The Parental Leave Paradox in Obstetrics and Gynecology

Medical school, residency, and fellowship occur during peak reproductive years for most trainees. This poses certain challenges for medical trainees as they approach family-building decisions. While the demands of residency have been well-elucidated, attempts at mitigating these demands alongside parenthood have long been neglected across various specialties. These challenges are perhaps most pronounced in Obstetrics and Gynecology residency programs, which are made-up of an 85% female-identifying workforce and whose training focuses on prenatal and postpartum health. Recent literature suggests an improvement in attitudes and policies towards parental leave during medical graduate education, however, there remains a lack of uniformity across specialties and programs. Through a recently developed Parental Leave Task Force made up of Obstetrics and Gynecology Trainees, we sought to conduct a review of the literature examining parental leave policies and their implications across various specialties as a call for uniform parental leave policies for all residents.

Awareness of von Willebrand disease among gynecologists: Investigating the referral of women with heavy menstrual bleeding to hematologists

Awareness of bleeding disorders, including von Willebrand disease, as a cause of heavy menstrual bleeding is low among gynecologists/obstetricians, potentially delaying diagnosis and appropriate treatment.

Bibliometric and visual analysis on oxidative stress in gynecological and reproductive diseases: A systematic review

BACKGROUND

The imbalance between the generation and elimination of reactive oxygen species (ROS) is defined as oxidative stress (OS). Elevated levels of OS are implicated in various diseases, especially in gynecological and reproductive disorders. The abundance of recent literature makes it challenging to assimilate all available information. This bibliometric analysis seeks to depict the research landscape of OS in gynecological and reproductive diseases and to identify future hotspots and trends.

METHODS

The Web of Science Core Collection served as the source for articles related to OS in gynecological and reproductive diseases. CtieSpace and VOSviewer software were utilized to analyzed countries/regions, institutions, journals, authors, and keywords of all eligible articles.

RESULTS

A total of 1423 articles were included. There was a gradual increase in the number of publications in this field. The USA maintained the highest number of publications, with 372 articles. Cleveland Clinic was the leading institution in terms of publication volume, contributing 67 articles. In total, 6925 authors were identified. Agarwal A as the most frequently co-cited author, received 812 citations across 43 publications. The predominant clusters included "placenta," "polycystic ovary syndrome," "male infertility," and "oocyte quality." Notably, "oocyte quality'" was identified as a current key research topic.

CONCLUSION

There was an uptrend in the number of articles addressing OS in gynecological and reproductive diseases. However, international collaboration and exchange were limited. The topic of male infertility had remained a consistent area of interest, and research on oocyte quality is poised to become a potential focal point in the future.

PLT antigen discrepancy pattern among couples with recurrent abortion

Background

Recurrent abortion refers to a condition of two or more consecutive pregnancies without known etiology affected by miscarriage before the completion of the 20th week of gestational age. However, several hypotheses have been proposed, but not much data are available concerning the relationship between human platelet antigens (HPAs) polymorphisms and recurrent abortion. This study was conducted to evaluate the genetic differences between HPA-1, -2, -3, -5, and - 15 in Iranian couples with a history of recurrent abortion.

Methods

In this cross-sectional study, a total of 74 couples with at least 2 recurrent abortions without any known specified reasons enrolled in the study. HPA polymorphisms genotyping was performed by single-specific primer PCR. Genotype frequency was calculated using the Hardy-Weinberg equation.

Results

A total of 39 couples (52.7%) had HPA genotyping partial mismatches. The most common partial mismatch pairs were found concomitantly on both HPA-15a and HPA-15b in three couples (4%), followed by two (2.7%) on HPA-3a and one (1.3%) in each HPA-2b and HPA-5b. There was a deviation from the Hardy-Weinberg equilibrium in the HPA-2 and -5 systems.

Conclusion

The present study declared that partial mismatches of HPA-3 and -15 genotypes were common among Iranian couples due to the history of recurrent abortion and approximately half of the couples carried at least one HPA gene that was absent in their partners. Further studies might be helpful to clarify the association between HPA polymorphisms and recurrent abortion, such as an investigation into the alloantibodies against HPAs.

Effect of calorie restriction and intermittent fasting on glucose homeostasis, lipid profile, inflammatory, and hormonal markers in patients with polycystic ovary syndrome: a systematic review

Background and objective

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that leads to ovarian cysts, irregular ovulation, and hormonal swings in women. It is a complex and heterogeneous condition that affects 4 to 20% of women of reproductive age worldwide and relates to reproductive, metabolic, and psychosocial dysfunction. Dietary and lifestyle modifications have been proposed to play a central role in the management of PCOS. This study aimed to provide a comprehensive systemic overview of the existing literature on the effects of intermittent fasting (IF) and calorie restriction (CR) regimens on disease markers of PCOS.

Designs and methods

Several databases, such as CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched for clinical trials and observational studies examined the effects of IF regimens such as time-restricted eating and Ramadan model of IF (RIF) on glucose homeostasis, lipid profile, inflammatory and hormonal markers in patients with PCOS.

Results

This systematic review solicited three articles, comprising a collective sample size of 75 females diagnosed with PCOS. The studies were published between 2015 to 2023 and were undertaken in three countries: China, Turkey, and Iran. The research articles examined the effects of intervention with IF and CR on PCOS-related parameters such as anthropometric measures and biochemical tests which included enzymes, glycemic control, lipid profile, hormonal, and oxidative stress, and inflammatory markers. The articles yielded mixed results, with two of them showing significant changes across all tested parameters. One of the three studies did not exhibit any significant changes.

Conclusion

Very limited studies examined the relationship between IR and CR with markers of PCOS. Further well-controlled studies need to be undertaken the combined results from the limited studies illustrate the intricate and diverse nature of IF, including the RIF, and its influence on measurements of body composition and biochemical markers related to PCOS.

[New disputes and interventions in the female body: divisions between gynecology and plastic surgery]

This article analyzes the tensions and disputes between the fields of gynecology and esthetic plastic surgery, the specialties which are authorized to perform aesthetic female genital surgeries in Brazil. Documentary materials are used, including scientific articles from the 1990s onward and institutional websites. While gynecologists have remained more cautious, recommending the surgery only for functional reasons, plastic surgeons have been more influential in publicizing these procedures and emphasizing the aesthetic dimension. Beyond professional disputes, we debate whether this phenomenon needs to be understood in light of the growing emphasis on self-improvement via biomedical resources and gender imperatives.

National and International Comparisons of Gynecological Research in Germany Based on a Bibliometric Analysis of Publications

Background

Recent years have seen a considerable shift from male doctors to female doctors in the field of gynecology. Female doctors are traditionally more involved with planning and maintaining their family. For gynecology, this could be associated with a risk that research activities will decrease, particularly if results are published in scientific journals.

Methods

In view of this shift, a comparative observational study was carried for 2022 in which 1306 publications were matched to 1786 female and male doctors reported on the websites of the 44 locations of university gynecology departments in Germany. In addition, the volume of publications issued between 2014 and 2022 was compared for Germany, France, the United Kingdom, and the United States. In Germany, the volume of publications in Gynecology was additionally compared with the publication outputs of the specialties Urology and Trauma Surgery.

