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45 p., ill., VOORWOORD 1 -- KERNBOODSCHAPPEN 2 -- 1 INLEIDING 8 -- 1.1 WAT IS ENDOMETRIOSE? 8 -- 1.1.1 Uiteenlopende klachten, van mild tot ernstig 9 -- 1.1.2 Geen rechtlijnig verband tussen de omvang van de aandoening en de ernst van de symptomen 9 -- 1.1.3 Ziektelast van endometriose 10 -- 1.1.4 Oorzaak endometriose niet bekend 10 -- 1.2 ENDOMETRIOSE EINDELIJK OP DE BELEIDSAGENDA 10 -- 1.3 ONDERZOEKSVRAGEN EN DOELSTELLING VAN HET ONDERZOEK 10 -- 1.4 DOELGROEP 11 -- 1.5 DISCLAIMER .11 -- 1.6 METHODOLOGIE 11 -- 2 DIAGNOSE EN BEHANDELING VAN ENDOMETRIOSE 12 -- 2.1 DIAGNOSE VAN ENDOMETRIOSE .12 -- 2.2 BEHANDELING VAN ENDOMETRIOSE 12 -- 2.2.1 Geen definitieve genezing 12 -- 2.2.2 Behandelingen om pijn en onvruchtbaarheid aan te pakken .12 -- 2.2.3 Onvoorspelbare werkzaamheid van behandelingen 13 -- 2.2.4 Aanvullende behandelingen? .13 -- 3 ERVARINGEN VAN PATIËNTEN MET ENDOMETRIOSE(ZORG) 13 -- 3.1 INLEIDING 13 -- 3.2 HOE GINGEN WE TE WERK? 13 -- 3.3 DE BELANGRIJKSTE BEVINDINGEN 14 -- 3.3.1 Meerdere knelpunten bij contacten met artsen .14 -- 3.3.2 Endometriose kan een ernstige impact hebben op alle aspecten van het leven 14 -- 3.3.3 Belang van steun van de omgeving 15 -- 3.3.4 Behoeften van personen met endometriose 15 -- 3.3.5 Patiëntenverenigingen maken zich zorgen over de chirurgische expertise in België 15 -- 4 ENDOMETRIOSEZORG IN BELGIË 16 -- 4.1 HOEVEEL VROUWEN IN ONS LAND HEBBEN ENDOMETRIOSE? 16 -- 4.2 GEEN GEGEVENS OVER DE AMBULANTE ENDOMETRIOSEZORG 16 -- 4.3 ZIEKENHUISOPNAMES VOOR ENDOMETRIOSE IN BELGIË (2016-2020) 16 -- 4.3.1 162 opnames op 100 000 vrouwen .16 -- 4.3.2 Vooral vrouwen van 15 tot 49 jaar 17 -- 4.3.3 Grootste aandeel opnames voor endometriose van de baarmoeder 17 -- 4.3.4 Verblijfsduur gemiddeld 3 dagen .18 -- 4.3.5 Vooral gynaecologen betrokken 18 -- 4.3.6 Heropnames na chirurgie voor endometriose 18 -- 4.3.7 Complicaties binnen de dertig dagen na ontslag .18 -- 4.3.8 Verdeling van de endometriosezorg onder de Belgische ziekenhuizen 19 -- 4.4 ORGANISATIE VAN

