Search

Refereed/Peer-reviewed Introduction/Purpose: Many guidelines have been utilised to diagnose polycystic ovarian syndrome (PCOS). The most recent are the International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 (2018 IEBG). This study aimed to assess the awareness, knowledge, and attitudes of Australasian sonographers' regarding these guidelines. Methods: An online cross-sectional survey was disseminated to sonographers. Qualitative and quantitative questions were asked around awareness, knowledge, and attitudes towards the 2018 IEBG. Statistical and thematic analyses of the results were performed. Results: Ninety responses were included in the final analysis. Fifty-two percent (52.2%) of participants were aware of the 2018 IEBG but only 31.1% used it in their workplaces. Fifty-eight percent (57.9%) of participants correctly identified the sonographic features that suggest PCOS, and 3.5% correctly identified all minimum recommended inclusions for reporting a gynaecological ultrasound for PCOS. Prior to being supplied the 2018 IEBG, 15.8% of participants correctly answered clinical scenario-based knowledge questions, which increased to 29.4% correctly after being supplied the guideline; however, this difference was not statistically significant. There were no statistically significant associations between demographics and knowledge of the 2018 IEBG. Discussion: Several areas of confusion surrounding wording and interpretation of the 2018 IEBG were highlighted. Consideration should be given to barriers of implementation and strategies to overcome these. Conclusion: More education surrounding the sonographic diagnosis of PCOS and the 2018 IEBG is needed. Scanning protocols used amongst sonographers varied, suggesting that inconsistency in sonographic diagnosis may exist. Future reviews of the 2018 IEBG should focus on reducing ambiguity in wording, which may be responsible for some of the varied interpretation of these guidelines.

The study of the placenta is of great importance, not only in the attempt to understand the etiopathogenesis of various maternal-fetal pathologies, but also in the attempt to understand whether it is possible to find the cause of pathological neonatal outcomes. On the other hand, abnormalities of blood vessel formation, such as angiodysplasias, have been poorly characterised in the literature, and there is a need for more studies investigating the potential impact on the fetus. In this paper, we retrospectively analysed 2063 placentas received at the Department of Pathology of the University of Bari ‘Aldo Moro’, among which we identified 70 placentas affected by angiodysplasia. On these placentas, we carried out histochemical staining with Masson’s Trichrome, orcein-alcian blue, and, subsequently, immunostaining with anti-CD31, CD34, and desmin and actin muscle smoothness antibodies. Finally, we performed a morphometric analysis on the allantochorionic and truncal vessels and correlated the results with neonatal outcomes. We studied the characteristics of the angiodysplasias in detail, dividing the patients into two classes (A and B) according to the morphology and histochemical characteristics of the affected vessels; statistical analysis reported a statistically significant association (p < 0.05) between the ratio of maximum thickness to maximum diameter (Tmax/Dmax) and neonatal outcome, with only 30% physiological outcome in the cohort of the placentas affected by angiodysplasia. These results shed light on a rather neglected aspect in the 2015 Amsterdam Classification, as well as in the literature, and provided strong evidence that placental angiodysplasia is predictive of an increased likelihood of the pathological fetal outcome, while other factors remain in the field. Studies with larger case series and guidelines with more attention to these aspects are mandated to further investigate the predictive potential of this pathology.

Background Diabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic interventions and the risk of any type of gynaecological or obstetric conditions. Methods Design: Umbrella review of systematic reviews and meta-analyses. Data sources: PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, manual screening of references. Eligibility criteria: Systematic reviews and meta-analyses of observational and interventional studies investigating the relationship between diabetes and anti-diabetic interventions with gynaecological or obstetric outcomes. Meta-analyses that did not include complete data from individual studies, such as relative risk, 95% confidence intervals, number of cases/controls, or total population were excluded. Data analysis: The evidence from meta-analyses of observational studies was graded as strong, highly suggestive, suggestive or weak according to criteria comprising the random effects estimate of meta-analyses and their largest study, the number of cases, 95% prediction intervals, I2 heterogeneity index between studies, excess significance bias, small study effect and sensitivity analysis using credibility ceilings. Interventional meta-analyses of randomised controlled trials were assessed separately based on the statistical significance of reported associations, the risk of bias and quality of evidence (GRADE) of included meta-analyses. Results A total of 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes were included. Strong or highly suggestive evidence only supported a positive association between gestational diabetes and caesarean section, large for gestational age babies, major congenital malformations and heart defects and an inverse relationship between metformin use and ovarian cancer incidence. Only a fifth of the randomised controlled trials investigating the effect of anti-diabetic interventions on women’s health reached statistical significance and highlighted metformin as a more effective agent than insulin on risk reduction of adverse obstetric outcomes in both gestational and pre-gestational diabetes. Conclusions Gestational diabetes appears to be strongly associated with a high risk of caesarean section and large for gestational age babies. Weaker associations were demonstrated between diabetes and anti-diabetic interventions with other obstetric and gynaecological outcomes. Trial registration Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/9G6AB).

OBJECTIVE: Myofascial tenderness is present in most chronic pelvic pain conditions and causes significant distress to patients. Treatment is challenging and often not curative. Cannabis is often used for self-management of chronic pelvic pain. However, we do not know which concentrations and routes of administration are most acceptable to users. We aimed to investigate patterns and willingness of cannabis product use among both habitual users and non-users with myofascial pelvic pain (MPP), to inform therapeutic development. STUDY DESIGN: We conducted a cross-sectional study of questionnaire responses from female patients with MPP from two tertiary pelvic pain centers. We aimed for a convenience sample of 100 responses with representation from both centers. Inclusion criteria were age over 18 with pelvic floor muscle tenderness on standard gynecologic examination. We collected information on demographics, pelvic pain history, cannabis use status, cannabis use preferences, validated opioid misuse risk assessment, and interest in using gynecologic cannabis products and used descriptive analyses. RESULTS: 77/135 (57 %) questionnaire respondents were cannabis users and 58 (43 %) were non-users. Most users consume cannabis daily, (48.1 %) orally (66.2 %) or by smoking (60.7 %), and rated cannabis as effective at relieving pelvic pain. 37/58 (63.8 %) non-cannabis users responded that they would be willing to use cannabis for pelvic pain. Lack of information and potential adverse effects were the most common reasons for unwillingness to use. Approximately 3 of 4 respondents were willing to try vaginal or vulvar application of cannabis products for pelvic pain. CONCLUSIONS: This cross-sectional study describes cannabis use patterns in MPP patients. Topical vulvar and vaginal cannabis products are of strong interest to both cannabis users and non-users and warrant further research.

Objective To observe the gastrointestinal function recovery in the patients with different feeding time after gynecological laparoscopic surgery. Methods A total of 132 patients undergoing laparoscopic surgery in our department from December 2020 to April 2021 were enrolled in this study. Five of them were excluded and 127 cases were finally enrolled, including 64 cases in the experimental group (taking food immediately after returning to the ward after surgery) and 63 cases in the control group (taking food 6 h after returning). The recovery of gastrointestinal function, the incidences of abdominal distention, nausea and vomiting, and the average length of postoperative hospital stay were recorded and compared between the 2 groups. Results The experimental group had significantly shorter time of first postoperative bowl sound (7.44±3.99 vs 10.48±4.62), first exhaust (11.50±6.75 vs 16.30±7.44 h), and first defecation (21.38±9.22 vs 28.68±12.99 h), and shorter average length of postoperative hospital stay (4.28±1.55 vs 5.59±4.07 d) when compared with the control group (P < 0.05). The incidences of abdominal distention, nausea and vomiting in postoperative patients were obviously lower in the experimental group than the control group (25.0% vs 46.0%, 14.1% vs 34.9%, P < 0.05). Early oral feeding after laparoscopic operation improved the recovery of intestinal function and shorten the postoperative hospital stay. Conclusion Postoperative early food-taking program is safe for patients undergoing gynecological laparoscopic surgery. It is beneficial to improve the recovery of gastrointestinal function, reduce the incidence of postoperative abdominal distention, nausea and vomiting, and promote early discharge of patients from hospital.