Results

Since 2014, the increase in the numbers of publications in the field of Gynecology in Germany was lower (225%) than that of the countries with which it was compared (238%/252%/260% for F/UK/USA). When Gynecology was compared with other medical specialties in Germany, the number of publications in Urology were found to have increased at a lower rate (196%) while the number of publications in the field of Trauma Surgery increased by more (286%) than that of Gynecology. At the start of 2023, the percentage of women who were working as doctors at the lowest hierarchical level (junior doctor) was 81%. The publication output per capita of female doctors working at lower levels in the medical hierarchy, i.e., working as junior doctors and senior physicians, was between 40% and 80% lower than that of male doctors working at the same level. However, female directors published as much as male directors did. In the lower hierarchy levels, men were up to 14% more likely to be without an academic title. Predictors for more extensive publication activities by young female and male doctors include the extent and quality of publications by doctors in senior positions, the presence of a comprehensive cancer center or an institute for human genetics at the location where the young doctors were working, and joint publications with foreign authors.

Conclusion

For the German Society of Gynecology and Obstetrics, the results suggest a number of approaches to promote young researchers. The support provided to young female doctors is especially important as this should help to retain them as junior researchers over the long term.

Turkish adaptation of the reproductive autonomy scale: Validity and reliability study

OBJECTIVE

This study aimed to determine the validity and reliability of the reproductive autonomy scale by adapting it to Turkish society.

MATERIALS AND METHODOLOGY

Designed with a methodological method, the study was conducted with an online form created by using Google Forms with 308 married women of reproductive age between the ages of 15 and 49 who use WhatsApp or Instagram. The cultural adaptation process of the scale was carried out in three stages: language validity, content validity, and pilot application. Exploratory and confirmatory factor analysis was used to test the scale's construct validity. The scale's reliability was evaluated using Cronbach's α internal consistency coefficient and test-retest analyses.

FINDINGS

As a result of the exploratory factor analysis conducted in the study, it was determined that reproductive autonomy scale (RAS) consists of 14 items and 3 subscales. Good fit index values were obtained in confirmatory factor analysis. Cronbach's α internal consistency coefficients for the RAS total and subscale were found to be 0.66, 0.64, 0.89, and 0.92, respectively. Additionally, test-retest analysis of the scale was determined to have a high correlation.

CONCLUSION

The reproductive autonomy scale is a valid and reliable measurement tool for measuring the reproductive autonomy of Turkish society.

Guideline No. 449: Diagnosis and Impact of Endometriosis - A Canadian Guideline

OBJECTIVE

To provide a contemporary approach to the understanding of the impact and methods for the diagnosis of endometriosis in Canada.

TARGET POPULATION

Individuals, families, communities, health care providers, and health care administrators who are affected by, care for patients with, or manage delivery of services for endometriosis.

OPTIONS

The diagnosis of endometriosis is facilitated by a detailed history, examination, and imaging tests with providers who are experienced in endometriosis care. Surgical evaluation with pathology confirms a diagnosis of endometriosis; however, it is not required for those whose diagnosis was confirmed with imaging.

OUTCOMES

There is a need to address earlier recognition of endometriosis to facilitate timely access to care and support. Education directed at the public, affected individuals and families, health care providers, and health care administrators are essential to reduce delays in diagnosis and treatment.

BENEFITS, HARMS, AND COSTS

Increased awareness and education about the impact and approach to diagnosis may support timely access to care for patients and families affected by endometriosis. Earlier and appropriate care may support a reduced health care system burden; however, improved clinical evaluation may require initial investments.

EVIDENCE

Each section was reviewed with a unique search strategy representative of the evidence available in the literature related to the area of focus. The literature searches for each section of this guideline are listed in Appendix A and include information from published systematic reviews described in the text.

VALIDATION METHODS

The recommendations were developed following two rounds of review by a national expert panel through an iterative 2-year consensus process. Further details on the process are shared in Appendix B. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix C (Table C1 for definitions and Table C2 for interpretations of strong and conditional recommendations).

INTENDED AUDIENCE

This guideline is intended to support health care providers and policymakers involved in the care of those impacted by endometriosis and the systems required to support them.

TWEETABLE ABSTRACT

Endometriosis impact and diagnosis updated guidelines for Canadian health care providers and policymakers.

Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory

Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.

Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study

BACKGROUND

Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking.

OBJECTIVE

This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app.

METHODS

This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users.

RESULTS

Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=-0.09).

CONCLUSIONS

This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app.

Dienogest in conjunction with GnRH-a for postoperative management of endometriosis

Objective: The aim of this study is to assess the postoperative efficacy of the combined administration of dienogest (DNG) and gonadotropin-releasing hormone agonists (GnRH-a) in patients diagnosed with endometriosis (EMS), while acknowledging the extensive use of DNG in the extended therapeutic management of EMS. Methods: In this retrospective study, a cohort of 154 patients who underwent conservative surgical intervention for EMS were scrutinized. The cohort was stratified into two distinct groups based on their prescribed pharmacological regimens. Group A, 70 patients received postoperative oral administration of DNG at a dosage of 2 mg/day, whereas Group B, 84 patients underwent treatment involving 3 to 4 injections of GnRH-a post-surgery, followed by DNG therapy. Parameters assessed included pelvic pain visual analog scale (VAS) scores, quality of life metrics (EHP-5), and the incidence of adverse reactions within both groups. Results: Both groups exhibited sustained low VAS scores following the prescribed treatments. The predominant occurrence of adverse bleeding patterns manifested predominantly within the initial 6 months of the treatment. Notably, Group B demonstrated a significantly diminished of experiencing frequent and irregular bleeding in comparison to the DNG group (20.0% vs. 8.3%, 12.9% vs. 3.6%, p < 0.05). The administration of GnRH-a did not exacerbate the impact on bone health. Subsequent to health promotion interventions, the incidence of weight gain in both groups declined to 7.1% during the 6-month follow-up (p < 0.05). Group B exhibited a 100% satisfaction rate with the treatment, concomitant with a noteworthy reduction in EHP-5 scores (p < 0.05). Patients with deep infiltrating endometriosis (DIE) nodules displayed marginally higher postoperative VAS scores than their non-DIE counterparts (0.89 ± 0.96 vs. 0.49 ± 0.78). However, with sustained medication use, pain scores within the DIE group exhibited a continual decrease, maintaining a low level of 0.29 ± 0.67 at 12 months and beyond. Conclusion: The short-term adjunctive use of GnRH-a prior to DNG treatment postoperatively in patients with EMS proves efficacious in mitigating early adverse bleeding, enhancing patient adherence, and improving overall quality of life. Notably, this therapeutic approach demonstrates favorable safety profiles and is equally effective in patients with DIE.

The Value of Using Patient-Specific 3D-Printed Anatomical Models in Surgical Planning for Patients With Complex Multifibroid Uteri

OBJECTIVES

To compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient's multifibroid uterus created from their magnetic resonance imaging.

METHODS

3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models.

RESULTS

Two staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference.

CONCLUSIONS

Patient-specific 3D anatomical models may be a useful tool to increase a surgeon's understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.

A Pilot Study in Fatigue Risk Management Among Obstetrics and Gynaecology Residents at the University of Alberta

OBJECTIVES

Combatting fatigue is an ongoing challenge in surgical residency programs impacting both patient care and resident well-being. There is a gap in understanding the nuances of fatigue perpetuation, especially where it relates to specific on-call duties. This pilot study seeks to explore the extent of sleep deprivation among Obstetrics and Gynecology (OBGYN) residents and identify obstacles to obtaining adequate rest.