45 p., ill., AVANT-PROPOS 1 -- MESSAGES CLÉS 2 -- 1 INTRODUCTION 8 -- 1.1 QU’EST-CE QUE L’ENDOMÉTRIOSE ? 8 -- 1.1.1 Des plaintes très diverses, de gravité légère à sévère 9 -- 1.1.2 Pas de relation directe entre l’étendue de l’atteinte et la gravité des symptômes 9 -- 1.1.3 Charge de morbidité de l’endométriose 10 -- 1.1.4 Une cause inconnue 10 -- 1.2 L’ENDOMÉTRIOSE ENFIN À L’AGENDA POLITIQUE 10 -- 1.3 QUESTIONS DE RECHERCHE ET OBJECTIF DE L’ÉTUDE 10 -- 1.4 GROUPE-CIBLE .11 -- 1.5 DISCLAIMER .11 -- 1.6 MÉTHODOLOGIE 11 -- 2 DIAGNOSTIC ET TRAITEMENT DE L’ENDOMÉTRIOSE 12 -- 2.1 DIAGNOSTIC DE L’ENDOMÉTRIOSE 12 -- 2.2 TRAITEMENT DE L’ENDOMÉTRIOSE 12 -- 2.2.1 Pas de traitement définitif 12 -- 2.2.2 Des traitements contre la douleur et l’infertilité .12 -- 2.2.3 Des traitements à l’efficacité imprévisible 13 -- 2.2.4 Et les traitements complémentaires ? 13 -- 3 EXPÉRIENCES DES PATIENTES AVEC LA PRISE EN CHARGE DE L’ENDOMÉTRIOSE 13 -- 3.1 INTRODUCTION .13 -- 3.2 COMMENT AVONS-NOUS PROCÉDÉ ? 13 -- 3.3 PRINCIPALES CONCLUSIONS .14 -- 3.3.1 Plusieurs écueils dans les contacts avec les médecins 14 -- 3.3.2 De graves répercussions sur toutes les facettes de la vie .14 -- 3.3.3 Importance du soutien de l’entourage 15 -- 3.3.4 Besoins des personnes atteintes d’endométriose 15 -- 3.3.5 Les associations de patientes se font du souci pour l’expertise chirurgicale en Belgique .15 -- 4 PRISE EN CHARGE DE L’ENDOMÉTRIOSE EN BELGIQUE .16 -- 4.1 COMBIEN DE FEMMES ATTEINTES D’ENDOMÉTRIOSE DANS NOTRE PAYS ? .16 -- 4.2 PAS DE DONNÉES SUR LA PRISE EN CHARGE AMBULATOIRE DE L’ENDOMÉTRIOSE 16 -- 4.3 ADMISSIONS HOSPITALIÈRES POUR CAUSE D’ENDOMÉTRIOSE EN BELGIQUE (2016-2020) 16 -- 4.3.1 162 admissions pour 100 000 femmes .16 -- 4.3.2 Surtout des femmes de 15 à 49 ans 17 -- 4.3.3 Davantage d’admissions pour endométriose utérine .17 -- 4.3.4 Trois jours de séjour en moyenne 18 -- 4.3.5 Principalement des gynécologues 18 -- 4.3.6 Réadmissions après chirurgie de l’endométriose 18 -- 4.3.7 Complications dans les 30 j

Preeclampsia represents one of the main causes of death in pregnancy, worldwide the WHO indicates that 20% of maternal deaths are caused by hypertensive problems. The problems that represent the highest risk index are hypertension and proteinuria, which are often generated from the 20th week of gestation, up to six weeks after delivery, values that generate a rapid increase of serious complications in preeclampsia including the death of the mother and fetus, However, if the gestational age of the fetus exceeds 36 weeks, the best treatment is the induction of labor, because it reduces the risk of complications, however if it is less than 33 weeks, expectant management including imaging, laboratory and welfare studies for the fetus should be initiated. Thus, it is of significant importance the study that provides the best prenatal control, diagnosis and adequate management of this disease, which are the most effective measures to reduce the mortality rate due to this cause., La preeclampsia representa una de las principales causas de muerte en el embarazo, a nivel mundial la OMS indica que un 20% de muertes maternas son provocados por problemas hipertensivos. Los inconvenientes que representan mayor índice de riesgo es la hipertensión y proteinuria, que a frecuencia se generan desde la semana 20 de gestación, hasta seis semanas después del parto, valores que generan un aumento rápido de complicaciones graves en la preeclampsia incluida la muerte de la madre y el feto, sin embargo, si la edad gestacional del feto supera a las 36 semanas, el mejor tratamiento es la inducción del parto, debido a que reduce el riesgo de sufrir complicaciones no obstante si es menor a las 33 semanas, se iniciar un manejo expectante que incluye estudios de imagenológica, laboratorio y de bienestar para el feto. De este modo es de significativa importancia el estudio que aporta el mejor control prenatal, diagnóstico y manejo adecuado de dicha enfermedad, medidas más eficaces para disminuir la tasa de morbi-mortalidad de esta patología.

Introduction: It is transcendental to study access to health in various fields and especially in populations in a state of vulnerability. Female inmates are considered a special population group, as they are different from other populations in terms of their freedom of movement. This state of vulnerability generates problems, especially in access to health services for the detection, treatment and prevention of diseases. Objective: The objective of the study was to detect access to gynecologist-obstetric health services in penitentiary establishments in Peru during the year 2021. Method: The study is descriptive, longitudinal, was carried out in the penitentiary setting and covers all the penitentiary establishments in the regions of Peru with a female penitentiary population distributed throughout the Peruvian territory during the year 2021. For data collection, the the secondary source documentary technique, the instrument in which the information collected was lost was the documentary file. Results: It was found that 13 women's prisons and 31 women's pavilions, of which only 15 (34.09%) have gynecologist-obstetric service, while 29 (35.91%) do not have gynecologist-obstetric service. . Of the total prison population studied, 4,360 inmates, not all of them received at least one gynecologist-obstetrician care during the year 2021 Discussion: Access to gynecologist-obstetric services in the women's prison population in Peru is restricted, placing women deprived of their liberty in a situation of vulnerability., Introducción: Resulta trascendental estudiar el acceso a la salud en diversos campos y sobre todo en poblaciones en estado de vulnerabilidad. Las mujeres internas se consideran un grupo de población especial, ya que son diferentes a otras poblaciones en cuanto a su libertad de movimiento. Este estado de vulnerabilidad genera problemas sobre todo en el acceso a servicios de salud para la detección, el tratamiento y la prevención de enfermedades. Objetivo: El objetivo del estudio fue diagnosticar el acceso a los servicios de la salud gineco-obstetra en los establecimientos penitenciarios del Perú durante el año 2021. Metodología: El estudio tiene carácter descriptivo, longitudinal, se realizó en el ámbito penitenciario y abarca todos los establecimientos penitenciarios de las regiones del Perú con población penitenciaria femenina distribuidas en el territorio peruano durante el año 2021. Para la recolección de datos se aplicó la técnica documental de fuente secundaria, el instrumento en el cual se registró la información recogida fue la ficha documental. Resultados: Se encontró que, de 13 establecimientos penitenciarios de mujeres y 31 pabellones de mujeres, solo 15 (34,09%) cuentan con servicio gineco-obstetra, mientras que 29 (65,91%) no cuentan con servicio gineco-obstetra. Del total de la población penitenciaria estudiada (4360) internas, no todas recibieron al menos una atención gineco-obstetra durante el año 2021 Discusión: El acceso a los servicios gineco-obstetras en la población penitenciaria de mujeres del Perú se muestra restringida, colocando en situación de vulnerabilidad a las mujeres privadas de su libertad.

