Obstetrics, Gynaecology and Reproductive Medicine最新文献

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Preimplantation genetic diagnosis 植入前遗传学诊断
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-05 DOI: 10.1016/j.ogrm.2023.12.004
Omar El Tokhy, Mona Salman, Tarek El-Toukhy
{"title":"Preimplantation genetic diagnosis","authors":"Omar El Tokhy,&nbsp;Mona Salman,&nbsp;Tarek El-Toukhy","doi":"10.1016/j.ogrm.2023.12.004","DOIUrl":"https://doi.org/10.1016/j.ogrm.2023.12.004","url":null,"abstract":"<div><p>Pre-Implantation genetic diagnosis is available to couples at risk of conceiving a pregnancy affected with a known genetic disorder. Assisted reproductive techniques<span> are used in combination with micromolecular diagnostic technologies to recognise at-risk embryos with pathogenic genetic variants at the pre-implantation stage using polar body, blastomere or trophectoderm biopsy. This review will discuss the varying genetic disorders diagnosed by Pre-Implantation Genetic Diagnosis, as well as the ethical, legal and safety implications of the process. Pioneering advances in molecular biology and cytogenomics have been utilised to expand the spectrum of genetic disorders detected.</span></p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 3","pages":"Pages 73-77"},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139985649","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}
引用次数: 0
Fetal macrosomia and large for gestational age 胎儿畸形和胎龄过大
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.12.003
Kate McMurrugh, Matias Costa Vieira, Srividhya Sankaran
{"title":"Fetal macrosomia and large for gestational age","authors":"Kate McMurrugh,&nbsp;Matias Costa Vieira,&nbsp;Srividhya Sankaran","doi":"10.1016/j.ogrm.2023.12.003","DOIUrl":"10.1016/j.ogrm.2023.12.003","url":null,"abstract":"<div><p><span><span>Birthweight has increased in the UK and abroad over the last 30 years, partly attributed to the increasing prevalence of maternal obesity and gestational diabetes. The aim of this review is to provide better understanding of definition, </span>epidemiology<span><span><span>, detection and management of the large fetus. Many definitions of large infants, or fetal overgrowth, have been described in the literature including macrosomia (weight above 4 kg) or </span>large for gestational age (LGA, defined as weight above the 90th centile by population, customised or international growth charts). Errors in estimation of </span>fetal weight<span><span><span><span> by ultrasound reduce the accuracy of predicting the actual birthweight. Although no single definition is currently universally accepted, the terminology LGA has the advantage of identifying the large fetus even when macrosomia has not yet occurred. Irrespective of definition, fetal overgrowth is associated with an increased risk of adverse perinatal outcomes including need for caesarean delivery, </span>postpartum haemorrhage<span>, third and fourth perineal tears, shoulder dystocia, low </span></span>Apgar score, admission to </span>neonatal intensive care unit<span><span><span>, and increased neonatal morbidity and </span>perinatal mortality. Major risk factors for LGA are maternal obesity, diabetes and increased </span>gestational weight gain<span> but these are not highly predictive of LGA. Previous efforts to prevent fetal overgrowth have had limited success which explain the current focus on improving management once an LGA fetus is identified by ultrasound. Management of LGA has changed substantially in the last decade in response to the ruling Montgomery v Lanarkshire Health Board [2015], national reports from the Healthcare Safety Investigation Branch (HSIB), and international literature. Induction of labour for large for gestational age at early term seems to reduce the incidence of shoulder dystocia but may increase the rate of the third and fourth degree tears. Caesarean section seems to be associated with a reduced risk of LGA related adverse neonatal outcomes, mainly birth<span> trauma, however the number needed to treat is high, being mostly recommended for estimated fetal weight above 4.5 kg in women with diabetes. NICE currently recommends that women with estimated fetal weight above the 95</span></span></span></span></span></span><sup>th</sup> centile should have a comprehensive discussion regarding birth options including expectant management, induction of labour and elective caesarean; choice should be offered due to the lack of clear evidence of benefit of one strategy over another. Observational evidence suggests that an estimated fetal weight between the 90<sup>th</sup> and the 95<sup>th</sup> centile have a much weaker association with adverse neonatal outcomes and is not associated with increased perinatal mortality compared to an estimated fetal we","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 3","pages":"Pages 66-72"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139129492","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}
