段意味着身体维护（大脑、骨骼、心脏等）是一种进化特征，选择在生育年龄后的几十年里继续发挥作用。这既带来了希望，也带来了挑战。这表明，干预不仅应侧重于恢复或模仿卵巢功能，还应关注整个生物体的整体长期健康。这意味着更年期不应仅仅被视为生育能力和卵巢功能的丧失，而是从一种进化功能向另一种进化功能的过渡。总之，尽管严格意义上的人类更年期在动物界很少见，但比较生物学研究表明，在非人类哺乳动物中，尤其是齿鲸和最近被描述的黑猩猩，在特定的物种生活史条件下，可以发展出一个后生育阶段。大象没有明显的排卵期，这证明寿命长是不够的，代际合作等其他进化选择因素至关重要。在人类中，这支持了更年期深深植根于我们物种的社会和进化历史的理解。它不是长寿的副作用，而是从一个进化阶段转向另一个进化阶段。更全面的理解，包括生理和社会因素，可能会导致对围绝经期妇女更深入的理解，也可能是更好的支持。撰写了初稿，并由H.E.和i.j.进行了修改。

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引用次数: 0

Patient-centered priorities in endometriosis and chronic pelvic pain: A mixed-methods and thematic analysis of intake narratives 以患者为中心的子宫内膜异位症和慢性盆腔疼痛优先：混合方法和专题分析的摄入叙述。

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-16 DOI: 10.1111/aogs.70096

Shay M. Freger, Narges Kalani, Monica Cornea, Serena Cavalier, Mathew Leonardi

<div> <section> <h3> Introduction</h3> <p>Understanding what patients prioritize when seeking care for endometriosis and chronic pelvic pain (CPP) is crucial for delivering personalized, responsive care. However, patient-defined goals remain poorly characterized across various life stages and disease phenotypes. This study aimed to explore and rank patient priorities at the time of tertiary referral to inform patient-centered care models.</p> </section> <section> <h3> Material and Methods</h3> <p>We conducted a convergent mixed-methods study of 649 new patients referred to a tertiary endometriosis center between 2021 and 2024. Participants completed a standardized intake form including two open-ended questions on their goals and reasons for seeking care. Qualitative data were analyzed using codebook thematic analysis, generating five overarching themes and 20 subthemes. Frequencies of coded themes were descriptively compared across age groups and ultrasound-confirmed endometriosis phenotypes. Quantitative data were analyzed using descriptive statistics, with subgroup comparisons based on age (18–24, 25–34, 35–44, 45–54, 55+) and phenotype (superficial, ovarian, deep, combined). The primary outcome was the ranked frequency of care priorities by subgroup. Secondary outcomes included cross-theme variation and co-occurrence patterns.</p> </section> <section> <h3> Results</h3> <p>Five key themes emerged: (1) managing pain and symptoms across a broad spectrum; (2) pursuing diagnostic clarity and validation; (3) balancing symptom relief with fertility planning and preservation; (4) restoring daily function, relationships, and mental well-being; and (5) seeking knowledge to navigate the disease and its management. Subgroup analysis revealed that though management and diagnosis were most frequently prioritized among all groups, fertility was more frequently prioritized by participants aged 25–34 (24.1%) and those with ovarian endometriosis (27.8%), while older participants more often prioritized quality of life and education. Participants with superficial or presumptive diagnoses more commonly emphasized diagnostic clarity and frustration with fragmented care. Many participants expressed a desire for alternatives to hormonal therapy and reported feeling unheard or unsupported in prior encounters.</p> </section> <section> <h3> Conclusions</h3> <p>Patient priorities differ meaningfully across age and endometriosis phenotype, with fertility, education, and quality of life shifting in relative importance over time. These findings support the need for personaliz

