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Objectives To determine the impact of postoperative dienogest on recurrence of endometriosis following conservative surgery. Methods The following databases were searched from inception to March 2019: Ovid MEDLINE, Ovid EMBASE, PubMed (Non-Medline records only), EBM Reviews - Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomised Controlled Trial Number Registry. Observational and randomized controlled studies with pre-menopausal women undergoing conservative surgery for endometriosis followed by post-operative dienogest treatment for at least 6 months were included. Primary outcome was the rate of endometriosis/endometrioma recurrence. For studies with a comparator group, we compared post-operative suppression with dienogest to no treatment. Results After screening 328 studies, 10 met inclusion criteria (9 retrospective, 1 prospective) representing 2031 patients (1184 treated, 846 controls). Among patients treated with dienogest, there were 2.11 recurrences per 100 women (95% CI: 1.43 to 3.11, 10 studies, 1184 patients, I2 = 0% fixed effects model). Comparatively, those managed expectantly had a significantly higher incidence of disease recurrence (28.61 events/100 women; 95% CI: 25.66 to 31.74, 6 studies, 846 patients, I2 = 83% fixed effects model). The odds of recurrence were significantly lower in women treated with dienogest compared to those without postoperative medical treatment (log odds -1.96, 95% CI -2.53 to -1.38, p Conclusions Women treated with dienogest following conservative endometriosis surgery have a significantly lower rate of disease recurrence compared to those not receiving post-operative hormonal suppression.

Objectives The administration of multiple repeat courses of antenatal corticosteroids (ACS) in pregnant patients who remain undelivered after initial ACS administration has not been shown to have clear benefit, and may have associated harms. This study aims to review the literature on the impact of a single “rescue” course or dose of ACS in patients who remain undelivered >7 days following administration of an initial course. Methods We conducted a comprehensive search of electronic databases, clinical trial registries, and reference lists of relevant publications. RCTs and observational studies published from 1972 that assessed neonatal outcomes after administration of a rescue course or dose of ACS compared to a single course were included. Two reviewers independently screened studies for inclusion and assessed risk of bias. Data was extracted by one reviewer. Results were synthesized narratively. Results A total of 1978 references were screened; three RCTs and four observational studies met inclusion criteria. These differed in gestational age ranges included, time elapsed between initial and rescue ACS, and inclusion of multiple pregnancies. Four studies investigated a rescue course and two studied a rescue dose; one study combined those groups. One study showed a significant decrease in mortality with rescue ACS, and two found decreased respiratory distress syndrome with a rescue course. None showed a significant difference in birthweight with rescue ACS. Conclusions While these results suggest that rescue ACS may be beneficial and not harmful compared to a single course, the results are limited due to the heterogeneity of the literature. Further well-designed studies are needed.