BJOG: An International Journal of Obstetrics & Gynaecology最新文献

英文中文

Population BRCA sequencing; time to move to the next phase? 群体BRCA测序;是时候进入下一阶段了吗?

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-02-01 DOI: 10.1111/1471-0528.15984

C. Gourley

A basic concept of cancer management is that prevention or early detection is more effective than treating advanced stage disease. Genetic stratification of risk is one way to prioritise patients for screening programs or risk reducing surgery. This is particularly appropriate in respect to high penetrance genes such as BRCA1 and BRCA2 when the malignancies that can be prevented are as deadly as triple negative breast cancer and high grade serous ovarian cancer. Access to BRCA1 and BRCA2 germline sequencing is currently largely based upon family history.

癌症管理的一个基本概念是预防或早期发现比治疗晚期疾病更有效。风险的遗传分层是筛选项目或降低风险手术优先考虑患者的一种方法。这尤其适用于高外显率基因，如BRCA1和BRCA2，因为可以预防的恶性肿瘤与三阴性乳腺癌和高级别浆液性卵巢癌一样致命。获得BRCA1和BRCA2种系测序目前主要基于家族史。

引用次数: 1

Exposure to Asian dust within a few days of delivery is associated with placental abruption in Japan: a case‐crossover study 在日本，分娩后几天内接触亚洲粉尘与胎盘早剥有关:一项病例交叉研究

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-02-01 DOI: 10.1111/1471-0528.15999

T. Michikawa, S. Yamazaki, A. Shimizu, H. Nitta, Kiyoko Kato, Y. Nishiwaki, S. Morokuma

Asian dust is a natural phenomenon in which dust particles are transported from desert areas in China and Mongolia to East Asia. Short‐term exposure to Asian dust has been associated with cardiovascular disease through mechanisms such as systemic inflammation. Because inflammation is a potential trigger of placental abruption, exposure may also lead to abruption. We examined whether exposure to Asian dust was associated with abruption.

亚洲沙尘是从中国和蒙古的沙漠地区向东亚输送沙尘颗粒的自然现象。短期接触亚洲粉尘与心血管疾病有关，其机制包括全身性炎症。因为炎症是胎盘早剥的潜在诱因，暴露于炎症也可能导致胎盘早剥。我们研究了接触亚洲粉尘是否与早剥有关。

引用次数: 1

The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study. 延迟夹断脐带对阴道分娩和剖腹产无胎儿窘迫的足月新生儿脐带血气分析的影响：一项前瞻性观察研究。

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-02-01 Epub Date: 2019-12-17 DOI: 10.1111/1471-0528.16026

N Giovannini, B L Crippa, E Denaro, G Raffaeli, V Cortesi, D Consonni, G E Cetera, F Parazzini, E Ferrazzi, F Mosca, S Ghirardello

Objective: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress.

Design: Prospective observational study.

Setting: University hospital.

Sample: CBG from 97 VDs and 124 CDs without fetal distress.

Methods: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs.

Main outcome measures: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO₂ ), partial pressure of carbon dioxide (pCO₂ ), pH, and postpartum haemorrhage.

Results: Arterial cord blood pH, bicarbonate ( ${HCO}_{3}^{-}$ , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; ${HCO}_{3}^{-}$ = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; ${HCO}_{3}^{-}$ = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO₂ increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit.

Conclusions: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs.

Tweetable abstract: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.