简介：了解患者在寻求子宫内膜异位症和慢性盆腔疼痛（CPP）治疗时优先考虑的问题，对于提供个性化、及时的治疗至关重要。然而，患者定义的目标在不同的生命阶段和疾病表型中仍然缺乏特征。本研究旨在探讨三级转诊时患者优先级的排序，以告知以患者为中心的护理模式。材料和方法：我们在2021年至2024年期间对649名新患者进行了一项融合混合方法研究，这些患者转介到三级子宫内膜异位症中心。参与者完成了一份标准化的入院表格，其中包括两个关于他们寻求治疗的目标和原因的开放式问题。定性数据分析使用代码本专题分析，产生5个总主题和20个副主题。编码主题的频率在不同年龄组和超声确认的子宫内膜异位症表型之间进行描述性比较。定量资料采用描述性统计进行分析，并根据年龄（18-24岁、25-34岁、35-44岁、45-54岁、55岁以上）和表型（浅表、卵巢、深部、综合）进行亚组比较。主要结局是按亚组排列的护理优先频率。次要结局包括跨主题变异和共现模式。结果：出现了五个关键主题：(1)管理广泛的疼痛和症状；(2)追求诊断的明确性和有效性；(3)平衡症状缓解与生育计划和保持；(4)恢复日常功能、人际关系和心理健康；(5)寻求知识来驾驭疾病及其管理。亚组分析显示，虽然管理和诊断在所有组中最常被优先考虑，但25-34岁的参与者（24.1%）和卵巢子宫内膜异位症（27.8%）更常优先考虑生育，而年龄较大的参与者更常优先考虑生活质量和教育。肤浅或推测诊断的参与者更普遍地强调诊断的清晰度和对碎片化护理的挫折感。许多参与者表达了替代激素治疗的愿望，并报告说在之前的遭遇中没有听到或不支持。结论：不同年龄和子宫内膜异位症的患者优先考虑的因素不同，生育能力、教育程度和生活质量的相对重要性随着时间的推移而变化。这些发现支持需要个性化的、生命阶段响应模式的护理，以适应不断变化的患者目标，并整合医学和社会心理领域。

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引用次数: 0

Prenatal diagnosis and perinatal outcomes of fetuses with congenital duodenal obstruction: A nine-year retrospective study from China 先天性十二指肠梗阻胎儿的产前诊断和围产期结局：一项来自中国的九年回顾性研究。

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-15 DOI: 10.1111/aogs.70117

Jianqin Lu, Fang Fu, Fei Guo, Hang Zhou, Ruibin Huang, Huanyi Chen, Chunling Ma, Liyuan Liu, Xiangyi Jing, Simin Yuan, Xiang Zhou, Qiuxia Yu, Manqiu Yang, Jin Han, Dongzhi Li, Ru Li, Can Liao

<div> <section> <h3> Introduction</h3> <p>Congenital duodenal obstruction (CDO) is one of the most common fetal gastrointestinal anomalies, but previous prenatal studies tend to investigate CDO as a portion of gastrointestinal obstruction. Few studies describe the genetic findings of CDO, especially copy number variants, in fetal cohorts with a relatively large sample size. The study aims to investigate the detection rate of genetic causes at different levels and to explore the potential influencing factors of perinatal outcomes of fetuses with CDO.</p> </section> <section> <h3> Material and Methods</h3> <p>This retrospective study analyzed karyotype, chromosomal microarray analysis, and trio-whole exome sequencing (trio-WES) results of singleton fetuses suspected of CDO in a tertiary center between January 2014 and September 2023. In addition, perinatal outcomes and postnatal medical records of enrolled cases were followed up and analyzed.</p> </section> <section> <h3> Results</h3> <p>A total of 98 fetuses were included in the study, of which 69 (70.4%) were classified as isolated CDO and 29 (29.6%) were classified as non-isolated. The overall rate of genetic anomalies was 20.4% (20/98). Trisomy 21 (9/98 [9.2%]) and microduplication of the 17q12 region (3/98 [3.2%]) were the most common chromosomal numerical abnormalities and pathogenic copy number variants found in this cohort, respectively. Compared to chromosomal microarray analysis, no additional pathogenic or likely pathogenic variants were found in seven cases undergoing trio-WES. The rate of chromosomal numerical and structural abnormalities was significantly higher in the non-isolated group (8/29 [27.6%] vs. 6/69 [8.7%], <i>p</i> < 0.05). In terms of perinatal outcomes, the live birth rate was significantly higher in the isolated group (52/69 [75.4%] vs. 15/29 [51.7%], <i>p</i> < 0.05) largely due to fewer terminations of pregnancy. All cases with positive genetic results elected to terminate the pregnancy, and 82% of those with negative results opted to continue the pregnancy. Neonatal mortality was significantly higher in the non-isolated group (2/15 [13.3%] vs. 0/52 [0.0%], <i>p</i> < 0.05). The overall neonatal survival rate was 97.0% (65/67).</p> </section> <section> <h3> Conclusions</h3> <p>The present study highlights the value of prenatal diagnostic testing for fetuses suspected of CDO, both in isolated and non-isolated cases. Genetic diagnostic outcomes exert substantial influence on pregnancy decision-making. Perinatal outcome and short-term prognosis of affected fetuses

