Women generally have higher-pitched voices than men – by an octave on average. Women’s voices range from 165 to 255 Hz while men’s voices are deeper at 85–155 Hz and the difference is classically attributed to the testosterone surge around puberty experienced by boys when their voices “break” as their vocal cords elongate and thicken. Women’s voices tend to change through the menopause transition, with lower estrogen levels leading to fewer glandular cells in the sub-epithelial layer of the vocal cords with resultant reduced vibratory properties. This produces a lower pitch which can impact on social situations and perceived attractiveness. A recent systematic review reported that hormone replacement therapy (HRT) may be associated with a higher speaking fundamental frequency in postmenopausal women with a normal body mass index, and this has been measured at a mean 186 Hz in hormone users and 175 Hz in non-users (Lin & Wang JAMA Otol H N Surg 2020; https://doi.org/10. 1001/jamaoto.2020.2174). They conclude that HRT can be associated with a higher-pitched voice if used by women in their postmenopause. Another unexpected consequence of HRT is reported in a recent observational study as it demonstrated that menopausal hormone therapy was associated with a decreased prevalence of osteoarthritis of the knees (Jung et al. Menopause 2019;26:598–602). It is likely that further “indirect” effects – both positive and negative – will be uncovered. This does not necessarily make them indications for commencing therapy but they may be viewed as fringe benefits and certain women could find them cogent reasons for considering medication and clinicians should be informed of these unanticipated consequences (Figure 1). Cancer surveillance in older women
女性的嗓音通常比男性高——平均高一个八度。女性的声音在165 - 255赫兹之间，而男性的声音在85-155赫兹之间，这一差异通常归因于青春期男孩的睾丸激素激增，当他们的声带拉长和变厚时，他们的声音会“断裂”。女性的声音往往会在绝经期发生变化，雌激素水平降低导致声带亚上皮层的腺细胞减少，从而导致振动特性降低。这会产生一个较低的音调，影响社交场合和感知吸引力。最近的一项系统综述报道，激素替代疗法(HRT)可能与正常体重指数的绝经后妇女较高的说话基本频率有关，激素使用者的平均说话基本频率为186 Hz，非激素使用者的平均说话基本频率为175 Hz (Lin & Wang JAMA Otol H N Surg 2020;https://doi.org/10。1001 / jamaoto.2020.2174)。他们得出结论，如果绝经后的女性使用激素替代疗法，可能会导致更高的音调。最近的一项观察性研究报告了HRT的另一个意想不到的结果，该研究表明，绝经期激素治疗与膝关节骨关节炎患病率降低有关(Jung等)。更年期26:598 2019;602)。进一步的“间接”影响——包括积极的和消极的——很可能会被发现。这并不一定使它们成为开始治疗的指征，但它们可能被视为附带益处，某些妇女可能会发现它们是考虑药物治疗的有力理由，临床医生应该被告知这些意想不到的后果(图1)
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16489","DOIUrl":"https://doi.org/10.1111/1471-0528.16489","url":null,"abstract":"Women generally have higher-pitched voices than men – by an octave on average. Women’s voices range from 165 to 255 Hz while men’s voices are deeper at 85–155 Hz and the difference is classically attributed to the testosterone surge around puberty experienced by boys when their voices “break” as their vocal cords elongate and thicken. Women’s voices tend to change through the menopause transition, with lower estrogen levels leading to fewer glandular cells in the sub-epithelial layer of the vocal cords with resultant reduced vibratory properties. This produces a lower pitch which can impact on social situations and perceived attractiveness. A recent systematic review reported that hormone replacement therapy (HRT) may be associated with a higher speaking fundamental frequency in postmenopausal women with a normal body mass index, and this has been measured at a mean 186 Hz in hormone users and 175 Hz in non-users (Lin & Wang JAMA Otol H N Surg 2020; https://doi.org/10. 1001/jamaoto.2020.2174). They conclude that HRT can be associated with a higher-pitched voice if used by women in their postmenopause. Another unexpected consequence of HRT is reported in a recent observational study as it demonstrated that menopausal hormone therapy was associated with a decreased prevalence of osteoarthritis of the knees (Jung et al. Menopause 2019;26:598–602). It is likely that further “indirect” effects – both positive and negative – will be uncovered. This does not necessarily make them indications for commencing therapy but they may be viewed as fringe benefits and certain women could find them cogent reasons for considering medication and clinicians should be informed of these unanticipated consequences (Figure 1). Cancer surveillance in older women","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85565412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is no clinically reliable screening test for ovarian cancer, and late presentations with poor prognoses remain the rule. Recent