Current state and future direction of task shifting in obstetric and gynecological care: A survey of obstetrician-gynecologists across Japan

To conduct a survey about task shifting in obstetric and gynecological care.A multivariate logistic regression analysis was conducted in Japanese hospitals using obstetrician-gynecologists (OB/GYNs) who answered that task shifting was rarely used at their working environment as the outcome variable and using their personal attributes (sex, age, type of medical institution employed at, and regional characteristics) as predictor variables. Opinions were gathered regarding promoting task shifting impact on individual work duties.Responses were collected from 919 OB/GYNs (49.9% women, 50.8% <40 years). Characteristics' analysis of 34.6% of OB/GYNs who thought that task shifting was hardly used indicated that it was used significantly more at private university hospitals (odds ratio 5.33, 95% confidence interval: 2.33-12.18) than at national university hospitals (odds ratio 3.54, 95% confidence interval: 1.67-7.51). "Transfer of patients (from operating rooms to the ward)" and "securing the contrast agent line" were the only items related to the task shifting status for individual work duties that were identified by most respondents, revealing that task shifting is not progressing. More than half and 9% of the OB/GYNs said that task shifting progression would improve and decline medical care quality, respectively. Overall, 46% and 24% of the respondents thought that task shifting could reduce working hours by ">1 hour, but <2 hours"/day and "<1 hour"/day, respectively.The current study confirmed that OB/GYNs working at university hospitals believe that task shifting is not progressing in university hospitals and that the working environment is poor. Even if task shifting reduces the number of working hours per day by 2 hours, the working hours of these physicians still exceed the criteria for death by overwork. Thus, further working hour reduction measures are needed in addition to task shifting, such as consolidation of medical institutions dealing with deliveries.To promote task shifting in obstetrical and gynecological care in Japan, it is necessary to continue promoting policy-based, institutional, and educational guidance.

Should we perform cervix removal during hysterectomy for benign uterine disease? Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF)

OBJECTIVE

To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best evidence available, concerning subtotal or total hysterectomy, for benign disease.

METHODS

The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines).

RESULTS

Conservation of the uterine cervix is associated with an increased risk of cervical cancer (0.05 to 0.27%) and an increased risk of reoperation for cervical bleeding (QE: high). Uterine cervix removal is associated with a moderate (about 11 min) increase in operative time when hysterectomy is performed by the open abdominal route (laparotomy), but is not associated with longer operative time when the hysterectomy is performed by laparoscopy (QE: moderate). Removal of the uterine cervix is not associated with increased prevalence of short-term follow-up complications (blood transfusion, ureteral or bladder injury) (QE: low) or of long-term follow-up complications (pelvic organ prolapse, sexual disorders, urinary incontinence (QE: moderate).

CONCLUSION

Removal of the uterine cervix is recommended for hysterectomy in women presenting with benign uterine disease (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be sufficient and the risk-benefit balance was considered to be favorable).

Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology

Artificial intelligence (AI) uses data and algorithms to aim to draw conclusions that are as good as, or even better than, those drawn by humans. AI is already part of our daily life; it is behind face recognition technology, speech recognition in virtual assistants (such as Amazon Alexa, Apple's Siri, Google Assistant and Microsoft Cortana) and self-driving cars. AI software has been able to beat world champions in chess, Go and recently even Poker. Relevant to our community, it is a prominent source of innovation in healthcare, already helping to develop new drugs, support clinical decisions and provide quality assurance in radiology. The list of medical image-analysis AI applications with USA Food and Drug Administration or European Union (soon to fall under European Union Medical Device Regulation) approval is growing rapidly and covers diverse clinical needs, such as detection of arrhythmia using a smartwatch or automatic triage of critical imaging studies to the top of the radiologist's worklist. Deep learning, a leading tool of AI, performs particularly well in image pattern recognition and, therefore, can be of great benefit to doctors who rely heavily on images, such as sonologists, radiographers and pathologists. Although obstetric and gynecological ultrasound are two of the most commonly performed imaging studies, AI has had little impact on this field so far. Nevertheless, there is huge potential for AI to assist in repetitive ultrasound tasks, such as automatically identifying good-quality acquisitions and providing instant quality assurance. For this potential to thrive, interdisciplinary communication between AI developers and ultrasound professionals is necessary. In this article, we explore the fundamentals of medical imaging AI, from theory to applicability, and introduce some key terms to medical professionals in the field of ultrasound. We believe that wider knowledge of AI will help accelerate its integration into healthcare. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Change in practice in gynecologic oncology during the COVID-19 pandemic: a social media survey