先天性十二指肠梗阻（CDO）是最常见的胎儿胃肠道异常之一，但以往的产前研究倾向于将CDO作为胃肠道梗阻的一部分进行研究。在样本量相对较大的胎儿队列中，很少有研究描述CDO的遗传发现，特别是拷贝数变异。本研究旨在调查不同层次遗传因素的检出率，探讨影响CDO胎儿围产期结局的潜在因素。材料与方法：回顾性分析2014年1月至2023年9月某三级中心疑似CDO的单胎胎儿的核型、染色体微阵列分析和三全外显子组测序（trio-WES）结果。此外，对入选病例的围产期结局和产后医疗记录进行随访和分析。结果：共纳入98例胎儿，其中分离性CDO 69例（70.4%），非分离性CDO 29例（29.6%）。总体遗传异常率为20.4%（20/98）。21三体（9/98[9.2%]）和17q12区微重复（3/98[3.2%]）分别是该队列中最常见的染色体数字异常和致病性拷贝数变异。与染色体微阵列分析相比，在进行三次wes的7例患者中未发现其他致病或可能致病的变异。非孤立组的染色体数量和结构异常率明显高于非孤立组（8/29[27.6%]比6/69[8.7%]）。结论：本研究强调了在孤立和非孤立病例中对疑似CDO胎儿进行产前诊断检测的价值。遗传诊断结果对妊娠决策有重大影响。围产期结局和短期预后的影响胎儿是合理的有利时，已知的遗传原因排除。

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引用次数: 0

Sociodemographic and occupational risk factors for premenstrual mood disorders among female workers 女工经前情绪障碍的社会人口和职业危险因素。

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-14 DOI: 10.1111/aogs.70121

Mariko Shimoda, Takumu Kurosawa, Ryu Takizawa

Introduction

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome, collectively referred to as premenstrual mood disorders (PMDs), are common among working women and can significantly impact their well-being and productivity. This study investigated the prevalence of PMDs and identified sociodemographic and occupational factors that contribute to the risk of PMDs among Japanese working women.

Material and Methods

This was a cross-sectional study based on a two-wave online survey conducted between January and June 2023. The study targeted individuals who were biologically female, aged 20–44 years, and currently employed in Japan. Data were collected on sociodemographic characteristics (e.g., age, marital status, education, income), occupational factors (e.g., working hours, job type), and health-related variables. The primary outcome was the presence of premenstrual disorders (PMDs), assessed using the Premenstrual Dysphoric Disorder Scale. Participants were classified as having PMDs if they met criteria for either PMDD or moderate-to-severe premenstrual syndrome (PMS). Those reporting no or only mild symptoms were categorized as not having PMDs. The secondary outcome was the identification of sociodemographic and occupational factors associated with the presence of PMDs. To examine these associations, logistic regression analysis was performed, comparing individuals with and without PMDs.

Results

Among 908 participants (mean age = 33.48, SD = 6.20), 13.66% had PMDD, and 30.51% had moderate-to-severe premenstrual syndrome. Greater PMD risk was associated with younger age, non-regular employment, working ≥60 h weekly, employment in small companies, the presence of children, and lower educational attainment. In contrast, a lower PMD risk was associated with having a manufacturing job.

Conclusions

Sociodemographic and occupational factors have a strong impact on PMDs among Japanese female workers. Promoting work–life balance and providing tailored mental health support in the workplace can help reduce PMDs. Future studies should further investigate these complex relationships.