work suggests that cellular proliferations in the fallopian tube may be precursors to cancer in the ovary which is a slow process, taking years to develop. Early intra-epithelial fallopian tube neoplastic changes and progression to highgrade serous epithelial ovarian cancer seem to be associated with a pathogenic genetic variant located in the TP53 gene. The TP53 variants could be markers of future malignancy predisposition. In established gynaecological cancers, DNA variants have been recovered in cytological samples obtained from the genital tract, raising the possibility of screening for molecular variants in cells that are exfoliated. Researchers selected 17 patients with ovarian cancer and looked for TP53 variants in cytology specimens taken years earlier as part of these women’s routine Pap smear testing (Paracchini et al. JAMA Netw Open 2020;3:e207566). In 11 women, they found DNA with TP53 variants – in some cases 6 years prior to the ovarian malignancy appearing clinically. The authors are extremely cautious about the hypothesis they are raising – namely the possibility of using Pap smear molecular testing as a screening test for future ovarian cancer risk. They make the case for large, long, prospective studies to guide investigations. They conclude their article with ‘Our results hint at a promising prospect to significantly improve the future diagnosis’ of ovarian cancer. This report is potentially very exciting.
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16454","DOIUrl":"https://doi.org/10.1111/1471-0528.16454","url":null,"abstract":"There is no clinically reliable screening test for ovarian cancer, and late presentations with poor prognoses remain the rule. Recent work suggests that cellular proliferations in the fallopian tube may be precursors to cancer in the ovary which is a slow process, taking years to develop. Early intra-epithelial fallopian tube neoplastic changes and progression to highgrade serous epithelial ovarian cancer seem to be associated with a pathogenic genetic variant located in the TP53 gene. The TP53 variants could be markers of future malignancy predisposition. In established gynaecological cancers, DNA variants have been recovered in cytological samples obtained from the genital tract, raising the possibility of screening for molecular variants in cells that are exfoliated. Researchers selected 17 patients with ovarian cancer and looked for TP53 variants in cytology specimens taken years earlier as part of these women’s routine Pap smear testing (Paracchini et al. JAMA Netw Open 2020;3:e207566). In 11 women, they found DNA with TP53 variants – in some cases 6 years prior to the ovarian malignancy appearing clinically. The authors are extremely cautious about the hypothesis they are raising – namely the possibility of using Pap smear molecular testing as a screening test for future ovarian cancer risk. They make the case for large, long, prospective studies to guide investigations. They conclude their article with ‘Our results hint at a promising prospect to significantly improve the future diagnosis’ of ovarian cancer. This report is potentially very exciting.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73040148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The traditional measures of perinatal outcomes are mortality rates, Apgar scores, delivery age and weight, but increasingly, more sophisticated criteria of pregnancy outcomes are being explored. This incorporates longitudinal studies that indicate that maternal socio-economic factors profoundly influence childhood and long-term development. The initial concept – that the intrauterine environment could affect the health of the adult – was hypothesised by Barker (BMJ 1995;311:171–4). He postulated that fetal malnutrition could give rise to heart disease in later life, which opened the way to more detailed investigations into the fetal origins of health and disease. His thesis was that the conceptus has ‘in its genes a generative programme for making a person’ and this programming could be influenced by the mother’s wellbeing. The question now being posed is: just how intimately is her uterine milieu influenced by her socio-economic status? Obstetric records and information from national databanks are able to detect the effects of teratogens, nutrition, metabolic disturbances, infections, drugs and more subtle factors such as stress and anxiety, with these factors playing out in