OBJECTIVE

COVID-19 has affected gynecologic cancer management. The goal of this survey was to evaluate changes that occurred in gynecologic oncology practice during the COVID-19 pandemic.

METHODS

A anonymous survey consisting of 33 questions (https://sites.google.com/view/gyncacovidfmartinelli) regarding interaction between gynecologic cancers and COVID-19 was distributed online via social media from April 9 to April 30, 2020. Basic descriptive statistics were applied. Analytics of survey-diffusion and generated-interest (visualizations, engagement rates, response rate) were analyzed.

RESULTS

The survey received 20 836 visualizations, generating an average engagement rates by reach of 4.7%. The response rate was 30%. A total of 86% of respondents completed the survey, for a total of 187 physicians surveyed across 49 countries. The majority (143/187; 76%) were gynecologic oncologists, and most were ≤50 years old (146/187; 78%). A total of 49.7% (93/187) were facing the early phase of the COVID-19 pandemic, while 26.7% (50/187) and 23.5% (44/187) were in the peak and plateau phases, respectively. For 97.3% (182/187) of respondents COVID-19 affected or changed their respective clinical practice. Between 16% (27/165) (before surgery) and 25% (26/102) (before medical treatment) did not perform any tests to rule out COVID-19 infection among patients. The majority of respondents did not alter indications of treatment if patients were COVID-19-negative, while treatments were generally postponed in COVID-19-positive patients. Treatments were considered priority for: early stage high-risk uterine cancers (85/187; 45%), newly diagnosed epithelial ovarian cancer (76/187; 41%), and locally advanced cervical cancer (76/187; 41%). Treatment of early stage low-grade endometrioid endometrial cancer was deferred according to 49% (91/187) of respondents, with hormonal treatment as the option of therapy (31%; 56/178). A total of 77% (136/177) of respondents reported no changes in (surgical) treatment for early stage cervical cancer in COVID-19-negative patients, while treatment was postponed by 54% (96/177) of respondent, if the patient tested COVID-19-positive. Neoadjuvant chemotherapy for advanced ovarian cancers was considered by over one-third of respondents as well as hypofractionation of radiation treatment for locally advanced cervical cancers.

CONCLUSION

COVID-19 affected the treatment of gynecologic cancers patients, both in terms of prioritization and identification of strategies to reduce hospital access and length of stay. Social media is a reliable tool to perform fast-tracking, worldwide surveys.

Speciality preference with respect to gender among medical students of Pakistan

This research was conducted to determine the impact of gender and other factors in choosing a medical speciality. This cross-sectional study was conducted from 5th February 2017 to 5th July 2017 at different Medical Colleges and Teaching Hospitals. Students from fourth, final year and House Officers were enrolled using a self made questionnaire. Data was analyzed using SPSS 22. Of the 314 participants, 171(54.5%) were males and 143(45.5%) were females. Majority chose Surgery 90(28.7%), and Internal Medicine 58(18.5%). Only 1(0.3%) participant chose Public Health as a career speciality. The main reason for choice for both genders was "Interest in Content" and "Good Salary". Research shows a shift in trend of women towards Surgery and Internal Medicine rather than Gynaecology and Paediatrics, which indicates more competition in Surgery in near future. Main influencing factors for choice were personal interest and good salary. Students should be counselled regarding career in Public Health and Psychiatry.

An update and systematic review on the treatment of primary dysmenorrhea

OBJECTIVES

Primary dysmenorrhea is a painful uterine contraction caused by endometrial laceration. Drug therapies and complementary medicine have been used to treat dysmenorrhea. The aim of this study was to investigate and offer an updated perspective on the treatments for dysmenorrhea.