METHODS

A survey was sent out to all OBGYN residents at the University of Alberta, collecting demographic and baseline sleep information and assessing perceived barriers to sleep. Residents then self-selected for participation in the second portion which involved recording all pages in a 12-hour shift and assigning an acuity rating to them. Mixed methods were used including thematic analysis of the page acuity survey and descriptive statistics for the primary survey.

RESULTS

In total, 21 residents completed the initial survey (67.7%) and 17 12-hour shifts were recorded. While junior residents (postgraduate year 1-2) and those carrying the low-risk pager slept less on call and had less sleep on days without call, barriers to sleep were not different when compared to senior residents and those carrying the high-risk pager. While low-risk and high-risk shifts had different primary contributors to fatigue (volume and acuity, respectively) both groups attributed fatigue to non-urgent pages. On review of pages, 49.4% were perceived as non-urgent. A total of 81% of residents supported the development of problem boards to reduce the number of non-urgent pages.

CONCLUSIONS

This pilot study demonstrated residents, regardless of seniority or shift, found non-urgent pages to be a significant contributor to on-call fatigue and supported the use of problem boards to reduce pages. Our approach can provide a framework for other institutions to learn more about resident fatigue and non-urgent paging in their program.

A global study on knowledge and perception of HPV and HPV vaccination among young obstetricians and gynecologists

Objective

Our goal is to improve the understanding of human papillomavirus (HPV) and its vaccination among obstetrics and gynecology trainees and young specialists worldwide.

Materials and Methods

This cross-sectional study was conducted through an online survey consisting of 28 questions by the World Association of Trainees in Obstetrics and Gynecology between February and August 2023. The questionnaire collected demographic data of the study participants and assessed the respondents' knowledge and perception of HPV, HPV vaccines, and vaccine dosing schedule.

Results

Two hundred five Ob/Gyn trainees and young Ob/Gyns from 52 countries completed the survey. The majority of respondents were trainees (158, 77.1%). Most trainees and young Ob/Gyns learned about HPV for the first time during medical school (149, 72.6%). Almost all (204, 99.5%) Ob/Gyns responded that HPV was sexually transmitted. More than half of the respondents had not received HPV vaccination (110, 53.7%). The vaccine was recommended for respondents mostly by their Ob/Gyn senior colleagues (110, 53.7%). Most of the respondents knew how to manage HPV-positive patients (179, 87.3%).

Conclusion

This study suggests that even though knowledge on HPV and its vaccination is satisfactory among trainees and young Ob/Gyns, HPV vaccination remains deficient. There is a need to understand, educate, and address the potential problem that lies underneath.

[The birthing chair, obstetric bed and gynecological chair in obstetrics and gynecology in Russia of XVIII-XX centuries]

The purpose of the study is to investigate material culture of obstetrics in New and Modern history of Russia. The most important objective of research is to involve into scientific circulation Russian empirical material in order to study transformation of culture of childbirth during transition from traditional to biomedical model of childbirth exemplified by material culture items (maternity beds, chairs, armchairs). The key approaches were those of historical anthropology, social history of medicine, theory of social control and medicalization. The methods of content analysis, narrative and interpretive analysis were applied to analyze empirical data. In the Russian folk tradition included no such special devices as maternity beds and birth chairs that was explained by dominance of vertical maternity pose. The first birth chairs were brought into Russia by foreign midwives. With development of clinical obstetrics horizontal position of woman in labor was approving that was conditioned by convenience of physicians. Since last quarter of the XIX century, Russian physicians began to experiment, inventing most convenient version of maternity beds and gynecological chairs. The Soviet system of obstetrics was mass and publicly accessible, but consolidated technocratic model of childbirth. In maternity wards, the "Rakhmanov obstetric bed" became widespread. The chairs were not used during childbirth, being used exclusively in gynecology. The material culture of Soviet maternity hospitals turned out to be extremely stable and conservative. In modern Russian obstetrics, with transition to holistic model of childbirth and actualization of free positioning of woman in labor, transformer beds and fitballs began to be applied to provide optimal course of birth process. The material culture of obstetrics is closely related to dominant type of maternity culture.

The global burden of disease due to benign gynecological conditions: A call to action

OBJECTIVE

Focusing on low- and middle-income countries (LMICs), this article uses data from the Global Burden of Disease (GBD) database to highlight the burden of morbidity due to benign gynecological conditions (BGCs).

METHODS

We analyzed 2019 morbidity data for all BGCs, measured as years lost to disability (YLDs). Disease burden was calculated for individual conditions, BGCs overall, and percentages of overall disease burden from all conditions. The same data extraction was performed for malaria, tuberculosis, and HIV/AIDS for comparison. The data were subcategorized by age and World Bank income level.

RESULTS

BGCs are major causes of disease morbidity worldwide. For women aged 15 years and over in high-income countries (HICs), 3 588 157 YLDs (3.94% of all YLDs) were due to BGC. In LMICs, 18 242 989 YLDs (5.35% of all YLDs) were due to BGCs. The highest burden of BGCs is seen during the reproductive years where conditions driven or exacerbated by reproductive hormones are the major causes of morbidity. In LMICs, for women aged 15-49, 14 574 100 YLDs (7.75% of all YLDs) were due to BGCs, declining to 3 152 313 YLDs (3.04%) in women aged 50-69 and 529 399 YLDs (1.06%) in women age 70+.

CONCLUSION

These data demonstrate a huge burden of morbidity due to BGCs. There is an urgent need for international stakeholders to prioritize the treatment and prevention of BGCs.

The prevalence of menstrual disorders and their association with psychological stress in Syrian students enrolled at health-related schools: A cross-sectional study

OBJECTIVES

Menstrual disorders are among the most prevalent health issues among young female students studying in health science faculties. This study aimed to provide insights into the menstrual patterns among medical faculty students and determine whether stress can be a risk factor for its various disorders.

METHODS

This cross-sectional study was conducted in the Faculties of Medicine, Dentistry, and Pharmacy at the Syrian Private University, Damascus, Syria, between October and November 2022. A total of 980 female students anonymously completed the identification of menstrual problems and the perceived stress scale (PSS) questionnaire. The data were analyzed using SPSS-25.

RESULTS

The mean age of students was 21.52 ± 2.06 years. The most common menstrual disorders in this study were dysmenorrhea (88%), and premenstrual syndrome (87%). A total of 82% had mild to moderate stress, 10% had high stress, and 8% had low stress. Moderate to high perceived stress was associated with an increased risk of PMS (OR = 1.79, P = 0.0037).

CONCLUSION

These findings stress the importance of universities, especially health science faculties, establishing protocols for early detection and intervention in students with stress and menstrual disorders. Implementing stress reduction education and timely counseling, along with preventive measures, is crucial for students' well-being. Further research is needed to refine interventions for this group.

Gender role conflicts experienced by Indonesian women with gynecological cancer: A phenomenological study

Background

Gynecological cancer and its treatments can lead to sexual problems, potentially disrupting the gender role performance of women. Sexuality and gender roles are context-specific, yet these issues remain unexplored in the Indonesian context.

Objective

This study aimed to explore the gender role conflicts experienced by Indonesian women having gynecological cancer.

Method

A qualitative design with a phenomenology approach was utilized in this study. Data were collected through individualized, face-to-face, in-depth interviews conducted from 1 April to 30 December 2022 with 22 women diagnosed with gynecological cancer who had undergone treatments at the Dharmais Cancer Hospital, Jakarta, Indonesia. Data were analyzed using thematic analysis.