导读：经前烦躁不安（PMDD）和经前综合症，统称为经前情绪障碍（PMDs），在职业女性中很常见，并会严重影响她们的健康和工作效率。本研究调查了经前综合症的患病率，并确定了导致日本职业女性经前综合症风险的社会人口统计学和职业因素。材料和方法：这是一项横断面研究，基于2023年1月至6月进行的两波在线调查。这项研究的对象是生理上为女性、年龄在20-44岁、目前在日本工作的人。收集了有关社会人口学特征（如年龄、婚姻状况、教育程度、收入）、职业因素（如工作时间、工作类型）和健康相关变量的数据。主要结果是经前紊乱（pmd）的存在，使用经前烦躁不安紊乱量表进行评估。如果参与者符合经前不悦症或中度至重度经前综合症（PMS）的标准，他们就被归类为患有经前不悦症。那些报告没有或只有轻微症状的人被归类为没有经前症候群。次要结果是确定与pmd存在相关的社会人口学和职业因素。为了检验这些关联，进行了逻辑回归分析，比较有和没有pmd的个体。结果：908名参与者（平均年龄33.48岁，SD = 6.20）中，13.66%患有经前不悦症，30.51%患有中度至重度经前综合症。更大的PMD风险与年龄更小、非正规工作、每周工作≥60小时、在小公司工作、有孩子和受教育程度较低有关。相比之下，较低的PMD风险与从事制造业工作有关。结论：社会人口因素和职业因素对日本女性经前综合症有重要影响。促进工作与生活的平衡，并在工作场所提供量身定制的心理健康支持，有助于减少经前综合症。未来的研究应进一步探讨这些复杂的关系。

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引用次数: 0

Patient education materials by ChatGPT: Real intention and interpretation. ChatGPT患者教育资料：真实意图及解读。

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-12 DOI: 10.1111/aogs.70123

Shigeki Matsubara

引用次数: 0

Longitudinal maternal hemodynamics from late pregnancy to postpartum in uncomplicated twin pregnancies—A glimpse into long-term cardiovascular risk? 无并发症双胎妊娠从妊娠晚期到产后的纵向母体血流动力学——对长期心血管风险的一瞥？

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-12 DOI: 10.1111/aogs.70120

Hannah Friederike Zekert, Anna-Lena Biermann, Vivien Dütemeyer, Nina Meier, Lena Radomsky, Peter Hillemanns, Constantin von Kaisenberg, Lars Brodowski

<div> <section> <h3> Introduction</h3> <p>Twin pregnancies impose greater cardiovascular demands than singleton gestations, potentially increasing long-term cardiovascular risk even in the absence of hypertensive disorders. Nevertheless, longitudinal assessments of maternal hemodynamics in uncomplicated twin pregnancies remain limited, and most available studies focus solely on the antenatal period. Chorionicity has been shown to markedly influence cardiovascular adaptation during twin gestation. This study aimed to investigate whether distinct hemodynamic adaptations occur in twin compared with singleton pregnancies during late gestation, 1 day and 6 weeks postpartum.</p> </section> <section> <h3> Material and Methods</h3> <p>In this prospective longitudinal cohort study conducted at Hannover Medical School from 08/24 to 05/2025, 36 women with twin pregnancies (8 monochorionic (MC), 28 dichorionic (DC)) and 37 with singleton pregnancies underwent noninvasive hemodynamic assessment at 34 weeks' gestation, 1 day postpartum, and 6 weeks postpartum.</p> </section> <section> <h3> Results</h3> <p>MC twin pregnancies exhibited significantly higher cardiac output (MC: 7.72 L/min; DC: 5.62 L/min; S: 6.27 L/min; <i>p</i> = 0.01) and lower systemic vascular resistance (MC: 958.83 dynes × s/cm<sup>5</sup>; DC: 1206.86 dynes × s/cm<sup>5</sup>; S: 1119.45 dynes × s/cm<sup>5</sup>; <i>p</i> = 0.01) during the third trimester, with a similar hemodynamic pattern appearing to persist in the postpartum period. MC twins also showed significant decreases in heart rate (T1: 86.37 bpm; T2: 77.73 bpm; T3: 66.67 bpm; <i>p</i> = 0.002), mean arterial pressure (T1: 93.0 mmHg; T2: 85.5 mmHg; T3: 78.0 mmHg; <i>p</i> = 0.03), and inotropism postpartum (T1: 1.92 W/m<sup>2</sup>; T2: 1.67 W/m<sup>2</sup>; T3: 1.54 W/m<sup>2</sup>; <i>p</i> = 0.04), whereas DC twins demonstrated a trend to higher stroke volume (T1: 69.6 mL; T2: 80.31 mL; T3: 82.63 mL; <i>p</i> = 0.01) and gradual increase of vascular resistance (T1: 1206.86 dynes × s/cm<sup>5</sup>; T2:1099.86 dynes × s/cm<sup>5</sup>; T3: 1426.78 dynes × s/cm<sup>5</sup>; <i>p</i> = 0.08).</p> </section> <section> <h3> Conclusions</h3> <p>Monochorionic twin pregnancies are characterized by elevated cardiac output and reduced vascular resistance in late pregnancy, with a similar hemodynamic pattern appearing to persist in the postpartum period. This persistent cardiovascular strain may underlie the elevated short-term cardiovascular risk observed after twin births. Our findings highlight the need for larger longitudinal studies