Background: Pregnancy can be associated with anxiety symptoms because of anticipated uncertainty. Aim: This study investigated pregnancy-related anxiety symptoms (PRASs) and their associated factors amongst pregnant women. Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Methods: This cross-sectional survey involved 230 pregnant women attending antenatal clinic at a tertiary teaching hospital in Nigeria. Pregnancy- related anxiety symptoms, maternal worries, personality traits and social support were measured by using Perinatal Anxiety Screening Scale (PASS), Cambridge Worry Scale (CWS), Big Five Personality Inventory (BFI10) and Maternal Social Support Scale (MSSS) respectively. Socio-demographic and obstetric details were also obtained. The Chi-square, t-test and logistic regression were used. Results: Respondents’ mean age was 28.2 ± 5.4 years, whilst 192 (83.5%) were of Yoruba ethnicity. Twenty-four respondents (10.4%) were in the first trimester, 85 (37.0%) in the second and 121 (52.6%) in the third trimester. Some 154 (67.0%) were parous. The prevalence of PRAS and major maternal worries were 43.5% and 55.7% respectively. The socio-demographic factors significantly associated with PRAS were age (p = 0.004), ethnicity (p = 0.001), educational level (p = 0.011) and living arrangement (p = 0.029). Associated obstetric factors include trimester (p = 0.01), hypertension (p = 0.006), past miscarriage(s) (p = 0.013) and past pregnancy complication (p = 0.030). Significant psychosocial factors were partner social support (p = 0.038), maternal worries (p < 0.001) and extraversion (p = 0.016). Factors that contributed significantly to regression models were older maternal age and socio-medical worries. Conclusion: High level of PRAS and major maternal worries were common amongst antenatal clinic attendees of a tertiary teaching hospital in Nigeria. Older maternal age and socio-medical maternal worries are important predictors of PRAS.&nbsp

Background: Challenges in recruiting appropriately trained obstetricians and gynaecologists have been identified across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student’s decision to pursue in a career in the speciality. Methods: Paper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25. Results: The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p=0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4% to 4.2% (p=0.50) and the dual speciality increased from 6.9% to 13.9% (p=0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied. Conclusions:While respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship.

Hintergrund Die Frauengesundheit von älteren Frauen ist vor allem in ländlichen Gebieten Deutschlands vor dem Hintergrund einer steigenden Anzahl von Frauen ab 50 Jahren und einer drohenden Unterversorgung bei medizinischen Leistungen zu betrachten. Einflüsse auf die Primärversorgung wie Delegation, Telemedizin oder interdisziplinäre Praktiken wurden in Studien beschrieben. Zu interdisziplinären Praktiken zählen Vernetzung und Zusammenarbeit von Fachärztinnen/Fachärzten (FÄ) in der ambulanten Primärversorgung. In Bezug auf die Gesundheit älterer Frauen berichteten Hausärztinnen/Hausärzte (HÄ) sowie Gynäkologinnen/Gynäkologen (Gyn) als zuständige FÄ-Gruppen in dieser Arbeit über die Versorgungssituation sowie über ihre Vernetzung und Zusammenarbeit. Darüber hinaus wurden Einflussfaktoren auf die Zusammenarbeit wissenschaftlich untersucht. Methodik Zwischen März und Juni 2018 wurde im Stadtstaat Berlin sowie in den Flächenländern Brandenburg und Mecklenburg-Vorpommern im Rahmen einer repräsentativen postalischen Befragung eine randomisierte Auswahl von 3.514 HÄ (67 % von 5.265 HÄ) und 1.031 Gyn in einer Vollerhebung quantitativ unter Verwendung eines selbst entwickelten und mit Expertinnen/Experten pilotierten Fragebogens befragt. Deskriptive Analysen wurden zur Darstellung von Versorgungssituation, formeller und informeller Vernetzung sowie zu 13 Aspekten der Zusammenarbeit genutzt. Die Ermittlung von Einflussfaktoren auf die Zusammenarbeit erfolgte jeweils mittels multipler logistischer Regressionen, adjustiert nach Alter und Geschlecht. Ergebnisse Der Fragebogen wurde von 1.389 FÄ (861 HÄ, 528 Gyn) ausgefüllt zurückgesendet, was einer Responserate von 31 % (25 % HÄ, 51 % Gyn) entsprach. Responder waren im Durchschnitt 54,4 Jahre alt, eher weiblich (72 %) und stammten aus den Flächenländern (55 %). Die gynäkologische Versorgungssituation wird von 30 % aller Responder als bedroht angesehen. Insgesamt gaben 68 % der FÄ an vernetzt zu sein, jedoch nur 10 % in formalen Strukturen. Haupteinflussfaktoren auf die engere Zusammenarbeit von HÄ und Gyn war das Praktizieren in einem Flächenland sowie die Angabe, Teil eines Netzwerks zu sein. So war die Zufriedenheit mit der Zusammenarbeit in Flächenländern höher als im Stadtstaat (Odds Ratio [OR] = 1,7, 95 %iges Konfidenzintervall [CI] = 1,3-2,1) sowie bei HÄ und Gyn als Teil eines informellen Netzwerks im Vergleich mit HÄ und Gyn ohne informelles Netzwerk (OR = 2,7, CI = 2,1-3,4). Schlussfolgerungen Die Versorgungssituation wird in Flächenländern und Stadtstaat im gleichen Maße als bedroht angesehen. Zusammenarbeit ist systematisch besser ausgeprägt zwischen ambulant tätigen HÄ und Gyn in Flächenländern sowie zwischen FÄ, die sich einem Netzwerk zugehörig fühlen. Eine stärkere informelle und formale Vernetzung könnte die Zusammenarbeit zwischen HÄ und Gyn verbessern, die Kontinuität und Sicherheit der ambulanten ärztlichen Versorgung älterer Frauen steigern und die Zufriedenheit der FÄ stärken., Background The health of elderly women, especially in rural areas of Germany, has to be considered within the context of an increasing number of women aged 50 and over and a threatening shortage of medical services. Influences on the primary healthcare such as delegation, telemedicine or interdisciplinary practices have been described in previous studies. Interdisciplinary practices include networking and collaboration between medical specialists in outpatient primary healthcare. Being the responsible medical specialists in this study, general practitioners (GPs) and gynaecologists (Gyns) reported on the healthcare situation as well as on their networking and collaboration. In addition, factors influencing these collaborations were scientifically investigated. Methods Between March and June 2018, a randomised selection of 3,514 GPs (67 % of 5,265 GPs) and 1,031 Gyns from the city state of Berlin and the territorial states of Brandenburg and Mecklenburg-Western Pomerania were surveyed quantitatively with a representative postal survey using a self-developed questionnaire, which was pilot-tested with the help of experts. Descriptive analyses were used to describe the healthcare situation, formal and informal networking and 13 aspects of the collaboration among GPs and Gyns. Factors influencing collaboration were determined using multiple logistic regressions, adjusted for age and gender. Results The questionnaire was completed and returned by 1,389 physicians (861 GPs, 528 Gyns), which corresponded to a response rate of 31 % (25 % GPs, 51 % Gyns). Responders were on average 54.4 years old, more likely to be female (72 %) and working in the territorial states (55 %). The gynaecological care situation was considered threatened by 30 % of all responders. Overall, 68 % of the Gyns stated that they were members of a network, but only 10 % in formal structures. The main factors influencing a closer collaboration between GPs and Gyns included practising in a territorial state and being member of a network. Satisfaction regarding collaboration was higher in territorial states than in the city state (odds ratio [OR] = 1.7, 95 % confidence interval [CI] = 1.3-2.1) and for GPs and Gyns that were members of an informal network compared to those GPs and Gyns without an informal network (OR = 2.7, CI = 2.1-3.4). Conclusions The healthcare situation is considered to be threatened to the same extent in the territorial states and the city state. Collaboration is systematically better developed between outpatient GPs and Gyns in the territorial states and between those who see themselves as members of a network. Stronger informal and formal networking could improve collaboration between GPs and Gyns, increase the continuity and safety of outpatient medical care for elderly women and increase the satisfaction of the specialists.

Background Endometriosis is characterized by the development of endometrial-like tissue outside of the uterus, which results in a persistent inflammatory response . It is an estrogen-dependent chronic disorder and affects millions of women in their reproductive age. The true incidence is not well known but it is around 6% or more. The clinical presentation of endometriosis varies. Most women will present with secondary dysmenorrhea, dyspareunia, pelvic pain, and infertility. Laparoscopy is the gold standard diagnostic tool for endometriosis, with surgical management being the mainstay in the treatment of endometriosis. Objectives The study's primary objective was to determine the effect of surgery on pain and infertility in women with endometriosis. Secondly, to determine the demographics, severity of endometriosis and laparoscopic complications, recurrence of symptoms and need for repeat surgery. Methodology To achieve the objectives of this research, the study design was a retrospective study. Seventyfive women with endometriosis who attended the reproductive Medicine Unit at Groote Schuur Hospital in Cape Town from January 2016 to December 2018 were analysed. Results Eighty-seven patients were identified with endometriosis from January 2016 to December 2018. Twelve folders could not be retrieved, therefore 75 patients out of the 87 were included in and analysed for this study. Some of the 75 patient files had missing information regarding some of the variables. Post laparoscopic surgery, the pain improved in 90%, 82%, 85% and 61% of patients with a P value < 0.05 at 6 weeks, 6 months, 1 year and 2 years, respectively. Thirty percent of women operated primarily for infertility conceived spontaneously within 2 years. Nine point three percent of patients were reoperated with a mean duration from primary to second surgery of 3 years ± 1.3. More than six percent (6.6%) had intraoperative complications with two patients having ureteric injuries, another two with bowel injuries, and one who had vascular injuries. The prevalence of endometriosis among women undergoing laparoscopic surgeries was 30.6% over the 3-year period. Chronic pelvic pain was the most common symptoms in 86.6% of patients. Dysmenorrhea was reported in 72,6%, 36.5% had dyspareunia, 50% had heavy menstrual bleeding and 53% had primary or secondary infertility. Chronic pelvic pain and infertility were found in 42.67%. Conclusion This study has shown a great improvement in pain post laparoscopic surgery varying from 90% at 6 weeks to 61% at 2 years. About one-third of patients operated on for primarily infertility will conceive spontaneously post-surgical intervention. We recommend a new study with a large sample size in order to determine the improvement and fertility according to the stages of endometriosis.