Results

Three themes were developed: 1) challenges in fulfilling female gender roles after having cancer diagnosis and therapies, 2) emotional struggles related to gender role conflicts, and 3) efforts to cope with gender role conflicts.

Conclusion

The study sheds light on how sexual complications due to gynecological cancer and its treatments extend beyond physical issues. A deeper layer of problems around sexual dysfunctions among gynecological cancer survivors is often rooted in traditional gender-role expectations. Nurses should have a comprehensive and contextual understanding of the unique experiences of women living with gynecological cancer to facilitate a positive adaptation to their cancer journey.

Gynecologic Adnexal Tumors and Tumor-Like Lesions in Children and Adolescents: Experience at a Cancer Center

Introduction. Tumors and tumor-like lesions of the uterine adnexa in children and adolescents are uncommon but may carry devastating consequences. Methods. We conducted an observational retrospective cohort study, to describe patients aged 0 to 19 years diagnosed with tumors and tumor-like lesions of the uterine adnexa at our institution between 2000 and 2018. Results. Eighty-nine patients with 105 adnexal lesions were included. Thirty-seven (42%) patients presented with benign tumors, 13 (15%) with borderline tumors, 25 (28%) with malignant tumors and 14 (16%) with tumor-like lesions. Germ cell tumors (n = 45|43%) were the most frequent, followed by epithelial tumors (n = 30|29%). No significant differences were found in the age distribution of the lesions by malignant potential or histologic group. Most patients (n = 80|90%) were treated primarily with conservative surgery, including cystectomy (n = 25|28%) and unilateral oophorectomy/adnexectomy (n = 54|61%). Thirty-four (38%) underwent surgical staging (partial omentectomy and peritoneal biopsies). Twenty (23%) patients with borderline and malignant tumors were submitted to chemotherapy. Four (5%) patients with borderline or malignant tumors relapsed, one of whom died from disease. Conclusion. Gynecological lesions in children and adolescents encompass a wide range of rare histological tumor subtypes, requiring evaluation by experienced pathologists. Most tumors were diagnosed at early stages, with low relapse and mortality rates. Conservative management, with fertility sparing surgery and limited use of adjuvant chemotherapy, is of utmost importance.

Revolutionizing Women's Health: A Comprehensive Review of Artificial Intelligence Advancements in Gynecology

Artificial intelligence has yielded remarkably promising results in several medical fields, namely those with a strong imaging component. Gynecology relies heavily on imaging since it offers useful visual data on the female reproductive system, leading to a deeper understanding of pathophysiological concepts. The applicability of artificial intelligence technologies has not been as noticeable in gynecologic imaging as in other medical fields so far. However, due to growing interest in this area, some studies have been performed with exciting results. From urogynecology to oncology, artificial intelligence algorithms, particularly machine learning and deep learning, have shown huge potential to revolutionize the overall healthcare experience for women's reproductive health. In this review, we aim to establish the current status of AI in gynecology, the upcoming developments in this area, and discuss the challenges facing its clinical implementation, namely the technological and ethical concerns for technology development, implementation, and accountability.

Endometriosis, polycystic ovary syndrome, and the thyroid: a review

Endometriosis and polycystic ovary syndrome (PCOS) are common gynecological disorders that constitute a significant burden of disease in women of fertile age. The disorders share a link to female reproduction and infertility; however, divergent effects on menstrual cycle, related hormones, and body composition have been proposed. Disorders of the thyroid gland including abnormal thyroid dysfunction (hyperthyroidism or hypothyroidism) and/or markers of thyroid autoimmunity similarly show a female predominance and onset in younger age groups. We reviewed the literature on the association between endometriosis, PCOS, and thyroid disease up until July 1, 2023, and identified 8 original studies on endometriosis and thyroid disease and 30 original studies on PCOS and thyroid disease. The studies were observational and heterogeneous regarding the design, sample size, and definitions of exposure and outcome; however, a tendency was seen toward an association between hyperthyroidism and endometriosis. Especially an association between endometriosis and slightly elevated levels of thyroid-stimulating hormone receptor antibodies has been found and corroborated in studies from different populations. On the other hand, the literature review turned a focus toward an association between hypothyroidism and PCOS, however, with uncertainties as to whether the association is caused by hypothyroidism per se and/or the thyroid autoantibodies (thyroid peroxidase and thyroglobulin antibodies). More evidence is needed to substantiate an association between endometriosis, PCOS, and thyroid disease, and to differentiate between the role of thyroid function and thyroid autoimmunity. Furthermore, studies are warranted to extend knowledge on the different disease characteristics and underlying mechanisms.

Plasma metabolomics for diagnostic biomarkers on ectopic pregnancy

Metabolomics is a relatively novel omics tool to provide potential biomarkers for early diagnosis of the diseases and to insight the pathophysiology not having discussed ever before. In the present study, an ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was employed to the plasma samples of Group T1: Patients with ectopic pregnancy diagnosed using ultrasound, and followed-up with beta-hCG level (n = 40), Group T2: Patients with ectopic pregnancy diagnosed using ultrasound, underwent surgical treatment and confirmed using histopathology (n = 40), Group P: Healthy pregnant women (n = 40) in the first prenatal visit of pregnancy, Group C: Healthy volunteers (n = 40) scheduling a routine gynecological examination. Metabolite extraction was performed using 3 kDa pores - Amicon® Ultra 0.5 mL Centrifugal Filters. A gradient elution program (mobile phase composition was water and acetonitrile consisting of 0.1% formic acid) was applied using a C18 column (Agilent Zorbax 1.8 μM, 100 x 2.1 mm). Total analysis time was 25 min when the flow rate was 0.2 mL/min. The raw data was processed through XCMS - R program language edition where the optimum parameters detected using Isotopologue Parameter Optimization (IPO). The potential metabolites were identified using MetaboAnalyst 5.0 and finally 27 metabolites were evaluated to be proposed as potential biomarkers to be used for the diagnosis of ectopic pregnancy.

Exploring the racial gradient in reproductive health: an examination of challenges to sexual health care faced by black female college students

OBJECTIVES

This study identifies and analyzes barriers to sexual and gynecological health care Black women face at a Historically Black College or University (HBCU) and a Predominantly White Institution (PWI) in southeastern America.

DESIGN

Participants identified as Black women who were sexually active, age 18-25, and undergraduate students. The research team conducted in-depth interviews across two campuses via Zoom. Interviews were coded using inductive thematic analysis.

RESULTS

We derived six specific themes that summarize Black female college students' barriers to care: Patient-provider Interactions, Economic Determinants of Health, Social Support, Access to Care, Lack of Primary Care, and No Challenges.

CONCLUSION

Reproductive and sexual health disparities can be mitigated with attention to diversity in medical school, affordable care, and teaching young women to prioritize their care for long-term reproductive health.

Unraveling the Enigma: A Case Report on Unilateral Ovarian Dermoid Cyst

Mature teratomas, also known as ovarian dermoid cysts, are benign embryonal tumors that develop slowly. One of the following imaging techniques is commonly employed to evaluate these cysts: transvaginal ultrasound, pelvic ultrasonography, magnetic resonance imaging, or computed tomography. The two surgical methods most frequently used for removing persistent or very large cysts are laparoscopy and laparotomy. A 42-year-old female, who is P3L1D2 with a history of previous cesarean section, presented with an abdominal mass that had been gradually increasing in size over the past five months. She also reported lower abdominal pain for the last five days. Upon further evaluation, she was diagnosed with a left ovarian dermoid cyst. The patient underwent exploratory laparotomy, during which a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The cut section of the gross cyst specimen revealed abundant sebaceous fluid and a large tuft of hair, which was confirmed by histopathology. The patient was followed up every three months for a year. Ovarian tumors typically manifest with nonspecific symptoms. The early recognition of dermoid cysts and prompt intervention are crucial to prevent potential complications.