METHODS

The present study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. The required information was collected based on searches for the following keywords: treatment, primary dysmenorrhea, medicinal plants, chemical drugs, and herbs. Searches were performed on databases Pubmed, Web of Sciences, Scopus, Iran medex, and SID by March 2018 to find literature in the English and Persian languages on this subject without a time limit.

RESULTS

This review included 17 papers, 10 of which on complementary medicine, three on drug therapies, and four on acupuncture and acupressure. The largest and smallest samples had 303 and 24 patients, respectively. Length of treatment ranged from one to six months and the measures most commonly used in the studies were the visual analogue scale and clinical efficacy. Reported complications included gastrointestinal events, nausea, vomiting, diarrhea, abdominal pain, and liver and kidney disorders.

CONCLUSION

Medicinal plants, drugs, and acupressure seem to suppress pain by reducing the level of prostaglandins, mediating nitric oxide, increasing beta-endorphin levels, blocking the calcium channel, and enhancing circulatory flow through the uterine pathway. Further trials are required to confirm the benefits of the procedures described and ensure the absence of complications.

Tackling poorly selected, collected, and reported outcomes in obstetrics and gynecology research

Clinical research should ultimately improve patient care. To enable this, randomized controlled trials must select, collect, and report outcomes that are both relevant to clinical practice and genuinely reflect the perspectives of key stakeholders including health care professionals, researchers, and patients. Unfortunately, many randomized controlled trials fall short of this requirement. Complex issues, including a failure to take into account the perspectives of key stakeholders when selecting outcomes, variations in outcome definitions and measurement instruments, and outcome reporting bias make research evidence difficult to interpret, undermining the translation of research into clinical practice. Problems with poor outcome selection, measurement, and reporting can be addressed by developing, disseminating, and implementing core outcome sets. A core outcome set represents a minimum data set of outcomes developed using robust consensus science methods engaging diverse stakeholders including health care professionals, researchers, and patients. Core outcomes should be routinely utilized by researchers, collected in a standardized manner, and reported consistently in the final publication. They are currently being developed across our specialty including infertility, endometriosis, and preeclampsia. Recognizing poorly selected, collected, and reported outcomes as serious hindrances to progress in our specialty, more than 80 journals including the Journal, have come together to support the Core Outcomes in Women's and Newborn Health (CROWN) initiative. The consortium supports researchers to develop, disseminate, and implement core outcome sets. Implementing core outcome sets could make a profound contribution to addressing poorly selected, collected, and reported outcomes. Implementation should ensure future randomized controlled trials hold the necessary reach and relevance to inform clinical practice, enhance patient care, and improve patient outcomes.

Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge

PURPOSE

What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP).

METHODS

A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP.

RESULTS

Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34 years old, compared to 75.8% aged 35-44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP.

CONCLUSIONS

In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.

Specialty-Specific Values Affecting the Management of Symptomatic Uterine Fibroids

PURPOSE

To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids.

METHODS

Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years.

RESULTS

Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests.

CONCLUSIONS

Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.

Facteurs génétiques à prendre en considération dans le cadre de l'examen gynécologique annuel

OBJECTIF

Offrir aux médecins un survol des troubles génétiques courants qui devraient être pris en considération dans le cadre de l'examen gynécologique annuel d'une patiente, et ce, afin de déterminer le risque que court celle-ci ou d'en venir à procéder à des examens particuliers ou à orienter la patiente vers un autre service de sous-spécialité, en fonction de ses antécédents personnels ou familiaux.

OPTIONS

Ces renseignements d'ordre génétique peuvent être utilisés aux fins de la sensibilisation des patientes et du dépistage ou du diagnostic de possibles maladies et/ou mutations.

