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Smartwatches provide health tracking in various ways and there has been a recent rise in reporting cardiac arrhythmias. While original studies focused on atrial fibrillation, fewer reports have been made on other arrhythmias especially in pregnancy. We report a pregnant patient who presented at 34 weeks' gestation with palpitations. An ECG recorded through her Apple Watch showed ventricular tachycardia. Hospital ECG confirmed monomorphic ventricular tachycardia likely caused by increased sympathetic tone from the gravid state. She was admitted to the cardiac intensive care unit for close monitoring with intravenous anti-arrhythmic agents; however, the rhythm persisted. She underwent a caesarean delivery and the arrhythmia resolved post partum. She later underwent a catheter ablation, after which she discontinued all anti-arrhythmic medications with no recurrence. This case highlights the importance of requesting relevant digital health information, if available, from patients in our modern era. Controlled clinical studies are needed to validate such practices.

Background Aims Materials and Methods Results Conclusions Women in leadership in obstetrics and gynaecology in Australia and Aotearoa New Zealand have historically been underrepresented, despite forming a significant portion of the workforce. This study extends prior research from 2017, examining shifts in gender representation, attitudes, and perceived leadership barriers within the specialty.The study aims to evaluate changes in gender diversity among leadership positions in the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and accredited training hospitals since 2017. Additionally, it seeks to understand current attitudes toward leadership and identify perceived barriers among RANZCOG consultants and trainees.A cross‐sectional approach was employed, utilising publicly available information, a survey distributed to RANZCOG members, and data from accredited training hospitals. Gender representation in leadership positions was analysed, and survey responses were collected from consultants and trainees to evaluate attitudes and perceived barriers.The study reveals an increase in women's representation in RANZCOG leadership, particularly on the council and in clinical leadership positions. While the proportion of women trainees remained stable, there was a noteworthy increase in women specialists. Survey responses revealed shared perceptions on leadership qualities but diverged on barriers, with more women expressing concerns about skillsets, caring responsibilities, and mentorship support.The findings underscore substantial progress in achieving gender equity in obstetrics and gynaecology leadership roles, attributed to RANZCOG initiatives, societal changes, and improved policies. Ongoing efforts, including structured mentorship and flexible arrangements, are recommended to sustain and further enhance gender representation and address specific barriers identified by women in the specialty. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of attending a clinical placement in considering a career in obstetrics and gynaecology. Design: Mixed methods study. Setting: London Medical School. Population: Fifth year medical students attending a clinical placement in obstetrics and gynaecology. Methods: Between January 2021 and January 2022, questionnaires were used and semi‐structured focus groups conducted, which were audio‐recorded. Descriptive statistics were conducted and a framework analysis on transcribed focus groups. Main outcome measure: The impact of the clinical placement on career choice. Results: Six main themes were identified from the analysis; three contributing to considering a career in obstetrics and gynaecology; pregnancy is not an illness, extraordinary experience of observing childbirth and variable specialty and three themes emerged contributing to not considering a career; lack of work–life balance, high stakes specialty and the emotional toll. Even at an undergraduate level, medical students exhibited concerns about the long‐term feasibility of achieving work–life balance and avoiding professional burnout, which was partly attributed to the responsibility of looking after both the woman and their baby. Conclusions: Obstetrics and gynaecology is perceived as an exciting and variable speciality by medical students. Students' experiences on the labour ward during a clinical placement appear to contribute to the consideration of a career in obstetrics and gynaecology. Students should be given opportunities to discuss their concerns about obstetrics, particularly over the potential psychological impact of adverse/traumatic birth events. It is crucial to provide a realistic introduction to obstetrics, to recruit enthusiastic junior doctors who will be resilient to the pressures of the speciality, to avoid burnout and minimise attrition rates. Linked article: This article is commented on by Charles Weissman, pp.969 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17751. [ABSTRACT FROM AUTHOR]

