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Objectives: To examine the experiences among Dutch and American clinicians on the impact of using encounter patient decision aids (ePDAs) on their clinical practice, and subsequently to formulate recommendations for sustained ePDA use in clinical practice., Design: Qualitative study using semi-structured interviews with clinicians who used 11 different ePDAs (applicable to their specialty) for 3 months after a short training. The verbatim transcribed interviews were coded with thematic analysis by six researchers via ATLAS.ti., Setting: Nine hospitals in the Netherlands and two hospitals in the USA., Participants: Twenty-five clinicians were interviewed: 16 Dutch medical specialists from four different disciplines (gynaecologists, ear-nose-throat specialists, neurologists and orthopaedic surgeon), 5 American gynaecologists and 4 American gynaecology medical trainees., Results: The interviews showed that the ePDA potentially impacted the patient-clinician dialogue in several ways. We identified six themes that illustrate this: that is, (1) communication style, for example, structuring the conversation; (2) the patient's role, for example, encouraging patients to ask more questions; (3) the clinician's role, for example, prompting clinicians to discuss more information; (4) workflow, for example, familiarity with the ePDA's content helped to integrate it into practice; (5) shared decision-making (SDM), for example, mixed experiences whether the ePDA contributed to SDM; and (6) content of the ePDA. Recommendations to possibly improve ePDA use based on the clinician's experiences: (1) add pictorial health information to the ePDA instead of text only and (2) instruct clinicians how to use the ePDA in a flexible (depending on their discipline and setting) and personalised way adapting the ePDA to the patients' needs (e.g., mark off irrelevant options)., Conclusions: ePDAs contributed to the patient-clinician dialogue in several ways according to medical specialists. A flexible and personalised approach appeared appropriate to integrate the use of ePDAs into the clinician's workflow, and customise their use to individual patients' needs., Competing Interests: Competing interests: DD reports grants from ZonMw, during the conduct of the study. GE reports other from EBSCO, during the conduct of the study., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract Introduction The COVID-19 pandemic in the past few years led to major adjustments in the provision of healthcare. This study aimed to investigate trainees’ perception of impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong. Methods A cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression. Results A total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O&G specialty training. Conclusion The O&G trainees in Hong Kong perceived that the COVID-19 pandemic had significant negative impacts on their training. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training.

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value 0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more timeconsuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers.

Introduction: Periodontal medicine indicates a strong relationship between Periodontal Health (PH) or disease and ‘systemic health.’ Although Periodontal Disease (PD) is quite distant from the area affected by endometriosis, both conditions share a similar pathogenesis. Both endometriosis and PD are chronic inflammatory diseases that occur more commonly in patients with systemic disorders. Moreover, significant alterations in immune modulators have been shown to occur in both diseases. Need for the Study: The research is to evaluate the correlation between endometriosis and PH for early diagnosis, treatment planning, and prevention of long-term sequelae. Aim: To evaluate the PH status in female patients with endometriosis. Materials and Methods: A cross-sectional study will be carried out in the Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India from September 2023 to March 2024, involving 384 participants (192 patients diagnosed with endometriosis and 192 controls). Assessment of oral hygiene, plaque accumulation, gingival status, Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (GR), and other factors will be measured to evaluate the PH of the patients.

Robotic-assisted surgery is an advanced surgical technique that combines the skill of a surgeon with the precision and capabilities of robotic systems. This approach has revolutionised the field of medicine by providing enhanced visualisation, improved dexterity, and greater control during surgical procedures.The most widely used robotic system is the da Vinci surgical System, which allows surgeons to perform minimally invasive surgeries with smaller incisions, reduced blood loss, and faster recovery time for patients. Robotic-assisted surgery has been successfully applied in various specialities, including gynaecology, urology, general surgery, and thoracic surgery. It offers benefits such as enhanced surgical precision, better outcomes, and improved postoperative quality of life. However, the decision to use robotic-assisted surgery depends on factors such as patient suitability, surgeon expertise, and the availability of robotic systems. Ongoing advancements in robotic technology continue to shape the future of surgical practice, with the potential for further improvements in surgical techniques and patient care. Overall, robotic-assisted surgery represents a significant milestone in surgical innovation, providing a promising approach to improve surgical outcomes and patient well-being. The present narrative review describes the effect of robotic surgery in different disciplines and its effects on surgical outcomes.