ObjectivesAmong youth in Nairobi, we (1) characterised fertility and contraceptive use dynamics by gender; (2) estimated pregnancy prevalence over the pandemic; and (3) assessed factors associated with unintended pandemic pregnancy for young women.DesignLongitudinal analyses use cohort data collected at three timepoints prior to and during the COVID-19 pandemic: June to August 2019 (pre-pandemic), August to October 2020 (12-month follow-up) and April to May 2021 (18-month follow-up).SettingNairobi, Kenya.ParticipantsAt initial cohort recruitment, eligible youth were aged 15–24 years, unmarried and residing in Nairobi for at least 1 year. Within-timepoint analyses were restricted to participants with survey data per round; trend and prospective analyses were restricted to those with complete data at all three timepoints (n=586 young men, n=589 young women).Primary and secondary outcome measuresPrimary outcomes comprised fertility and contraceptive use for both genders, and pregnancy for young women. Unintended pandemic pregnancy (assessed at 18-month follow-up) was defined as a current or past 6-month pregnancy with intent to delay pregnancy for more than 1 year at 2020 survey.ResultsWhile fertility intentions remained stable, contraceptive dynamics varied by gender—young men both adopted and discontinued coital-dependent methods, whereas young women adopted coital-dependent or short-acting methods at 12-month follow-up (2020). Current pregnancy was highest at 2020 (4.8%), and approximately 2% at 2019 and 2021. Unintended pandemic pregnancy prevalence was 6.1%, with increased odds for young women recently married (adjusted OR (aOR)=3.79; 95% confidence interval (CI) 1.83–7.86); recent contraceptive use was protective against unintended pandemic pregnancy (aOR=0.23; 95% CI 0.11–0.47).ConclusionsCurrent pregnancy in Nairobi was highest at the height of the COVID-19 pandemic (2020), and subsided to pre-pandemic levels by 2021 data collection; however, requires further monitoring. New marriages posed considerable risk for unintended pandemic pregnancy. Contraceptive use remains a crucial preventive strategy to averting unintended pregnancy, particularly for married young women.

BACHELOR THESIS ABSTRACT Author: Františka Skalická Supervisor: Mgr. Klaudia Fabičovic Consultant: MUDr. Vendula Parmová Title of bachelor thesis: The influence of physiotherapy in irregular menstrual cycle Abstract: Menstrual cycle disorders are nowadays a very common problem for many women. These include dysmenorrhea, premenstrual syndrome, functional female sterility or luteal insufficiency. Their etiology may also be associated with musculoskeletal dysfunction. Luteal insufficiency is considered to be a luteal phase of less than 12 days. This condition may be one of the possible causes of infertility, but studies on this topic are lacking. The aim of my bachelor's thesis is to evaluate the influence of luteal insufficiency using diagnostic and therapeutic approaches in physiotherapy. Three women with luteal insufficiency underwent individually tailored physiotherapy ongoing for 6 months with the aim of prolonging the luteal phase. The symptothermal method was used to objectify the length of the luteal phase before and after therapy, allowing easy and reliable control of the menstrual cycle and increasing the likelihood of conception through accurate timing of the fertile period. The main 4 pillars of therapy were postural correction, elimination of functional changes in the musculoskeletal system,...

Summary A 17-year-old lady presented with primary amenorrhoea, headache, nausea and lethargy. She had delayed pubertal development that also includes under-developed breast (Tanner Stage 2). Hormonal investigations showed a high serum prolactin level of 1 680 000 mIU/L (normal value: 45–375 mIU/L), with low oestradiol, progesterone, follicular-stimulating hormone and luteinizing hormone. Early morning cortisol level was 206 nmol/L (normal value: >450 nmol/L), thyroxine was 7.5 pmol/L (normal value: 9.0–24.0 pmol/L) with TSH 5.091 mIU/L (normal value: 0.4–4.5 mlU/L). A pituitary MRI showed a 2.7 (AP) × 3.7 (W) × 4.6 cm (CC) macroadenoma, with invasion into the left cavernous sinus and encasement of cavernous portion of the left internal carotid artery. MRI pelvis showed absent uterus, cervix and 2/3 upper vagina confirming Mullerian hypoplasia. Cytogenetics showed 46XX. These findings were suggestive of Mayer–Rokitansky–Kauser–Hauser (MRKH) syndrome with the presence of a pituitary macroprolactinoma and panhypopituitarism. She was treated with hydrocortisone, levothyroxine and cabergoline. Repeated MRI showed a reduction in tumour size by approximately 50%. This case illustrated a rare coexistence of these two conditions, being only the third reported case in the world. In addition, this would be the first case of a functioning pituitary adenoma in a patient with MRKH syndrome. Learning points Comprehensive hormonal and radiological investigations are important in the management of a young patient with primary amenorrhoea. Coexistence pathology of two separate pathologies should be considered in patient presenting with primary amenorrhoea. Early diagnosis of MRKH or any disorders of sex development should be treated early, providing pharmacological, surgical, psychological and emotional support to the patient and reducing risk of associated complications. Abnormal pituitary hormones, particularly panhypopituitarism, would impose greater impact not only psychologically but also metabolically leading to cardiovascular, morbidity and mortality risks in this patient if not treated early. A multidisciplinary approach is necessary for patients presenting with MRKH to ensure appropriate treatments and follow-up across the lifespan of the patient.

229 p. Reproducción asistida. Se trata de un proceso complejo, que requiere una sincronía entre el desarrollo delembrión y el endometrio, pero también, una adecuada comunicación entre ambos. Los microRNAs(miRNAs) y las vesículas extracelulares (VE) del fluido endometrial (FE) se han descrito comomediadores de la comunicación embrión-endometrio. Creemos que el análisis de miRNAs libres yasociados a VE del FE podría proporcionar una técnica no-invasiva para reconocer un endometrioimplantativo. El objetivo es definir un método no invasivo que sea sencillo, sensible, reproducible y queademás permita la rápida identificación de un endometrio implantativo mediante el análisis de miRNAs.Hemos comparado cinco metodologías diferentes, dos de ellas consistían en una extracción directa deRNA mientras que las otras tres tenían un enriquecimiento en VE antes de la extracción de RNA. Se llevóa cabo una small RNA-seq para determinar el método más eficiente y encontrar un modelo predictivopara diferenciar entre endometrio implantativo y no-implantativo. Los modelos se confirmaron medianteqPCR en dos conjuntos de muestras, cohorte de descubrimiento (n=30) y de validación (n=60). Nuestrosresultados mostraron que los protocolos de enriquecimiento de VE permiten detectar un mayor númerode miRNAs. Además, obtuvimos dos modelos predictivos basados en tres miRNAs que permitendiferenciar entre endometrio implantativo y no-implantativo. Este estudio introduce nuevos protocolospara analizar miRNAs libres y asociados a VE a partir de volúmenes muy pequeños de FE, que podríanimplementarse en la práctica clínica para la evaluación del estado del endometrio utilizando biomarcadores no invasivos basados en miRNAs. Lo que permitiría planificar la transferencia embrionaria evitando la perdida de embriones cuando se trasfieren a un endometrio que no esta implantativo. Increasing embryo implantation rates is one of the greatest challenges of assisted reproductiontechniques. It is a complex process that requires synchrony between embryo development and theendometrium, but also adequate embryo-endometrium crosstalk. MicroRNAs (miRNAs) and extracellularvesicles (EVs) in the endometrial fluid (EF) have been described as mediators of embryo-endometrialcommunication. We believe that the analysis of free and EV-associated miRNAs from the EF couldprovide a non-invasive technique to recognize an implantative endometrium. The aim is to define a noninvasivesimple, sensitive, reproducible method that allows rapid identification of an implantativeendometrium by miRNA analysis. We compared five different methodologies, two of them consisted of adirect RNA extraction while the other three had an enrichment in EV before RNA extraction. A smallRNA-seq was performed to determine the most efficient method and to find a predictive model todifferentiate between implantative and non-implantative endometrium. The models were confirmed byqPCR on two sets of samples, discovery (n=30) and validation (n=60) cohorts. Our results showed thatEV enrichment protocols allow detection of a higher number of miRNAs. In addition, we obtained twopredictive models based on three miRNAs that allow differentiation between implantative and nonimplantativeendometrium. This study introduces new protocols to analyze free and EV-associatedmiRNAs from very small volumes of EF, which could be implemented in clinical practice for theassessment of endometrial status using non-invasive miRNA-based biomarkers. This would allow theplanning of embryo transfer avoiding the loss of embryos when they are transferred to a non-implantativeendometrium. CICbioGUNE