Introduction: Interdisciplinarity in pediatrics and gynecology is crucial for comprehensive care throughout the life cycle. This review explores the existing literature on strategies, challenges and applications of this approach. Development: The need for collaboration between pediatricians and gynecologists was identified, highlighting the importance of continuity of care. Strategies include interprofessional training and shared care protocols. The challenges addressed include organizational barriers, differences in training and cultural resistance. Technological innovations and ethical considerations are also key aspects. Practical applications or future lines of research: The development of interdisciplinary training programs and the integration of technology in clinical practice is suggested. Future research could focus on evaluating interdisciplinary models and exploring the impact of socioeconomic and cultural factors. Conclusions: An interdisciplinary approach in pediatrics and gynecology improves the quality of care and promotes comprehensive health. Despite the challenges, the opportunities for effective integration are vast, with significant potential to positively impact care across the lifecycle., Introducción: La interdisciplinariedad en pediatría y ginecología es crucial para una atención integral a lo largo del ciclo de vida. Esta revisión explora la literatura existente sobre estrategias, desafíos y aplicaciones de este enfoque. Desarrollo: Se identificó la necesidad de colaboración entre pediatras y ginecólogos, destacando la importancia de la continuidad de cuidado. Las estrategias incluyen formación interprofesional y protocolos de atención compartidos. Los desafíos abordados comprenden barreras organizativas, diferencias en formación y resistencias culturales. Las innovaciones tecnológicas y consideraciones éticas también son aspectos clave. Aplicaciones prácticas o futuras líneas de investigación: Se sugiere el desarrollo de programas de formación interdisciplinaria y la integración de tecnología en la práctica clínica. Futuras investigaciones podrían centrarse en evaluar modelos interdisciplinarios y explorar el impacto de factores socioeconómicos y culturales. Conclusiones: Un enfoque interdisciplinario en pediatría y ginecología mejora la calidad de la atención y promueve una salud integral. A pesar de los desafíos, las oportunidades para la integración efectiva son amplias, con un potencial significativo para impactar positivamente en la atención a lo largo del ciclo de vida.

INTRODUCTION. Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury. METHODS. Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly. RESULTS. Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01). CONCLUSION. We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis., INTRODUCTION: Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury.METHODS: Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly.RESULTS: Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01).CONCLUSION: We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis.

Background: Different indigenous peoples in the Philippines still utilize medicinal plants in treating gynecologic diseases. However, there is a lack of information regarding these medicinal plants used in treating gynecologic conditions in the Philippines. Hence, this systematic review compiled the available literature on medicinal plants used for gynecologic healthcare by various indigenous groups in the Philippines. Methods: Ethnobotanical studies that reported medicinal plants used for gynecologic diseases were obtained from OVID Medline, Scopus, and EBSCO CINAHL. A review of titles, abstracts, and articles was done independently by four reviewers. The quality of the studies was assessed using the quality assessment tool for ethnobotanical studies. Results: A total of 27 studies, including 98 different records, that cited the use of medicinal plants to treat gynecologic diseases were included in the qualitative synthesis. Most ethnobotanical studies were conducted in Northern Mindanao, Central Luzon, and Caraga, Philippines. The most common plant family, genus, and species were Fabaceae, Mimosa, and Mimosa pudica L., respectively. Leaves, roots, and stems were predominantly used, commonly prepared by decoction. Medicinal plants reported in ethnobotanical studies were widely used to treat dysmenorrhea (34 ssp.), irregular menstruation (28 spp.), myoma (four spp.), and infertility (four spp.). A significant proportion of medicinal plants used to treat gynecologic diseases in the Philippines had records of toxicologic (18 spp., 31.03%) or teratogenic (one sp., 1.72%) properties. Other species were reported as both nontoxic and toxic (five spp., 8.62%) and toxic and teratogenic (one sp., 1.72%). However, some were nontoxic or teratogenic (11 sp., 18.97%). In addition, 22 plant species had no data on toxicity or teratogenicity. Conclusion: This systematic review showed that medicinal plants and traditional healing practices are crucial in gynecologic healthcare in th