Abstract 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.

Background Despite high reported prevalence of pelvic organ prolapse (POP), women report difficulties accessing evidence-based and reliable information about the condition. Many rely on social media and other popular and highly visible internet platforms which have been found to contain poor quality information that is difficult for the average patient to understand. The aim of the study is to co-design an information website for premenopausal women with POP. The website design will be based on the Website Developmental Model for the Healthcare Consumer (WDMHC) framework. Methods A four phase process will be utilised as per the WDMHC framework: 1) User, task and environmental analysis; 2) Functional and representational analysis; 3) Cognitive walkthrough, keystroke level model, heuristic testing; 4) Content based testing, expert testing and user-based testing. Ethics approval has been obtained (LS-23-19-Carroll-Ful). Two groups of stakeholders will be recruited (i) patient group (ii) healthcare professional (HCP) group. Patient participants will be recruited from an online pelvic floor dysfunction (PFD) support group (n=950 members). A website designer and HCP stakeholders involved in the multidisciplinary team caring for women with POP will be invited to participate. Both groups will participate in separate co-design online workshops. Focus group workshops will be video-recorded, transcribed and imported into NVivo. Themes and subthemes will be developed. The website will be designed and disseminated to all participants for feedback. Cognitive walkthrough and heuristic testing will be undertaken. Following this, necessary modifications will be made to the website. Participants will then complete a modified System Usability Scale (SUS) and the eHealth Impact Questionnaire, while five HCPs will complete the DISCERN instrument. Conclusion This study will inform the design and testing of an information website for women with POP. The website design and content will be informed by patient and HCP stakeholder voices and the health literacy literature.

Abstract 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, I 2 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 ).

Background: Despite high reported prevalence of pelvic organ prolapse (POP), women report difficulties accessing evidence-based and reliable information about the condition. Many rely on social media and other popular and highly visible internet platforms which have been found to contain poor quality information that is difficult for the average patient to understand. The aim of the study is to co-design an information website for women with POP. The website design will be based on the Website Developmental Model for the Healthcare Consumer (WDMHC) framework. Methods: A four phase process will be utilised as per the WDMHC framework: 1) User, task and environmental analysis; 2) Functional and representational analysis; 3) Cognitive walkthrough, keystroke level model, heuristic testing; 4) Content based testing, expert testing and user-based testing. Ethics approval has been obtained (LS-23-19-Carroll-Ful). Two groups of stakeholders will be recruited (i) patient group (ii) healthcare professional (HCP) group. Patient participants will be recruited from an online pelvic floor dysfunction (PFD) support group (n=950 members). A website designer and HCP stakeholders involved in the multidisciplinary team caring for women with POP will be invited to participate. Both groups will participate in separate co-design online workshops. Focus group workshops will be video-recorded, transcribed and imported into NVivo. Themes and subthemes will be developed. The website will be designed and disseminated to all participants for feedback. Cognitive walkthrough and heuristic testing will be undertaken. Following this, necessary modifications will be made to the website. Participants will then complete a modified System Usability Scale (SUS) and the eHealth Impact Questionnaire, while five HCPs will complete the DISCERN instrument. Conclusion: This study will inform the design and testing of an information website for women with POP. The website design and content will be informed by patient and HCP stakeholder voices and the health literacy literature.