Purpose Although hysterectomy is one of the most frequently performed gynaecological surgeries, there is a dearth of evidence on perioperative care. The aim of the current study was to identify sociodemographic, surgical-related and work-related predictors of recovery following different approaches of hysterectomy. Methods Eligible patients for this retrospective cohort study were women who underwent vaginal, abdominal or laparoscopic hysterectomy for both benign and malignant gynaecological disease in 2014 in Máxima Medical Centre in the Netherlands. The main outcome measure was full return to work (RTW). Data were collected using a patient survey. Potential prognostic factors for time to RTW were examined in univariate Cox regression analyses. The strongest prognostic factors were combined in a multivariable model. Results In total 83 women were included. Median time to full return to work was 8 weeks (interquartile range [IQR] 6–12). The multivariable analysis showed that higher age (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.012–1.095) and same day removal of indwelling catheter (HR 0.122, 95% CI 0.028–0.539) were predictors of shorter duration until full RTW after hysterectomy. Conclusions This study provided insight in the predictors of recovery after hysterectomy. By identifying patient specific factors, pre-operative counselling can be individualized, changes can be made in perioperative care and effective interventions can be designed to target those factors.

Most high-end ultrasound systems now incorporate three-dimensional imaging as a standard feature. As such, the use of three-dimensional ultrasound is becoming routine in many facets of medical ultrasound, especially obstetrics and gynaecology. Three-dimensional ultrasound can enhance or even alter a diagnosis in many gynaecological pathologies. However, like any technique, the usefulness and accuracy of the application relies on the operator having adequate application knowledge and technical acquisition skills to be able to use it to its full potential. This is the first part of a two-part series on this topic. This article serves to educate sonographers and other ultrasound users on how to incorporate a three-dimensional ultrasound assessment into their routine gynaecological examinations, why this should be done and how to overcome some of the pitfalls encountered with this technique. Refereed/Peer-reviewed

Refereed/Peer-reviewed Three-dimensional ultrasound (3DUS) is becoming a standard part of obstetric and gynaecological ultrasound examinations. With most high-end ultrasound systems now incorporating three-dimensional functionality, the technology can be used to enhance and/or confirm a diagnosis in many gynaecological pathologies. Part one of this two-part series covered the technical aspects of performing three-dimensional gynaecological ultrasound. This paper, part two, presents a pictorial essay of 3DUS in gynaecological imaging serving to educate sonographers and other ultrasound users on the typical appearance of some common, and not so common ultrasound findings.

Purpose The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact. Methods Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020. Results A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic. Conclusion The results show that patients’ confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients’ confidence in their physicians, which is crucial for a successful treatment’s outcome.

Objective: Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. Methods: This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION 5. Consultation transcripts in the ‘after’ group were checked for adherence to the steps required for intended use of decision aids. Results: 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53–19.47). Conclusion: The level of SDM was higher after the introduction of the package than before. Practice implications: This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.

IntroductionPlacebo-controlled surgical designs are recommended to ascertain treatment effects for elective surgeries when there is genuine doubt about the effectiveness of the surgery. Some elective surgeries for pain have been unable to show an effect beyond sham surgery, suggesting contributions from contextual factors. However, the nature of contextual factors in elective surgery is largely unexplored. Further, methodological difficulties in placebo-controlled surgical trials impact the ability to estimate the effectiveness of a surgical procedure. These include an overall lack of testing the success of blinding, absence of comparison to a no-surgery control group and dearth of test for neuropathic pain.For women with peritoneal endometriosis, there is uncertainty regarding the pain-relieving effect of surgery. Surgery may put patients at risk of complications such as postsurgical neuropathic pain, without guarantees of sufficient pelvic pain relief. The planned placebo-controlled trial aims to examine the effect of surgery on pelvic pain, widespread pain and neuropathic pain symptoms in women with peritoneal endometriosis, and to test the contribution of contextual factors to pain relief.Methods and analysisOne hundred women with peritoneal endometriosis will be randomised to either diagnostic laparoscopy with excision of endometrial tissue (active surgery), purely diagnostic laparoscopy (sham surgery) or delayed surgery (no-surgery control group). Outcomes include pelvic pain relief, widespread pain, neuropathic pain symptoms and quality of life. Contextual factors are also assessed. Assessments will be obtained at baseline and 1, 3 and 6 months postrandomisation. Mixed linear models will be used to compare groups over time on all outcome variables.Ethics and disseminationThe trial is approved by the Regional Ethics Committee in the Central Denmark Region (1-10-72-152-20). The trial is funded by a PhD scholarship from Aarhus University, and supported by a grant from ‘Helsefonden’ (20-B-0448). Findings will be published in international peer-reviewed journals and disseminated at international conferences.Trial registration numberNCT05162794.

Endometriosis is a chronic gynaecological condition and this study aimed to identify the prevalence of perceived cognitive functioning difficulties in individuals living with endometriosis and the association of pain, fatigue and depression with these difficulties. Using a mixed methods design, data was collected through an online survey from individuals living with endometriosis (n=1239). It was found that on average, the sample reported impaired cognitive functioning and high levels of pain, fatigue and depression symptoms. Pain, fatigue and depression were all strongly associated with diminished perceived cognitive functioning. Qualitative accounts verified these findings. This mixed-methods study demonstrated that perceived cognitive difficulties are highly prevalent in individuals living with endometriosis. Endometriosis-related pain and fatigue and depressive symptoms were strongly associated with poorer cognitive functioning indicating that psychosocial intervention is warranted.

Summary Hypothyroidism occurring in the postpartum period can be due to pituitary or hypothalamic disease as in Sheehan’s syndrome and postpartum autoimmune hypophysitis or due to a primary thyroid disease as in postpartum thyroiditis. It is important that the correct diagnosis is ascertained because hypothalamic or pituitary disorders are often associated with other pituitary hormone deficiencies, especially life-threatening adrenal insufficiency or adrenal crisis. A combination of various symptoms and biochemical markers, especially serum thyroid-stimulating hormone levels dictate the initial diagnostic pathway. We present a case of a woman who presented with a 2-month history of tiredness and neck discomfort following delivery. A thyroid function test demonstrated results, which we initially interpreted as central hypothyroidism. Follow-up results indicated that this was in fact the transition period between the thyrotoxic phase and hypothyroid phases of postpartum thyroiditis. This case highlights the potential for diagnostic confusion between central hypothyroidism and postpartum thyroiditis. Learning points Postpartum thyroiditis affects one in twenty mothers within 12 months of delivery. The majority of patients have transient thyrotoxicosis only, some have transient hypothyroidism only, and the rest has a triphasic pattern (thyrotoxic, hypothyroid then a euthyroid phase). During the transition from the thyrotoxic phase to hypothyroid phase, when serum TSH is still suppressed, the biochemical results can resemble that of central hypothyroidism. If central hypothyroidism is suspected, then urgent diagnostic investigations should be carried out along with the assessment of adrenal function. There is a potential for diagnostic confusion between postpartum central hypothyroidism and postpartum thyroiditis; however, the obstetric history, clinical symptoms, and signs (headaches, breastfeeding, goitre, etc.) and serum adrenocorticotropic levels should help with the differential diagnosis.

Background: All surgical procedures have potential risk of complications of which obstetrics and gynaecological surgeries are no exception. However, the prognosis of such encounters depends on prompt diagnosis and timely interventions in this scenario by the general surgeons. Aim: To determine the general surgical encounters following obstetrics and gynaecological surgeries at the University of Port Harcourt Teaching Hospital (UPTH): a 10 – year review. Method: This was a 10 –year retrospective review of all the encounters involving the general surgeon following obstetrics and gynaecological surgeries at the University of Port Harcourt Teaching Hospital (UPTH). The information was obtained from the patients case notes. Permission for the study was granted by the ethical committee of the hospital. Data obtained was analysed using SPSS version 25. Results: There were 92 surgical encounters for the period under review. The mean age was 33 ± 2 years. The age range was 20 to 48 years. The modal parity was 2. The marital status of subjects, 60 (65.3%) were married, 26 (28.3%) were single, 4 (4.3%) were divorced and 2 (2.1%) were widowed. The commonest obstetrics and gynaecological surgery was emergency caesarean section 24 (63%) while the most common surgical encounter was incisional hernia 42 (76%). The preferred incision made to repair encounters was mid-line incision 46 (67.4%). Majority of the cadre of surgeons that repaired surgical encounters were consultants 55 (60.9%). Conclusion: The commonest surgical encounter following obstetrics and gynaecological surgery was emergency caesarean section. Incisional hernia was the most common surgical encounter. Prompt diagnosis and intervention by the combined team of the general surgeons and the obstetrician/gynaecologist resulted in favourable outcome. Collaboration between obstetrician and gynaecologist and other surgical specialties cannot be overemphasized for better prognosis in cases of adverse intra-operative encounters.

Objective: To identify the main scientific evidence snaging the risk factors of puerperal infection. Method: This is a scope review based on the recommendations of The Joanna Brigs Institute. PubMed, Cochrane Library and LILACS databases were searched. Where studies were selected, extracted and mapped. The identified risk factors that obtained recurrent citations in scientific productions were identified. Results: Found 147 articles published between 2000 and 2019, 20 of them included. The risk factors most cited in the scientific evidence were: cesarean delivery, socioeconomic condition and schooling, rupture of the membrane of greater 24 hours, number of vaginal touches, cesarean section in the second stage of labor, among others. Conclusion: Cesarean delivery was considered as the most cited risk factor in the literature, and social vulnerability proved to be a relevant epidemiological factor in the field of women's health.

Background There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment. However, little is understood about the role and optimal nature of prehabilitation for gynaecological cancer patients, who usually face extensive and life-changing surgery in addition to other treatments that impact significantly on physiological and psychosexual wellbeing. Review question This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to engagement and delivery that should be considered when designing a prehabilitation intervention for this group of women. Methods Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, reporting on multimodal prehabilitation in gynaecological cancers were included in the final review, whether qualitative, quantitative or mixed-methods. Qualitative studies on unimodal interventions were also included, as these were thought to be more likely to include information about barriers and facilitators which could also be relevant to multimodal interventions. A realist framework of context, mechanism and outcome was used to assist interpretation of findings. Results In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n = 12), endometrial only (n = 1), mixed ovarian, endometrial, vulvar (n = 5) and non-specific gynaecological tumours (n = 6). There was considerable variation across studies in terms of screening for prehabilitation, delivery of prehabilitation and outcome measures. Key mechanisms and contexts influencing engagement with prehabilitation can be summarised as: (1) The role of healthcare professionals and organisations (2) Patients’ perceptions of acceptability (3) Factors influencing patient motivation (4) Prehabilitation as a priority (5) Access to prehabilitation. Implications for practice A standardised and well evidenced prehabilitation programme for women with gynaecological cancer does not yet exist. Healthcare organisations and researchers should take into account the enablers and barriers to effective engagement by healthcare professionals and by patients, when designing and evaluating prehabilitation for gynaecological cancer patients.

IntroductionNatural Orifice Transluminal Endoscopic Surgery is a minimal invasive technique using natural body orifices like the vagina. Benefits of a vaginal assisted NOTES hysterectomy (VANH) are no visible scars, less blood loss, shorter surgery time and it allows more women to undergo a hysterectomy in a day-care setting compared with the total laparoscopic hysterectomy. Trials comparing vaginal hysterectomy (VH) and VANH are lacking. The aim of this study is to compare hysterectomy by VANH versus VH for same-day discharge (SDD), complications, surgical outcomes, postoperative recovery, quality of life, costs and cost-effectiveness.Methods and analysisThe study is a single-blinded, multicentre, randomised controlled trial. Eligible women with benign indication for hysterectomy will be randomly allocated to the VH (control) group or the VANH (intervention) group. The primary outcome is SDD. We calculated a sample size of 124 women assuming 27% SDD difference with an alpha of 0.05 and power of 0.8. A total of 83 patients will be included in the VANH-group and 41 patients in the VH-group, using an enrolment ratio of 2:1. Secondary outcomes are; surgery-related complications, surgical outcomes, postoperative recovery, quality of life, costs and cost-effectiveness.Ethics and disseminationThe study was approved on 27 May 2021 by the Ethics Committee of the Zuyderland Medical Centre Heerlen. The first patient was randomised on 8 July 2021. The last participant randomised should be treated before 31 December 2022. The results will be presented in peer-reviewed journals and at scientific meetings within 4 years after starting recruitment.Trial registration numberNCT04886791.

This is an independent report on NHS waiting lists for elective procedures in England. It isthe first analysis to focus specifically on procedures rather than the overall waiting list which includes outpatients and medical treatments. We report that in addition to the 1 million people waiting for elective procedures on the NHS waiting list in England, there are also 3.3 million people on the 'hidden' waiting list. We have presented specialty-level breakdowns and have identified 20 key procedures that represent 70% of the waiting list. We project waiting lists through to 2030.

Contains fulltext : 287740.pdf (Publisher’s version ) (Open Access) OBJECTIVE: International validation of the Dutch Delphi study about which anatomical structures should be taught to ensure safe and competent practice among general gynaecologists. STUDY DESIGN: Validation study with gynaecologists and trainees in gynaecology from academic, non-academic teaching and non-academic, non-teaching hospitals worldwide. The relevance of 123 items included in the Dutch Delphi study was scored on a Likert scale between 1 (not relevant) and 5 (highly relevant). Consensus was defined when ≥70 % of the panellist scored the item as relevant or very relevant and the average rating was ≥4. RESULTS: A total of 192 gynaecologists and trainees from seven countries (Belgium, Germany, Norway, Oceania, Sweden, United Kingdom and United States) completed the questionnaire. Of the 123 structures, 72 (58.5%) were internationally relevant. When the 72 relevant structures from the international Delphi study were compared with the 86 relevant structures from the Dutch Delphi study, 70 (81.4%) structures matched. CONCLUSIONS: This study identified 70 anatomical structures that should be taught for safe and competent practice of general gynaecologists based on national and international validation. The results of our study identify the learning needs (i.e., the content) for an international anatomy curriculum. The development of the curriculum (i.e., the form) can be determined by each country and used to standardize and guide postgraduate training in gynaecology. This is an important step in the era of international teaching and training.

Summary Adrenocortical carcinoma (ACC) is a malignant disorder with rapid evolution and severe prognosis in adults and most produce cortisol and androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, especially in women, tend to be larger and have worse prognosis compared with other types of ACCs. We report the case of a 58-year-old woman who presented with bilateral breast enlargement and postmenopausal genital bleeding. She presented high estradiol (818 pg/mL – 25 times above upper normal limit for postmenopausal women) and testosterone (158 ng/dL – 2 times above upper normal limit) levels and no suppression of cortisol after overnight 1 mg dexamethasone test (12.5 µg/dL; normal reference value: < 1.8 µg/dL). The patient had no clinical features of cortisol excess. MRI showed a 12 cm tumor in the right adrenal. Clinical findings of bilateral breast enlargement and postmenopausal genital bleeding with no signs of hypercortisolism associated with hormonal findings of elevated estradiol and testosterone levels would indicate either an ovarian etiology or an adrenal etiology; however, in the context of plasma cortisol levels non-suppressive after dexamethasone test and the confirmation of an adrenal tumor by MRI, the diagnosis of an adrenal tumor with mixed hormonal secretion was made. The patient underwent an open right adrenalectomy and pathological examination revealed an ACC with a Weiss’ score of 6. Estradiol and testosterone levels decreased to normal range soon after surgery. She was put on mitotane treatment as adjuvant therapy, but due to side effects, we were unable to up-titrate the dose and she never achieved serum mitotane dosage above the desired 14 µg/mL. The patient remained in good health without any local recurrence or metastasis until 5 years after surgery, when increased levels of estradiol (81 pg/mL – 2.5 times above upper normal limit) and testosterone (170 ng/dL – 2.1 times above upper normal limit) were detected. MRI revealed a retroperitoneal nodule measuring 1.8 × 1.2 cm. The pathological finding confirmed the recurrence of the estrogen-secreting ACC with a Weiss’ score of 6. After the second procedure, patient achieved normal estrogen and androgen serum levels and since then she has been followed for 3 years. The overall survival was 8 years after the diagnosis. In conclusion, although extremely rare, a diagnosis of an estrogen-secreting ACC should be considered as an etiology in postmenopausal women presenting with bilateral breast enlargement, genital bleeding and increased pure or prevailing estrogen secretion. Learning points: Estrogen-secreting adrenocortical carcinomas are exceedingly rare in adults and account for 1−2% of adrenocortical carcinomas. Estrogen-secreting adrenal tumors can be present in females, but are even more rare, we found few cases described in the literature. In women, they present with precocious puberty or postmenopausal bleeding. Feminization in the context of an adrenal tumor is considered almost pathognomonic of malignancy. Feminizing ACCs tend to be larger and with worse prognosis compared with nonfeminizing ACCs.

Cell lines are widely used for various research purposes including cancer and drug research. Recently, there have been studies that pointed to discrepancies in the literature and usage of cell lines. That is why we have prepared a comprehensive overview of the most common gynaecological cancer cell lines, their literature, a list of currently available cell lines, and new findings compared with the original studies. A literature review was conducted via MEDLINE, PubMed and ScienceDirect for reviews in the last 5 years to identify research and other studies related to gynaecological cancer cell lines. We present an overview of the current literature with reference to the original studies and pointed to certain inconsistencies in the literature. The adherence to culturing rulesets and the international guidelines helps in minimizing replication failure between institutions. Evidence from the latest research suggests that despite certain drawbacks, variations of cancer cell lines can also be useful in regard to a more diverse genomic landscape.

Background Failing conservative therapies, uterine artery embolisation (UAE) has been proposed as a uterine‐sparing option for treatment of symptomatic adenomyosis. UAE appears effective at short‐term; however long‐term durability is less well established. Aims To evaluate the long‐term clinical efficacy of UAE for treatment of adenomyosis. Materials and Methods One hundred and four women with initial clinical success following UAE for adenomyosis (results previously published) were further followed with a two‐part online survey. Part one inquired about menopause, symptom recurrence, need for further intervention and overall satisfaction. Part two comprised the Uterine Fibroid Symptom and health‐related Quality of Life (UFS‐QOL) questionnaire. Maintenance of clinical success was defined as remaining ‘happy’ or ‘very happy’ with overall outcome, no recurrence of symptoms, or need for further intervention. Results Of those women with initial success, 91/104 (88%) participated in this long‐term study at mean 52 months following UAE. Maintenance of clinical success was demonstrated in 82/91 (90%) women. For the remaining 9/91 (10%) women, mean time to failure was 31 months. There were 53/91 (58%) women who reached menopause at mean age of 51.5 years, occurring at mean 30 months post‐UAE. UFS‐QOL demonstrated significant decrease in symptom severity from 58.9 to 20.0 (P

STUDY QUESTION Can markers of human endometrial hypoxia be detected at menstruation in vivo? SUMMARY ANSWER Our in vivo data support the presence of hypoxia in menstrual endometrium of women during physiological menstruation. WHAT IS KNOWN ALREADY Current evidence from animal models and human in vitro studies suggests endometrial hypoxia is present at menstruation and drives endometrial repair post menses. However, detection of human endometrial hypoxia in vivo remains elusive. STUDY DESIGN, SIZE, DURATION We performed a prospective case study of 16 women with normal menstrual bleeding. PARTICIPANTS/MATERIALS, SETTING, METHODS Reproductively aged female participants with a regular menstrual cycle underwent objective measurement of their menstrual blood loss using the alkaline haematin method to confirm a loss of 3 cm. Participants attended for two MRI scans; during days 1–3 of menstruation and the early/mid-secretory phase of their cycle. The MRI protocol included dynamic contrast-enhanced MRI and T2* quantification. At each visit, an endometrial sample was also collected and hypoxia-regulated repair factor mRNA levels (ADM, VEGFA, CXCR4) were quantified by RT-qPCR. MAIN RESULTS AND THE ROLE OF CHANCE Women had reduced T2* during menstrual scans versus non-menstrual scans (P = 0.005), consistent with menstrual hypoxia. Plasma flow (Fp) was increased at menstruation compared to the non-menstrual phase (P = 0.0005). Laboratory findings revealed increased ADM, VEGF-A and CXCR4 at menstruation on examination of paired endometrial biopsies from the menstrual and non-menstrual phase (P = 0.008; P = 0.03; P = 0.009). There was a significant correlation between T2* and these ex vivo hypoxic markers (P LIMITATIONS, REASONS FOR CAUTION This study examined the in vivo detection of endometrial hypoxic markers at specific timepoints in the menstrual cycle in women with a menstrual blood loss WIDER IMPLICATIONS OF THE FINDINGS Heavy menstrual bleeding (HMB) is a common, debilitating condition. Understanding menstrual physiology may improve therapeutics. To our knowledge, this is the first in vivo data supporting the presence of menstrual hypoxia in the endometrium of women with normal menstrual bleeding. If aberrant in those with HMB, these non-invasive tests may aid diagnosis and facilitate personalized treatments for HMB. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by Wellbeing of Women grant RG1820, Wellcome Trust Fellowship 209589/Z/17/Z and undertaken in the MRC Centre for Reproductive Health, funded by grants G1002033 and MR/N022556/1. H.O.D.C. has clinical research support for laboratory consumables and staff from Bayer AG and provides consultancy advice (but with no personal remuneration) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc; Myovant Sciences GmbH. H.O.D.C. receives royalties from UpToDate for articles on abnormal uterine bleeding. TRIAL REGISTRATION NUMBER N/A.

Background Vulvodynia and pudendal neuralgia comprise significant contributors to vulvar-related pain and its impact on daily life. Aim A retrospective clinical audit was conducted at the Women's Health & Research Institute of Australia, Sydney, to determine the pattern of use and the efficacy of the application of topical amitriptyline 0.5% plus oestriol 0.03% in organogel (AOO), to the vulvar vestibule in reducing the impact of pain on daily life. Materials and methods There were 1174 patients who received a script from May 2017 until February 2020: 1054 patients agreed to be contacted and had a valid email address. Results There were 376 (35.7%) patients who replied. Pain with intercourse was the main indication for use. Treatment was rated effective by 51.2% (95% CI: 35.4-66.8%) of patients less than 30 years of age, 66.7% (95% CI: 57.3-74.9%) of patients 30-50 years of age, and 58.3% (95% CI: 50.9-65.4%) in patients over 50. Stinging at the site of application was the most commonly reported side effect. Conclusion Topical AOO is an effective and well-tolerated treatment for vulvar pain.

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Introduction This study aimed to assess the accuracy of transvaginal ultrasound (TVUS) for the mapping of endometriosis before surgery when performed by sonographers in an outpatient women's imaging centre. Methods A prospective longitudinal cohort study was performed. The study group comprised of 201 women who underwent a comprehensive TVUS assessment, performed by a sonographer. Laparoscopy was performed as the reference standard. Complete TVUS and surgical data were available for 53 women who were included in the final analysis. Results Endometriosis was confirmed at a surgery in 50/53 (94.3%) participants, with 25/53 (47.2%) having deep endometriosis (DE) nodules and/or endometriomas present. TVUS for mapping of DE had an overall sensitivity of 84.0%, specificity of 89.3%, PPV of 87.5%, NPV of 86.2%, LR+ of 7.85, LR- of 0.18, and accuracy of 86.8% (P < 0.001). Ovarian immobility had poor sensitivity for detecting localised superficial endometriosis, DE, adhesions, and/or endometriomas (Left = 61.9% and right = 13.3%) but high specificities (left = 87.5% and right = 94.7%). Site-specific tenderness had low sensitivities and moderate specificities for the same. All soft markers of endometriosis failed to reach statistical significance except for left ovarian immobility (P =

Background: Carboplatin, the key drug used in treating gynaecological cancer, has an approximately 12–16% risk of hypersensitivity reactions. We aimed to investigate the efficacy and adverse effects of carboplatin desensitisation therapy for gynaecological cancer. Methods: The desensitisation protocol was standardised as a four-step, 4-h, carboplatin administration in the hospital. A retrospective medical record review was conducted on 15 patients who underwent carboplatin desensitisation for gynaecological malignancies at our hospital. Patients’ data were analysed to evaluate the treatment success rate, therapeutic effect of desensitisation, adverse events, and treatment. Results: Of 91 carboplatin desensitisation cycles scheduled; the completion rate was 93.4% (85/91). Adverse events occurred in 23 of these 91 (25.3%). In four (4.4%) of the 23 cycles, hypersensitivity reactions could be treated only by discontinuing the infusion and slowing the administration, while in the remaining 19 (20.9%), medication was administered intravenously after discontinuing the infusion to manage hypersensitivity reactions. No treatment-related deaths occurred. Overall, 23 series of anti-cancer agent regimens, including carboplatin desensitisation, were administered to the 15 patients. The therapeutic response rate was 82.6% and the disease control rate was 95.7%. Conclusions: Carboplatin desensitisation was beneficial in patients with a history of carboplatin-induced hypersensitivity reactions.

Background and objective: Mode of delivery is one of the issues that most concerns obstetricians. The caesarean section rate has increased progressively in recent years, exceeding the limit recommended by health institutions. Obstetricians generally lack the necessary technology to help them decide whether a caesarean delivery is appropriate based on antepartum and intrapartum conditions. Methods: In this study, we have tested the suitability of using three popular artificial intelligence algorithms, Support Vector Machines, Multilayer Perceptron and, Random Forest, to develop a clinical decision support system for the prediction of the mode of delivery according to three categories: caesarean section, euthocic vaginal delivery and, instrumental vaginal delivery. For this purpose, we used a comprehensive clinical database consisting of 25038 records with 48 attributes of women who attended to give birth at the Service of Obstetrics and Gynaecology of the University Clinical Hospital "Virgen de la Arrixaca" in the Murcia Region (Spain) from January of 2016 to January 2019. Women involved were patients with singleton pregnancies who attended to the emergency room on active labour or undergoing a planned induction of labour for medical reasons. Results: The three implemented algorithms showed a similar performance, all of them reaching an accuracy equal to or above 90% in the classification between caesarean and vaginal deliveries and somewhat lower, around 87% between instrumental and euthocic. Conclusions: The results validate the use of these algorithms to build a clinical decision system to help gynaecologists to predict the mode of delivery.

Abnormal menstruation may result in several pathological alterations and gynaecological diseases, including endometriosis, menstrual pain and miscarriage. However, the pathogenesis of menstruation remains unclear due to the limited number of animal models available to study the menstrual cycle. In recent years, an effective, reproducible, and highly adaptive mouse model to study menstruation has been developed. In this model, progesterone and oestrogen were administered in cycles following the removal of ovaries. Subsequently, endometrial decidualisation was induced using sesame oil, followed by withdrawal of progesterone administration. Vaginal bleeding in mice is similar to that in humans. Therefore, the use of mice as a model organism to study the mechanism of menstruation and gynaecological diseases may prove to be an important breakthrough. The present review is focussed ond the development and applications of a mouse model of menstruation. Furthermore, various studies have been described to improve this model and the research findings that may aid in the treatment of menstrual disorders in women are presented.

Objective To explore the impact of the COVID-19 pandemic on the mental health of Obstetricians and Gynaecologists. Study design A cross-section survey-based study amongst doctors working within Obstetrics and Gynaecology in the United Kingdom. Results A total of 207 doctors completed the survey. Obstetricians and Gynaecologists reported significantly higher rates of both Major Depressive Disorder (versus, p = 0.023) and Generalised Anxiety Disorder (versus, p = 0.044) as compared to the UK-wide estimates. Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (versus, p = 0.047). Although the prevalence of GAD was higher amongst registrars compared to their Consultant and/or Senior House Officer counterparts, this was not statistically significant. Respondents felt that the most significant factor for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only of respondents felt able to talk to colleagues about their mental health. Conclusions Key findings include the high prevalence of mental health conditions amongst doctors, demonstration of the persistent taboo that mental health carries within the speciality and the key contributory factors to poor mental health. Further work should be done to assess if changes to the way new and updating guidelines, protocols and pathways are disseminated reduces the impact on the mental health of doctors. With the threat of a second COVID-19 peak looming, now more than ever, it is vital that steps are taken to break the stigmatisation of mental health amongst doctors, encouraging doctors to seek help when required.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age with reproductive, metabolic and endocrine implications. While the exact pathophysiological mechanisms of the syndrome are unknown, its heterogeneity suggests a multifactorial causal background. In the last two decades, numerous environmental chemicals, including Bisphenol-A (BPA) that is used in the synthesis of polycarbonate plastics, have been proposed as potential contributors to the aetiology of PCOS. This review provides a holistic overview of the available data regarding the possible relation of PCOS with BPA exposure. We have included a total number of 24 studies. Eleven human case-control and 13 animal studies provided data regarding this potential relation. Accumulating evidence suggests that a correlation between high levels of BPA and the presence of PCOS may exist. Contradicting results from human and animal studies, however, render it difficult to conclude on the exact role of BPA in the pathogenesis of PCOS. BPA may constitute a consequence of the syndrome rather than a cause, but further research is still needed to clarify this. Continued efforts to study the early origins of PCOS, using prospective-designed studies, are required to identify the exact effect of BPA on women with PCOS.

Summary HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance (IR) and Acanthosis Nigricans, constitutes a rare nosologic entity. It is characterized from clinical and biochemical hyperandrogenism accompanied with severe insulin resistance, chronic anovulation and metabolic abnormalities. Literally, HAIR-AN represents an extreme case of polycystic ovary syndrome (PCOS). In everyday practice, the management of HAIR-AN constitutes a therapeutic challenge with the available pharmaceutical agents. Specifically, the degree of IR cannot be significantly ameliorated with metformin administration, whereas oral contraceptives chronic administration is associated with worsening of metabolic profile. Liraglutide and exenatide, in combination with metformin, have been introduced in the management of significantly obese women with PCOS with satisfactory results. Based on this notion, we prescribed liraglutide in five women with HAIR-AN. In all participants a significant improvement regarding the degree of IR, fat depositions, androgen levels and the pattern of menstrual cycle was observed, with minimal weight loss. Furthermore, one woman became pregnant during liraglutide treatment giving birth to a healthy child. Accordingly, we conclude that liraglutide constitutes an effective alternative in the management of women with HAIR-AN. Learning points: HAIR-AN management is challenging and classic therapeutic regimens are ineffective. Literally HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance and Acanthosis Nigricans, represents an extreme case of polycystic ovary syndrome. In cases of HAIR-AN, liraglutide constitutes an effective and safe choice.

Background The diagnosis of Asherman syndrome, or 'intra-uterine adhesions' is often overlooked when the symptoms of amenorrhea and hematometra are missing. Aims This audit reviews the clinical data of a large cohort of patients treated by a single operator. Materials and methods From July 1998 till the end of December 2017, 423 patients with intra-uterine adhesions were treated by a single operator. Clinical information was obtained by review of the medical files and phone interviews. Results Amenorrhea was recorded in 163/423 patients (38.5%), 225/423 (53.2%) patients did not have amenorrhea and for 35/423 (8.3%) patients the information was missing. A hematometra was documented in 19/423 (4.5%) patients. Pregnancy was achieved in 215/246 (87.4%). Patients with stage II disease did best with a pregnancy rate of 94.5% (P = 0.029). Conclusion Asherman syndrome should be considered in any woman with a history of miscarriage or postpartum curettage who then fails to conceive again.

Introduction Vaginal dilation is often indicated as an intervention for the management of radiation therapy‐induced vaginal adhesions and stenosis (RTVAS). However, limited research exists underpinning this intervention and diversity in patient recommendations internationally are reported. In the absence of New Zealand (NZ) national guidelines regarding the management of RTVAS, a survey of NZ radiation therapy departments was conducted to gain an overview of current practice. Methods A two‐section online survey was developed to capture RTVAS education and management overview across NZ. Section one focused on departmental resourcing and section two on local standard practice regarding vaginal dilator usage. One RTVAS education representative from each department was invited to complete the survey. Results Eight of nine NZ departments completed the survey. Consistent treatment indications were identified for RTVAS patient education with the involvement of diverse staffing groups at various time‐points throughout the treatment process. Protocols for RTVAS management existed in each RT department with staff commonly trained by informal peer observation. Dilator usage was recommended regardless of patient sexual activity. Agreement was shown regarding the recommended start time of dilator usage and frequency. The recommended duration of dilator use post‐treatment varied from 6 months to greater than 36 months. Conclusions This work illustrates both concordance and diversity in practice and contributes to the limited body of literature available. Further research is warranted to explore patterns of practice between departmental protocols and individual practitioners in further detail., How do New Zealand's RT departments manage RT‐induced vaginal adhesions and stenosis for female pelvic cancer patients? For the first time, the results of a national survey are published and give an overview of current practice in New Zealand.

