There are many articles published every year. 2018 has passed. Which articles are most worth paying attention to in the field of obstetrics and gynecology? Recently, Medscape critic Peter Kovacs has selected the five most important articles in the field of women's health in his mind in 2018.

　　1. Cervical cancer screening: HPV alone is not recommended for children under 30

　　ACOG, the American Preventive Association Working Group and the American Cancer Society jointly recommended screening guidelines:

　　(1) Medium-risk population (non-immunosuppressive population, no previous cervical intraepithelial neoplasia CIN level 2 and above): starting at 21 years old, cytology examination every 3 years from 21 to 65 years old. Another option is 21 to 29 years old, cytology check every 3 years, 30 to 65 years old, cytology + high-risk HPV check every 5 years. If three cytology tests continue to be negative in the past five years, or two cytology tests are negative in the past 2 years + high-risk HPV negative in the past 10 years, screening will be terminated at the age of 65.

　　(2) High-risk women (immune deficiency, previous CIN level 2 and above): HIV patients who start sexually active or start at 21 years old, and other people start at 21 years old. Then screen every year, if all 3 tests are negative, then every 3 years. After 30 years of age, cytology is screened every year until all 3 tests are negative, then every 3 years. Or cytology + high-risk HPV testing every 3 years. Continuous lifelong screening. For patients exposed to uterine diethylstilbestrol, they are screened annually.

　　(3) Low-risk women (total hysterectomy, no risk of CIN 2 and above) are no longer recommended for screening.

　　Currently, the evidence supporting the benefit of routine combined screening (cytology + high-risk HPV subtypes) is very weak, especially for people under 30 years of age. HPV examination alone, especially for women under the age of 30 whose HPV infection rate itself is very high, and the rate of overdiagnosis and treatment is also high, is also contradictory. To avoid over-diagnosis and treatment, over-frequency inspection is not recommended.

　　2. Ulipristal acetate (UPA) can prevent 2/3 of uterine fibroids from surgery

　　The Premya trial is a non-intervention trial involving 73 research centers in many European countries. 1473 women who were scheduled to undergo surgery for symptomatic uterine fibroids received 5 mg UPA for 3 months before surgery. After 3 months, only 38.8% of patients had surgery. The clinical symptoms of 60% of patients have been significantly and significantly improved. After 15 months of follow-up, 50% of them still maintained improvement in symptoms. In addition, among the 1473 patients, 87.8% of the patients had improved clinical symptoms. After 15 months of follow-up, more than 74% of the patients had improved symptoms.

　　GnRHa is currently the only effective drug for symptomatic uterine fibroids, and the side effects caused by long-term low estrogen status make it impossible to use for a long time. UPA is a progesterone receptor modulator and does not have this side effect. This clinical trial shows that for most patients, the effectiveness of UPA can last up to 15 months. Two-thirds of people therefore avoided surgery. As a result, complications, mortality, and medical expenses related to surgery have been greatly reduced.

　　3. For women under 60 years of age and within 10 years of menopause, it is recommended to use hormone replacement therapy for hot flashes, osteoporosis and urogenital symptoms

　　Combination of estrogen and progesterone replacement therapy (HT) was once considered beneficial to postmenopausal women. The WHI trial followed up for HT patients for 18 years. A total of 7,489 deaths were caused by coronary heart disease, stroke, pulmonary embolism, insomnia, bladder disease, and urinary incontinence. The rate increases, the symptoms of vasoconstriction, calcium deficiency, and the risk of fractures decrease.

　　For the CEE+MPA or CEE program alone, there is no obvious correlation with all-cause mortality, cardiovascular disease, and tumor-related mortality. The results of the trial do not change the current treatment plan: For women under 60 years of age and within 10 years of menopause, hormone replacement therapy is recommended for hot flashes, osteoporosis, and genitourinary symptoms. The results of the trial are also applicable to risk notification to women who will obviously benefit but are hesitant to related side effects.

　　4. Emergency contraception: Mifepristone, UPA, LNG

　　The earliest emergency contraception method is the Yuzpe method: 100mcg ethinyl estradiol + 0.5 mg levonorgestrel tablets (LNG), used twice q12 h within 72 hours. This article analyzed 115 randomized controlled trials involving 60,479 women, and compared the contraceptive effects of IUD, expectant treatment, LNG, different doses of mifepristone (<25 mg, 25-50 mg), and Yuzpe. Comment: Mifepristone, UPA, and LNG are more effective than Yuzpe method and have fewer side effects. LNG is more effective when administered within 72 hours, and Yuzpe is more effective when administered within 24 hours.

　　5. The microarray comparative genomic hybridization technology on the culture medium can be used as a non-invasive preimplantation genetic screening method?

　　In the past 40 years, in vitro fertilization embryo transfer technology has made tremendous progress. At present, 2% to 5% of newborns are born with this technology, and there are more than 1 million assisted reproduction cycles in the world each year. It is more important to improve the accuracy of preimplantation genetic screening, especially for the diagnosis of aneuploidy chromosomes in elderly women. At present, the main inspection method is chorionic villus biopsy or next-generation sequencing technology, but there are disadvantages such as fetal loss, misdiagnosis caused by embryo mosaicism, and potential damage to the fetus.

　　Scholars such as Feichtinger M boldly launched a proof-of-concept test study: extract cells from blastocyst fluid, and obtain genetic material after cultured in a medium. The subjects of the study were 22 elderly women, of which 18 samples were successfully cultured and expanded with genetic material. For the detection of aneuploid chromosomes, this method has a sensitivity of 73.3%, a specificity of 66.7%, a positive predictive value of 91.7%, and a negative predictive value of 33.3%.