双胎妊娠比单胎妊娠对心血管的需求更大，即使在没有高血压疾病的情况下，也可能增加长期心血管风险。然而，对无并发症双胎妊娠的母体血流动力学的纵向评估仍然有限，大多数现有研究仅关注产前。绒毛膜性已被证明在双胎妊娠期间显著影响心血管适应。本研究旨在探讨在妊娠晚期、产后1天和产后6周，与单胎妊娠相比，双胎妊娠是否存在明显的血流动力学适应。材料和方法：在汉诺威医学院进行的这项前瞻性纵向队列研究中，36名双胎妊娠妇女（8名单绒毛膜（MC）， 28名双绒毛膜（DC））和37名单胎妊娠妇女在妊娠34周、产后1天和产后6周进行了无创血液动力学评估。结果：MC双胎妊娠在妊娠晚期表现出较高的心排血量（MC: 7.72 L/min; DC: 5.62 L/min; S: 6.27 L/min, p = 0.01）和较低的全身血管阻力（MC: 958.83 dynes × S /cm5; DC: 1206.86 dynes × S /cm5; S: 1119.45 dynes × S /cm5, p = 0.01），并在产后持续出现类似的血流动力学模式。MC双胞胎还显示显著降低心率(T1: 86.37 bpm; T2: 77.73 bpm; T3: bpm 66.67; p = 0.002),平均动脉压(T1: 93.0毫米汞柱;T2: 85.5毫米汞柱,T3: 78.0毫米汞柱;p = 0.03),和inotropism产后(T1: 1.92 W / m2; T2: 1.67 W / m2, T3: 1.54 W / m2; p = 0.04),而直流双胞胎表现出趋势高中风体积(T1: 69.6毫升;T2: 80.31毫升;T3: 82.63毫升;p = 0.01)和血管阻力逐渐增加(T1: 1206.86达因×s / cm5; T2:1099.86达因×s / cm5;T3: 1426.78达因×秒/厘米5；p = 0.08)。结论：单绒毛膜双胎妊娠的特点是妊娠后期心输出量升高，血管阻力降低，类似的血流动力学模式在产后持续存在。这种持续的心血管压力可能是双胞胎出生后观察到的短期心血管风险升高的基础。我们的发现强调需要更大规模的纵向研究来探索从生理适应到潜在的心血管不适应的转变。

{"title":"Longitudinal maternal hemodynamics from late pregnancy to postpartum in uncomplicated twin pregnancies—A glimpse into long-term cardiovascular risk?","authors":"Hannah Friederike Zekert, Anna-Lena Biermann, Vivien Dütemeyer, Nina Meier, Lena Radomsky, Peter Hillemanns, Constantin von Kaisenberg, Lars Brodowski","doi":"10.1111/aogs.70120","DOIUrl":"10.1111/aogs.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Twin pregnancies impose greater cardiovascular demands than singleton gestations, potentially increasing long-term cardiovascular risk even in the absence of hypertensive disorders. Nevertheless, longitudinal assessments of maternal hemodynamics in uncomplicated twin pregnancies remain limited, and most available studies focus solely on the antenatal period. Chorionicity has been shown to markedly influence cardiovascular adaptation during twin gestation. This study aimed to investigate whether distinct hemodynamic adaptations occur in twin compared with singleton pregnancies during late gestation, 1 day and 6 weeks postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective longitudinal cohort study conducted at Hannover Medical School from 08/24 to 05/2025, 36 women with twin pregnancies (8 monochorionic (MC), 28 dichorionic (DC)) and 37 with singleton pregnancies underwent noninvasive hemodynamic assessment at 34 weeks' gestation, 1 day postpartum, and 6 weeks postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MC twin pregnancies exhibited significantly higher cardiac output (MC: 7.72 L/min; DC: 5.62 L/min; S: 6.27 L/min; <i>p</i> = 0.01) and lower systemic vascular resistance (MC: 958.83 dynes × s/cm<sup>5</sup>; DC: 1206.86 dynes × s/cm<sup>5</sup>; S: 1119.45 dynes × s/cm<sup>5</sup>; <i>p</i> = 0.01) during the third trimester, with a similar hemodynamic pattern appearing to persist in the postpartum period. MC twins also showed significant decreases in heart rate (T1: 86.37 bpm; T2: 77.73 bpm; T3: 66.67 bpm; <i>p</i> = 0.002), mean arterial pressure (T1: 93.0 mmHg; T2: 85.5 mmHg; T3: 78.0 mmHg; <i>p</i> = 0.03), and inotropism postpartum (T1: 1.92 W/m<sup>2</sup>; T2: 1.67 W/m<sup>2</sup>; T3: 1.54 W/m<sup>2</sup>; <i>p</i> = 0.04), whereas DC twins demonstrated a trend to higher stroke volume (T1: 69.6 mL; T2: 80.31 mL; T3: 82.63 mL; <i>p</i> = 0.01) and gradual increase of vascular resistance (T1: 1206.86 dynes × s/cm<sup>5</sup>; T2:1099.86 dynes × s/cm<sup>5</sup>; T3: 1426.78 dynes × s/cm<sup>5</sup>; <i>p</i> = 0.08).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Monochorionic twin pregnancies are characterized by elevated cardiac output and reduced vascular resistance in late pregnancy, with a similar hemodynamic pattern appearing to persist in the postpartum period. This persistent cardiovascular strain may underlie the elevated short-term cardiovascular risk observed after twin births. Our findings highlight the need for larger longitudinal studies ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"288-297"},"PeriodicalIF":3.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adhesion molecules in the maternal–fetal interface in healthy pregnancies and preeclampsia 健康妊娠和子痫前期母胎界面的粘附分子