Background and aim: To evaluate the clinical, pathological and surgical characteristics of adnexal masses in hysterectomized women with one or both ovaries conserved.Material and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology over twenty months, including 80 hysterectomized women with one or both adnexa preserved and later presented with subsequent adnexal masses. The previous surgical histories of these patients, present clinical and pathological characteristics of ovarian cysts, and possible management options were evaluated.Results: Among the study's 224 hysterectomized women presented to the Gynaecology Outpatient Department (OPD), 80 women with adnexal masses were included. Among the 80 hysterectomies, most were abdominal hysterectomies. Moreover, most patients underwent hysterectomy between 40 and 50 years of age. Symptomatic Fibroid uterus was the most common indication for hysterectomy. Among the 80 women in, 68.8% women, both ovaries were preserved. The most common presenting symptom was pain abdomen. Adnexal masses are evaluated by clinical examination, Radiological imaging modalities, and tumour markers depending on the need. Among the 80 women, 43.8% needed surgical intervention, 48.8% managed with conservative treatment, and 7.5% were referred to Oncology. Benign ovarian epithelial tumours were the most common type among surgically treated.Conclusions: The management of adnexal masses in hysterectomized women should be individualized, depending on the presenting symptoms, the size of the adnexal mass, radiological findings, tumour markers, and expected future complications.

Automated surgical tool classification will improve the workflow of surgery. Previous research tackled this task mainly in cholecystectomy procedures due to availability of a relatively large and labelled set (Cholec80 dataset). However, the complexity of the procedure type has an impact on the robustness of the deep learning approaches. Therefore, the classification capability of CNNs on data of more complex procedures with many surgical tools was investigated. In this work, laparoscopic videos of 14 gynaecological procedures were recorded and labelled for surgical tool presence. Then, the DenseNet-121 model was trained to identify surgical tools according to functionality. Experimental results imply high classification performance for some surgical tools. The mean average precision over all the tools was 67%. This study is an initial benchmark for detecting surgical tools in realistic settings.

Background: Human-centric artificial intelligence (HCAI) aims to provide support systems that can act as peer companions to an expert in a specific domain, by simulating their way of thinking and decision-making in solving real-life problems. The gynaecological artificial intelligence diagnostics (GAID) assistant is such a system. Based on artificial intelligence (AI) argumentation technology, it was developed to incorporate, as much as possible, a complete representation of the medical knowledge in gynaecology and to become a real-life tool that will practically enhance the quality of healthcare services and reduce stress for the clinician. Our study aimed to evaluate GAIDS’ efficacy and accuracy in assisting the working expert gynaecologist during day-to-day clinical practice. Methods: Knowledge-based systems utilize a knowledge base (theory) which holds evidence-based rules (“IF-THEN” statements) that are used to prove whether a conclusion (such as a disease, medication or treatment) is possible or not, given a set of input data. This approach uses argumentation frameworks, where rules act as claims that support a specific decision (arguments) and argue for its dominance over others. The result is a set of admissible arguments which support the final decision and explain its cause. Results: Based on seven different subcategories of gynaecological presentations—bleeding, endocrinology, cancer, pelvic pain, urogynaecology, sexually transmitted infections and vulva pathology in fifty patients—GAID demonstrates an average overall closeness accuracy of zero point eighty-seven. Since the system provides explanations for supporting a diagnosis against other possible diseases, this evaluation process further allowed for a learning process of modular improvement in the system of the diagnostic discrepancies between the system and the specialist. Conclusions: GAID successfully demonstrates an average accuracy of zero point eighty-seven when measuring the closeness of the system’s diagnosis to that of the senior consultant. The system further provides meaningful and helpful explanations for its diagnoses that can help clinicians to develop an increasing level of trust towards the system. It also provides a practical database, which can be used as a structured history-taking assistant and a friendly, patient record-keeper, while improving precision by providing a full list of differential diagnoses. Importantly, the design and implementation of the system facilitates its continuous development with a set methodology that allows minimal revision of the system in the face of new information. Further large-scale studies are required to evaluate GAID more thoroughly and to identify its limiting boundaries.