[spa] Se plantea a partir de la necesidad de aplicar criterios de Medicina Personalizada la conveniencia de averiguar cuál es la percepción del riesgo de sufrir un cáncer ginecológico que siente una mujer y qué hace para prevenirlo, y se contrasta esta información con la evidencia disponible para su edad de cual es realmente el cáncer ginecológico que más la amenaza y cuál debería ser su actitud preventiva, practicándose una intervención educativa para corregir, si los hubiere, déficits en el concepto y en la actuación derivada., [eng] Based on the need to apply Personalized Medicine criteria, the convenience of finding out what is the perception of the risk of suffering a gynaecological cancer that a woman feels and what she does to prevent it is considered. This information is contrasted with the evidence available for her age, which is really the gynaecological cancer that threatens the most and what should be its preventive attitude, practicing an educational intervention to correct, if any, deficits in the concept and in the derived action.

In this thesis, we aimed to study how we can improve the diagnosing of adenomyosis by imaging the uterus in part I, especially using ultrasound and considering the assessment of the uterine junctional zone. In part II, we aimed to investigate the role of angiogenesis in the pathogenesis and clinical manifestation of adenomyosis and to explore whether this mechanism could be a potential treatment target. In chapter 2 (part I), we explored whether the terminology used to describe ultrasound images of adenomyosis needed to be better defined in a modified Delphi study. There was consensus on the need to distinguish between direct and indirect features of adenomyosis. Direct features indicate the presence of ectopic endometrium in the myometrium, while indirect features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. In chapter 3 (Part I), a comprehensive literature review was conducted to investigate the accordance on the definition of the junctional zone across different diagnostic approaches and examine how the imaging findings can be linked to histological findings. The conclusion in this review was that on histology, gradual tissue changes distinguish the junctional zone from the middle and outer myometrium. The thickness of the junctional zone was reported larger on MRI than on TVUS images. Clinicians should be aware that findings on MRI cannot readily be extrapolated to ultrasound. The focus of the second part of this thesis was on the role of angiogenesis in adenomyosis. We hypothesized that the level of angiogenesis is increased in the ectopic and eutopic endometrium of patients with adenomyosis in comparison with patients without adenomyosis. In chapter 4 we performed a systematic search and found an increased mean vascular density (MVD) and angiogenic properties in the ectopic and eutopic endometrium compared to control endometrium. Although the association has not sufficiently been studied yet, it is likely

HIV-related stigma experienced in healthcare settings may be particularly detrimental to people with HIV (PWH). This study aims to examine the drivers of stigma and enacted HIV-related stigma among healthcare providers working in HIV and non-HIV care at a large teaching hospital in Denmark. In total, 162 providers working in gynecology and obstetrics, and 57 providers working in infectious diseases completed the "Measuring HIV stigma and discrimination among health facility staff" questionnaire. Compared to providers working in infectious diseases, providers working in gynecology and obstetrics had less training in infection control, HIV, and stigma, and although their level of worry and negative attitudes toward PWH was overall low, they were more like to use extra precaution measures (e.g., double gloves) when caring for PWH (20% versus 0%). Addressing HIV-related stigma in healthcare is important, as any amount of HIV-related stigma from providers has the potential to compromise the patients' engagement in care and health outcomes.

[spa] Partiendo de una revisión histórica del origen del procedimiento preventivo del cáncer de cuello uterino, se actualiza su recomendación preventiva así como la de la revisión ginecológica., [eng] Based on a historical review of the origin of the cervical cancer preventive procedure, its preventive recommendation as well as that of gynecologic screening is updated.

Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to, Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with

INTRODUCTION. Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury. METHODS. Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly. RESULTS. Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01). CONCLUSION. We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis., INTRODUCTION: Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury.METHODS: Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly.RESULTS: Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01).CONCLUSION: We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis.

Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to, Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with

Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in S

Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them. Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review. Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects. Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical in

Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in S

Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them. Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review. Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects. Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical in

Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in S

An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.

type:Journal Article, Aim: There is a chronic shortage of obstetrician-gynecologists in Japan. To increase the number of obstetrician-gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey., Methods: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician-gynecologists employed, and number of newly joined obstetrics-gynecology residents and resigned obstetrician-gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013–2015 was considered a surrogate marker for the number of newly joined obstetrics-gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician-gynecologists., Results: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician-gynecologists than those who did not (95% confidence interval: 1.000–1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician-gynecologists., Conclusions: The experience of observing deliveries may encourage medical students to become obstetrician-gynecologists.

Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in S

Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them. Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review. Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects. Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical in

Obstetricians know the statistics-1 out of every 10 babies is born premature; preeclampsia affects 1 in 25 pregnant people; the United States has the highest rate of maternal mortality in the developed world. Yet, physicians and scientists still do not fully understand the biology of normal pregnancy, let alone what causes these complications. Obstetrics and gynecology-trained physician-scientists are uniquely positioned to fill critical knowledge gaps by addressing clinically-relevant problems through fundamental research and interpreting insights from basic and translational studies in the clinical context. Within our specialty, however, physician-scientists are relatively uncommon. Inadequate guidance, lack of support and community, and structural barriers deter fellows and early stage faculty from pursuing the physician-scientist track. One approach to help cultivate the next generation of physician-scientists in obstetrics and gynecology is to demystify the process and address the common barriers that contribute to the attrition of early stage investigators. Here, we review major challenges and propose potential pathways forward in the areas of mentorship, obtaining protected research time and resources, and ensuring diversity, equity, and inclusion, from our perspective as early stage investigators in maternal-fetal medicine. We discuss the roles of early stage investigators and leaders at the institutional and national level in the collective effort to retain and grow our physician-scientist workforce. We aim to provide a framework for early stage investigators initiating their research careers and a starting point for discussion with academic stakeholders. We cannot afford to lose the valuable contributions of talented individuals due to modifiable factors or forfeit our voices as advocates for the issues that impact pregnant populations.

BackgroundIn response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting.ObjectiveTo evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives.MethodsApplicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests.Results45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98).ConclusionsThe VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial

IntroductionResearch suggests that interprofessional education, bringing learners together to learn about, with, and from each other, improves health professions education and can improve health outcomes. Little research has measured outcomes of interprofessional education between midwifery students and obstetrics and gynecology residents. The purpose of this study was to examine self-assessed interprofessional and collaborative competencies among midwifery students and obstetrics and gynecology residents.MethodsBaseline self-assessed interprofessional and collaborative competencies were compared with follow-up measurements to evaluate learners' experiences over an 11-month study period. Participants were midwifery students and obstetrics and gynecology residents who experienced interprofessional learning activities. The Interprofessional Education Collaborative Competency Self-Assessment Survey (IPEC Survey) and Interprofessional Collaborative Competency Attainment Survey (ICCAS) were used.ResultsOf 256 learners at 4 demonstration sites, 223 (87%) completed the baseline, and 121 of 237 eligible learners (51%) completed the follow-up surveys. The IPEC Survey total score (t = 2.31, P = .02) and interaction subscale (t = 2.85, P = .005) and ICCAS score (t = 4.04, P = .001) increased for midwifery students but not obstetrics and gynecology residents on the IPEC Survey (t = 0.32, P = .75) and ICCAS (t = -0.05, P = .96) measures. Midwifery students (87%) and residents (57%) reported improved overall ability to collaborate. Learners responding to 3 open-ended questions valued team-based experiences, including learning how to communicate with each other; appreciated learning each other's education and scope of practice; and recommended skills development including uncommon clinical events, case discussions, and direct clinical care.DiscussionThis study advanced knowledge about interprofessional education between midwifery students and obstetrics and gynecology residents. M

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and traine

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT

Aim: There is a chronic shortage of obstetrician-gynecologists in Japan. To increase the number of obstetrician-gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey., Methods: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician-gynecologists employed, and number of newly joined obstetrics-gynecology residents and resigned obstetrician-gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013–2015 was considered a surrogate marker for the number of newly joined obstetrics-gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician-gynecologists., Results: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician-gynecologists than those who did not (95% confidence interval: 1.000–1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician-gynecologists., Conclusions: The experience of observing deliveries may encourage medical students to become obstetrician-gynecologists.

type:Journal Article, Aim: There is a chronic shortage of obstetrician-gynecologists in Japan. To increase the number of obstetrician-gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey., Methods: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician-gynecologists employed, and number of newly joined obstetrics-gynecology residents and resigned obstetrician-gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013–2015 was considered a surrogate marker for the number of newly joined obstetrics-gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician-gynecologists., Results: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician-gynecologists than those who did not (95% confidence interval: 1.000–1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician-gynecologists., Conclusions: The experience of observing deliveries may encourage medical students to become obstetrician-gynecologists.

The Mothers of Gynecology: Re-envisioning a Common Gynecologic Instrument K. BORHAM1, H. Barbier1, L. Weir2, M. Lutgendorf1 1Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center 2Air Force Surgeon General Chief Women's Health Consultant, Air Force Medical Readiness Agency (AFMRA) OBJECTIVES AIMS 1. Rename Sims speculum for all aspects of sterile processing 2. Provide education and resources for the AFD and residency training programs as well as military medical students 3. Provide education and resources for the Armed Forces Service Consults for active duty Gynecologic Surgeons and Obstetricians 4. Incorporate education for the Medical Education and Training Campus for Surgical Technologists at Fort Sam Houston, TX 5. Demonstrate action plan at WRNMMC with DHA support • J. Marion Sims known as “the father of modern gynecology” • Developed surgical techniques on slaves, particularly with vesicovaginal and rectovaginal fistulas • Lucy, Anarcha, and Betsey now recognized as “The Mothers of Gynecology” BACKGROUND 1) Advocate for name change to • Contribute to the dismantling of systemic racism • Address implicit bias within our field 2) Set leading example of action plan • Pilot site with DHA guidance 3) District wide impact followed by ACOG network • Junior Fellows • Fellows The authors have no conflicts of interest to disclose. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences (USUHS), Department of the Navy, Department of the Air Force, Department of the Army, Department of Defense, or the United States Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The author(s) are military service members. This work was prepared as part of their official duties. Title 17 U.S.C 105 provides that ‘Copyright protection under this ti, RITM0029472, Rename Sims speculum for all aspects of sterile processing 2. Provide education and resources for the AFD and residency training programs as well as military medical students 3. Provide education and resources for the Armed Forces Service Consults for active duty Gynecologic Surgeons and Obstetricians 4. Incorporate education for the Medical Education and Training Campus for Surgical Technologists at Fort Sam Houston, TX 5. Demonstrate action plan at WRNMMC with DHA support

Objective: To investigate the role of needleoscopic-assisted laparoscopy in terms of surgical impact and psychological outcomes in RR-BSO for BRCA1/2 patients. Study design: Prospective monocentric trial conducted at the Division of Gynecologic Oncology, “Fondazione Policlinico Universitario A. Gemelli” IRCSS in Rome. Between March 2016 and March 2018, 26 consecutive patients were prospectively enrolled in the study and underwent RR-BSO. Peri-operative surgical variables were collected. The psychological interview was performed at the discharge and during the first post-operative follow-up visit (between 30 and 60 days after surgery). Results: We reported a median OT of 18.5 min (range, 15–37), a median EBL of 0 mL (0–20), and no conversion to laparoscopy or laparotomy. The median VAS score was “at rest” of 2, 3, and 1; while under “Valsalva maneuver” was 4, 3, 2, respectively at 2, 4, and 24 h. 77% (20/26) of the whole population had a previous diagnosis of breast cancer. All patients expressed great cosmetic satisfaction both at discharge and after 30/60 days, with an 84.6% of score 5 and a 15.4% of score 4. The highest number of “score 5”, concerning the cosmetic outcomes, were clustered in the subgroup of breast cancer survivors with a 95% of score 5 versus 50% of score 5 in patients with no previous breast cancer (p = 0.0073). Similarly, the maximal psychological advantage of the ultra-MIS approach was revealed in the breast cancer survivors (70% of score 5 versus 16% of score 5, p = 0.02). Conclusions: The use of 2.4 mm instruments raises the possibility of decreasing post-operative incisional pain, reducing hospitalization, and ensuring better cosmetic and psychological outcomes without increasing complications. The full psychosomatic benefit of ultra-MIS within BRCA mutation carriers is revealed in breast cancer survivors, probably due to the comparison with the mutilating and invasive previous breast surgery.

Objectives: This study aimed to assess the validity and psychometric properties of the Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. Methods: This was a cross-sectional study aimed at midwives and obstetricians in Spain. An online survey was conducted consisting of 2 parts: the first part collected different variables, and the second part collected the SVEST-E. The temporal stability of the instrument was evaluated using the test-retest method. For the construct validity and reliability, an exploratory factor analysis and a confirmatory factor analysis were performed using FACTOR program v.10 with a polychoric correlation matrix. Results: A total of 689 professionals participated in the study (323 obstetrician physicians/366 midwives). The mean (SD) score on the SVEST-E for the total sample was 3.09 (0.50). The parallel analysis of the exploratory factor analysis suggested a 5-factor solution, with a total explained variability of 61.8%. The goodness-of-fit indices of the model were the following: root mean square error of approximation = 0.038 (95% confidence interval [CI], 0.031–0.042) and comparative fit index = 0.989 (95% CI, 0.988–0.992). The factor model obtained was confirmed by confirmatory factor analysis, obtaining the values of root mean square error of approximation = 0.038 (95% CI, 0.026–0.053) and comparative fit index = 0.989 (95% CI, 0.969–1.000). The intraclass correlation coefficient was 0.97 (95% CI, 0.94–0.99). Conclusions: The SVEST-E instrument maintains the same items as the original questionnaire but introduces changes in the organization of its dimensions. The Spanish version maintains adequate construct validity, reliability, and temporal stability, so it is a valid tool to evaluate the second victim experience in Spanish health professionals.