Deciphering the potential of proteomic-based biomarkers in women's reproductive diseases: empowering precision medicine in gynecology

CONTEXT

Gynecological disorders represent a complex set of malignancies that result from a diverse array of molecular changes affecting the lives of over a million women worldwide. Ovarian, Endometrial, and Cervical cancers, Endometriosis, PCOS are the most prevalent ones that pose a grave threat to women's health. Proteomics has emerged as an invaluable tool for developing novel biomarkers, screening methods, and targeted therapeutic agents for gynecological disorders. Some of these biomarkers have been approved by the FDA, but regrettably, they have a constrained diagnostic accuracy in early-stage diagnosis as all of these biomarkers lack sensitivity and specificity. Lately, high-throughput proteomics technologies have made significant strides, allowing for identification of potential biomarkers with improved sensitivity and specificity. However, limited successes have been shown with translation of these discoveries into clinical practice.

OBJECTIVE

This review aims to provide a comprehensive overview of the current and potential protein biomarkers for gynecological cancers, endometriosis and PCOS, discusses recent advances and challenges, and highlights future directions for the field.

CONCLUSION

We propose that proteomics holds great promise as a powerful tool to revolutionize the fight against female reproductive diseases and can ultimately improve personalized patient outcomes in women's biomedicine.

Detrusor nerve radiofrequency ablation (DENERA): Experimental study of safety and efficacy in an ovine model

PURPOSE

The subtrigonal perivesical nerve plexus contains a large proportion of the bladder's innervation. A transurethral radiofrequency ablation approach has successfully denervated this region to alleviate overactive bladder symptoms, with some urothelial heat injury. We report a novel transvaginal RFA device (DENERA) and assess its feasibility and efficacy in denervating the perivesical nerve plexus of in vivo sheep.

METHODS

In 14 adult female in vivo sheep, pulsed radiofrequency energy was applied transvaginally for three cycles of 4 min, maintaining the tissue temperature at 45°C, with 30 s of rest between each cycle. The control group (n = 4) was sacrificed without ablation, and various groups were sacrificed 1 week (n = 3), 4 weeks (n = 4), and 12 weeks (n = 3) after ablation. The bladder subtrigones were harvested then analyzed with H&E, S100, and TH immunostaining to quantify their neural density and neural vacuolization.

RESULTS

The ablation procedure increased the neural vacuolization the most at 1 week and decreased the neural density the most at 4 weeks, with both variables displaying a significant change followed by a slight rebound towards baseline at 12 weeks. The H&E analysis showed that the needles penetrated deep into the subtrigonal detrusor muscle. The sheep recovered from the procedure with no complications or damage in the bladder wall or urothelium.

CONCLUSIONS

This study shows that one DENERA treatment can cause subtrigonal denervation with some rebound afterwards and no complications. DENERA may become a promising OAB treatment option that can ablate the perivesical plexus without harming the urothelium.

A biography of Dr Carl Bodon: Pioneer of intracardiac injection of adrenaline

This biographical essay will provide historical insights about Dr Carl Bodon who performed one of the first successful intracardiac injections of adrenaline to a patient and made important contributions to the understanding of cardiac diseases and women's health. Dr Bodon's biography reveals the story of a medical doctor who lived during tumultuous times between two world wars and ultimately died in the Holocaust. His story sheds light on forgotten contributors to the medical field and its practices.

Initial experience with the enhanced recovery after surgery (ERAS) protocols in gynecologic surgery at an urban academic tertiary medical center

Background

The enhanced recovery after surgery (ERAS) protocols have been consistently associated with improved patient experience and surgical outcomes. Despite the release of ERAS Society guidelines specific to gynecologic oncology, the adoption of ERAS in gynecology on global level has been disappointingly low and some centers have shown minimal improvement in clinical outcomes after adopting ERAS. The aim of this study is to describe the development and early experience of ERAS protocols in gynecologic surgery at an urban academic tertiary medical center.

Methods

This was an observational prospective cohort study. The target patient population included those with low comorbidities who were scheduled to undergo various types of gynecologic surgeries for both benign and malignant diseases between October 2020 and February 2021. Two attending surgeons implemented the protocols for their patients (ERAS cohort) while three attending surgeons maintained the conventional perioperative care for their patients (non-ERAS cohort). Baseline characteristics, surgical outcomes and patients' answers to a 12-question survey were compared. A case-matched comparative analysis was also performed between the ERAS cohort and the historical non-ERAS cohort (those who received the same types of surgical procedures from the two ERAS attending surgeons prior to the implementation of the protocols).

Results

A total of 244 patients were evaluated (122 in the ERAS cohort vs. 122 in the non-ERAS cohort). The number of vials of opioid analgesia used during the first two postoperative days was significantly lower whereas the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen was more frequent in the ERAS cohort group. The patients in the ERAS group reported less postoperative pain, feelings of hunger and thirst, and greater amount of exercise postoperatively. These benefits of the ERAS cohort were more pronounced in the patients who underwent laparotomic surgeries than those who underwent laparoscopic surgeries. The case-matched comparative analysis also showed similar results. The length of hospital stay did not differ between those who underwent the ERAS protocols and those who did not.

Conclusions

The results of the study demonstrated the safety, clinical feasibility and benefits of the ERAS protocols for patients undergoing gynecologic surgeries for both benign and malignant indications.

Finite element analysis of female pelvic organ prolapse mechanism: current landscape and future opportunities

The prevalence of pelvic organ prolapse (POP) has been steadily increasing over the years, rendering it a pressing global health concern that significantly impacts women's physical and mental wellbeing as well as their overall quality of life. With the advancement of three-dimensional reconstruction and computer simulation techniques for pelvic floor structures, research on POP has progressively shifted toward a biomechanical focus. Finite element (FE) analysis is an established tool to analyze the biomechanics of complex systems. With the advancement of computer technology, an increasing number of researchers are now employing FE analysis to investigate the pathogenesis of POP in women. There is a considerable number of research on the female pelvic FE analysis and to date there has been less review of this technique. In this review article, we summarized the current research status of FE analysis in various types of POP diseases and provided a detailed explanation of the issues and future development in pelvic floor disorders. Currently, the application of FE analysis in POP is still in its exploratory stage and has inherent limitations. Through continuous development and optimization of various technologies, this technique can be employed with greater accuracy to depict the true functional state of the pelvic floor, thereby enhancing the supplementation of the POP mechanism from the perspective of computer biomechanics.