Objective: To evaluate the effect of self-care guidelines on improving menopausal urogenital symptoms. Method: The quasi-experimental study was conducted from September 2018 to February 2019 at the outpatient clinic at the maternity hospital of Ain Shams University, Egypt, and comprised menopausal women reporting urogenital symptoms. The participants were divided into 10 equal groups and were subjected to 30-minute theoretical and practical self-care sessions 3 times per week for 4 weeks. Data was collected using interviews, Day-to-Day Impact of Vaginal Aging questionnaire and Urinary Incontinence Questionnaire. Data was collected at baseline, immediately after the intervention and after 3 months from the first evaluation. The collected data were statistically analysed using the statistical package for social science (SPSS version 20), percentage (%), the arithmetic mean (), standard deviation (SD), and chi-square (X2 & P-value) were calculated. Results: Of the 120 women with mean age 48.03±3.04 years (range: 45-50 years), 72(60%) had secondary education, 109(90.8%) were married, 44(36.7%) were working in an office and 7(55.8%) were housewives. The mean age at menopause was 46.57±2.33 years (range: 42-50 years). Urogenital symptoms post-intervention reduced significantly (p

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Background: Adolescents in India contribute to 22% of the country’s population and are susceptible to various preventable and treatable health issues. Objectives: To estimate the burden and to describe the pattern of gynaecological disorders among adolescent girls attending the outpatient and inpatient departments of a private medical college hospital in South India. Materials and methods: This was a hospital based cross sectional analytical study done among 500 adolescent girls of 10-19 years age group in a private medical college hospital in South India during December 2020 to December 2021 using a pretested questionnaire. Data was analysed using IBM SPSS version 23. Chi-square test or Fischer exact test was done to find the association between categorical variables. Mann Whitney U test was used to compare the difference between means. P value less than 0.05 was considered to be significant for all comparisons. Results: Mean age of study population was 15.94 ± 2.52 years. Menstrual abnormalities reported in 303 (60.6%) girls followed by 240 (48%) girls had leucorrhoea, 68 (13.6%) had urinary tract infection and 54(10.8%) had PCOS. Conclusion: There is a high burden of gynaecological disorders and lack of awareness on various components of adolescent reproductive and sexual health among adolescents.

Abstract Background Standardised assessment is key to structured surgical training. Currently, there is no consensus on which surgical assessment tool to use in live gynaecologic surgery. The purpose of this review is to identify assessment tools measuring technical skills in gynaecologic surgery and evaluate the measurement characteristics of each tool. Method We utilized the scoping review methodology and searched PubMed, Medline, Embase and Cochrane. Inclusion criteria were studies that analysed assessment tools in live gynaecologic surgery. Kane’s validity argument was applied to evaluate the assessment tools in the included studies. Results Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, procedure-specific rating scales or as a non-procedure-specific error assessment tool. Conclusion This scoping review presents the current different tools for observational assessment of technical skills in intraoperative, gynaecologic surgery. This scoping review can serve as a guide for surgical educators who want to apply a scale or a specific tool in surgical assessment.

Introduction: Primary vaginal malignant melanomas are rare tumours with a limited number of cases published in the literature. They primarily affect post-menopausal women with a median age of 57–68 years and have a dismal prognosis. The 5-year survival rate, regardless of treatment, is approximately 5–25%. Case description: We present the case of an 87-year-old female who presented with haematuria and urinary incontinence. She was diagnosed with AJCC stage IIIC vaginal melanoma. Considering her age and the extent of malignancy, surgery was not a viable option and immunotherapy with nivolumab and ipilimumab was initiated as treatment. Discussion: The diagnosis of vaginal melanomas includes pathological analysis and immunohistochemistry (IHC) of the mass, imaging to determine extent, and genetic testing. Surgery is the preferred treatment in suitable cases. For metastatic or unresectable cases, immunotherapy or targeted therapy is the preferred first-line treatment. Due to the lack of an adequate number of cases to conduct randomized clinical trials, prognostic factors and treatment protocols for vaginal melanomas are not clearly defined. At present, the management of these tumours is largely based on retrospective studies and anecdotal evidence accompanied by significant knowledge gaps. Our case will be a valuable addition to the existing literature on vaginal melanomas that are managed non-surgically.