目的在无胎儿窘迫的足月阴道分娩（VDs）和剖宫产（CDs）中，确定3分钟延迟脐带夹闭（DCC）后脐带血气（CBG）参数的变化：设计：前瞻性观察研究：地点：大学医院：样本：97 例 VD 和 124 例无胎儿窘迫的 CD 的 CBG：比较出生时未闭合脐带和 3 分钟 DCC 后 VD 和 CD 的成对动静脉 CBG 参数：主要结果测量：动脉和静脉脐血的碱过量、碳酸氢盐、血细胞比容和血红蛋白、乳酸、新生儿预后、氧分压（pO2）、二氧化碳分压（pCO2）、pH值和产后出血：结果：3 分钟 DCC 后，动脉脐血 pH 值、碳酸氢盐（HCO3- ，毫摩尔/升）和碱过量（BE，毫摩尔/升）在 VDs 中均显著下降（pH = 7.23 对 7.27；P HCO3- = 23.3 对 24.3；P = 0.004；BE = -5.1 对 -2.9；P HCO3- = 26.2 对 27.2；P 2），仅在 CDs 中上升（57 对 51；P 结论：3 分钟 DCC 后，动脉脐血 pH 值、碳酸氢盐（HCO3- ，毫摩尔/升）和碱过量（BE，毫摩尔/升）均显著下降：3 分钟 DCC 后，CDs 的酸碱状态转为混合性酸中毒，而 VDs 则普遍为代谢性酸中毒。Tweetable摘要：3分钟DCC后，剖宫产和阴道分娩的酸碱状态分别转向混合性酸中毒和代谢性酸中毒。

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引用次数: 0

Long‐term predictors of residual or recurrent cervical intraepithelial neoplasia 2–3 after treatment with a large loop excision of the transformation zone: a retrospective study 宫颈上皮内瘤残留或复发的长期预测因素:一项回顾性研究

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-02-01 DOI: 10.1111/1471-0528.15996

M. Fernández-Montolí, S. Tous, Gonzalo Medina, Marta Castellanau, A. García-Tejedor, S. de Sanjosé

To assess the long‐term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2–3) and time to recurrence after large loop excision of the transformation zone (LLETZ).

评估预测残留/复发宫颈上皮内瘤变(CIN 2-3)和大环切除转化区(LLETZ)后复发时间的长期危险因素。

引用次数: 31

Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study 通过连续产前评估改善妊娠早期巨细胞病毒感染胎儿的预后:一项单中心回顾性研究

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-02-01 DOI: 10.1111/1471-0528.15935

V. Faure-Bardon, A. Millischer, B. Deloison, P. Sonigo, D. Grevent, L. Salomon, J. Stirnemann, M. Nicloux, J. Magny, M. Leruez-Ville, Yves Ville

To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT).

目的:探讨不同妊娠时间点(妊娠中期末;孕32周进行产前磁共振成像(MRI)检查;并使用在妊娠晚期(US3rdT)进行的所有超声扫描。

引用次数: 35

Insights from outside BJOG 来自BJOG外部的见解

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-01-15 DOI: 10.1111/1471-0528.16049

A. Kent, S. Kirtley

Approximately 10% of all pregnancies will be complicated by hypertension but only one-quarter of these will be diagnosed as having pre-eclampsia. The distinction is important as women with chronic or gestationally related hypertension usually present earlier and have a more benign passage through pregnancy – although they can develop superimposed preeclampsia. Much of antenatal care is devoted to the early detection of hypertensive disorders but the quest for biomarkers to predict pre-eclampsia has been largely unsuccessful. Risk scores and algorithms are promising (Sovio and Smith BJOG 2019;126:963–70) and placental growth factor testing may expedite the diagnosis of pre-eclampsia and could save admission costs (Duhig et al. BJOG 2019;126:1390–8). Early preterm pre-eclampsia is a clinical challenge and late preterm pre-eclampsia can be managed by immediate or expectant treatment in high-income countries (Chappell et al. Lancet 2019;394:1181–90). However, sudden deterioration can occur, even in optimal circumstances, and episodes of severe hypertension constitute emergencies that demand admission and an urgent decrease in blood pressure. The method of choice is intravenous antihypertensive therapy, usually hydralazine or labetalol, which are rapid acting and effective but require intensive maternal–fetal monitoring because of potential precipitous reductions in blood pressure with resultant hypoperfusion. Relatively few women worldwide have access to facilities where the safe administration of these agents is practicable, so when hypertensive crises arise in lowand middle-income countries (LMICs), oral antihypertensive drugs are given. The three most widely used are nifedipine (a calciumchannel blocker), labetalol (a combined a and b blocker) and methyldopa (a central nervous system a agonist). All are cheap, easily stored and readily available even in remote obstetric facilities. The head-to-head efficacy of these drugs was tested in a trial in India in which women presenting with a systolic blood pressure of at least 160 mmHg or a diastolic blood pressure of at least 110 mmHg were given one of these agents orally (Easterling et al. Lancet 2019;394:1011–21). Nifedipine (10 mg) or labetalol (100 mg) were given hourly with escalation if required and methyldopa was given as a 1000-mg stat dose; blood pressure control was defined as 120–150 mmHg systolic and 70–100 mmHg diastolic blood pressure. Nearly 900 women participated in the trial with a mean gestational age of 37 weeks, and four out of five of them achieved the desired blood pressure targets within 6 hours. Delivery usually followed blood pressure control, with the three drugs proving to be safe and effective despite methyldopa being restricted by its singledose constraint – a strategy that is not universally followed. These are encouraging data gathered in real-world conditions that will inspire individuals working with limited resources and prove that patients can be protected from potenti