The "oldest and the newest of nurses": Nursing and the Professionalization of Obstetrics and Gynecology

When in the late nineteenth century American physicians increasingly replaced midwives in the care of obstetrical and gynecological patients, they could do so only because they were aided by another emerging group of healthcare professionals: nurses. Nurses were instrumental in assisting physicians in the care of patients in labor and during recovery. They were also necessary for male physicians because the vast majority of nurses were women and their presence during gynecological and obstetrical treatments made it more socially acceptable for men to examine female patients. In hospital schools in the northeast and through long-distance nursing programs, physicians taught students about obstetrical nursing and instructed them to protect the modesty of female patients. They also tried to instill strict professional hierarchies between nurses and physicians, emphasizing that nurses should never attempt to deliver a patient without a physician. But as nursing emerged into a unique professional practice separate from that of physicians, nurses were able to negotiate better education in the care of laboring patients. In order to take over women's sexual and reproductive health care from traditional providers, physicians conceded to nurses' demands for more authority in patient care.

Gender and Racial Diversity Among Obstetrics and Gynecology Departments and Gynecologic Oncology Divisions in Canada: Are We There Yet?

OBJECTIVES

Gender and racial diversity in academic Canadian departments of obstetrics and gynecology (OBGYN) have not been previously described. We examined gender representation in leadership in academic OBGYN departments and gynecologic oncology (GO) divisions, and determined factors predictive of leadership and promotion including racialized status.

METHODS

This cross-sectional study of Canadian residency-affiliated academic OBGYN departments queried institutional websites in January 2021 to compile a list of academic faculty. Subjective gender was assessed using photographs and pronouns, and racialized status was determined using photographs. Logistic regression analyses determined predictive factors for leadership roles. Fassiotto et al. rank equity indices (REI) and Hofler et al. representation ratios were calculated.

RESULTS

Within 16 Canadian institutions there were 354 (33.6%) men and 699 (66.4%) women, with 18.3% racialized faculty. Men were more likely to reach full professorship (P < 0.00001) and leadership positions of department chair, vice-chair or division head (P = 0.01). Representation ratios for women in OBGYN were <1 for all administrative leadership positions, and pairwise comparisons of the probability of promotion for women OBGYNs using REI reveal significant disparities between senior and junior administrative leadership and professorial ranks. Racialized physicians were less likely to have attained full professorship (P = 0.002). Ninety-seven academic GOs were identified: 68 (70.1%) were women, 17 (17.5%) racialized. Seven GO divisions (44%) had no racialized members. On multivariate analysis, only year of completion of fellowship was predictive of leadership.

CONCLUSION

In academic Canadian OBGYN departments women are underrepresented in leadership and full professor positions. Racialized faculty are underrepresented in full professorship.

A reliable and valid tool to assess the sexual acceptability of contraceptive methods

Introduction

Adequate identification of the sexual acceptability of contraceptive methods is key for designing health promotion interventions, assessing their impacts, and increasing their effectiveness. This study aimed to develop and validate a questionnaire to explore the preferences of women depending on their epidemiological characteristics and their partner relationships-the Sexual Acceptability of Contraceptive Methods Questionnaire [in Spanish, Aceptabilidad Sexual de los Métodos Anticonceptivos (ASMA)].

Methods

Psychometric validation was conducted using Exploratory Factorial Analysis (EFA) and confirmatory factor analysis (CFA). The reliability of the final version of the questionnaire was explored using Cronbach's alpha and McDonald omega to estimate internal consistency.

Results

A three-factor model was identified. Factor 1 (explaining 28.32% of the model) corresponds to questions concerning the use and placement of the contraceptive and includes 6 items; Factor 2 (explaining 24.23%) corresponds to other factors that affect the relationship such as bleeding and side effects of the contraceptive method and includes 10 items; and Factor 3 (explaining 18.94%) corresponds to the couple relationship and includes 8 items.

Conclusion and implications

The ASMA questionnaire provides a valid and reliable tool for assessing the sexual acceptability of various contraceptive methods. This instrument gathers data that provide information on various aspects of women's sexuality, health, education, and beliefs, all of which can determine the preference for one contraceptive method over another. Moreover, the tool can help to identify profiles of women who have different preferences when selecting a particular method.

Disseminated Anaplastic Lymphoma Kinase (ALK)-Positive T-cell Lymphoma Involving the Uterus and Cervix: A Case Report

Primary or secondary non-Hodgkin lymphomas (NHLs) involving the female gynecologic tract are rare. T-cell subtypes are further rare and portend a worse prognosis. We present a case of a 23-year-old female presenting with a cervical mass accompanied by constitutional symptoms and abnormal vaginal bleeding. Immunohistochemistry studies revealed the presence of disseminated T-cell non-Hodgkin lymphoma that was anaplastic lymphoma kinase (ALK)-positive. The patient demonstrated a complete response to systemic chemotherapy initially and again after the relapse of the disease one year after diagnosis. To our knowledge, this is the first case of an ALK-positive T-cell lymphoma with secondary involvement of the uterus and cervix; all previously published cases of this histologic subtype in the gynecologic tract describe primary disease of the vagina. This case emphasizes the importance of immunohistochemistry studies inclusive of T-cell and B-cell markers when evaluating biopsies from cervical tumors to render the appropriate diagnosis and guide systemic therapy.

Delayed Hemorrhage: A Rare Complication of Loop Electrosurgical Excision Procedure

Loop electrosurgical excision procedure (LEEP) is a common procedure used to treat cervical dysplasia. It is performed by using an electrical current and loop wire to remove abnormal cervical tissue. Common complications include intraoperative and postoperative bleeding. A rare complication is delayed hemorrhage, presenting in 0.8-1.3% of women, which can require sutures, transfusions, or inpatient care. We present the case of a 41-year-old female presenting to the emergency department nine days after a LEEP procedure with heavy vaginal bleeding that resulted in delayed hemorrhage. Within hours of arrival, the patient passed several large clots and her hemoglobin dropped from 12.2 gm/mL to 6.9 gm/mL requiring emergency surgery and blood transfusion. The delayed hemorrhage was further exacerbated by this patient's concurrent clopidogrel use. It is pivotal to identify high-risk patients to help prevent potential procedural complications through the use of preoperative instructions and emerging intraoperative interventions. It is also imperative to provide adequate guidance to patients about the postoperative course and how to identify signs and symptoms of a life-threatening situation.

Learning Curves of OBGYN Residents Preparing for the FLS Manual Skills Exam

OBJECTIVE

To describe obstetrics and gynecology (OBGYN) resident practice patterns and learning curves as they prepare for the Fundamentals for Laparoscopic Surgery (FLS) manual skills exam and to assess the importance of meeting proficiency, based on published standards, for passing the FLS manual skills exam.

METHODS

This is a prospective observational study of OBGYN resident physicians from July 2018 to January 2022. Residents recorded details about their FLS practice sessions and proficiency metrics for each task repetition. Manual skills exam scores were then compared to task practice variables. Learning curves were developed from resident practice patterns.

RESULTS

Fifty OBGYN residents participated in the study. The median number of repetitions per FLS manual skills task ranged from 3.5 (interquartile range [IQR] 2-7) (Task 3) to 7.5 (IQR 3-14) (Task 1). The average number of hours spent practicing was 5.4 hours (SD 3.4 hours), with a median of 3.7 sessions with faculty and/or fellow guidance and 1 self-practice session. All residents passed the FLS manual skills exam. Only for Task 2 (95% confidence interval [CI] 0.24, 5.21) and for the total number of repetitions for all tasks (95% confidence interval [CI] 0.22, 3.74) was a greater number of practice repetitions associated with higher FLS manual skills exam scores. Notably, postgraduate year, number and type of practice sessions, and the number of hours were not associated with higher scores. For all tasks, learning curves showed the greatest rate of improvement in the first 10 to 15 repetitions before diminishing returns.

