Nonobstetrie Lower Genital Tract Trauma

EDITORIAL COMMENT": We accepted this paper for publication to remind readers of the different types of nonobstetric trauma to the lower genital tract. The mechanism of tearing in the upper vagina during coitus is debated; this report does not favour the theory that tearing in the unsupported upper vagina results from levator spasm rather than direct injury (A).
A. Ahnaimugan S, Asuen MI. Coital laceration of the vagina. Aust NZ J Obstet Gynaecol 1980; 20: 180–181.
Summary: In a 4-year-period there were 31 admissions to Nehru Hospital, because of nonobstetrie injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.     

生殖道HPV感染与阴道混合性感染相关危险因素的研究

目的:探讨生殖道人乳头瘤病毒(HPV)感染与阴道混合性感染之间的相关危险因素。方法:对2015年6月至2016年10月就诊于西安交通大学第一附属医院妇科门诊,同时行阴道微生态及HPV分型检测的1914例患者的检查结果并进行分析。结果:1914例患者中,HPV感染率28.00%(536/1914)。1378例未感染HPV者中阴道感染性疾病发生率为55.88%(770/1378),536例HPV感染者中阴道感染性疾病的发生率为65.30%(350/536),HPV感染者较未感染者阴道感染性疾病的发生率高(P<0.05)。阴道微生态正常者HPV感染率为25.26%(97/384),阴道混合性感染者HPV感染率33.86%(64/189),阴道混合性感染者HPV感染率较阴道微生态正常者高(P<0.05)。以阴道微生态正常者为对照(OR=1),阴道混合性感染与HPV感染间的OR1=1.515(95%CI 1.037~2.213)。阴道微生态正常者HPV16/18感染率为7.55%(29/384),阴道混合性感染者HPV16/18感染率为17.99%(34/189),混合性感染者较阴道微生态正常者高(P<0.05)。以阴道微生态正常者为对照(OR=1),阴道混合性感染与HPV16/18感染间的OR2=2.685(95%CI 1.580~4.563)。结论:阴道混合性感染可增加HPV及HPV16/18的感染率,特别是可以增加HPV16/18的感染率。     

Non-obstetric Female Genital Tract Trauma in Port Moresby, Papua New Guinea

In a 3-year period there were 25 admissions to Port Moresby General Hospital because of non obstetric injuries to the female genital tract. The injuries were caused by voluntary coitus, rape, assault and falls. The most frequent injury was a laceration to the posterior fornix of the vagina. Although rape was frequently committed in Port Moresby, it was not the major cause of genital tract injury.     

两种分娩方式对正常生殖道菌群的影响

目的 :观察剖宫产和自然分娩两种分娩方式对正常产妇生殖道菌群的影响。方法 :选择 4 8例无易感因素的正常产妇 ,2 0例择期剖宫产 ,2 8例自然分娩 ,分别在术前、术时、术后行阴道液、宫腔液细菌培养 ,分娩前后不使用任何抗生素 ,观察分娩期和产褥期生殖道菌群的自然变化和产后感染情况。结果 :剖宫产术前阴道细菌培养阳性率为 6 0 % ,术后为 85 % (P>0 .0 5 ) ,术前宫腔细菌培养为阴性 ,术后为 35 .0 % (P<0 .0 1) ,自然分娩时阴道细菌培养阳性率为 39.3% ,分娩后为 78.6 % (P<0 .0 1) ,分娩时宫腔细菌培养阳性率为 7.1% ,分娩后为 32 .4 % (P<0 .0 1) ;剖宫产术后伤口感染率为5 .0 % ,自然分娩伤口感染率为 3.6 % (P>0 .0 5 )。结论 :两种分娩方式均可影响正常生殖道的菌群生态环境 ,造成菌群失调。在无易感因素的条件下 ,不使用抗生素 ,剖宫产与自然分娩的感染率无差异 ,不增加产褥期感染     

Clinical Decision‐Making for Repair of Spontaneous Childbirth Trauma: Validation of Cues and Related Factors