ISSUES

L'utilisation de ces renseignements d'ordre génétique pourrait mener à l'amélioration de l'évaluation des risques et des avantages et à celle de la prise en charge dans le cadre de l'examen gynécologique annuel. RéSULTATS: Les études publiées en anglais, jusques et y compris en mai 2010, ont été récupérées par l'intermédiaire de recherches menées dans PubMed et la Cochrane Library au moyen d'un vocabulaire contrôlé (« gynaecological diagnosis », « genetic inheritance ») et de mots clés (« genetic risk », « genetic mutation », « inheritance », « family history », « uterus », « ovary », « endometrial », « vagina », « colon », « gastric », « renal », « breast », « cardiac », « thrombophilia », « diabetes », « epilepsy », « leiomyomata uteri ») appropriés. D'autres sources ont été identifiées par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales.

VALEURS

Le niveau des résultats ne permet pas la formulation de recommandations factuelles. AVANTAGES, DéSAVANTAGES ET COûTS: La présente opinion de comité améliorera l'utilisation de nouvelles connaissances génétiques et leur application aux soins gynécologiques offerts annuellement aux femmes. Les occasions de gestion du risque et de diagnostic, pour ce qui est des troubles gynécologiques génétiques, s'en trouveront améliorées. Une compréhension plus exhaustive des troubles génétiques pourrait entraîner une hausse de l'anxiété et du stress psychologique chez les femmes et les membres de leur famille.

COMMANDITAIRE

Société des obstétriciens et gynécologues du Canada.

RECOMMANDATIONS

Le niveau des résultats ne permet pas la formulation de recommandations factuelles.

[Robotic surgery in gynecology]

INTRODUCTION

The aim of this review is to provide a general historical and contemporary perspective on the implementation and use of robot-assisted laparoscopy in gynecology as well as the experience gained to date.

CONTENTS

Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, radical hysterectomy, lymph node dissections or sacrocolpopexies. Robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss and shorter hospital stay when compared to open or laparoscopic surgery.

CONCLUSIONS

Robotic surgery is associated with a shorter learning curve and has allowed a larger number of gynecologists to master complex laparoscopic procedures. Robot-assisted surgery offers all the benefits of minimally invasive surgery, making them accessible to a much broader spectrum of patients.Key words: robotic surgery - gynecology hysterectomy - da Vinci laparoscopy.

[Sexual medicine in obstetrics and gynecology]

Obstetrics and gynecology specialists should be women's favoured interlocutors when talking about their sexuality. Indeed every day they assess their patient's intimacy, they manage pathologies that have a potential but well-known impact on sexuality, and they are very early aware of a more global approach like psycho-somatic. Furthermore, women are going to meet their obstetrician and gynecologist through all ages, from adolescence to post-menopause. At every step sexual problems can occur that can be searched, investigated and mostly managed by this specialist. The relationship between female sexual medicine and obstetrics and gynecology is undeniable and deserve to be favoured and consolidated.

Ultrasound in Africa: what can really be done?

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important technology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa. It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.

The Changing Scenario of Obstetrics and Gynecology Residency Training

BACKGROUND

Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents.

OBJECTIVE

We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years.

METHODS

We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002-2003 and 2012-2013.

RESULTS

The average number of cesarean sections per resident increased from 191.8 in 2002-2003 to 233.4 in 2012-2013 (17%; P < .001; 95% CI -47.769 to -35.431), the number of vaginal deliveries declined from 320.8 to 261 (18.6%; P < .001; 95% CI 38.842-56.35), the number of forceps deliveries declined from 23.8 to 8.4 (64.7%; P < .001; 95% CI 14.061-16.739), and the number of vacuum deliveries declined from 23.8 to 17.6 (26%; P < .001; 95% CI 5.043-7.357). Between 2002-2003 and 2007-2008, amniocentesis decreased from 18.5 to 11 (P < .001, 95% CI 6.298-8.702), and multifetal vaginal deliveries increased from 10.8 to 14 (P < .001, 95% CI -3.895 to -2.505). Both were not included in ACGME reporting after 2008.

CONCLUSIONS

Ob-gyn residents' training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.