CONCLUSION

Greater number of practice hours and sessions were not associated with better manual exam scores in a cohort of OBGYN residents with a high proportion of supervised practice sessions. Achieving more advanced proficiency at certain FLS tasks may allow for better performance on the exam.

Modification of Fundamentals of Laparoscopic Surgery Manual Tasks Simulation Curriculum With the Addition of the Vaginal Cuff Closure Training

OBJECTIVE

Fundamentals of Laparoscopic Surgery (FLS) is a multiple-choice test and a manual skills exam using simulation that Obstetrics and Gynecology (OBGYN) residents must pass to qualify for board certification. There is insufficient validity evidence supporting the use of FLS as a high-stakes exam. This study examines the correlation between OBGYN residents' performance on the FLS manual tasks and simulated vaginal cuff closure.

METHODS

We compared residents' performance on FLS tasks with simulated vaginal cuff suturing on a model. During the first coached simulation session, after completion of training on the standard 5 FLS tasks, residents were coached on vaginal cuff closure using a simulated model placed inside the standard FLS box trainer. At a subsequent session, their performance was scored using the Global Operative Assessment of Laparoscopic Skills Scale (GOALS) and a second task-specific metric, and these scores were compared to their official FLS score.

RESULTS

Twenty-nine residents completed the vaginal cuff simulation training between June 2019 and November 2021. Nineteen of the 29 were able to complete the cuff closure with the mean time to completion being 14.5 minutes. We found no correlation between official manual skills FLS scores and vaginal cuff GOALS scores (rho = -0.02, p = 0.90) or cuff closure assessment tool score (rho = -0.015, p = 0.048). There was also no correlation between time to completion for any FLS task and vaginal cuff closure OSAT scores. All residents reported that they found the cuff to be a useful addition to the FLS curriculum.

CONCLUSIONS

Our study demonstrated that trainee performance on a simulated vaginal cuff closure model did not correlate with official FLS manual tasks skills. This finding adds to the body of evidence disputing the use of FLS as a high-stakes exam to assess laparoscopic skills in gynecology in the relationship with other variables category.

Association Between Serum Glycated Hemoglobin Levels at Early Gestation and the Risk of Subsequent Pregnancy Loss in Pregnant Women Without Diabetes Mellitus: Prospective Cohort Study

BACKGROUND

As a severe morbidity during pregnancy, the etiology of spontaneous pregnancy loss (SPL) remains largely unknown. Serum glycated hemoglobin (HbA1c) level is an established predictor of SPL risk among women with diabetes, but little is known about whether such an association exists among pregnant women without diabetes when glycemic levels are within the normal range.

OBJECTIVE

This study aimed to quantify the association between maternal HbA1c levels in early pregnancy and subsequent SPL risk in a cohort of pregnant women without diabetes.

METHODS

This prospective cohort study involved 10,773 pregnant women without diabetes enrolled at their first antenatal care visit at a hospital's early pregnancy clinic from March 2016 to December 2018 in Shanghai, China. HbA1c and fasting blood glucose (FBG) levels were examined at enrollment. Participants with diabetes before or pregnancy or those diagnosed with gestational diabetes were excluded. Diagnosis of SPL, defined as fetal death occurring before 28 gestational weeks, was derived from medical records and confirmed via telephone interviews. We used generalized linear models to quantify the associations of continuous and dichotomized maternal HbA1c levels with SPL risk and reported crude and adjusted risk ratios (RRs) and 95% CIs. A restricted cubic spline (RCS) regression model was used to assess the potential nonlinear dose-response relationship. Adjusted covariates included maternal age, education level, preconception BMI, gestational weeks, gravidity, history of adverse pregnancy outcomes, family history of diabetes, folic acid supplementation, and smoking and drinking during the periconception period.

RESULTS

In total, 273 (2.5%) SPL cases occurred. Every 0.5% increase in HbA1c levels was linearly associated with a 23% increase in SPL risk (adjusted RR [aRR] 1.23; 95% CI 1.01-1.50). The RCS model revealed that this association was linear (P=.77 for the nonlinearity test). Analyses based on dichotomized HbA1c levels showed a significantly increased risk of SPL when HbA1c levels were ≥5.9% (aRR 1.67; 95% CI 0.67-3.67), and the significance threshold was ≥5.6% (aRR 1.60; 95% CI 1.01-2.54). Sensitivity analyses showed similar results when including the participants with missing SPL records or HbA1c data. Linear associations of HbA1c levels remained significant even in the subgroups without overweight, alcohol consumption, and a family history of diabetes and adverse pregnancy outcomes. Every 1 mmol/L increment in maternal FBG levels was associated with a >2-fold higher risk of SPL (aRR 2.12; 95% CI 1.61-2.80; P<.001).

CONCLUSIONS

Higher HbA1c levels in early pregnant women without diabetes are associated with an increased SPL risk in a dose-response manner. Pregnant women with an HbA1c level above 5.6% at early gestation need attention for its potentially increased risk for SPL. Our findings support the need to monitor HbA1c levels to identify individuals at high risk of subsequent SPL in the general population of pregnant women.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02737644; https://clinicaltrials.gov/study/NCT02737644.

Efficacy Analysis of Neoadjuvant versus Adjuvant Cisplatin-Paclitaxel Regimens for Initial Treatment of FIGO Stages IB3 and IIA2 Cervical Cancer

BACKGROUND Large cancer lesions are often challenging to treat with surgical intervention alone. Neoadjuvant chemotherapy is frequently used for FIGO stage IB3 and IIA2 cervical cancers to optimize the outcomes of radical surgeries. This study aimed to compare the effectiveness of neoadjuvant chemotherapy, followed by adjuvant chemotherapy and radiotherapy, if necessary, with the traditional approach of adjuvant chemotherapy and radiotherapy after radical hysterectomy in treatment-naïve patients with cervical cancer of specified stages. MATERIAL AND METHODS A total of 245 female patients were administered either 70 to 85 mg/m² cisplatin and 165 to 175 mg/m² paclitaxel every 21 days (2 cycles) prior to radical hysterectomy, followed by adjuvant chemotherapy and radiotherapy if needed (neoadjuvant therapy, NT cohort, n=105), or received adjuvant chemotherapy and radiotherapy after radical hysterectomy adjuvant therapy, AT cohort, n=140). RESULTS In the NT cohort, 76% of patients responded to neoadjuvant chemotherapy, while 24% did not. Adverse operative, intraoperative, and postoperative outcomes were significantly more common among the non-responders (P<0.05). After 5 years, 91% of responders and 72% of non-responders survived without recurrence (P=0.0372), and 3% of responders and 28% of non-responders had died (P=0.0005). CONCLUSIONS The resistance to neoadjuvant chemotherapy is a poor prognostic factor. Neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant chemotherapy/radiotherapy appears to be advantageous for cervical cancer patients who respond well to neoadjuvant chemotherapy.

Gender gap-Gender-specific development in the field of obstetrics and gynecology in Germany in the last 20 years

Background

Gender Gap refers to differences between men and women in terms of access to medical education, career development, and leadership positions in medical practice and research. Although women now make up most medical school graduates in many countries, they are often underrepresented in higher positions.

Objective

The aim of this study is therefore to analyze the gender-specific development in the field of Obstetrics and Gynecology in Germany over the past 20 years and to survey the current status quo.