大约10%的孕妇会并发高血压，但其中只有四分之一会被诊断为先兆子痫。这种区别很重要，因为患有慢性或妊娠高血压的妇女通常更早出现，并且在怀孕期间更良性——尽管她们可能会并发先兆子痫。许多产前保健致力于高血压疾病的早期检测，但寻找生物标志物来预测先兆子痫的努力在很大程度上是不成功的。风险评分和算法是有希望的(Sovio和Smith BJOG 2019; 126:963-70)，胎盘生长因子检测可以加快先兆子痫的诊断，并可以节省入院成本(Duhig等)。问卷2019;126:1390-8)。在高收入国家，早期早产子痫前期是一项临床挑战，晚期早产子痫前期可通过立即或预期治疗进行管理(Chappell等)。柳叶刀394:1181 2019;90)。然而，即使在最佳情况下，也可能发生突然恶化，严重高血压发作构成紧急情况，需要入院治疗并紧急降低血压。选择的方法是静脉降压治疗，通常是肼嗪或拉贝他洛尔，这是快速有效的，但需要密切监测母胎，因为血压可能急剧下降，导致低灌注。在世界范围内，能够安全使用这些药物的设施的妇女相对较少，因此，当中低收入国家出现高血压危机时，会给予口服抗高血压药物。最广泛使用的三种药物是硝苯地平(一种钙通道阻滞剂)、拉贝他洛尔(一种a和b联合阻滞剂)和甲基多巴(一种中枢神经系统激动剂)。所有这些都很便宜，易于储存，甚至在偏远的产科设施也可以随时获得。在印度的一项试验中测试了这些药物的正面疗效，其中收缩压至少为160毫米汞柱或舒张压至少为110毫米汞柱的妇女口服其中一种药物(Easterling等人)。《柳叶刀》2019年;394:1011-21)。硝苯地平(10mg)或拉贝他洛尔(100mg)每小时给药，必要时增加剂量，甲基多巴起始剂量为1000mg;血压控制定义为收缩压120-150 mmHg和舒张压70-100 mmHg。近900名平均胎龄为37周的女性参加了这项试验，其中五分之四的女性在6小时内达到了预期的血压目标。通常在血压控制后给药，这三种药物被证明是安全有效的，尽管甲基多巴受到单剂量限制——这一策略并不是普遍遵循的。这些在现实条件下收集的令人鼓舞的数据将激励那些在资源有限的情况下工作的人，并证明通过适当的干预可以保护患者免受潜在的高血压发病率甚至死亡率。

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引用次数: 0

Surgical registries with patient‐reported outcome data – important tools in monitoring complications after pelvic floor repair surgery 具有患者报告结果数据的手术登记-监测盆底修复术后并发症的重要工具

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-01-01 DOI: 10.1111/1471-0528.15991

S. Zacharias, EK Uustal

Mid urethral slings (MUS) to treat incontinence were widely introduced almost twenty years ago. After an initial multicenter study in Sweden showed good results and low complications at 2, 6 and 12 months follow-up (Ulmsten et al 1998; Int Urogynecol. J Pelvic Floor Dysfunct. 1998-9: 210-3), hundreds of international studies have confirmed good results and low complication rates also in the long term. However, after millions of women have received MESH implants, rare complications have begun to accumulate.