Roles of Obstetrician-Gynecologist Hospitalists with Changes in the Obstetrician-Gynecologist Workforce and Practice

Obstetrician-gynecologists (OB-GYNs) are the fourth largest group of physicians and the only specialty dedicated solely to women's health care. The specialty is unique in providing 24-hour inpatient coverage, surgical care and ambulatory preventive health care. This article identifies and reviews changes in the OB-GYN workforce, including more female OB-GYNs, an increasing emphasis on work-life balance, more sub-specialization, larger group practices with more employed physicians and, finally, an emphasis on quality and performance improvement. It then describes the evolution of the OB-GYN hospitalist movement to date and the role of OB-GYN hospitalists in the future with regard to these workforce changes.

Trends in family planning and contraception carried out in primary health care in Croatia: 1995-2012: study based on routinely collected data

The lack of objective findings provided the reason to undertake this study with the main aim of exploring the trends in family planning and contraception carried out in primary health care in Croatia. Based on the Croatian health statistical yearbooks from 1995 to 2012, data were collected on the number and structure of visits and the number and type of prescribed contraceptives by public and private gynecological practices, and visits to family practices and school medicine services. The results showed that only a small number of fertile women received primary care for family planning issues, trends that are evident through the entire follow-up period. A trend of "migration" from the public to the private sector is also observed. Family doctors and school medicine are almost entirely excluded from the provision of family planning despite the magnitude of the family planning problem resulting in a waste of human and material resources.

Preventive health care for women in Croatia: ongoing trends from 1995 to 2012

The privatization of gynecological services and the introduction of additional reimbursements to capitation fees are ongoing mini reforms in Croatia. In order to evaluate the outcomes of this, study was performed with the main aim of determining trends in preventive activities carried out in public and private gynecological practices from 1995 to 2012. The Croatian Health Service Yearbooks served as the basis for data collection. Data were collected on the number of general check-ups, the number of targeted check-ups, and the number of follow-up check-ups. The results indicate a trend of continuous decline in the number of general and follow-up check-ups, as well as breast examinations and Pap smears, in public gynecological practices even after the introduction of contractual obligations and additional reimbursements and fee-for-service payments. One important note is that many resources were invested in general checks-up interventions, which proved to be ineffective, while fewer resources were invested in the more effective Pap smear interventions.

The combined oral contraceptive pill -- recent developments, risks and benefits

The introduction of the birth control pill as an effective, coitally-independent method of contraception was a public health milestone of the last century. Over time, combined oral contraception (COC) formulations and pill-taking regimens have evolved with improved safety and tolerability while maintaining contraceptive efficacy. In addition to protection against pregnancy, use of combined oral contraception confers a number of significant non-contraceptive benefits to users. COC use is also associated with well-studied risks. Common side effects are generally self-limiting and improve with increasing duration of use while serious adverse events, including venous thromboembolism, are rare among healthy COC users. Contraceptive decision-making should include consideration of both the risks and benefits of a given method versus the real consequences of unintended pregnancy.

Prophylactic antibiotics in obstetrics–gynecology: a current asset, a future liability?

Currently, prophylactic antibiotics have proven effective in lowering the postoperative and postprocedure infection rate following vaginal hysterectomy, emergency cesarean section for the patient in labor, radical hysterectomy, abdominal hysterectomy, pregnancy termination, hysterosalpingogram and intrauterine device insertion. Guidelines for the most effective and safe use are presented. Concerns are raised regarding the widespread prolonged use of prophylactic antibiotics on women in labor to prevent Group B streptococcal infections in newborn children and women with prolonged preterm membrane rupture. There is also an awareness needed of a growing incidence of infections seen in the hospital from community-acquired methicillin-resistant Staphylococcus aureus and Clostridium difficile. These problems have not been addressed by the current prophylactic antibiotic strategies.