引用次数: 0
How to investigate and manage acute thrombosis in pregnancy 如何检查和处理妊娠期急性血栓症
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.10.003
Hazel MI Powell, Mandish K. Dhanjal
{"title":"How to investigate and manage acute thrombosis in pregnancy","authors":"Hazel MI Powell,&nbsp;Mandish K. Dhanjal","doi":"10.1016/j.ogrm.2023.10.003","DOIUrl":"10.1016/j.ogrm.2023.10.003","url":null,"abstract":"<div><p><span><span>Venous thromboembolism (VTE) remains the leading cause of direct maternal death in the UK, despite the widespread use of personalised risk-stratified </span>thromboprophylaxis in pregnancy. The primary risk factors associated with VTE are increasingly common, namely obesity, medical comorbidities and maternal age. Therefore, it is imperative that all clinicians seeing pregnant patients acutely can adequately assess, investigate and treat possible VTE. Clinical diagnosis of VTE is challenging due to its non-specific symptoms that mirror </span>obstetric<span><span><span> physiology. This article will consider the management of deep vein thrombosis (DVT), </span>pulmonary embolism<span><span> (PE) and cerebral venous thrombosis (CVT). Universally, prompt imaging and </span>anticoagulation are required. The support of obstetric, </span></span>haematology<span>, medical, radiology<span> and anaesthetic specialists is imperative for the complex or critically ill patient. Thrombolysis<span> should be considered with massive PE associated with haemodynamic instability and not withheld due to pregnancy. Critically, these patients require multidisciplinary plans for delivery, contraception and future pregnancy.</span></span></span></span></p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 1","pages":"Pages 11-18"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135764135","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}
引用次数: 0
Understanding perinatal mortality 了解围产期死亡率
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.10.001
Chivon Winsloe, Dharmintra Pasupathy
{"title":"Understanding perinatal mortality","authors":"Chivon Winsloe,&nbsp;Dharmintra Pasupathy","doi":"10.1016/j.ogrm.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.ogrm.2023.10.001","url":null,"abstract":"<div><p><span>The term perinatal mortality refers to antepartum and </span>intrapartum<span> stillbirths<span>, and early neonatal deaths. Although the overall rate of perinatal mortality is falling in high-income countries, a slower rate of reduction in stillbirths has been seen. In high income countries antenatal stillbirth contributes to a large proportion of overall stillbirths. This article explores the causes of perinatal mortality and the recent evidence and interventions and their impacts on reducing perinatal mortality in the high-income settings.</span></span></p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433866","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}
引用次数: 0
Respiratory disease in pregnancy 孕期呼吸系统疾病
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.10.002
Catherine E. Aiken
{"title":"Respiratory disease in pregnancy","authors":"Catherine E. Aiken","doi":"10.1016/j.ogrm.2023.10.002","DOIUrl":"10.1016/j.ogrm.2023.10.002","url":null,"abstract":"<div><p><span><span>Breathlessness is a common pregnancy symptom, which nonetheless always merits careful history taking and consideration of the wide range of possible underlying causes. The physiological changes in respiration during pregnancy include an increase in </span>minute ventilation<span><span>, primarily due to increased tidal volume. The partial pressure of oxygen in the maternal blood is slightly higher than outside of pregnancy and that of carbon dioxide slightly lower. It is important to be alert to these expected parameters, and maintain a high index of suspicion where borderline partial pressures are noted in a pregnant woman. Respiratory problems during pregnancy may arise from the airways themselves (e.g. asthma), the </span>pulmonary vasculature<span> (e.g. thromboembolism), or from the mechanics of breathing (e.g. diaphragmatic splinting). In this review, a symptom-based approach to respiratory problems commonly encountered in </span></span></span>obstetric practice is discussed.</p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 1","pages":"Pages 6-10"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135709020","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}
引用次数: 0
Self-assessment questions 自我评估问题
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.10.005
Anna Richmond