From recalled childbirth cases, a series of cues and related factors were previously identified that were used by midwives when making decisions to suture or not suture perineal and associated trauma incurred during spontaneous vaginal delivery. This study aimed to determine the validity of these cues and related factors. A panel of 18 experienced midwives evaluated their content validity using the criteria of “necessity” and “sufficiency.” The two main cue categories—“bleeding” and “birth trauma”—were considered by 18 (100%) of the panel members to be necessary to assess. At least 16 (89%) panel members considered the following specific cues necessary to assess: in the bleeding category—type, flow, amount, and effect of application of pressure or ice; in the birth trauma category—trauma sites, trauma types, dimensions of trauma, types of tissue, alignment of tissue, edema, and bruising. Seventeen (94%) panel members considered seven woman‐centred related factors that were necessary to assess and 14 (78%) considered the combination of all cues in bleeding, birth trauma, and related factors sufficient for making the decision to suture or not. The availability of these validated cues and related factors has the potential to guide a comprehensive assessment on which the decision to suture or not suture depends. This addition to the domain of midwifery knowledge enables educational preparation of midwives who will have the capacity to more adequately support women in childbirth.     

Genital Findings in Cases of Child Sexual Abuse: Genital vs Vaginal Penetration

Study ObjectiveTo (1) examine the prevalence of abnormal genital findings in a large cohort of female children presenting with concerns of sexual abuse; and (2) explore how children use language when describing genital contact and genital anatomy.DesignIn this prospective study we documented medical histories and genital findings in all children who met inclusion criteria. Findings were categorized as normal, indeterminate, and diagnostic of trauma. Logistic regression analysis was used to determine the effects of key covariates on predicting diagnostic findings. Children older than 4 years of age were asked questions related to genital anatomy to assess their use of language.SettingA regional, university-affiliated sexual abuse clinic.ParticipantsFemale children (N = 1500) aged from birth to 17 years (inclusive) who received an anogenital examination with digital images.Interventions and Main Outcome MeasuresPhysical exam findings, medical history, and the child's use of language were recorded.ResultsPhysical findings were determined in 99% (n = 1491) of patients. Diagnostic findings were present in 7% (99 of 1491). After adjusting for age, acuity, and type of sexual contact reported by the adult, the estimated odds of diagnostic findings were 12.5 times higher for children reporting genital penetration compared with those who reported only contact (95% confidence interval, 3.46-45.34). Finally, children used the word “inside” to describe contact other than penetration of the vaginal canal (ie, labial penetration).ConclusionA history of penetration by the child was the primary predictor of diagnostic findings. Interpretation of children's use of “inside” might explain the low prevalence of diagnostic findings and warrants further study.     

树突状细胞与生殖道黏膜免疫

树突状细胞是机体内功能最强大的抗原提呈细胞,广泛分布于机体黏膜表面,在固有免疫应答和适应性免疫应答中发挥重要作用.女性生殖道黏膜免疫既涉及对外来病原体的免疫防御,又涉及到对同种异体的精子及半同种异体移植物(胚胎)的免疫耐受,必然具有特殊的免疫学机制.综述树突状细胞与生殖道黏膜免疫研究进展.     

树突状细胞与生殖道黏膜免疫

树突状细胞是机体内功能最强大的抗原提呈细胞,广泛分布于机体黏膜表面,在固有免疫应答和适应性免疫应答中发挥重要作用。女性生殖道黏膜免疫既涉及对外来病原体的免疫防御,又涉及到对同种异体的精子及半同种异体移植物（胚胎）的免疫耐受,必然具有特殊的免疫学机制。综述树突状细胞与生殖道黏膜免疫研究进展。     

Fetal Complications Related to Minor Maternal Trauma

The active lifestyle of pregnant women, in combination with the increased incidence of violence in society, place women at greater risk for accidental injury during pregnancy. This identification of increased risk has altered the health care management of mother and fetus after injury. The health care provider treating this patient population must perform thorough maternal-fetal assessments and be suspicious of fetal Compromise, even in the face of maternal stability.     

Patterns of Treatment of Accidental Genital Trauma in Girls

Study Objective

To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS).