Search

The Islamic Golden Age was the time in history from eighth to fourteenth century. This era was marked by expansion of Islamic world to all the Middle East, North Africa, South and East Europe, and Central Asia. The Islamic world was the wealthiest region in the world at that time and that wealth was utilized to promote great flourishing in the arts, philosophy, science, and medicine. The practice of healing was considered the most noble of human undertakings by Islamic scholars. In this era, many great physician-scientists emerged in the Islamic world, albeit several were not Muslims, who examined prior writings, corrected many, and proceeded to produce their own observations and innovations. This article highlights some of the most important contributions to gynecology of some prominent scholars during this shining phase of medical history. [ABSTRACT FROM AUTHOR]

Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.

Objective: To exalore the clinical value of serum mesothelin conbined with CDK6 in the diagnosis of early ovarian cancer. Metiiods: 51 cases of patients who were diagnosed as stage I ~ II ovarian cancer (experimental group) in the department of obstetrics and gynecology of our hospital from June 2014 to June 2017 and 43 cases of patients with normal ovarian tissue were diagnosed by pathology(control group) and selected as the research object. The serum MSLN, CA125, CA199, HE4, VEGF-C levels and CDK6 expression of ovarian tissue were detected and compared. The significantly different indicators between the two groups were further analyzed by multifactor logistic regression. At the same time, the correlative analysis between the new index and the serum CA125, CA199 levels were carried out, the diagnostic value for early ovarian cancer was analyzed by ROC curve. Results: The serum MSLN, CA125, CA199, HE4, VEGF-C levels and CDK6 expression of experimental group were significantly higher in the experimental group than those of the control group (P<0.05). Multifactor logistic regression showed that serum MSLN, CA125 levels and CDK6 expression were valuable in the diagnosis of early ovarian cancer (P<0.05), and the serum CA125 had the highest impact(RR=1.421). The serum MSLN level of ovarian cancer patients(r=0.573, P=0.013) and the CDK6 expression of the Ovarian tissue (r=0.412 ,P=0.037) were positively correlated with serum CA125 level. ROC curves indicated that the area of the ROC curve of serum MSLN, CDK6 expression, serum CA125 and MSLN combined with CDK6 were 0.639, 0.700, 0.715 and 0.765, The area under the curve of MSLN combined with CDK6 was the highest. Conclusion: The clinical value of serum MSLN combined with CDK6 expression in the ovarian cancer tissue for the diagnosis of early ovarian cancer was superior to the conventional serological index CA125, CA199. [ABSTRACT FROM AUTHOR]

Peripartum haemorrhage remains one of the main causes of maternal mortality world-wide. The German, Austrian and Swiss Societies of Gynaecology and Obstetrics have updated the current guidelines for the treatment of peripartum haemorrhage together with the German Society of Anaesthesiology and Intensive Care Medicine and the Society of Thrombosis and Haemostasis Research. The recommendations have been the result of a thorough review of the available scientific literature and a consensus process involving all members of the guideline group. A key element of the anaesthesiological and haemostatic management is the development of a multidisciplinary standard operating procedure combining surgical as well as medical and haemostatic treatments depending on the severity of bleeding. The guideline underscores the value of clinical and laboratory diagnostics of peripartum haemorrhage as early as possible, even pre-emptively. This allows for an early identification of causes of bleeding and a specific treatment. The guideline comprises evidence-based recommendations for the use of uterotonics, tranexamic acid and blood products such as factor concentrates, fresh frozen plasma, platelet concentrates, packed red blood cells, recombinant activated factor VII and desmopressin. In addition, recommendations for blood conservation strategies involving the use of cell salvage, permissive hypotension and transfusion triggers are given. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (ie, placenta accreta, increta, and percreta).Methods: We conducted a population-based data linkage study including all primiparous women who delivered in New South Wales, Australia, between 2003 and 2012. Data were obtained from linked birth and hospital admissions with a minimum lookback period of 2 years. Prior procedures invasive of the uterus were considered including gynecologic laparoscopy with instrumentation of the uterus; hysteroscopy, including operative hysteroscopy; curettage, including suction curettage and surgical termination; and endometrial ablation. Modified Poisson regression was used to determine the association between the number of prior gynecologic procedures and risk of abnormally invasive placenta.Results: Eight hundred fifty-four cases of abnormally invasive placenta were identified among 380,775 deliveries included in the study (22.4/10,000). In total, 33,296 primiparous women had at least one prior procedure (8.7%). Among women with abnormally invasive placenta, 152 (17.8%) had undergone at least one procedure compared with 33,144 (8.7%) among women without abnormally invasive placenta (P<.01). After adjustment, the relative risk was 1.5 for one procedure (99% CI 1.1-1.9), 2.7 for two procedures (99% CI 1.7-4.4), and 5.1 for three or more procedures (99% CI 2.7-9.6). Abnormally invasive placenta was also positively associated with maternal age, socioeconomic advantage, mother being Australia-born, placenta previa, hypertension, multiple births, use of assisted reproductive technology, and female fetal sex.Conclusion: Women with a history of prior invasive gynecologic procedures were more likely to develop abnormally invasive placenta. These insights may be used to inform management of pregnancies in women with a history of gynecologic procedures. [ABSTRACT FROM AUTHOR]

Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at, or close to, 75% for each, and obtaining a set of 5 ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the task force expects that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum and the competency assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology. [ABSTRACT FROM AUTHOR]

Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available.