Summary A 33-year-old female presented with a right 11.6 cm ovarian cyst. Routine pre-operative thyroid function tests showed thyroid stimulating hormone (TSH) of less than 0.02 mU/L (0.3–3.05) and a free thyroxine (FT4) of 5.5 pmol/L (10–28.2) suggesting either assay interference, triiodothyronine (T3) ingestion or hypopituitary hypothyroidism. A free triiodothyronine (FT3) level was requested which was high normal 6.9 pmol/L (3.1–8.1). Parallel assays on a different platform were similar but with a raised FT3 of 7.2 pmol/L (3.1–6.8). TSH receptor stimulating antibody (TSHAb) and thyroid peroxidase antibodies (TPO) were negative. Antithyroglobulin antibody (TgAb) was positive at 155.6 IU/mL (0–115). She was clinically euthyroid. Thyroid ultrasound showed a normal sized mildly heterogeneous gland with low blood flow and a solitary 1.5 cm U3 (BTA) nodule with higher blood flow. Thyroid Tc99m uptake was very low 0.2% (0.6–3.0) with no nodule uptake. These results demonstrated an extrathyroidal source of excessive autonomous T3 production resulting in the low thyroxine (T4). With carbimazole her TSH rose to 11.9 mU/L, FT4 rose to 7.7 pmol/L and FT3 reduced to 3.6 pmol/L. Histological diagnosis was Struma Ovarii. Her TSH, FT4 and FT3 remained normal thereafter. In conclusion, an extrathyroidal source of high T3 secretion was diagnosed using routine thyroid tests and scans. We believe this is the first description of a Struma Ovarii exclusively secreting T3 hormone characterised by the paradoxical rise of a low FT4 to normal with treatment. Two years later she developed non-secreting peritoneal deposits of highly differentiated follicular carcinoma. Learning points: Abnormally low TSH and FT4 levels suggestive of possible T3 ingestion, or less likely, hypopituitary hypothyroidism should always be followed by an assay of FT3. The diagnosis of an extrathyroidal source of T3 can be made using conventional thyroid tests, thyroid ultrasound scanning and technetium thyroid uptake and scan imaging. In a pre-menopausal patient this avoids a radiation dose to the pelvis. Pelvic radioisotope scanning of a suspected Struma Ovarii causing thyrotoxicosis can be reserved for patients whose thyroid function remains abnormal after initial surgery. Carbimazole is effective in the treatment of extrathyroidal autonomous T3 hormone production from a Struma Ovarii. The pathological appearance of a Struma Ovarii is not a guide to its malignancy. Even with a benign appearance they can disseminate to peritoneum, as highly differentiated follicular carcinoma (previously known as peritoneal strumosis). Hyperthyroid secretion by a Struma Ovarii may not be replicated in the metastatic follicular carcinoma in the peritoneum.

Ultrasound is the first-line imaging modality in the assessment of the female reproductive system in all age groups. However, the paediatric and adolescent subset of patients present a particular set of challenges. These include technical challenges that come from largely being limited by transabdominal imaging as well as dealing with the often-complex social issues around the sexual health of adolescents. In addition, this group of patients has a unique set of pathologies that are not seen in the adult population and conversely, common gynaecological conditions affecting adults such as endometriosis and polycystic ovarian syndrome are difficult to diagnose in adolescents. Therefore, we propose that paediatric and adolescent gynaecological ultrasound requires a different approach. This paper summarises the differences in technique, common pathologies and touches on some of the relevant social issues that are unique to this population of patients. Refereed/Peer-reviewed

Contains fulltext : 225410.pdf (Publisher’s version ) (Closed access) Objective: Determination of the anatomical structures that should be taught to ensure safe and competent practice among general gynaecologists. Study Design: A two-round Delphi survey, face-to-face meeting in focus groups and an individual interview. Participants were medical doctors and trainees from gynaecology, surgery, urology and radiology from academic, non-academic teaching and non-academic, non-teaching hospitals in the Netherlands. Relevant structures were collected from gynaecology surgery atlas based on most common gynaecological surgeries and diseases. These structures were supplemented and critically viewed in focus groups followed by a Delphi survey. In the Delphi survey gynaecologist and trainee's gynaecology from all over the Netherlands scored the items on a Likert scale between 1 (not relevant) and 5 (highly relevant). Consensus was defined when >= 70 % of the panellist scored the item as relevant or very relevant and the average rating was >= 4. Main outcome was clinically relevant anatomical structures. Results: Consensus on 86 clinically relevant anatomical structures divided by nine categories. Conclusions: This study identified a core list of anatomical structures that are relevant to the safe and competent practice of general gynaecologists and that can be used to guide gynaecology postgraduate education. This is the first step in a much wider and complex process of becoming a competent gynaecologist. (C) 2019 Elsevier B.V. All rights reserved.

Objective The aim was to study clinical, histopathological and immunological changes in the vagina and cervix of women with primary SS, which might explain vaginal dryness. Methods We included 10 pre-menopausal female primary SS patients with vaginal dryness and 10 pre-menopausal controls undergoing a laparoscopic procedure. The vaginal health index was recorded. Multiplex immunoassays and flow cytometry were performed on endocervical swab and cervicovaginal lavage samples to evaluate cellular and soluble immune markers. Mid-vaginal and endocervical biopsies were taken and stained for various leucocyte markers, caldesmon (smooth muscle cells), avian V-ets erythroblastosis virus E26 oncogene homologue (ERG; endothelial cells) and anti-podoplanin (lymphatic endothelium). The number of positive pixels per square micrometre was calculated. Results One patient was excluded because of Clamydia trachomatis, and two controls were excluded because of endometriosis observed during their laparoscopy. Vaginal health was impaired in primary SS. CD45+ cells were increased in vaginal biopsies of women with primary SS compared with controls. Infiltrates were predominantly located in the peri-epithelial region, and mostly consisted of CD3+ lymphocytes. In the endocervix, CD45+ infiltrates were present in patients and in controls, but a higher number of B lymphocytes was seen in primary SS. Vascular smooth muscle cells were decreased in the vagina of primary SS patients. No differences were found in leucocyte subsets in the vaginal and endocervical lumen. CXCL10 was increased in endocervical swab samples of primary SS patients. Conclusion Women with primary SS show impaired vaginal health and increased lymphocytic infiltration in the vagina compared with controls. Vaginal dryness in primary SS might be caused by vascular dysfunction, possibly induced by IFN-mediated pathways.

Objectives: To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the ASPIRE COVID-19 study. \ud Setting: Maternity care provision in England. \ud Participants: Interviews were held with 26 national governmental, professional, and service-user organisation leads (July-Dec 2020). Other data included public-facing outputs logged from 25 maternity Trusts (Sept/Oct 2020) and data extracted from 78 documents from eight key governmental, professional, and service-user organisations that informed national maternity care guidance and policy (Feb-Dec 2020). \ud Results: Six themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting. ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum; and 'Loss of human rights for gain in infection control’ emphasizes how a predominant focus on infection control was at a cost to psychological safety and human rights. \ud Conclusions: Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations. \ud \ud Strengths and limitations of this study\ud • This is the first paper to consider links between policy and practice in companionship and visiting in maternity care during the COVID-19 pandemic.\ud • Data triangulation across national level stakeholders in policy and practice and public facing Trust documentation provides nuanced and context related perspectives on why and how companionship and visiting was impacted. \ud • Stakeholders included national representatives from all key agencies involved in maternity care. \ud • Practice related issues were collected from 25 Trusts websites and social media-based public facing information, which may or may not reflect actual care practices. \ud • The paper focuses on antenatal and intrapartum care, with postnatal (including neonatal) care to be the focus of future publications.\ud • The study does not include information directly reported by parents or healthcare professionals.

Gynaecology is the medical practice dealing with the health of thefemale reproductive system. Female genital tract is most common site for tumors in females. The most common type of female genital tract cancers are; cervical, ovarian and endometrial carcinoma. There are other less common tumors including tumors of vagina, vulva and fallopian tubes. The aim of this study is to compare the prevalence of gynaecological specimens and pathology attended to in the tertiary institutions of Bayelsa state from a period of 2015 to 2020. This study was carried out in Niger Delta University Teaching Hospital, Okolobiri and Federal Medical Centre, Yenagoa, involving the cervical specimens, endometrial specimens and vulva specimens received in their various Histopathology units. The sample size was determined based on the number of specimens received in the both tertiary institutions from 2015 to 2020. Data were retrieved by writing out the patients information, e.g. age, diagnosis and specimen types according to the year it was received. The data retrieved was statistically analyzed using SPSS and Microsoft excel. Tables and frequencies were generated. NDUTH, Okolobiri received a total number of 73 cervical specimens with no positive case of cervical cancer, 171 endometrial curettage specimens with 0.6% of endometrial cancer, and 2 vulva specimens with no carcinoma reported from a period of 2015 to 2020 while FMC, Yenagoa received a total number of 513 cervical specimens with no cervical cancer reported, 391 endometrial curettage specimens with 0.3% of endometrial cancer reported and no vulva specimen was received from a period of 2015 to 2020. From this study, we observed that Federal Medical Centre, Yenagoa received more gynaecological specimens (cervical specimens, and Endometrial curettage specimens) than Niger Delta University Teaching Hospital, Okolobiri. Female subjects who visited the gynaecological clinic more fell within the age brackets of 30 to 39 years in the both facilities.