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-12 DOI: 10.1111/aogs.70111

Ingrid Kverndalen Frisch, Trond Melbye Michelsen, Tove Lekva, Marie Cecilie Paasche Roland, Ane Cecilie Westerberg

Introduction

Adhesion molecules are markers of endothelial activation, and they are involved in placentation and inflammation. We compared levels of vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion molecule-1 (ICAM1), and E-selectin (SELE) in maternal and fetal vessels of preeclampsia and healthy pregnancies. Furthermore, we investigated if the placenta releases adhesion molecules.

Material and Methods

Blood was sampled from three maternal (antecubital vein, uterine vein, and radial artery as a proxy for the uterine artery) and two fetal vessels (umbilical vein and artery) in 75 healthy pregnancies and 37 cases of preeclampsia undergoing cesarean delivery. Samples were also collected among 70 healthy pregnancies and 35 preeclampsia cases at three visits (gestational weeks 14–16, 22–24, and 30–32) in a longitudinal cohort. Proteins were relatively quantified on SomaLogic's 5000-multiplex platform. Venoarterial differences on both sides of the placenta were used to indicate placental release and uptake.

Results

Before the onset of preeclampsia, we observed elevated maternal antecubital vein levels of VCAM1 (visits 1 and 3) and ICAM1 (all three visits). At delivery, VCAM1 and SELE were elevated in maternal vessels in preeclampsia compared to healthy, except for VCAM1 in the uterine vein. On the fetal side of the placenta, adhesion molecules were lower in preeclampsia compared to healthy pregnancies. There were no venoarterial differences on the maternal side of the placenta that indicated placental protein release. On the fetal side of the placenta, healthy controls had a positive venoarterial difference of SELE, indicating placental release to the fetus. VCAM1 and SELE levels were higher in fetal circulation as compared to maternal circulation in healthy pregnancies, whereas in preeclampsia, this was only the case for VCAM1. ICAM1 was higher in maternal than fetal circulation in healthy controls and preeclampsia.

Conclusions

Alterations in maternal levels of adhesion molecules were seen before the onset of PE. In preeclampsia, adhesion molecules were elevated in the maternal and lower in the fetal circulation. There was no placental release of the adhesion molecules to the mother, indicating a general systemic endothelial dysfunction. The results highlight new insights into the pathophysiology of preeclampsia that warrant further exploration.