Background On an international scale, the necessity of preoperative coagulation screen remains controversial, yet in China, coagulation screen is still a routine test before surgery required by the Ministry of Health of China. Methods A retrospective review of 26,807 patients > 18 y presenting with problems related to the areas of gynecology and obstetrics from March 2013 to July 2015 was performed, and the rate of major bleeding and the amount of blood lost during surgery were compared among groups of patients grouped according to the values of preoperative APTT, the departments the patients belonged to, or the measures for intervention. Results Groups with increased APTT had higher rates of major bleeding (9.80% & 26.14% vs 2.77%, P < 0.001) and more blood loss (862.9 and 1455.6 ml vs 194.0 ml, P < 0.001). And the same conclusion could be induced in both the obstetric and gynecological patients when they were taken into account separately. For obstetric patients, once those with high bleeding risks, e.g., placental abruption, placental implantation, or preoperative massive hemorrhage were excluded, groups with increased APTT would no longer demonstrated the higher rate of major bleeding (0.91% & 2.38% vs 0%, P = 0.409 & 0.833) and would even have a lower amount of blood loss (202.76 and 228.09 ml vs 322.13 ml, P = 0.003 and 0.027). In increased APTT patients without bleeding or bleeding tendency, FFP intervention would not make a difference in the rate of major bleeding (7.69% vs 8.37%, P = 0.203) and the amount of blood loss (271.35 ml vs 306.63, P = 0.865). Conclusion For Chinese patients from the Obstetrics and Gynecology Departments, APTT is a good screen test to predict surgical hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology.Study Design: A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology.Results: Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics.Conclusion: European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. The outcomes will be described in core trainings standards, aimed at harmonising training in Obstetrics and Gynaecology in Europe to promote high quality care. [ABSTRACT FROM AUTHOR]

Background: Fast-track surgery (FTS), also known as enhanced recovery after surgery, is a multidisciplinary approach to accelerate recovery, reduce complications, minimise hospital stay without increasing readmission rates, and reduce health care costs, all without compromising patient safety. The advantages of FTS in abdominal surgery most likely extend to gynaecological surgery, but this is an assumption, as FTS in elective gynaecological surgery has not been well studied. No consensus guidelines have been developed for gynaecological oncological surgery although surgeons have attempted to introduce slightly modified FTS programmes for patients undergoing such surgery. To our knowledge, there are no published randomised controlled trials; however, some studies have shown that FTS in gynaecological oncological surgery leads to early hospital discharge with high levels of patient satisfaction. The aim of this study is whether FTS reduces the length of stay in hospital compared to traditional management. The secondary aim is whether FTS is associated with any increase in post-surgical complications compared to traditional management (for both open and laparoscopic surgery). Methods/design: This trial will prospectively compare FTS and traditional management protocols. The primary endpoint is the length of post-operative hospitalisation (days, mean ± standard deviation), defined as the number of days between the date of discharge and the date of surgery. The secondary endpoints are complications in both groups (FTS versus traditional protocol) occurring during the first 3 months post-operatively including infection (wound infection, lung infection, intraperitoneal infection), post-operative nausea and vomiting, ileus, post-operative haemorrhage, post-operative thrombosis, and the Acute Physiology and Chronic Health Enquiry II score. Discussion: The advantages of FTS most likely extend to gynaecology, although, to our knowledge, there are no randomised controlled trials. The aim of this study is to compare the post-operative length of hospitalisation after major gynaecological or gynaecological oncological surgery and to analyse patients' post-operative complications. This trial may reveal whether FTS leads to early hospital discharge with few complications after gynaecological surgery. [ABSTRACT FROM AUTHOR]

The article presents a study to analyze understanding of clinical gynecology and violence associated with gynecology clinic and examination of socio-cultural devices employed in patient and doctor relationship during interactions between male physicians and women receiving reproductive care.

Objectives: To find out the choices of female medical students in selection of their future specialties and to study the factors influencing their decision. Methodology: This cross-sectional study was conducted among public & private sector medical colleges of Peshawar including Khyber Medical College (KMC), Rahman Medical College (RMC), Peshawar Medical College (PMC) & Kabir Medical College (KaMC). A semi structured questionnaire based on the objectives was distributed among the students to collect their responses. Frequencies were calculated for all the variables including demographic and objective specific variables for the study. Results: A total of 300 female students gave their responses out of 333, who were given the questionnaire. Regarding the specialty of their personal interest, 90(30%) students answered surgery and allied, 110(36.67%) medicine & allied while 70(23.33%) females selected obstetrics & gynaecology as their specialty of choice. The choice was mainly driven by personal interest [n=189 (65.85%)] and inspiration from a role model [n=36 (12.54%)]. Out of these 300, 85 students were not sure if they will be working in the specialty of their personal interest or not, due to many reasons including whether they will be able to adjust work-life balance [n=21 (24.71%)] and difficulty in the exams of specialty of choice [n=18 (21.18%)]. Conclusion: A large number of female students selected medicine and allied as their choice specialty. The choice was mostly driven by personal interest. There were almost a quarter of students who were not sure whether they will be working in the specialty of choice due to various reasons. [ABSTRACT FROM AUTHOR]