infancy, childhood, adolescence and adult life. Gross insults to the fetus are readily studied but less obvious influences during gestation reveal themselves as physiological outliers of cognitive, behavioural and emotional variations downstream. These in turn can be traced back to parental socio-economic status, incorporating income, education, employment, inequality, food, housing, security, neighbourhood, development and social support (Papageorghiou BJOG 2020;127:431–2). The links between broad socio-economic status and adverse pregnancy outcomes are clear (Reynolds et al. Eur J Obstet Gynecol Reprod Biol 2020; 250:86–92), but quite what in the social or economic spectrum causes the effects is difficult to elucidate. The factors impinging on the fetus can be direct, such as non-ionising radiation (Li et al. JAMA Netw Open 2020;3:e201417), or via maternal intake, or intrinsically generated by the mother’s emotions (Wu et al. JAMA Netw Open 2020;3: e1919940). Other links are generating a large volume of research publications. What is being shown is that disadvantaged women have increased exposure to air pollution (Vrijens et al. JAMA Netw Open 2020;3:e205156; and Fleisch et al. JAMA Netw Open 2020;3:e206046) or foods containing phthalates (which are known endocrine disruptors; Zhang et al. JAMA Network Open 2020;3: e202159), plus they are more likely to experience overor under-nutrition with the quality and quantity of calories they ingest affecting the blood pressure of their offspring at the age of 5 years (Cox et al. JAMA Netw Open 2020;3: e204662). There is also a strong association between socio-economic status and drugtaking, with perhaps the most alarming article entitled ‘Associations of Maternal Prenatal Drug Abuse With Measures of Newborn Brain Structure, Tissue
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16409","DOIUrl":"https://doi.org/10.1111/1471-0528.16409","url":null,"abstract":"The traditional measures of perinatal outcomes are mortality rates, Apgar scores, delivery age and weight, but increasingly, more sophisticated criteria of pregnancy outcomes are being explored. This incorporates longitudinal studies that indicate that maternal socio-economic factors profoundly influence childhood and long-term development. The initial concept – that the intrauterine environment could affect the health of the adult – was hypothesised by Barker (BMJ 1995;311:171–4). He postulated that fetal malnutrition could give rise to heart disease in later life, which opened the way to more detailed investigations into the fetal origins of health and disease. His thesis was that the conceptus has ‘in its genes a generative programme for making a person’ and this programming could be influenced by the mother’s wellbeing. The question now being posed is: just how intimately is her uterine milieu influenced by her socio-economic status? Obstetric records and information from national databanks are able to detect the effects of teratogens, nutrition, metabolic disturbances, infections, drugs and more subtle factors such as stress and anxiety, with these factors playing out in infancy, childhood, adolescence and adult life. Gross insults to the fetus are readily studied but less obvious influences during gestation reveal themselves as physiological outliers of cognitive, behavioural and emotional variations downstream. These in turn can be traced back to parental socio-economic status, incorporating income, education, employment, inequality, food, housing, security, neighbourhood, development and social support (Papageorghiou BJOG 2020;127:431–2). The links between broad socio-economic status and adverse pregnancy outcomes are clear (Reynolds et al. Eur J Obstet Gynecol Reprod Biol 2020; 250:86–92), but quite what in the social or economic spectrum causes the effects is difficult to elucidate. The factors impinging on the fetus can be direct, such as non-ionising radiation (Li et al. JAMA Netw Open 2020;3:e201417), or via maternal intake, or intrinsically generated by the mother’s emotions (Wu et al. JAMA Netw Open 2020;3: e1919940). Other links are generating a large volume of research publications. What is being shown is that disadvantaged women have increased exposure to air pollution (Vrijens et al. JAMA Netw Open 2020;3:e205156; and Fleisch et al. JAMA Netw Open 2020;3:e206046) or foods containing phthalates (which are known endocrine disruptors; Zhang et al. JAMA Network Open 2020;3: e202159), plus they are more likely to experience overor under-nutrition with the quality and quantity of calories they ingest affecting the blood pressure of their offspring at the age of 5 years (Cox et al. JAMA Netw Open 2020;3: e204662). There is also a strong association between socio-economic status and drugtaking, with perhaps the most alarming article entitled ‘Associations of Maternal Prenatal Drug Abuse With Measures of Newborn Brain Structure, Tissue ","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82955834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-26DOI: 10.22541/au.159050758.80698942