粘附分子是内皮细胞活化的标志，它们参与胎盘和炎症。我们比较了子痫前期和健康妊娠的母体和胎儿血管中血管细胞粘附分子-1 （VCAM1）、细胞间粘附分子-1 （ICAM1）和e选择素（SELE）的水平。此外，我们还研究了胎盘是否释放粘附分子。材料与方法：选取75例健康妊娠和37例剖宫产子痫前期孕妇的3条母体血管（胎前静脉、子宫静脉和代表子宫动脉的桡动脉）和2条胎儿血管（脐静脉和动脉）进行血液取样。在纵向队列中，70名健康孕妇和35名先兆子痫患者在三次就诊（妊娠14-16周、22-24周和30-32周）中收集样本。在SomaLogic的5000-multiplex平台上对蛋白质进行相对定量。胎盘两侧的静脉动脉差异被用来指示胎盘的释放和摄取。结果：在子痫前期发病前，我们观察到母体肘部静脉VCAM1（第1次和第3次就诊）和ICAM1（所有3次就诊）水平升高。分娩时，子痫前期孕妇血管中的VCAM1和SELE均高于健康孕妇，但子宫静脉中的VCAM1除外。在胎盘的胎儿侧，与健康孕妇相比，子痫前期的粘附分子较低。胎盘母体侧静脉动脉无差异，表明胎盘蛋白释放。在胎盘的胎儿侧，健康对照组的SELE静脉动脉差异呈阳性，表明胎盘向胎儿释放。与健康妊娠的母体循环相比，胎儿循环中的VCAM1和SELE水平更高，而在子痫前期，只有VCAM1是如此。在健康对照组和子痫前期，ICAM1在母体循环中高于胎儿循环。结论：在PE发病前，母体黏附分子水平发生改变。在子痫前期，粘附分子在母体中升高，在胎儿循环中降低。胎盘未向母体释放粘附分子，表明存在全身内皮功能障碍。这些结果突出了对子痫前期病理生理学的新见解，值得进一步探索。

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引用次数: 0

Severity of perineal tears and deviations in perineal body anatomy: A three-dimensional ultrasound study. 会阴撕裂的严重程度和会阴体解剖的偏差：三维超声研究。

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-10 DOI: 10.1111/aogs.70114

Hanne Sether Lilleberg, Franziska Siafarikas, Kari Bø, Marie Ellström Engh

Introduction: Perineal tears are classified into four degrees based on severity. Second-degree tears, which involve the muscles fusing into the perineal body, but not the anal sphincter, vary in extent and have recently been subcategorized. However, knowledge about their long-term anatomical impact on the perineal body remains limited, as postpartum evaluation has largely relied on inspection and palpation. This study aimed to examine the association between the severity of perineal tears not affecting the anal sphincter, diagnosed at delivery, and deviations in the muscles fusing into the perineal body, assessed by three-dimensional ultrasound 1 year after vaginal delivery.

Material and methods: This prospective cohort study included 384 primiparous women with vaginal deliveries at Akershus University Hospital, Norway, from January 2021 to July 2022. Perineal tears were classified and sutured according to international standards at delivery. In addition, second-degree tears were subclassified according to the percentage of the perineal body damage (<50% = 2A, ≥50% = 2B, entire perineal body without anal sphincter = 2C). Women with third- or fourth-degree tears were excluded. One year after delivery, participants underwent three-dimensional endovaginal and endoanal ultrasound examinations. The transverse perineal, puboperinealis, and puboanalis muscles were examined at their fusion into the perineal body. A deviation was defined as a muscle discontinuity or absence in at least one of the muscles.

Results: The proportion of women with sonographically detected muscle deviations increased with tear severity: 22% for first-degree (n = 24), 52.7% for 2A (n = 29), 60% for 2B (n = 21) and 86.2% for 2C (n = 25). Among women with episiotomies (n = 126), 60.6% had one or more muscle deviations. A higher number of muscles were affected in the 2C tear group compared to 2B and 2A.

Conclusion: Sonographic deviations in the muscles fusing into the perineal body increase with the severity of perineal tears.

