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首页> 外文期刊>American Journal of Obstetrics and Gynecology >Secondary analyses from a randomized clinical trial: Age as the key prognostic factor in endometrial carcinoma
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Secondary analyses from a randomized clinical trial: Age as the key prognostic factor in endometrial carcinoma

机译：一项随机临床试验的二级分析：年龄是子宫内膜癌的关键预后因素

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TO THE EDITORS: Kramer et al reported a doubling of the incidence of severe postpartum hemorrhage (PPH) over recent years (1999-2008), although were unable to explain the overall temporal trend despite analyzing traditional risk factors. An audit of 2 UK units, delivering more than 4000 babies per year, showed increases in PPH greater than 1000 mL, and PPH greater than 2000 mL, of greater than 500% (2003-2012).Traditional risk factors (increased maternal age, parity, fetal macrosomia, etc) appeared to be less significant because many cases occurred in young, nulliparous women undergoing induction of labor that resulted in the delivery of an appropriate-for-gestational-age baby by cesarean section. There is evidence for prepregnancy injuries to the myo-metrium resulting from physical efforts during defecation, which is endemic (>30%) in Western populations and excessive traction to the cervix during minor gynecologic procedures. Both injure uterine and tubal nerves in their course through the uterosacral ligaments, and both continue to increase in frequency in Western societies. There is also direct evidence for minor gynecological procedures causing adverse reproductive outcomes (eg, preterm labor) that may also result from prepregnancy denervatory injuries.
机译：致编者：Kramer等人报告了近年来（1999-2008年）严重产后出血（PPH）的发生率翻了一番，尽管尽管分析了传统的危险因素仍无法解释总体时间趋势。对英国的2个单位进行的审计显示，每年有4000多个婴儿分娩，PPH大于1000 mL和PPH大于2000 mL的增加幅度超过500％（2003-2012）。传统危险因素（产妇年龄增加，均等，胎儿巨大儿等）似乎没有那么重要，因为许多病例发生在年轻未产妇中，她们接受引产，导致通过剖宫产分娩了适合胎龄的婴儿。有证据表明，排便期间的体力劳动会导致子宫肌层的孕前伤害，这在西方人群中是地方病（> 30％），而在较小的妇科手术过程中过度牵引子宫颈。在整个过程中，子宫和输卵管都会通过子宫ac韧带受伤，并且在西方社会，它们的频率都在不断增加。也有直接的证据表明，少量的妇科手术会导致不良的生殖结果（例如，早产），也可能是孕前去神经支配损伤所致。

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