Study objectiveThere has been a surge in publications on robotic gynecologic surgery. This study determined the characteristics and trends of published articles in robotic gynecologic surgery using bibliometric analysis, and also identified socioeconomic indicators associated with scientific productivity in this field.MethodsThe Scopus database was used to retrieve articles related to robotic gynecologic surgery from 2001 until 2021. Analyses and network visualization were conducted using Bibliometrix package in R platform, VOSviewer software, and GraphPad Prism software.Main resultsA total of 642 articles spanning from 2001 to 2021 were published, with exponential increase starting in 2007. The most productive country in this field is the USA, while the most productive institution is the Memorial Sloan-Kettering Cancer Center. The Journal of Minimally Invasive Gynecology produced the most significant number of research articles, while Gynecologic Oncology received the highest total citations. The central themes of research from 2001 to 2009 include the keywords “radical hysterectomy” and “laparoscopy” while from 2010 to 2021, the keywords include “robotic surgery” and “cervical cancer”. Gross domestic product and the number of international collaborations had the highest correlation with scientific productivity in robotic gynecologic surgery.ConclusionThis study showed the research landscape – the leading authors, institutions, and countries – in robotic gynecologic surgery. The top institutions and countries in this field were from developed countries. This study emphasizes more investment in research, support for researchers and physicians, and foster more collaborations with leading countries and institutions, all to improve clinical care for gynecologic patients globally.

Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them. Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review. Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects. Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical in

Background To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 +/- 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in S

Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them. Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review. Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects. Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical in

The history of the modern Italian gynecology is closely related to the figure of an enlightened clinician and passionate master, Luigi Mangiagalli (1850-1928), who, with good reason, can be considered one of the fathers of this discipline. In 1906, Mangiagalli founded the Obstetric-Gynecological Institute in Milan, directing this structure until 1925. The aim of this paper is to describe some aspects of Italian gynecology at the beginnings of the twentieth century through the analysis of 250 original medical records, dating back to the years 1906-1912, fragments of real life of women, midwives and doctors in a pioneering era of obstetrics and gynecology.

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients had used the iron supplement while 86 (35%) patients didn’t use iron supplements (P-value 0.001). Iron supplement used by 245 patients was analyzed and only 93 (38%) patients had used the iron supplement while 152 (62%) patients didn’t use iron supplements. CONCLUSION: The coverage of antenatal iron and folic acid supplements is very low in the surveyed districts of Pakistan due to lack of parental education and older aged women belonging to poor households.

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients had used the iron supplement while 86 (35%) patients didn’t use iron supplements (P-value 0.001). Iron supplement used by 245 patients was analyzed and only 93 (38%) patients had used the iron supplement while 152 (62%) patients didn’t use iron supplements. CONCLUSION: The coverage of antenatal iron and folic acid supplements is very low in the surveyed districts of Pakistan due to lack of parental education and older aged women belonging to poor households.

Purpose: Obesity is prevalent in gynecological cancer survivors and is associated with impaired health outcomes. Concerns due to cancer and its treatment may impact changes in lifestyle after cancer. This study aimed to assess the association between cancer-related psychosocial factors and changes in physical activity and diet, 18 months after initial treatment among gynecological cancer survivors. Methods: Cross-sectional data from the ROGY Care study were used, including endometrial and ovarian cancer patients treated with curative intent. The Impact of Cancer Scale (IOCv2) was used to assess cancer-related psychosocial factors. Self-reported changes in nutrients/food groups and in physical activity post-diagnosis were classified into change groups (less/equal/more). Multivariable logistic regression models were used to assess associations. Results: Data from 229 cancer survivors (59% endometrial, 41% ovarian, mean age 66 ± 9.5, 70% tumor stage I) were analyzed. In total, 20% reported to eat healthier from diagnosis up to 18 months after initial treatment, 17% reported less physical activity and 20% more physical activity. Health awareness (OR 2.79, 95% CI: 1.38; 5.65), body change concerns (OR 3.04 95% CI: 1.71; 5.39), life interferences (OR 4.88 95% 2.29; 10.38) and worry (OR 2.62, 95% CI: 1.42; 4.85) were significantly associated with less physical activity up to 18 months after initial treatment whereby gastrointestinal symptoms were an important confounder. Conclusion(s): This study underlines the need to raise awareness of the benefits of a healthy lifestyle and to provide tailored lifestyle advice, taking into account survivors’ health awareness, body change concerns, life interferences, worry and gastrointestinal symptoms, in order to improve health behavior among gynecological cancer survivors. Trial Registration: http://clinicaltrials.gov Identifier: NCT01185626, August 20, 2010

The modern vaginal speculum is used in the field of obstetrics and gynecology in order to hold the vaginal walls open for the purpose of conducting pelvic exams. Routine pelvic exams are highly recommended for women above the age of 18 in order to screen for cancer and other infections of the female anatomy. The problems with the modern speculum deal with its form and function. The 2-billed design of the speculum is grossly outdated, and is often the source of pain and discomfort for patients as it pinches and contorts the vaginal opening. In terms of function, the modern speculum is difficult for physicians to use effectively as it severely limits their field of view into the vaginal cavity. The present research team proposes a redesign of the vaginal speculum that improves both form and function in order to provide a more comfortable experience for patients and increased usability for physicians.