Background: There are no definitive criteria for identifying which patients with The International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer will benefit from adjuvant therapy after radical hysterectomy. The aims of this study were to clarify the efficacy of adjuvant therapy and assess complications after radical hysterectomy in patients with FIGO stage IB1 cervical cancer with intermediate risk factors. Methods: Between January 2005 and December 2009, the medical records of 75 stage IB1 patients' intermediate risk factors (i.e., tumor size 2–4 cm, lymphovascular involvement, and/or deep stromal invasion >1/2) who underwent radical hysterectomy at six institutions were collected, and these patients were enrolled in this nonrandomized retrospective study. We simplified the criteria of intermediate risk factors as much as possible, as the criteria adopted in some clinical studies are complicated in practice. Results: The patients were grouped according to the receipt of adjuvant therapy as follows: 46 patients, no further treatment; 19 patients, external beam radiation treatment, including 9 patients who received brachytherapy; 5 patients, concurrent chemoradiotherapy (CCRT); and 5 patients, chemotherapy (CT). The clinical outcomes and complications in each group were analyzed. After an average follow-up of 82.6 months (range, 24–135 months), only one patient with all three risk factors who received radiotherapy (RT) experienced recurrence. Excluding this patient, the remaining patients who received RT, CCRT, or CT had two or three risk factors. Lymphedema was significantly more common among patients who received RT or CCRT, whereas the incidence of ileus and ureteral obstruction was not different among the treatment groups. However, an unsutured peritoneum increased the risk of ileus. Conclusions: The findings of this study suggest that RT and CCRT after radical hysterectomy are not beneficial in patients with intermediate risk factors. In particular, RT and CCRT appeared to increase the incidence of lymphedema. A prospective randomized study is needed to verify the findings of this study. [ABSTRACT FROM AUTHOR]

Introduction: Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta-analysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery.Material and Methods: Searches were conducted using Embase, Medline, CINAHL, and the Cochrane Library up to 27 June 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI).Results: Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95% CI CI -2.94 to -0.20) and total (MD -3.05 days, 95% CI -4.87 to -1.23) length of hospital stay compared with traditional perioperative care, without an increase in complications, mortality or readmission rates.Conclusion: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. [ABSTRACT FROM AUTHOR]

The article presents a report written by the interprofessional Task Force on Collaborative Practice outlining a mechanism that all specialties and practices can use to achieve the core expectations of the health care system. The report provides a framework for organizations or practices across all specialities to develop team-based care and is most useful for those charged with developing new practice models based on the changing demographics of health care practices.

The objectives of this study were to explore current provision of laparoscopic simulation training, and to determine attitudes of trainers and trainees to the role of simulators in surgical training across the UK. An anonymous cross-sectional survey with cluster sampling was developed and circulated. All Royal College of Obstetricians and Gynaecologists (RCOG) Training Programme Directors (TPD), College Tutors (RCT) and Trainee representatives (TR) across the UK were invited to participate. One hundred and ninety-six obstetricians and gynaecologists participated. Sixty-three percent of hospitals had at least one box trainer, and 14.6% had least one virtual-reality simulator. Only 9.3% and 3.6% stated that trainees used a structured curriculum on box and virtual-reality simulators, respectively. Respondents working in a Large/Teaching hospital (p = 0.008) were more likely to agree that simulators enhance surgical training. Eighty-nine percent agreed that simulators improve the quality of training, and should be mandatory or desirable for junior trainees. Consultants (p = 0.003) and respondents over 40 years (p = 0.011) were more likely to hold that a simulation test should be undertaken before live operation. Our data demonstrated, therefore, that availability of laparoscopic simulators is inconsistent, with limited use of mandatory structured curricula. In contrast, both trainers and trainees recognise a need for greater use of laparoscopic simulation for surgical training. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the perceptions of fellowship program directors of incoming clinical fellows for subspecialty training. METHODS: A validated survey by the American College of Surgeons was modified and distributed to all fellowship program directors in four subspecialties within obstetrics and gynecology: female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal–fetal medicine, and reproductive endocrinology–infertility. The 59-item survey explored five domains concerning preparedness for fellowship: professionalism, independent practice, psychomotor ability, clinical evaluation, and academic scholarship. A Likert scale with five responses was used and tailored to each subspecialty. Standard statistical methods were used to compare responses between subspecialties and to analyze data within each subspecialty individually. RESULTS: One hundred thirty directors completed the survey, for a response rate of 60%. In the domain of professionalism, more than 88% of participants stated that incoming fellows had appropriate interactions with faculty and staff. Scores in this domain were lower for gynecologic oncology respondents (P=.046). Responses concerning independent practice of surgical procedures (hysterectomy, pelvic reconstruction, and minimally invasive) were overwhelmingly negative. Only 20% of first-year fellows were able to independently perform a vaginal hysterectomy, 46% an abdominal hysterectomy, and 34% basic hysteroscopic procedures. Appropriate postoperative care (63%) and management of the critically ill patient (71%) were rated adequate for all subspecialties. CONCLUSION: Graduating residents may be underprepared for advanced subspecialty training, necessitating an evaluation of the current structure of resident and fellow curriculum. [ABSTRACT FROM AUTHOR]

This article, for the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, supplies educators with a review of best practices regarding incorporation of the electronic medical record (EMR) into undergraduate medical education. The unique circumstances of the obstetrics and gynecology clerkship require specific attention as it pertains to medical student use of the EMR. An outline of the regulatory requirements and authoritative body recommendations provides some guidance for implementation in the undergraduate medical education setting. A review of the basic framework for development of an EMR curriculum and examples of curricular innovations published in the literature offers solutions for obstacles that may be encountered by students and medical educators. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors associated with 'patient satisfaction' and 'willingness to return to the provider' in gynecology and to assess similarities as well as differences between the two concepts. Methods: Study data were obtained from 968 randomly selected gynecology patients discharged from 22 hospitals who responded to a mailed survey. The validated instrument consisted of 37 items and assessed medical and service aspects of care, patient and visit characteristics. The dependent variables consisted of ratings of willingness to return to the provider and overall satisfaction. Bivariate and multivariate techniques were used to reveal relationships between indicators and both dependent variables. Results: The multivariate analyses identified individualized medical care, kindness of medical practitioners, treatment outcome and organization of discharge as the most consistent predictors of the patients' likelihood to return and overall satisfaction. Differences between both concepts pertained to the significance of service variables (cleanliness and quality of food) for patient satisfaction and visit-related characteristics (length of stay and occurrence of complications) for willingness to return. Conclusions: Study findings suggest that patient satisfaction and willingness to return to the provider do not reflect the same concepts. Although service aspects such as quality of food influence satisfaction ratings, they do not increase the likelihood that patients choose the same hospital in case of another treatment. Communication between patients and medical practitioners is highly important. Revealed predictors of both concepts are alterable by healthcare professionals and should be focused on to enhance patient satisfaction and to increase the probability patients return to their provider. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In patients with locally advanced gynecologic malignancies, total pelvectomy represents the only curative treatment option. After finishing the resection, if possible, the digestive and urinary reconstruction phases begin. Multiple surgical techniques were imagined in order to search the ideal urinary reservoir. This is a literature review of the most important types of urinary reconstructions: incontinent conduits, continent pouches and orthotopic ileal neobladder. [ABSTRACT FROM AUTHOR]

The problem of optimization of the midwife care in all areas of gynecology services is particularly significant and is due to the tendency of increase of the requirements for the quality of the healing process. The specifics of the labor midwife involving direct work with gynecological ill patient assumes the ownership, development and improvement of a number of specific professional competencies. Their formation and development is a key objective of the learning process in higher medical school. Practical training for health care in gynecological diseases is carried out in specialized outpatient surgeries and gynecological wards or clinics, under the direction of teachers / mentors / according to state requirements for the training of future midwives. The purpose of scientific communication is to reveal the terms of the effectiveness of practical preparations for the implementation of health care in gynecological diseases. Studied is the opinion of a total of 94 students of specialty "midwife" studying in the Faculty of Medicine, Stara Zagora. The study covers the period of study 2012/13 and 2013/14 years. Used the method of the anonymous survey through which they have collected and analyzed the respondents' answers to their degree of satisfaction with the distribution of hours of clinical practice in gynecological sector, the quality of practical training in gynecology, as well as their willingness to care for patients with gynecological diseases. Conclusions made it possible to reveal the terms of the effectiveness of practical preparations for the implementation of health care in gynecological diseases. [ABSTRACT FROM AUTHOR]

Introduction: Ovarian cysts are commonly encountered lesions. They are amongst the most frequent cause of hospitalization and surgery in gynecologic practice. One cannot confidently distinguish a benign lesion from a malignant one on the basis of clinical, radiological or gross characteristics alone so a histopathology examination is a must as it guides therapy. The study was undertaken to determine the morphologic spectrum of the cystic lesions of the ovary. Methods: This is a descriptive study which was carried out at Kathmandu Medical College Teaching Hospital for a period of two years from 1st January 2011 to 31st December 2012. A Total of 135 cases of ovarian cysts were received and processed in the Pathology Department. Hematoxylin and Eosin stained slides were examined. Results: Among the 135 ovarian cystic lesions, 119 cases (88.15%) were unilateral and 16 cases (11.85%) were bilateral. There were 59 cases (43.7%) of benign cysts, 69 cases (51.1%) of benign tumors, 5 cases (3.7%) of malignant tumors and 2 cases (1.5%) of borderline epithelial tumors. The age of patients ranged from 13 years to 73 years with mean age of presentation of 43 years. Among the ovarian cystic lesions the incidence of mature cystic teratoma was the highest (30%). The most common non-neoplastic cyst was endometriotic cyst (39%), while the most common benign tumor was mature cystic teratoma (58%). The malignant tumor encountered in the study was serous cystadenocarcinoma. Two cases of borderline epithelial tumors (1.5%) were also observed in the study. Conclusion: The most common cystic lesion that were encountered in the study was benign tumor followed by benign cyst. Of the benign tumors, mature cystic teratoma was the most frequently observed lesion. Among the non-neoplastic cysts, endometriotic cyst was the most frequently observed lesion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective was to determine the effect of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation, contraception and other gynecologic skills. Methods: Data from the first 10 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Pre- and postrotation surveys assessed residents’ experience with abortion, contraception and other gynecologic skills. Thirty-nine residency program director surveys were analyzed to assess benefits of the training from the educators’ perspective. Results: A total of 491 residents completed both pre- and postrotation surveys. During the rotation, residents, including those who partially participated, gained significant exposure to all methods of first- and second-trimester termination and contraception care. Ninety-seven percent of Residency Program Directors reported that training improved resident competence in abortion and contraception care. Conclusion: Routine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to increase proficiency in patient counseling, contraception care, ultrasound and all aspects of uterine evacuation, regardless of level of participation. [Copyright &y& Elsevier]