Materials and methods

An narrative review was carried out on the development of female graduates of human medicine, the proportion of women in contract medical care and clinical care, as well as the gender-specific evaluation of obtaining a gynecological/obstetric additional qualification. habilitation figures in the field of Obstetrics and Gynecology were evaluated about gender distribution. All data were received from federal institutes.

Results

A total of 46.7% (n = 95,234) of all inpatient doctors were female. A total of 46.7% (n = 95,234) of the physicians in hospitals were female. A total of 46% (1,832/3,958) were the portion of females as assistant physicians, 39.8% (n = 45.551) as specialists, 35.3% (n = 18789) as senior physicians, 25.1% (n = 2394) as first senior physicians and 25% (n = 10) as chief physicians in hospital. A total of 64.6% (n = 3958) of the physicians in Obstetrics and Gynecology were female. A total of 46% (1,832/3,958) were the portion of females as assistant physicians, 64.6% (n = 3958) as specialists, 65.0% (n = 1919) as senior physicians, 26.4% (n = 207) first senior physicians and 25% (n = 10) as chief physicians in Obstetrics and Gynecology.

Discussion

The problem with the gender gap in medicine, does not seem to be access to teaching or starting a residency. But in the functions with increasing responsibility and management functions, e.g., as senior physicians, women are already rarely seen. In Obstetrics and Gynecology, too, there is a shortage of women in leading positions, despite the relatively high numbers, for example as senior physicians. Factors like maternity and establishing a family are points mentioned therefore, but also stereotypes seem to be considerable facts.

Conclusion

However, it is important to recognize the need for more women in higher positions in medicine and actively work to encourage more women to choose a career in medicine.

Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study

BACKGROUND

Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions.

OBJECTIVE

This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools.

METHODS

Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value.

RESULTS

A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS.

CONCLUSIONS

The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

ExcLAMation marks in a pelvic lymph node

Extrapulmonary lymphangioleiomyomatosis (LAM) can present as incidental nodal LAM in gynecological surgery specimens, that warrants systemic investigation and follow-up of concurrent and subsequent development of pulmonary and extrapulmonary LAM.

Patient involvement in research within the Gynecological Cancer InterGroup: A call to action for a systematic approach: Results from a survey

Background and Aims

Involving patients in research, not only as trial subjects, is not a newly established practice. Over the last two decades, patient roles have gradually expanded to become active research contributors, creating a more patient-centered research landscape. Our survey has explored the scope of patient involvement within the Gynecologic Cancer InterGroup (GCIG), an International Gynecologic Cancer Research Consortium, and identified challenges in developing a systematic, meaningful and sustainable level of patient involvement.

Methods

In late 2019, the GCIG Harmonisation Operations Committee conducted an online survey across 26 national and/or international research cooperative groups, aiming to identify current patient involvement practices implemented by each group. Twelve questions were asked. The results have been generated to support a systematic strategic planning process to increase patient involvement into clinical research projects.

Results

More than half of the 26 participating groups have either already involved (15, [58%]) or are planning (6, [23%]) to involve patients in their research activities. Gaining patient support in raising public awareness around clinical trials appears to be one of the most desired benefits (21, [81%]). Ten respondents managed to integrate patient involvement into their standard practice. When involving patients in research the groups mostly consider that patients bring added value to the study (19, [73%]), although only eight groups (40%) have a well-organized process in doing so.

Conclusion

Even though patient involvement is considered a significant added value to clinical research, its application within GCIG groups is not considered on a regular basis and is predominantly limited to operational aspects of research activities. The lack of resources and expertize, as well as the missing well-organized and structured process of some groups, combined with their ability to ensure process sustainability, are among the main factors affecting implementation and adoption of patient involvement within GCIG research activities.

FIGO best practice guidance in surgical consent

Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures.

Ovarian Teratoma Presenting With Gliomatosis Peritonei and a Melange of Symptoms Mimicking Ovarian Cancer in a Paediatric Patient

Gliomatosis peritonei (GP) is a rare condition characterised by mature glial nodules that implant in the peritoneum, lymph nodes, or omentum. GP is typically associated with mature or immature ovarian teratomas and usually affects adolescent females. Although neuroglia may be a standard feature of mature ovarian teratomas, widespread peritoneal glial nodules, ascites, and pleural effusion are rare, particularly in the paediatric population. We report a case of a giant left mature ovarian teratoma associated with GP and omental splenunculus in a 12-year-old female who presented with constipation, an adnexal mass, ascites, pleural effusion, and elevated CA-125 levels. The patient successfully underwent fertility-sparing surgery in the form of a left salpingo-oophorectomy, omentectomy, and resection of peritoneal glial deposits. In light of the current scarcity of data on this clinical entity in the literature, we hope to raise awareness of this rare presentation of mature ovarian teratoma, the challenges associated with preoperative diagnosis, and the impact of fertility-sparing surgery on potential oncological and reproductive outcomes in a paediatric patient.

Deciphering the Role of Insulin-Like Growth Factor 1 in Endometrial Cancer in Patients With Polycystic Ovary Syndrome: Protocol for a Methodological Approach Using Cell Culture Experiments

BACKGROUND

Endometrial cancer (EC) is the most common gynecological cancer in women globally. It is linked to increasing obesity rates and longer life spans. The molecular mechanisms leading to EC are unclear; however, women with polycystic ovary syndrome (PCOS) have a 3- to 5-fold increased EC risk. According to a pilot study conducted in the United Kingdom, insulin-like growth factor-1 (IGF-1) gene and protein were raised in the endometrium and blood of women with EC and PCOS, compared with those without PCOS (controls). Therefore, raised serum IGF-1 levels may contribute to an increased EC risk in women with PCOS, but it is necessary to test this hypothesis since not all studies have demonstrated this association.

OBJECTIVE

This study aims to investigate the role of IGF-1 in mediating EC risk in PCOS. This will be achieved by evaluating the proliferative effects of PCOS serum, IGF-1, and IGF-1 antagonist on human endometrial cancer 1-A and 1-B cell lines, with a comparison to controls (using serum from women without PCOS and cell culture media). The study will also identify differentially expressed genes and pathways activated by various treatments.

METHODS

We intend to recruit 20 women with PCOS and 20 women without PCOS for this cross-sectional study. All experiments will be carried out 4 times to ensure consistency. We will perform transcriptomic and phosphoproteomic profiling to identify differentially expressed genes and phosphoproteins between different treatments using RNA sequencing and phosphoproteomics. We will also perform bioinformatics pathway analysis to identify whether any unique collection of genes or phosphoproteins explains increased EC risk in PCOS. The primary outcome measure will be the cell proliferation (growth) difference measured by cell index values. Our protocol stands out due to its unique approach; no previous study has used this approach to investigate the oncogenic effect of serum from women with PCOS. Additionally, no previous study has considered the differential mutations of genes related to the insulin signaling pathway across various types of human EC cell lines and the potential impact of these variations on their experimental findings.

RESULTS

Participants are currently being recruited. It is expected that preliminary findings suitable for analysis and publication will be available by the summer of 2024.

CONCLUSIONS

Although we currently do not have any results to report, sharing our protocol at this stage will aid in research collaboration, provide an opportunity for early feedback, and help reduce duplication of effort by other research groups. The findings of our study will have broader implications. A deeper understanding of the mechanisms underlying the regulation of the IGF system in PCOS and EC will improve our ability to develop effective treatment modalities for EC and will be a vital step toward reducing EC in women globally.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48127.