G. Hofmeyr
{"title":"Balloon labour induction and the price of elegance","authors":"G. Hofmeyr","doi":"10.22541/au.159050758.80698942","DOIUrl":"https://doi.org/10.22541/au.159050758.80698942","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75745002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitamin D supplementation in pregnancy Very few supplements in pregnancy, other than folic acid, have convincing evidence that they improve maternal or fetal outcomes in well-nourished women. Adding supplements and measuring their effects downstream is laborious and expensive in terms of time and resources. Research in this field also requires measurable endpoints that can be attributable to the intervention shortly after birth, then through infancy and childhood before environmental effects obfuscate results. Against this background, some recently published vitamin D antenatal studies are remarkable. They were randomised controlled trials of high-dose or regular-dose vitamin D starting in early pregnancy to investigate whether high-dose supplementation prevents asthma and promotes skeletal development in children. In the asthma trial, the initial set of results when the children were 3 years old had shown that there was some protection against respiratory malfunction but this was starting to wane by the third year. Now the investigators present their follow-up data of the entire cohort at 6 years of age (Litonjua et al. N Engl J Med 2020;382:525–33). They found that any early effect was not sustained, irrespective of maternal levels of vitamin D at study entry. The study had an elegant design and diligent follow-up, and epitomises the essential nature of final conclusions being reached, which were that high-dose vitamin D is of doubtful value beyond 3 years in preventing asthma or wheeze in children whose parents were susceptible to respiratory conditions (von Mutius and Martinez N Engl J Med 2020;382:574–75). There have been two further studies from Scandinavia assessing the effects of high-dose vitamin D supplementation in the second half of pregnancy and its outcomes in terms of the child’s skeletal health at 6 years of age. The first showed overall higher bone mineralisation status as measured by dual-energy X-ray absorptiometry scans, and this effect was most pronounced in offspring of vitamin D-deficient mothers and children born during the winter months (Brustad et al. JAMA Pediatr 2020. https://doi.org/10.1001/jamaped iatrics.2019.6083). The second looked at dental enamel defects in children in a similar age group and found that, if mothers received high-dose supplements, the children had fewer enamel defects, which they suggest will have benefit for future dental health (Nørrisgaard et al. JAMA Pediatr 2019;173:924–30). These outcomes are encouraging but possible long-term side effects of over-dosage have not been explored so at present routine high-dose vitamin D is not recommended for all women (Holmlund-Suila et al. JAMA Pediatr 2020. https://doi.org/10.1001/jamapedia trics.2019.6102).
除了叶酸外，很少有令人信服的证据表明，在营养良好的妇女中，维生素D补充剂能改善母体或胎儿的结局。就时间和资源而言，在下游添加补充剂并测量其效果既费力又昂贵。该领域的研究还需要可测量的终点，这些终点可归因于出生后不久的干预，然后在环境影响混淆结果之前通过婴儿期和儿童期。在这种背景下，最近发表的一些产前维生素D研究是值得注意的。他们从怀孕早期开始进行了高剂量或常规剂量维生素D的随机对照试验，以研究高剂量补充维生素D是否能预防哮喘并促进儿童骨骼发育。在哮喘试验中，儿童三岁时的初步结果表明，对呼吸功能障碍有一定的保护作用，但到了第三年，这种作用开始减弱。现在研究人员提供了整个队列6岁时的随访数据(Litonjua等)。中华医学杂志，2020;32(2):525 - 533。他们发现，无论母亲在研究开始时的维生素D水平如何，任何早期效果都无法持续。该研究设计精美，随访细致，体现了最终结论的本质，即高剂量维生素D在预防父母易患呼吸系统疾病的儿童哮喘或喘息3年以上的价值值得怀疑(von Mutius and Martinez N Engl J Med 2020; 382:574-75)。斯堪的纳维亚半岛还有两项进一步的研究，评估了在怀孕后半段补充高剂量维生素D的影响，以及它对孩子6岁时骨骼健康的影响。第一项研究通过双能x射线吸收仪扫描显示，骨骼矿化状态总体较高，这种影响在维生素d缺乏母亲的后代和冬季出生的儿童中最为明显(Brustad等人)。美国医学会儿科杂志2020。https://doi.org/10.1001/jamaped iatrics.2019.6083)。第二项研究观察了同年龄段儿童的牙釉质缺陷，发现如果母亲服用高剂量的补品，孩子的牙釉质缺陷就会减少，他们认为这对未来的牙齿健康有益。JAMA pediatrics; 2019; 173:924-30)。这些结果令人鼓舞，但过量服用可能产生的长期副作用尚未得到探讨，因此目前并不建议所有女性使用常规高剂量维生素D (holmrand - suila等)。美国医学会儿科杂志2020。https://doi.org/10.1001/jamapedia trics.2019.6102)。