导读：会阴撕裂根据严重程度分为四个等级。第二度撕裂，涉及会阴体的肌肉融合，但不涉及肛门括约肌，程度不同，最近被细分。然而，关于它们对会阴体的长期解剖学影响的知识仍然有限，因为产后评估主要依赖于检查和触诊。本研究旨在探讨分娩时诊断的不影响肛门括约肌的会阴撕裂的严重程度与阴道分娩后1年三维超声评估的会阴肌肉融合到会阴体的偏差之间的关系。材料和方法：这项前瞻性队列研究包括2021年1月至2022年7月在挪威Akershus大学医院阴道分娩的384名初产妇。分娩时按国际标准对会阴撕裂进行分类缝合。此外，根据会阴体损伤的百分比对二度撕裂进行细分(结果：超声检测到肌肉偏离的女性比例随着撕裂严重程度的增加而增加：一级撕裂为22% (n = 24)， 2A撕裂为52.7% (n = 29)， 2B撕裂为60% (n = 21)， 2C撕裂为86.2% （n = 25）。在126例接受外阴切开术的女性中，60.6%有一种或多种肌肉偏差。与2B和2A撕裂组相比，2C撕裂组受影响的肌肉数量更多。结论：随着会阴撕裂的严重程度，会阴体融合肌肉的声像图偏差增加。

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引用次数: 0

Risk factors for shoulder dystocia-related brachial plexus injuries: A case–control study 肩难产相关臂丛损伤的危险因素：一项病例对照研究

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2025-12-09 DOI: 10.1111/aogs.70116

Karin Heinonen, Terhi Saisto, Mika Gissler, Nanna Sarvilinna

Introduction

Brachial plexus injury (BPI) is one of the major complications associated with shoulder dystocia. This study aimed to identify risk factors for shoulder dystocia-related BPI (SD BPI) in the Finnish population.

Material and Methods

The study included all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352). Singleton deliveries complicated by shoulder dystocia, BPI, and clavicle fracture were identified using ICD-10 codes O66.0, P13.4, P14.0, and P14.1 (n = 1708). Following a thorough review of medical records, 374 cases of BPI were identified, 259 of which were related to shoulder dystocia. The background-matched control group (n = 566) consisted of singleton deliveries without BPI.

Results

The incidences of both BPI with and without shoulder dystocia declined significantly during the study period, from 0.16% to 0.05% and from 0.09% to 0.03%, respectively. Multivariate analysis identified the following independent risk factors for SD BPI: birthweight ≥4000 g (adjusted odds ratio, aOR 15.3), maternal diabetes (aOR 4.0), vacuum extraction (aOR 3.7), and maternal height ≤160 cm (aOR 2.7). A predictive model based on these four risk factors demonstrated a positive predictive value of 48.2% and a negative predictive value of 92.9% for SD BPI cases. The odds of permanent BPI were 2.5-fold for cases associated with shoulder dystocia compared to those without. Antepartum and intrapartum variables were not predictive of permanent SD BPI. Among all BPI cases, 69.3% were associated with shoulder dystocia and 64.2% with birthweight ≥4000 g.

Conclusions

Birthweight ≥4000 g, maternal diabetes, height ≤160 cm, and vacuum extraction independently increased the risk of SD BPI. Notably, 14.7% of all BPI cases occurred in the absence of both shoulder dystocia and birthweight ≥4000 g.

臂丛损伤（Brachial plexus injury， BPI）是肩关节难产的主要并发症之一。本研究旨在确定芬兰人群中肩难产相关BPI （SD BPI）的危险因素。材料和方法：该研究包括2006年至2015年期间在赫尔辛基和乌西马医院区的所有分娩（n = 181 352）。采用ICD-10编码O66.0、P13.4、P14.0和P14.1 （n = 1708）对单胎分娩合并肩难产、BPI和锁骨骨折进行鉴定。在对医疗记录进行全面审查后，确定了374例BPI，其中259例与肩部难产有关。背景匹配的对照组（n = 566）包括没有BPI的单胎分娩。结果：在研究期间，伴有和不伴有肩难产的BPI发生率均显著下降，分别从0.16%下降到0.05%和从0.09%下降到0.03%。多因素分析确定SD BPI的独立危险因素如下：出生体重≥4000 g（调整优势比aOR为15.3）、母体糖尿病（aOR为4.0）、真空抽吸（aOR为3.7）、母体身高≤160 cm （aOR为2.7）。基于这四种危险因素建立的预测模型对SD BPI病例的阳性预测值为48.2%，阴性预测值为92.9%。肩关节难产患者发生永久性BPI的几率是无肩关节难产患者的2.5倍。产前和产时变量不能预测永久性SD BPI。在所有BPI病例中，69.3%与肩难产相关，64.2%与出生体重≥4000 g相关。结论：出生体重≥4000 g、母体糖尿病、身高≤160 cm、抽吸分别增加SD BPI的风险。值得注意的是，14.7%的BPI病例发生在没有肩关节难产和出生体重≥4000 g的情况下。

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