Color Doppler sonography in obstetrics and gynecology

This review aims to provide the reader with an overview of the present and future clinical applications in color Doppler sonography for the evaluation of vascularity and blood flow within the uterus (both gravid and nongravid), ovaries, fetus and placenta. The clinical use of color Doppler sonography has been demonstrated within many organ systems. Color Doppler sonography has become an integral part of cardiovascular imaging. Significant improvements have recently occurred, improving the visualization and evaluation of intra-organ vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler sonography. Spatial representation of vascularity can be improved by utilizing 3D and 4D (live 3D) processing. Greater sensitivity of color Doppler sonography to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy and for pelvic organs. The potential use of contrast enhancement is also mentioned as a means to further differentiate benign from malignant ovarian lesions. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in a variety of obstetric and gynecologic disorders.

The prescribing of contraceptives for adolescents in German gynecologic practices in 2007 and 2011: a retrospective database analysis

OBJECTIVE

To investigate the prescribing trend of contraceptives in adolescent girls aged 12-18 years and to compare prescribing patterns of the most frequently used contraceptives among this population in Germany in 2007 and 2011.

METHODS

A retrospective cohort study was conducted to analyze contraceptive prescriptions written by gynecologists in 2007 and 2011 in Germany by using the IMS Disease Analyzer database (IMS HEALTH). All adolescent girls aged 12-18 years with at least 1 prescription of a contraceptive drug in 2007 or 2011 were identified. The prevalence of contraceptive prescriptions was calculated and the types of contraceptive substances prescribed were examined.

RESULTS

A total of 21,026 teenage girls in 2007 and 18,969 in 2011 received contraceptive prescriptions. The prevalence of contraceptive prescribing rose significantly between 2007 and 2011 (P < .001). The percentage of teen girls who received prescriptions of levonorgestrel and chlormadinone pills was significantly higher in 2011 compared to 2007 (P < .001). However, the portion of contraceptive pills containing drospirenone or desogestrel significantly decreased in 2011 compared to 2007 (P < .01).

CONCLUSION

There was a significant increase in contraceptive prescription usage among adolescent girls between 2007 and 2011 in Germany. However, the prescription behavior of doctors also changed; they consequently prescribed contraceptives with more evidence. Further research is needed to better understand the various factors associated with contraceptive use among this population.

Update on adolescent gynecology

Adolescent gynecology is an important part of clinical care of adolescent females. This discussion provides a basic review of current issues in adolescent gynecology, including consideration of current pubertal concepts with attention also given to delayed and precocious puberty. Causes of breast masses are reviewed, including discussion of the ANDI classification. It is recommended that physicians provide sexuality education to their adolescent patients, in addition to the community, to reduce the high rates of unintended adolescent pregnancy and STIs in teens that continue in the United States. Finally, attention is provided to ovarian masses and their management. Adolescent medicine physicians may have to work with a variety of specialists in their care of adolescents and the many gynecologic conditions that may arise.

[What's new in gynecology and obstetrics in 2012?]

Intraoperative radiotherapy (IORT) has been shown to be as effective as traditional radiotherapy in the management of early stage breast cancer. IORT is performed in a single session and consists in a single irradiation in the tumorectomy cavity. Medically assisted procreation does not seem to favor neither gynecological nor non-gynecological cancers. Nevertheless medically assisted procreation technique ICSI (intracytoplasmic sperm injection) is associated with an increased risk of birth defect. This is not the case of IVF (in vitro fertilization). The causality of the treatment or of the infertility itself is unclear. During pregnancy, nicotine-replacement patches at usual dosage do not seem to increase abstinence smoking rates. A selective, and not a systematic thyroid screening strategy, is now recommended during first trimester of pregnancy.

[Current treatments of vulvar cancer]

Vulvar cancers are rare genital tumors. Their etiology is better understood. The management of these tumors has benefitted from recent therapeutic advances that decrease the morbidity of the treatments. Surgery is still the major curative option. But the limitation of the vulvar resections and the development of the sentinel-node technique have led to lower surgical morbidity and sequellas without increasing the risk of recurrence. Also improvements in radiotherapeutic treatment have been observed. Currently radiotherapy is realized in association with surgery in case of presence of risk factors of recurrence, or in place of surgery when this treatment is not possible or is too much aggressive. Morbidity of radiotherapy has largely decreased and association with chemotherapy leads probably to increased efficacy.