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16259","DOIUrl":"https://doi.org/10.1111/1471-0528.16259","url":null,"abstract":"Vitamin D supplementation in pregnancy Very few supplements in pregnancy, other than folic acid, have convincing evidence that they improve maternal or fetal outcomes in well-nourished women. Adding supplements and measuring their effects downstream is laborious and expensive in terms of time and resources. Research in this field also requires measurable endpoints that can be attributable to the intervention shortly after birth, then through infancy and childhood before environmental effects obfuscate results. Against this background, some recently published vitamin D antenatal studies are remarkable. They were randomised controlled trials of high-dose or regular-dose vitamin D starting in early pregnancy to investigate whether high-dose supplementation prevents asthma and promotes skeletal development in children. In the asthma trial, the initial set of results when the children were 3 years old had shown that there was some protection against respiratory malfunction but this was starting to wane by the third year. Now the investigators present their follow-up data of the entire cohort at 6 years of age (Litonjua et al. N Engl J Med 2020;382:525–33). They found that any early effect was not sustained, irrespective of maternal levels of vitamin D at study entry. The study had an elegant design and diligent follow-up, and epitomises the essential nature of final conclusions being reached, which were that high-dose vitamin D is of doubtful value beyond 3 years in preventing asthma or wheeze in children whose parents were susceptible to respiratory conditions (von Mutius and Martinez N Engl J Med 2020;382:574–75). There have been two further studies from Scandinavia assessing the effects of high-dose vitamin D supplementation in the second half of pregnancy and its outcomes in terms of the child’s skeletal health at 6 years of age. The first showed overall higher bone mineralisation status as measured by dual-energy X-ray absorptiometry scans, and this effect was most pronounced in offspring of vitamin D-deficient mothers and children born during the winter months (Brustad et al. JAMA Pediatr 2020. https://doi.org/10.1001/jamaped iatrics.2019.6083). The second looked at dental enamel defects in children in a similar age group and found that, if mothers received high-dose supplements, the children had fewer enamel defects, which they suggest will have benefit for future dental health (Nørrisgaard et al. JAMA Pediatr 2019;173:924–30). These outcomes are encouraging but possible long-term side effects of over-dosage have not been explored so at present routine high-dose vitamin D is not recommended for all women (Holmlund-Suila et al. JAMA Pediatr 2020. https://doi.org/10.1001/jamapedia trics.2019.6102).","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78425102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ‘per vaginum’ (PV) examination is central to making any gynaecological diagnoses but is it warranted in asymptomatic women? If a woman does not require cervical screening or her intra-uterine device checking, is a PV examination a legitimate part of a ‘well-woman’ visit? Harms and benefits need to be weighed about every aspect of our professional interactions and far more asymptomatic women attend clinics and doctors than those with symptoms. The potential harms of a PV examination – or to use the American term bimanual pelvic examination (BPE) – are listed as pain, discomfort, fear, anxiety and embarrassment (Bloomfield et al. Ann Intern Med 2014;161: 46–53). More importantly, the prospect of being examined vaginally may dissuade women from consulting a professional for contraceptive initiation or supplies. A survey from the USA has estimated that in 15–20-year-old women, half of all BPEs are done unnecessarily and that three-quarters of tests for cervical cancer are not in accordance with current recommendations (Qin et al. JAMA Intern Med 2020;180:274–80). Two of the most common reasons for PV examinations that could – and should – be avoided are prior to starting oral contraceptives and for cervical screening in women under the age of 25 years. Both topics are crucial to well-woman consultations but the need for a physical pelvic examination is not indicated in either set of circumstances.