{"title":"Self-assessment questions","authors":"Anna Richmond","doi":"10.1016/j.ogrm.2023.10.005","DOIUrl":"https://doi.org/10.1016/j.ogrm.2023.10.005","url":null,"abstract":"","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 1","pages":"Pages 26-28"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433875","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}
引用次数: 0
Epithelial ovarian, fallopian tube and primary peritoneal cancer: an overview 上皮性卵巢癌、输卵管癌和原发性腹膜癌:概述
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.ogrm.2023.10.004
Jane Borley
{"title":"Epithelial ovarian, fallopian tube and primary peritoneal cancer: an overview","authors":"Jane Borley","doi":"10.1016/j.ogrm.2023.10.004","DOIUrl":"10.1016/j.ogrm.2023.10.004","url":null,"abstract":"<div><p><span><span>Ovarian, fallopian tube and </span>primary peritoneal cancer<span> has the poorest survival outcomes of all gynaecological malignancies<span>. The majority of women present with advanced stage, high grade disease following a period of generalised abdominal symptoms. There is currently no effective screening programme. Diagnosis is based on imaging and histology. Stratification of adnexal masses into benign and malignant categories has helped ensure appropriate patients are referred to the </span></span></span>gynaecology<span><span> oncology<span> team. The mainstay of treatment is surgery and chemotherapy, with removal of all residual disease being one of the most important </span></span>prognostic factors<span>. Recent advances in targeted therapies are also beginning to improve outcomes.</span></span></p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 1","pages":"Pages 19-25"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455290","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}
引用次数: 0
Self-assessment questions 自我评估问题
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2023-12-29 DOI: 10.1016/j.ogrm.2023.12.005
Anna Richmond
{"title":"Self-assessment questions","authors":"Anna Richmond","doi":"10.1016/j.ogrm.2023.12.005","DOIUrl":"https://doi.org/10.1016/j.ogrm.2023.12.005","url":null,"abstract":"","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 3","pages":"Pages 78-80"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139985650","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}
引用次数: 0
Clinical management of female genito-urinary fistula 女性泌尿生殖系统瘘的临床治疗
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2023-12-23 DOI: 10.1016/j.ogrm.2023.12.001
Charlotte Mahoney, Fiona Reid
{"title":"Clinical management of female genito-urinary fistula","authors":"Charlotte Mahoney,&nbsp;Fiona Reid","doi":"10.1016/j.ogrm.2023.12.001","DOIUrl":"10.1016/j.ogrm.2023.12.001","url":null,"abstract":"<div><p><span>Genito-urinary fistula<span> describes an abnormal connection between an epithelial surface of the female genital tract and the urological tract. The UK incidence is 100–120 cases per year with the majority caused by iatrogenic injury<span> during pelvic surgery, most commonly involving the </span></span></span>bladder<span>. Women describe continuous vaginal leakage of urine. If the bladder fistula is diagnosed within 6 weeks of the index injury conservative treatment with an indwelling catheter on free drainage is recommended. Surgical repair ideally is performed by vaginal approach, with the abdominal approach reserved for ureteric fistula. Surgery is best performed in one of the high volume supra-regional fistula centres.</span></p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 3","pages":"Pages 53-57"},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188438","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}
引用次数: 0
Hormone replacement therapy 激素替代疗法
Obstetrics, Gynaecology and Reproductive Medicine Pub Date : 2023-12-23 DOI: 10.1016/j.ogrm.2023.12.002
Sophie Bennett, Raj Mathur
{"title":"Hormone replacement therapy","authors":"Sophie Bennett,&nbsp;Raj Mathur","doi":"10.1016/j.ogrm.2023.12.002","DOIUrl":"10.1016/j.ogrm.2023.12.002","url":null,"abstract":"<div><p><span>The importance of menopause and the short and long term effects of this have been underestimated and under discussed. With the media currently highlighting issues that affect women, it is important to understand menopause, the effects of this and how to mitigate these effects. When prescribing any drug or treatment, the risks must be properly discussed and women given as much information as possible to make an informed choice about their health. This is likely to look different for every woman who comes for a consultation as menopause and subsequent reactions to </span>HRT are individual.</p></div>","PeriodicalId":53410,"journal":{"name":"Obstetrics, Gynaecology and Reproductive Medicine","volume":"34 3","pages":"Pages 58-65"},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139192467","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}
引用次数: 0
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