Background: Pain during osmotic dilator insertion is rated as moderate to severe, even with use of a 1% lidocaine paracervical block (PCB). Buprenorphine, a partial mu-opioid receptor agonist, can improve the analgesic properties of a local anesthetic and also prolong the duration of local anesthetic effect when administered in a perineural block.Methods: This is a multi-site, randomized, double-blind controlled trial conducted from May 2020–May 2021. Participants presenting for dilation and evacuation who required osmotic dilators for cervical preparation were randomized 1:1 to receive a 1% buffered lidocaine PCB or a 1% buffered lidocaine + 0.15mg buprenorphine PCB. The primary outcome was pain scores during osmotic dilator insertion as rated on an 11-point numeric rating scale. Secondary outcomes included pain at additional time points and side effects. We used a Mann-Whitney U test to compare median pain scores between groups. Results: We randomized 57 participants. There was no difference in median pain scores between the lidocaine + buprenorphine and the lidocaine alone PCB groups during osmotic dilator insertion (3.5 vs. 4, p=0.88). There were no differences in median pain scores at any time point after dilator insertion. Participants receiving buprenorphine had a higher incidence of vomiting post-dilator insertion (70% vs. 21%, p=0.0007). Discussion: Addition of buprenorphine to a 1% lidocaine paracervical block did not reduce pain at the time of osmotic dilator insertion or at any time point post-insertion. The addition of buprenorphine to a PCB may increase rate of side effects, particularly vomiting, without any pain control benefit.

BackgroundInequitable outcomes in sexual and reproductive health disproportionately burden communities minoritized by systems of oppression. Although there is evidence linking structural determinants to these inequities, clinical learners have limited exposure to these topics in their training. We developed a curriculum aimed to teach clinical learners the structural determinants of sexual and reproductive health.MethodWe implemented Kern's six-step method for curriculum development. Through literature review, we identified structural competency as the foundational framework and explored community priorities for clinical training. We assessed learner needs regarding structural equity training, articulated goals and objectives, and chose video modules as the primary educational strategy. We collaboratively developed content with community scholars and reproductive justice advocates. For phase 1 of our curriculum, we created pillar videos with reflection questions, resources, and a visual glossary of key terms. All materials are available through an online educational platform offering open-access, evidence-based curricula.ExperienceWe launched our curriculum with a social media campaign and presented our videos at several national convenings. We implemented videos with clinical learners with positive preliminary evaluation results.ConclusionWith rigorous development rooted in community engagement, our curriculum contributes to the tools promoting structural equity training in obstetrics and gynecology.

Background: Pain during osmotic dilator insertion is rated as moderate to severe, even with use of a 1% lidocaine paracervical block (PCB). Buprenorphine, a partial mu-opioid receptor agonist, can improve the analgesic properties of a local anesthetic and also prolong the duration of local anesthetic effect when administered in a perineural block.Methods: This is a multi-site, randomized, double-blind controlled trial conducted from May 2020–May 2021. Participants presenting for dilation and evacuation who required osmotic dilators for cervical preparation were randomized 1:1 to receive a 1% buffered lidocaine PCB or a 1% buffered lidocaine + 0.15mg buprenorphine PCB. The primary outcome was pain scores during osmotic dilator insertion as rated on an 11-point numeric rating scale. Secondary outcomes included pain at additional time points and side effects. We used a Mann-Whitney U test to compare median pain scores between groups. Results: We randomized 57 participants. There was no difference in median pain scores between the lidocaine + buprenorphine and the lidocaine alone PCB groups during osmotic dilator insertion (3.5 vs. 4, p=0.88). There were no differences in median pain scores at any time point after dilator insertion. Participants receiving buprenorphine had a higher incidence of vomiting post-dilator insertion (70% vs. 21%, p=0.0007). Discussion: Addition of buprenorphine to a 1% lidocaine paracervical block did not reduce pain at the time of osmotic dilator insertion or at any time point post-insertion. The addition of buprenorphine to a PCB may increase rate of side effects, particularly vomiting, without any pain control benefit.

This article provides information on the practical work carried out in the field of medicine in Bukhara during the years of independence, reforms aimed at strengthening public health, the activities of foreign medical institutions

The presented work presents the concept of simultaneous operations, a review of domestic and foreign literature on the problems of performing simultaneous operations in gynecology - issues of terminology, classification, features of performing combined operations when combining gynecological diseases with another surgical pathology.

The presented work presents the concept of simultaneous operations, a review of domestic and foreign literature on the problems of performing simultaneous operations in gynecology - issues of terminology, classification, features of performing combined operations when combining gynecological diseases with another surgical pathology.