Objective: Sexual and reproductive health is an integral part of the health and well-being of adolescents. In this paper, the authors summarized the outline of the problems of sexual violence against children, with special emphasis on that against girls. The commentary was written from the point of view of general gynaecologists, sexologists, obstetrics and gynaecology nurses, clinical psychologist, and dermatologist. Mechanism: For the convenience of the readers’ better understanding, we described things in the following order; first, we explained the concept of child sexual abuse, then we discussed symptoms of sexual violence against children, and special attention was given to the issue of Sexually Transmitted Diseases (STD). Lastly, we emphasized general principles of physical diagnostics in the case of suspicion of sexual harassment of children. Findings in Brief: This work reveals the importance of holistic care of sexual assault victims. Conclusions: The cooperation of gynaecologists with dermatologists, medical examiners, paediatricians, psychologists, and dieticians is essential to interdisciplinary collaboration for children. Acquaintance by doctors with symptoms that can be a sign of sexual abuse of a child is necessary. If they appear in the form of physical injuries or STDs, they will probably be possible to diagnose only by medical service.

Gynaecological care is generally perceived as focused on reproductive health. However, when women enter the non-reproductive life phase, other reasons to seek gynaecological care gain in importance. This paper presents findings on the reasons for women in the 50 years and older age group to seek gynaecological consultation and treatment. Our findings are based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008–2011), conducted by the Robert Koch Institute (RKI), as well as the 2016 claims data from the Associations of Statutory Health Insurance Physicians (KVen), provided by the Central Research Institute of Ambulatory Health Care in Germany (Zi). At this age, cancer screening and menopausal complaints can become, as DEGS1 data shows, important reasons to seek gynaecological services. Around 65.0% of 50- to 79-year-old women took advantage of breast palpation examinations during the last twelve months, and 58.0% underwent cervical cell smear tests (pap smear). 47.2% of women had their last menstrual period at age 50 or later. KV data shows that with 45.3% and 33.1% of cases respectively, menopausal symptoms (International Statistical Classification of Diseases and Related Health Problems, 10th revision, ICD-10: N95) and screening for malignant neoplasms (ICD 10: Z12) were the most frequently billed services. The data clearly shows reasons for consultation and treatment of women aged 50 years and older and these should therefore be considered in treatment planning and design.

There are relatively few representative data on the utilisation of physician services in Germany and its influencing. Based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008–2011), we analyse the utilisation of gynaecology and general practitioner (GP) services, with a focus on women aged 50 years and older. We compare these findings with data from the German National Health Interview and Examination Survey 1998 (GNHIES98) and, based on this and further data, discuss possible developments. Figures for seeking GP services (over 80%) are constantly high across the entire lifespan, whereas figures for gynaecology services drop with age. Around 60% of women aged 50 years and older go to a gynaecological practice at least once a year. Socioeconomic status and place of residence are important determinants for the utilisation of services. Around half of all women aged 50 years and older sought both gynaecology and GP services at least once over a one-year period. Under 10% had only been to a gynaecologist, and around one third sought GP services only. Compared to GNHIES98, figures for GP and gynaecology services were considerably higher in DEGS1, health insurance data, however, shows no increase in the use of gynaecology services between 2008 and 2018. The results highlight the need to increase awareness among GPs of the needs of middle-aged and older women for gynaecological consultation and treatment.

Abstract This brief communication summarizes the key highlights presented at the 2019 Phytoneering Research and Experience Summit held at the Palma Convention Centre and the educational finca Sa Canova (Majorca, Spain) from the 25th to the 27th of July 2019. More than 100 professionals from academia, industry and public services took part. The scientific programme included three dedicated symposium sessions and a moderated poster session. In total, 13 oral communications and 23 posters were presented. The invite-only conference, entitled: “Phytoneering Research & Experience Summit (PRES) 2019 - Building bridges between nature’s healing potential and evidence-based medicine - 20 years of phytoneering”, had participants from 20 different nations, reflecting the international character of the event. This participant group included researchers as well as clinicians with different fields of interest, e.g. gynaecology, urology, respiratory diseases and paediatrics. They all share an interest in evidence-based phytotherapy and phytoneering, which is the combination of ancient knowledge about medicinal plants and state-of-the-art technology to produce evidence-based herbal medicine. This approach offers solutions to reduce the growing number of unnecessarily prescribed antibiotics in the above-mentioned areas, with the aim of preventing further progression of antibiotic resistance. The conference was sponsored by Bionorica® SE.

Background: Indications for transfusion in obstetrics may be emergent as well as non-emergent: the keystone of transfusion practice is that it should be appropriate, that is, not given when not required and not missed when required Objectives: To identify key areas where there is a need to change policy so as to prevent unnecessary blood transfusion, to formulate strategies for appropriate preoperative blood requisition and to change clinicians’ approach regarding blood component utilization. Results: The mean age was 30.04 years (SD ± 8.08) and ranged from 16 to 70 years. The incidence of blood transfusion among all admissions was 418 out of 3078 (13.6%). The mean pre-transfusion PCV for patients who received blood transfusion was 23.06 ± 6.1% compared to 34.2 ± 4.54% obtained in the non-transfused patients. Only 59.8% of blood was utilized while 40.2% of blood was not needed. Conclusion: Current practice at O&G department, AKTH appears to be generally inconsistent with the guidelines. This indicates inefficient transfusion practice when comparing with the standard.

Introduction and purpose: Eating disorders are a serious problem in the developing world. The media are flooding the public images of thinness promoting it as a healthy, fashionable and perfect. This contributes to the increasing prevalence of eating disorders like anorexia, bulimia, anorexia nervosa or atypical bulimia nervosa. The frequency of appearance of these diseases is unknown. It is suspected that it occurs in the range of a few percent. Description of the state of knowledge: Pregorexia has a very similar symptoms to other eating disorders. The patients are trying to alleviate the impact of pregnancy on the body. Women try to control their weight by reducing calories intake, exercising, taking laxatives or diuretics. Low mother’s body weight could cause hypotrophy malformations due to micronutrient deficiency - eg. neural tube defects, cognitive disorders, premature birth or even miscarriage. The placenta develops slowly, there is a risk of placenta abruption. Pregorexia can cause maternal anemia, impaired bone mineralization or postnatal depression. Women which are suffering from pregorexia often give birth girls, which can be associated to the lower resistance of boys maternal malnutrition and loss of the pregnancy. Conclusions: Pregorexia is not a phenomenon that is occurring very often, but it is a big risk to the fetus. Increasingly, young mothers have a problem with acceptance of changes in their bodies during pregnancy. The role of a doctor in an interview with a pregnant woman is to ask about nutrition and weight gain as factors directly affecting the child. Pregnant women with eating disorders should be under a special psychological care, during pregnancy and after birth.

Background: Many efforts are made to find safer and more feasible therapeutic strategies to improve gynaecological care. Non-pharmacological treatments, such as osteopathic interventions, could be used as complementary strategies to better manage different gynaecological conditions. This review aims to report the effectiveness of osteopathic treatment in the gynaecology and obstetrics field, updating the previous review published in 2016. The secondary aim was to elucidate the role of somatic dysfunction (SD) in osteopathic assessment and treatment procedures, as well as their health and economic implications. Methods: An electronic search was conducted in the following databases: Embase, MEDLINE (PubMed), and Science direct. All types of clinical studies published between May 2014 and December 2021 have been included: randomised controlled trial (RCT), controlled before/after, interrupted time series quasi RCT, case controls, case reports, case series, observational, clinical studies involving any type of osteopathic treatment, (standardised, semi-standardised or patients’ need-based treatment) performed alone or in combination with other treatments, were included). Results: A total of 76,750 were identified through database searching and other sources. After the removal of duplicates, 47,655 papers were screened based on title and abstract. A total of 131 full-text articles were consequently assessed for eligibility. Twenty-one new articles were included in the synthesis. A total of 2632 participants with a mean age of 28.9 ± 10.5 years were included in the review. Conclusions: Results showed an effectiveness of osteopathic care in gynaecology and obstetrics, but the studies were too heterogeneous to perform quantitative analysis and make clinical recommendations. Nevertheless, osteopathic care could be considered a safe complementary approach to traditional gynaecological care.

Port site metastasis is a rare complication and carcinosarcoma is itself a rare malignant tumour of the ovary. Hereby, Authors report a case of an ovarian carcinosarcoma which was retrospectively diagnosed from the metastasis which developed at the specimen retrieval port site of primary laparoscopic surgery. A 48-year-old nulliparous lady underwent laparoscopic cystectomy previously for endometrioma. Six months postlaparoscopy, she developed pain and palpable mass at the trochar site. Fine Needle Aspiration Cytology (FNAC) showed metastatic adenocarcinoma of ovarian origin confirmed by immunohistochemistry. Six cycles of chemotherapy followed by total hysterectomy, resection of the mass and attached tubal segment, opposite salpingo-oophorectomy and omentectomy was done. Post-surgery, patient was followed-up with three chemotherapy sessions. Final histopathological report showed carcinosarcoma of ovary at port site with omental deposit.

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: Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect). Method: This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects. Results: Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported. Conclusion: This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect. [ABSTRACT FROM AUTHOR]

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014–2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014–2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.

Introduction: International institutions have emphasised the role of midwives in ensuring women health, which guarantees family health and its physical, psychological, social, and spiritual aspects. The integration of midwifery knowledge with psychology is a good opportunity for the patients and healthcare providers. Distraction technique is a psychological approach, which has interested the field of medicine. Aim: To review the effectiveness of Distraction techniques in Obstetrics and Gynaecology. Materials and Methods: This systematic review study was conducted on articles indexed in Cochrane Library, Web of Sciences, PubMed, Scopus, Google Scholar, CINHAL and Persian databases including SID, Magiran, and Barakat Knowledge Network System in October 2018 without time restriction. Search was conducted according to MeSH-based keywords, including distraction or distraction technique Distraction OR Distraction techniques and use + or AND with keywords Midwife, Birth Attendants, Traditional Midwives, Traditional Birth Attendant, Genital Diseases, Female, Gynaecologic Surgical Procedures, Reproductive Medicine, Obstetrics, Pregnancy Complications, Obstetric Surgical Procedures, Gynaecology and Gynaecological diseases. To ensure, inclusion of relevant articles the search process was conducted once again by using keywords of dysmenorrhea, vomiting, nausea, pregnancy, delivery and cesarean section. The inclusion criteria, based on PICOS were: Clients of obstetricsgynaecology centres; receiving a distraction technique; clinical trials with a parallel design; psychosomatic outcomes; fulltext articles in Persian and English. Evaluation of the quality of articles was done using Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. Results: Five out of 595 articles were included in this systematic review. Outcomes of these studies were intensity of pain, and stress and anxiety in patients visiting obstetrics-gynaecology centres. Results showed that the distraction techniques could reduce the intensity of pain in patients under obstetricsgynaecology procedures, and also the stress of prepubescent girls caused by genital examination. Moreover, the meta-analysis results showed that the mean score of anxiety in pregnant women and women at labour, who received distraction interventions, was significantly lower than the control (mean difference: -7.0; 95% Confidence Interval: -13.7 to -0.4; p=0.04). Conclusion: According to the results, distraction is a simple, low-cost, and accessible technique for reducing pain, anxiety, and stress in the field of obstetrics and gynaecology. Moreover, given that there are scant studies into this field and their high risk of bias, it is recommended to use distraction techniques in different areas of clinical trials with higher quality.