“阴道检查”(PV)是妇科诊断的核心，但对于无症状的女性是否有必要?如果女性不需要子宫颈检查或宫内节育器检查，那么PV检查是否是“健康女性”就诊的合法部分?在我们职业互动的各个方面都需要权衡利弊，无症状的女性比有症状的女性更多地去诊所和看医生。PV检查——或者用美国术语双盆腔检查(BPE)——的潜在危害包括疼痛、不适、恐惧、焦虑和尴尬(Bloomfield等)。中华医学杂志，2014;16(1):1 - 3。更重要的是，阴道检查的前景可能会阻止女性向专业人士咨询避孕措施的开始或供应。美国的一项调查估计，在15 - 20岁的妇女中，一半的bpe是不必要的，四分之三的宫颈癌检测不符合目前的建议(Qin等人)。JAMA Intern Med 2020; 180:274-80)。可以而且应该避免进行PV检查的两个最常见的原因是在开始口服避孕药之前和25岁以下妇女的子宫颈筛查。这两个话题对健康女性的咨询都是至关重要的，但在任何一种情况下都不需要进行盆腔物理检查。
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16196","DOIUrl":"https://doi.org/10.1111/1471-0528.16196","url":null,"abstract":"The ‘per vaginum’ (PV) examination is central to making any gynaecological diagnoses but is it warranted in asymptomatic women? If a woman does not require cervical screening or her intra-uterine device checking, is a PV examination a legitimate part of a ‘well-woman’ visit? Harms and benefits need to be weighed about every aspect of our professional interactions and far more asymptomatic women attend clinics and doctors than those with symptoms. The potential harms of a PV examination – or to use the American term bimanual pelvic examination (BPE) – are listed as pain, discomfort, fear, anxiety and embarrassment (Bloomfield et al. Ann Intern Med 2014;161: 46–53). More importantly, the prospect of being examined vaginally may dissuade women from consulting a professional for contraceptive initiation or supplies. A survey from the USA has estimated that in 15–20-year-old women, half of all BPEs are done unnecessarily and that three-quarters of tests for cervical cancer are not in accordance with current recommendations (Qin et al. JAMA Intern Med 2020;180:274–80). Two of the most common reasons for PV examinations that could – and should – be avoided are prior to starting oral contraceptives and for cervical screening in women under the age of 25 years. Both topics are crucial to well-woman consultations but the need for a physical pelvic examination is not indicated in either set of circumstances.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85591455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01Epub Date: 2019-12-03DOI: 10.1111/1471-0528.16007
R L Goldenberg, E M McClure
{"title":"Thoughts on assigning cause of death for stillbirth and neonatal death: a commentary.","authors":"R L Goldenberg, E M McClure","doi":"10.1111/1471-0528.16007","DOIUrl":"10.1111/1471-0528.16007","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85251922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When is antibiotic cover indicated for surgical procedures and how often is it used appropriately? These are complex but important questions that are seldom confronted at personal, institutional or national levels, but an informative article on the topic from Australia has been published (Ierano et al. JAMA Netw Open 2019;2:e1915003). Gathering data from more than onefifth of the country’s hospitals, the researchers showed that 10–20% of inpatient antibiotic prescriptions were for surgical antimicrobial prophylaxis and they were able to gauge the appropriateness of the medication. Of nearly 10 000 procedural assessments, they found incorrect timing and too long a duration were the most common errors, occurring in roughly half of the cases for which they had information. National guidelines suggest some clean procedures do not require ‘cover’ and that when used, prophylaxis should be a single dose and should certainly not be extended for 24 hours or longer. It was noted that gynaecological surgeons had higher rates of incorrect use than orthopaedic surgeons (used as the reference group). This is ground-breaking work, and the authors are commended for their initiative. The stewardship of antimicrobials is essential to guard against antibiotic-resistance development. Some countries have guidelines or position statements that are specific for obstetrics and gynaecology about the type, timing and duration of antimicrobial prophylaxis. If these were promoted, they may encourage individuals to conform within our speciality and could be an incentive to others to achieve the wider goal of correct antibiotic usage for surgery.