中尿道吊带术(MUS)用于治疗尿失禁已近20年。瑞典最初的一项多中心研究在随访2、6和12个月时显示出良好的效果和较低的并发症(Ulmsten et al . 1998;Int Urogynecol。[J]盆底功能障碍，1998-9:210-3)，数百项国际研究证实了良好的效果和长期的低并发症发生率。然而，在数以百万计的妇女接受了MESH植入物后，罕见的并发症开始积累。

引用次数: 0

Prophylactic antibiotics in caesarean delivery before or after cord clamping – protecting the mother at the expense of the infant’s microbiota? 在脐带夹紧前后剖腹产时预防性使用抗生素——以牺牲婴儿的微生物群为代价保护母亲?

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-01-01 DOI: 10.1111/1471-0528.15960

Acr Winther, PB Axelsson, T. Clausen, Ecl Løkkegaard

To prevent postoperative infections after caesarean deliveries, most obstetric guidelines recommend intravenous antibiotic prophylaxis before skin incision as opposed to after cord clamping (1). However, the clinical reality may have changed since this procedure was recommended. In this commentary, we will argue against this recommendation, as we regard the benefits to the mother do not outweigh the potentially detrimental effects on the infant.

为了预防剖腹产术后感染，大多数产科指南建议在切开皮肤前静脉注射抗生素预防，而不是在脐带夹紧后静脉注射抗生素(1)。然而，自从这种方法被推荐以来，临床现实可能已经发生了变化。在这篇评论中，我们将反对这一建议，因为我们认为对母亲的好处不会超过对婴儿的潜在有害影响。

引用次数: 8

Gaining insights into reproductive health from historical events 从历史事件中了解生殖健康

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-01-01 DOI: 10.1111/1471-0528.15963

Amz Jukic

Maternal exposures may affect offspring reproductive health, but these effects are likely small, requiring large samples, or large changes in the exposure to detect. Also, enough time must pass to allow the offspring to reach an age at which the health endpoints of interest are observable. Drastic historical events that affect large numbers of people and are discrete in their time period of occurrence, provide an opportunity to examine how the maternal prenatal experience influences the reproductive health of the offspring.

母亲的接触可能影响后代的生殖健康，但这些影响可能很小，需要大量的样本，或暴露的大变化来检测。此外，必须有足够的时间让后代达到可观察到的健康终点的年龄。影响大量人口的重大历史事件在其发生的时间段内是离散的，为研究产妇产前经历如何影响后代的生殖健康提供了机会。

引用次数: 0

Understanding and interpreting community sequencing measurements of the vaginal microbiome 理解和解释阴道微生物组的群落测序测量

BJOG: An International Journal of Obstetrics & Gynaecology

Pub Date : 2020-01-01 DOI: 10.1111/1471-0528.15978

HL Berman, M. McLaren, Benjamin J Callahan

Community‐wide high‐throughput sequencing has transformed the study of the vaginal microbiome, and clinical applications are on the horizon. Here we outline the three main community sequencing methods: (1) amplicon sequencing, (2) shotgun metagenomic sequencing, and (3) metatranscriptomic sequencing. We discuss the advantages and limitations of community sequencing generally, and the unique strengths and weaknesses of each method. We briefly review the contributions of community sequencing to vaginal microbiome research and practice. We develop suggestions for critically interpreting research results and potential clinical applications based on community sequencing of the vaginal microbiome.

社区范围内的高通量测序已经改变了阴道微生物组的研究，临床应用即将到来。在这里，我们概述了三种主要的群落测序方法:(1)扩增子测序，(2)散弹枪宏基因组测序和(3)元转录组测序。我们讨论了群落测序的优点和局限性，以及每种方法的独特优点和缺点。我们简要回顾了群落测序对阴道微生物组研究和实践的贡献。我们提出建议，批判性地解释研究结果和潜在的临床应用基于群落测序的阴道微生物组。

引用次数: 19

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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BJOG: An International Journal of Obstetrics & Gynaecology

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