As recent scholarship has demonstrated, the Hippocratic treatises include many ritual elements. Taking this blurred boundary between medicine and ritual as a starting point, I will focus on a particular operation in the Hippocratic treatise Barrenness (Steril. 18.3)—which stands out because of the exceptional specificity of the procedure described. I wish to argue that this specificity can be best accounted for by comparing the procedure to a ritual described in Sophron's fragment 4A. Reading these texts together and pointing out their correspondences not only helps in explaining the procedure in Steril. 18.3 more satisfactorily than has been done to date, but also allows me to propose a new interpretation of the title of Sophron 4A and the contents of its ritual. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Performing brachytherapy on female patients with gynaecological cancer is a sensitive procedure, apart from it being an intricate investigation. The aim of this study: establishing gynaecological cancer patients' expectations, experiences and understandings of the high dose-rate brachytherapy treatment procedure. Exploring these patients' life-worlds provides further insights into improving their preparedness and experiences. METHODS: a qualitative research design with a descriptive phenomenological research approach was used. Recruitment entailed using purposive sampling. To obtain rich insights into the lived experiences, data was acquired through semi-structured interviews until data saturation. RESULTS: major challenges were experienced with mixed thoughts and feelings, from negative trauma to desires being fulfilled. These patients should have received more information regarding their upcoming brachytherapy treatment. This would have alleviated some of their fears and anxieties, which would in turn have provided them with a better brachytherapy treatment experience. Envisaged outcomes and desires are used to cope. Patients influence each other negatively, so they rather wanted to "see for themselves". CONCLUSION: despite some disappointments and negative experiences throughout the brachytherapy continuum, the patients were left with a positive outlook, saying that it is an excellent and necessary treatment. Further studies should be done to elaborate on fulfilments of recommendations in the brachytherapy department of radiation oncology.

INTRODUCTION: Access to laparoscopy is low in Cameroon where customers' satisfaction has not been reported so far. We assessed patients' satisfaction with the process of care during laparoscopic surgery in a new tertiary hospital. METHODS: A questionnaire was addressed to consenting patients (guardians for patients under 18) with complete medical recordswho underwent laparoscopyat the Douala Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from November 1, 2015 to July 31, 2016. The following modified Likert's scale was used to assess satisfaction: very weak: 0-2.5; weak 2.6-5; good: 5.1-7.5; very good: 7.6-10. Only descriptive statistics were used. RESULTS: Response rate was 90% (45/50). Of the 45 respondents, 39 (86.7%) were female, 14(31.1%) were referred and 39 (86.7%) paid by direct cash deposit. Mean age was 36.8,11.9 years. Laparoscopies were carried out in emergency for 3 (6.7%) patients. Digestive abnormalities indicated 13 (28.9%) laparoscopies while gynaecologic diseases accounted for 32 (71.1%) cases. Perception of the overallcare process was good with a mean satisfaction score of 6.8 , 1.4. Scores in categories were: 0% (Very weak); 13.3% (weak); 57.8% (Good) and 28.9% (very good). Specifically mean satisfaction scores were: 7.8 , 1.0 with doctors' care; 7.1 , 1.3 with hospital administration; 7.0 , 1.2 with nursing and 4.7 , 1.4 with the costs. Maincomplaints were: long waiting time (73.3%), constraining geographical access(66.7%) and expensiveness (48.9%). CONCLUSION: Patients were globally satisfied with the process of care but financial and geographical barriers should be addressed.

Uterine perforation is an uncommon yet serious complication of surgical management of first and second trimester termination of pregnancies. The rate of uterine perforation is under reported, as patients are usually asymptomatic. Although uncommon, uterine perforation can cause life-threatening complications for some patients. This case report discusses a second trimester surgical termination resulting in uterine perforation and haemorrhage secondary to an avulsion of the infundibulopelvic ligament and prolapse of the left fallopian tube and ovary into the uterine cavity. A literature search was undertaken to compare this case report to those previously published. To the best of our knowledge, this is the first case report in Australia that discusses a unique case of a severed infundibulo-pelvic ligament as a cause for trans-vaginal uterine bleeding post second trimester termination of pregnancy.