外科手术什么时候需要使用抗生素，使用频率如何?这些都是复杂但重要的问题，很少在个人、机构或国家层面面临，但澳大利亚发表了一篇关于这一主题的翔实文章(Ierano et al.)。美国医学杂志2019;2:e1915003)。研究人员从全国五分之一以上的医院收集数据，发现10-20%的住院抗生素处方用于外科抗菌预防，他们能够衡量药物的适当性。在近1万份程序性评估中，他们发现时间不正确和持续时间过长是最常见的错误，在他们掌握信息的案例中，大约有一半发生了这种错误。国家指南建议，一些清洁的程序不需要“覆盖”，并且在使用时，预防措施应该是单次剂量，当然不应该延长24小时或更长时间。值得注意的是，妇科外科医生的不正确使用率高于骨科外科医生(作为参照组)。这是一项开创性的工作，作者因其首创精神而受到赞扬。对抗菌素的管理对于防止抗生素耐药性的发展至关重要。一些国家制定了针对产科和妇科的关于抗菌药物预防的类型、时间和持续时间的指导方针或立场声明。如果这些得到推广，它们可能会鼓励个人遵守我们的专业，并可能激励其他人实现正确使用手术抗生素的更广泛目标。
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16155","DOIUrl":"https://doi.org/10.1111/1471-0528.16155","url":null,"abstract":"When is antibiotic cover indicated for surgical procedures and how often is it used appropriately? These are complex but important questions that are seldom confronted at personal, institutional or national levels, but an informative article on the topic from Australia has been published (Ierano et al. JAMA Netw Open 2019;2:e1915003). Gathering data from more than onefifth of the country’s hospitals, the researchers showed that 10–20% of inpatient antibiotic prescriptions were for surgical antimicrobial prophylaxis and they were able to gauge the appropriateness of the medication. Of nearly 10 000 procedural assessments, they found incorrect timing and too long a duration were the most common errors, occurring in roughly half of the cases for which they had information. National guidelines suggest some clean procedures do not require ‘cover’ and that when used, prophylaxis should be a single dose and should certainly not be extended for 24 hours or longer. It was noted that gynaecological surgeons had higher rates of incorrect use than orthopaedic surgeons (used as the reference group). This is ground-breaking work, and the authors are commended for their initiative. The stewardship of antimicrobials is essential to guard against antibiotic-resistance development. Some countries have guidelines or position statements that are specific for obstetrics and gynaecology about the type, timing and duration of antimicrobial prophylaxis. If these were promoted, they may encourage individuals to conform within our speciality and could be an incentive to others to achieve the wider goal of correct antibiotic usage for surgery.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83576870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What is the study population from which this trial was recruited, and what was the purpose of the initial study? .............................................. What is the recruitment rate? How does this affect the risk of bias? .............................................. This study uses a validated instrument to compare neurodevelopmental outcomes. What does the term ‘validated instrument’ mean, and how has this instrument been validated? .............................................. What was the approach to follow up for this study, and what was the follow-up rate? What does this mean for the results? What do you think of the authors’ discussion of this? .............................................. How would you answer the woman in the scenario? What would you tell her about this study?
{"title":"What are the effects of exercise in pregnancy on the developing fetus?","authors":"J. Jardine","doi":"10.1111/1471-0528.16070","DOIUrl":"https://doi.org/10.1111/1471-0528.16070","url":null,"abstract":"What is the study population from which this trial was recruited, and what was the purpose of the initial study? .............................................. What is the recruitment rate? How does this affect the risk of bias? .............................................. This study uses a validated instrument to compare neurodevelopmental outcomes. What does the term ‘validated instrument’ mean, and how has this instrument been validated? .............................................. What was the approach to follow up for this study, and what was the follow-up rate? What does this mean for the results? What do you think of the authors’ discussion of this? .............................................. How would you answer the woman in the scenario? What would you tell her about this study?","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88615048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some years ago, delayed umbilical cord clamping was investigated and compared with immediate cord clamping. Numerous studies demonstrated the advantages to the neonate, and subsequently to young children, of allowing placental transfusion to take place – so much so, that the World Health Organization (WHO) recommendations advocate waiting 1–3 minutes before clamping the cord in term deliveries and at least 1 minute in preterm situations. Two other sets of circumstances have recently been addressed.
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16091","DOIUrl":"https://doi.org/10.1111/1471-0528.16091","url":null,"abstract":"Some years ago, delayed umbilical cord clamping was investigated and compared with immediate cord clamping. Numerous studies demonstrated the advantages to the neonate, and subsequently to young children, of allowing placental transfusion to take place – so much so, that the World Health Organization (WHO) recommendations advocate waiting 1–3 minutes before clamping the cord in term deliveries and at least 1 minute in preterm situations. Two other sets of circumstances have recently been addressed.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89895023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：