Aim of the study: Laparoscopy is one of the most common diagnostic and therapeutic procedures in gynecology, allowing for an accurate macroscopic evaluation of abdominal and pelvic cavity with minimal invasiveness. The most common indications for gynecological laparoscopy are infertility, diagnosis and treatment of pelvic pain, ectopic pregnancy, endometriosis, adnexal inflammation, benign adnexal tumors and cysts. The aim of this study was retrospective evaluation of the causes of conversion to laparotomy procedures performed in the Department of Gynecology, Institute of Polish Mother's Memorial Hospital in the years 2006-2012. Material and methods: The study involved 906 patients hospitalized in the Department of Gynecology ICZMP in Lodz between 2006 and 2012, who had undergone laparoscopic surgery. An analysis of 42 case records of patients in whom laparoscopy was performed initially, and then conversion to laparotomy occurred. Results: 906 laparoscopies were performed in the Department of Gynecology in the years 2006-2012. A detailed analysis of the indications for endoscopic surgery that ended in conversion to laparotomy was performed. Of all endoscopic procedures performed, in 42 cases (4.6%) the need for conversion from laparoscopy to laparotomy occurred. The most common cause was massive adhesions - in 21 cases (50%). Heavy bleeding was the reason for conversion to laparotomy in 5 patients (12%). Technical difficulties in performing laparoscopic surgery occurred in 4 women (9.5%), and difficulty to produce pneumoperitoneum in 2. In 4 patients during surgery there was damage to the intestines. The diagnosis of ovarian cancer established intraoperatively resulted in the completion of the surgery by laparotomy in 2 cases (4.8%). In other 2 patients, tumor location and its size (in both cases, tumor diameter greater than 10 cm) led to the completion of the procedure in a classical way. Conclusions: Laparoscopy is a common and generally acceptable medical diagnostic method used in the Department of Gynecology, Institute of Polish Mother's Health Center. As with any surgical intervention, however, it involves a risk of complications, the proportion of which leads to the need for conversion to laparotomy. [ABSTRACT FROM AUTHOR]

El artículo presenta un caso de estudio sobre probable embarazo ectópico de una mujer mexicana de 24 años de edad observado por el autor en 1956. El autor ofrece un resumen de la historia médica de la paciente, así como sus observaciones sobre el caso, incluyendo los resultados de la intervención quirúrgica. Se ofrece también una revisión bibliográfica sobre los principales aportes sobre el tema desde 1682 hasta 2013.

Objective: To determine the degree of compliance with the antibiotic prophylactic guidelines in patients undergoing obstetric and gynecological surgery at the Hospital Universitario San Jorge de Pereira, Colombia. To conduct an exploratory analysis of the factors associated with non-compliance. Materials and methods: Cross-sectional descriptive study that enrolled all women undergoing surgery in the obstetrics and gynecology service of a tertiarycare hospital providing care to patients under the health regime subsidized by public funds, located in the Department of Risaralda, Colombia, between January 1st and December 31st, 2010. Patients whose clinical records did not reflect the time of administration of the antibiotic were excluded. A consecutive sampling was used. The assessment included social and demographic variables, the type of intervention, the type of wound, surgical risk, timeliness of antibiotic administration and the type of antimicrobials prescribed. Percent compliance is presented together with an exploratory analysis of factors associated with non-compliance, done using the SPSS 20.0 statistical package. Results: A total of 911 patients with a mean age of 28.6+10.2 years were intervened. Of them, 76.8% underwent Cesarean section and 18.7% abdominal hysterectomy. The antibiotics most commonly used were cefazolin (89.5%) and ampicillin (8.2%). Of the procedures, 42.0% complied with the guidelines. A statistically significant association was found with non-compliance with the guidelines, age under 18, and not use of cefazolin. Conclusion: Percent compliance was under 50%. This means that strategies must be put in place in order to improve the level of compliance with clinical practice guideline in this hospital [ABSTRACT FROM AUTHOR]

Abstract: Uterine artery embolization (UAE) is a minimally invasive interventional radiological procedure to occlude the arterial supply to the uterus. UAE has been very useful for controlling hemorrhage following delivery/abortion, in ectopic or cervical pregnancy, gestational trophoblastic disease or carcinoma cervix. Currently it is being mostly used for treating uterine fibroids. It requires a shorter hospital stay with early resumption to normal activity. This review briefly summarizes the role of this relatively new technique in gynecologic practice. [Copyright &y& Elsevier]

Abstract: Study Objective: To examine our experience with intrauterine device (IUD) use in adolescents and young women. Design: Retrospective descriptive study evaluating outcomes after IUD insertion for patients 21 years or less over an 8-year period. Setting: Three sites including a Pediatric and Adolescent gynecology private practice, a Title X clinic, and community based, grant funded clinic serving a high risk teen population. Participants: Females from menarche to age 21. Main Outcomes Measured: The probability of IUD retention, differences in IUD retention probabilities between two age groups, and risk factors for IUD removal, expulsion, and infection were evaluated. Results: 233 records showed 50% of the <18-year-old age group and 71.5% of the 18–21-year-old group had their IUD in place at 5 years. Age was found to be a significant factor for removal (P < 0.001), with under 18-year-olds at greater risk of removal/expulsion (hazard ratio (HR) = 2.85). Parity (RR = 5.6 for nulliparous vs multiparous patients, P < 0.001) and prior STI (RR = 5.5, P < 0.001) were significant risk factors for infection. Nulliparous patients were at higher risk of expulsion (P = 0.045), though age was not a statistically significant risk factor. Conclusions: The rate of continuation was lower in adolescents under 18 compared to18–21-year-olds, but was still higher than for other hormonal contraceptives. Despite this groups'' high risk for STI the IUD did not increase the risk of infection and may offer some degree of protection. IUDs appear to be a safe option in young adolescents (<18 years old) and nulliparous women. [Copyright &y& Elsevier]

Objective: We sought to study the frequency, and reasons that third-year medical students on an ObGyn clerkship are denied the opportunity to be involved in patient care. Methods: Students from four hospitals affiliated with the University of Connecticut Medical School completed an anonymous postclerkship survey. Results: Among the 157 students studied (66 males and 91 females), 51% (n=80) were denied the opportunity to participate in a gynecologic examination and 47% (n=73) were denied the opportunity for routine ObGyn care by patients. Among these students, 55% (n=44) and 38% (n=28) stated that being male was the reason they were excluded from gynecologic and routine care, respectively. Of the 80 students who were denied involvement in a gynecologic examination, 81% (n=65) were denied involvement by clinic patients. Of the 44 males who stated they were denied the opportunity to be involved in a gynecologic examination due to their gender, 89% (n=39) were refused by clinic patients. Compared with female students, male students are statistically more likely to be denied the opportunity to be involved in gynecologic examinations (RR= 1.69 [1.24-2.29]), especially by clinic patients (RR= 2.07 [1.41-3.03]). Conclusion: A significant number of students were denied the opportunity to be involved in ObGyn care experiences. More frequently male students were denied involvement in care, with a higher incidence among clinic patients. We hypothesize that being denied involvement provides a negative perception of the ObGyn specialty, especially to male students, possibly affecting their decision to choose ObGyn training. Précis: A significant number of medical students, particularly males, were denied involvement in patient care, primarily by clinic patients, during the ObGyn clerkships. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the individual characteristics associated with the absence of cervical smear (CCST); to investigate the role of residential neighbourhood, particularly practitioner density; and to explore changes in individual and contextual determinants after taking regular consulting in primary care for gynaecological health (RCGH) into account. Methods: Data: 1843 adult women from the SIRS survey conducted in 2005 in the Paris metropolitan area. Multilevel logistic regressions analysed factors associated with never-screening. Results: 10% of the women had never undergone CCST. Being single, less educated, of foreign origin, with no children, and without health insurance, having never worked, having never undergone a serious health problem and/or having nobody in their circle with cancer were associated with no CCST. Once adjusted on individual characteristics, living in a middle- (OR=1.95; IC=1.05–3.62) or in a lower-class neighbourhood (OR=2.31; IC=1.26–4.25) was associated with increased risks of never-screening, but neighbourhood physician density was not. Interactions were found between socioeconomic status and RCGH. Individual- and neighbourhood-level associations with CCST were different for women with or without an RCGH. Conclusion: This study analysed individual and contextual inequalities in CCST practice in the Paris metropolitan area. To benefit from an RCGH did not seem to reduce all the social inequalities in CCST practice. [Copyright &y& Elsevier]

Se presenta una reproducción de un artículo publicado en la misma revista en 1957. Se trata de la cuestión de la ética en la práctica de la ginecología y la obstetricia, incluyendo los temas del control de la natalidad, la fecundación artificial y el aborto. Se enfoca en las consecuencias referidas a la salud moral, a la salud física y para la sociedad.

Se presenta una historia de la práctica de la ginecología y la obstetricia en el estado de Sinaloa, México. Se incluya la práctica de la medicina en la época prehispánica, durante la conquista y en el país de México independiente. Se enfoca en la educación médica disponible en México y en la condición de la salud de mujeres en Sinaloa durante el siglo XXI.

The article presents a study which examines the factors and attributes that are considered by obstetrics and gynecology fellowship directors in the selection of applicants for fellow interview and ranking. It shows that high quality obstetrics and gynecology residency training program and clinical research study experience during or after residency were among the factors in prematch considerations. It notes that education pedigree and research study experience were used to select fellows.

The article offers information on a study conducted by the authors related to perspectives of trainees on part-time obstetrics and gynecology specialist training in search of work/life balance. A survey was sent through e-mail to all Australian obstetrics and gynecology trainees, collecting information on personal experience of part-time training (PTT) and training data status. It highlights that more PT respondents were females and around 105 valid responses were received. It mentions that majority stated caring for children and better exam preparation as reasons for PT training. It states that most experienced work/life balance, improved morale and family commitments as reasons for their support of PTT.

Objective. To evaluate the surgical outcomes of robotic-assisted sacrocolpopexy (RASCP) before and after the incorporation of hands-on training for urology and gynecology residents. Study Design. Forty-one patients underwent RASCP between December 2008 and March 2010 with one surgeon. RASCP was performed in the context of surgical repair of complex pelvic organ prolapse and/or stress urinary incontinence. The first 20 cases (group I) were performed exclusively by the attending surgeon. In the last 21 cases (group II), the urology resident performed a 50% or more of the RASCP while the gynecology resident performed the supracervical hysterectomy. The primary outcome measure was vaginal vault support at 24 weeks postoperatively based on pelvic organ prolapse quantification (POP-Q). Results. Mean±SD operative time for the entire surgery including RASCP was 282.3 ± 51.3min and median EBL was 83.1 ± 50.4mL. Patient demographics and stage of disease did not differ between groups. Procedure time, PACU time, blood loss, and intraoperative complications were similar between groups. Follow-up POP-Q evaluations demonstrated significant correction of all points on vaginal examination for both groups (P < 0.001). Conclusions. Incorporation of resident training during RASCP allows teaching of robotic surgery techniques in an effective manner without prolonging operative time or affecting the overall surgical outcome. [ABSTRACT FROM AUTHOR]

Due to the associated social stigma, most women experiencing symptoms of anal incontinence (AI) do not seek medical assistance or volunteer their symptoms when consulting a healthcare provider for other conditions. As gynaecologists, we regularly have contact with women who could be experiencing AI, particularly those with urinary incontinence or pelvic organ prolapse, those who have undergone pelvic radiotherapy or women following childbirth. Although most of the investigations and specific management for patients with AI will be performed by other members of the multidisciplinary healthcare team (e.g. colorectal surgeons, dieticians, occupational therapists, physiotherapists) we have an important role to play in identifying these patients and referring them appropriately. [ABSTRACT FROM AUTHOR]

Se presenta una reproducción de un artículo publicado en la misma revista en 1956. Se discurre sobre el tratamiento de los procesos infecciosos de los genitales externos e internos, incluyendo la vulvovaginitis, la granuloma inguinal y la sífilis. Se presentan los métodos más comunes de tratar las infecciones durante los años 40 y 50.

The article discusses the results of a study which analyzed the quality of evidence contained in the American College of Obstetricians and Gynecologists (ACOG). According to the authors, 57.1 percent of the guidelines contained obstetric and 36 percent focused on gynecologic. They add that 30 percent provided level A evidence, 37.7 percent for level B while 32.3 percent for level C. They indicate that one third of the recommendations are based on good and consistent scientific evidence.

Please cite this paper as: Bhuiyan A, Goodall D. The role of the South Asia Federation of Obstetrics and Gynaecology (SAFOG) in South Asia. BJOG 2011; 118 (Suppl. 2): 22-25. [ABSTRACT FROM AUTHOR]

Se presenta una reproducción de un artículo publicado en la misma revista en el año 1956, el cual se trata de los métodos del diagnóstico en la ginecología del tiempo. Los métodos analizados incluyen la exploración de la endocrinología, los métodos histopatológicos y los de la química biológica. Se ofrece información de la investigación más moderna del tiempo.

Objective: To compare different oral ovulation induction agents in treating infertile women with polycystic ovary syndrome (PCOS). Design: Decision-analytic model comparing three treatment strategies using probability estimates derived from literature review and sensitivity analyses performed on the baseline assumptions. Setting: Outpatient reproductive medicine and gynecology practices. Patient(s): Infertile women with PCOS. Intervention(s): Metformin, clomiphene citrate, or metformin with clomiphene citrate. Main Outcome Measure(s): Live birth. Result(s): Within the baseline assumptions, combination therapy with metformin and clomiphene citrate was the preferred therapy for achieving live birth in women with PCOS. Sensitivity analysis revealed the model to be robust over a wide range of probabilities. Conclusion(s): Combination therapy with metformin and clomiphene citrate should be considered as first-line treatment for infertile women with PCOS. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether polymorphism in CYP17A1 gene is associated with uterine leiomyomas (ULM) and to evaluate differences in epidemiologic and genetic factors among solitary and multiple leiomyomas.Design: Prospective case control study.Setting: Tertiary gynecology department.Patient(s): One hundred eighty-one women with clinically and surgically diagnosed ULM, 41 healthy control subjects, and 92 population control subjects.Intervention(s): Completing the questionnaires, peripheral venous puncture.Main Outcome Measure(s): Polymerase chain reaction and restriction-fragment-length polymorphism analyses were performed to genotype women regarding the CYP17A1 -34 A/G (rs743572) gene polymorphisms. Epidemiologic data was collected by questionnaire and compared between women with ULM and healthy control subjects.Result(s): Women with multiple ULM had higher prevalence of positive family history, lower age at menarche, lower parity, higher percentage of smoking, younger age at first sexual intercourse, lower prevalence of CYP17A1 AA genotype and lower CYP17A1 A allele frequency than healthy control subjects. These trends were not apparent among women with solitary ULM.Conclusion(s): Carriage of CYP17A1 AA is protective for developing ULM in our population. Women with solitary ULM mostly resembled healthy control subjects, whereas women with multiple ULM differed in CYP17A1 AA genotype and external stimuli. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of infertility on female sexual function. Design: A case-control study. Setting: Academic infertility and gynecology practices. Patient(s): One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study. Intervention(s): Anonymous survey and Female Sexual Function Index. Main Outcome Measure(s): Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction. Result(s): Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls. Conclusion(s): Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study. [ABSTRACT FROM AUTHOR]

El artículo presenta una evaluación de los procedimientos de exploración ginecológica. Se incluyen los exámenes bacteriológicos, los métodos endoscópicos y la radiología ginecológica como procedimientos utilizados frecuentemente. También se discurre sobre la exploración de varias enfermedades ginecológicas, incluyendo la infección tuberculosa, las infecciones gonocócicas y el sífilis, con información sobre los tratamientos comunes para cada infección.

Please cite this paper as: Rashid S, Khaund A, Murray L, Moss J, Cooper K, Lyons D, Murray G, Lumsden M. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids. BJOG 2010;117:985–989. Objective The aim of this study was to evaluate and compare both ovarian function and menstrual characteristics following uterine artery embolisation (UAE) and surgery. Design Subgroup of women from a randomised controlled trial. Setting Gynaecology and radiology units in Scotland, UK. Population Ninety-six women from the randomised controlled trial comparing embolisation with surgery as a treatment for fibroids (REST), which recruited 157 patients (106 UAE; 51 surgery). Methods Seventy-three women undergoing UAE and 23 women undergoing surgery (with ovarian conservation) had serum follicle-stimulating hormone (FSH) measurements taken on day 3 of the menstrual cycle prior to treatment, and at 6 and 12 months post-treatment. Data on menstrual cycle characteristics was also collected. Main outcome measures Ovarian failure, as defined by an FSH level of >40 iu/l, and change in duration of menses and length of menstrual cycle. Results There was no significant difference in the rate of ovarian failure at 12 months between UAE (11%) and surgical patients (18%) ( P = 0.44). This finding was not influenced by age. The mean duration of menstrual flow decreased significantly, from baseline to 12 months, by 1.7 days (SD 3.8), (95% CI 0.8–2.6). There was no statistically significant change in mean cycle length at 12 months (0.7 days [SD 4.9]; 95% CI [−0.5, 1.9]). Conclusions There is no evidence for UAE accelerating a deterioration in ovarian function at 1 year, when compared with surgery. UAE is associated with a decrease in the duration of menstrual flow at 1 year. [ABSTRACT FROM AUTHOR]

Abstract: Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the organization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties). We measured dissemination of the feedback technique by using a questionnaire filled in by Obstetrics & Gynecology and Pediatrics residents (n =63). Data on network tie strength was gathered with a structured questionnaire given to medical specialists (n =81). Social network analysis was used to compose the required network coefficients. We found a strong effect for network tie strength and no effect for the Teach-the-Teacher training course on the dissemination of the new structured feedback technique. This paper shows the potential that social networks have for disseminating innovations in health service delivery and organization. Further research is needed into the role and structure of social networks on the diffusion of innovations between departments and the various types of innovations involved. [Copyright &y& Elsevier]

This article explores the intersection of medical practice and moralities of gender in the context of obstetrics and gynaecology clinics in Chennai, South India. The focus of the article grows out of an attempt to better understand the moral values that underpin obstetric and gynaecological (O&G) practice in relation to female sexuality. Its key concern is the cultural construction of ideal femininity and the way gendered boundaries are put in place to neutralize the sexual potential of the medical encounter and to protect values around virginity. To deconstruct the ways in which O&G practice works to reinforce these norms, it analyses the configuration of spatial arrangements in the clinics, as well as the discursive strategies employed by medical staff and patients. It also examines how the arrangement of space and speech in the context of the clinic reflect the moral codes that govern female sexuality in South Indian culture more generally. Finally, it shows the depth to which everyday moralities of gender operate in the clinic and how medical practice serves to maintain the boundaries that shape the expectations surrounding femininity and sexuality. [ABSTRACT FROM AUTHOR]

The essay discusses the development of surgical techniques in Greek and Roman medicine related to gynecological issues. Among other topics addressed are previous scholarship on medical practice as related to women specifically, ancient Greek and Roman literary sources used, and archaeological evidence related to surgical tools, the last primarily from the Roman period.