Introduction: Preconception is a critical period to optimise gamete function and early placental development, essential for successful conception and long-term maternal-child health. However, there is a lack of preconception services and consequently, global fertility rates continue to fall and mothers embark on their pregnancy journey in poor health. There is an urgent need to implement a holistic community-level preconception care programme to optimise risk factors for poor fecundability and improve long-term maternal-child health. Method: We reviewed current evidence on fecundability lifestyle risk factors, the efficacy of existing preconception interventions and the use of digital platforms for health optimisation, to create a new digital-based preconception intervention model that will be implemented via an app. We present the theory, content and mode of delivery of this holistic model targeting couples planning for pregnancy. Results: We propose a new model featuring a user-friendly mobile app, which enables couples to self-assess fecundability risks through a personalised risk score that drives a tailored management plan. This tiered management provides anticipatory guidance supported by evidence-based recommendations, and promotes ongoing engagement for behavioural optimisation and specialist referrals as required. Based on the health belief model, this new model delivered with a mobile app seeks to shift couples’ perceptions about their susceptibility and severity of subfertility, benefits of making a change and barriers to change. Conclusion: Our proposed digital-based intervention model via a mobile app stands to enhance preconception care by providing personalised risk assessments, real-time feedback and tiered management to optimise preconception reproductive health of couples. This model forms a reference content framework for future preconception care intervention delivery. [ABSTRACT FROM AUTHOR]

Background: In addition to its widely-appreciated contraceptive applications, the oral contraceptive pill (ocp) conveys both oncological and non-oncological benefits. Oncological benefits include a decreased risk of endometrial, ovarian, and colorectal cancer. Non-oncological benefits include reducing androgenic effects and alleviating menstruation-related problems. this study aimed to ascertain knowledge levels of non-contraceptive benefits and risks of OCP use among participants without contraindications to OCPs. this study also assessed factors associated with participants being more likely to consider taking OCPs. Methods: 263 women aged 21 to 40 years old with no contraindications for OCP usage participated in this study. an anonymous questionnaire collected sociodemographic information and assessed participants' knowledge of the non-contraceptive benefits and risks associated with OCP use. Multivariate linear regression was used to assess factors associated with knowledge levels. Multivariate logistic regression was used to investigate factors associated with being more likely to consider taking OCPs among women who did not presently take them. Results: Multivariate logistic regression revealed that participants who were more knowledgeable overall about the non-contraceptive benefits of OCPs were more likely to consider taking OCPs (coefficient = 0.184, p-value = 0.00). Knowledge of both oncological and non-oncological benefits of OCP use was relatively poor, especially among older women. Current OCP users were found to be more knowledgeable about their benefits. Conclusions: As women with greater knowledge of non-contraceptive benefits of OCPs are more likely to consider taking them, knowledge gaps regarding OCPs should be filled, so that more women may reap the non-contraceptive benefits of OCPs. [ABSTRACT FROM AUTHOR]

Background: Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants. Aim: This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern. Methods: Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022. Results: Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population. Conclusion: Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require. [ABSTRACT FROM AUTHOR]

Background: There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. Objective: The study aimed to identify what is known about health providers' reasons for participating in abortion provision. Eligibility criteria: Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. Sources of evidence: We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. Methods: Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. Results: From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). Conclusion: Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience. [ABSTRACT FROM AUTHOR]

Abstract Background Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. Methods Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Results Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). Conclusions GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.

Background Surgical site infections (SSIs) pose a significant challenge in obstetric and gynaecological surgeries, with incidence rates ranging from 0.5% to 15%. These infections not only impact patient outcomes but also contribute to extended hospital stays and increased healthcare costs. To address this issue, a hospital-based interventional study is proposed, focusing on the implementation of a comprehensive quality improvement protocol within the Department of Obstetrics and Gynecology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha. Methods The study will include approximately 800 obstetric and gynaecological surgeries per year. Ethical approval has been obtained and written informed consent will be obtained from all enrolled women. The intervention involves the implementation of a surgical site infection prevention quality improvement protocol, encompassing elements such as standardized pre-operative antiseptic agents, proper cleaning procedures, and the use of injectable cefazolin. A structured proforma will be developed for data collection, covering demographic details, surgical parameters, surgeon characteristics, and post-operative outcomes. Expected outcome This study aims to assess the efficacy of the quality improvement protocol in reducing the incidence of surgical site infections. We anticipate that the implementation of this protocol will lead to a significant reduction in SSIs, improving patient outcomes and safety in obstetric and gynaecological surgeries. The study's findings will not only contribute to the body of knowledge on infection prevention but will also serve as a valuable framework for enhancing surgical safety in similar healthcare settings. Continuous evaluation and refinement of the protocol will be crucial for sustained success in reducing SSIs and improving overall patient care.

Background: Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. Methods: Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Results: Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). Conclusions: GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension. [ABSTRACT FROM AUTHOR]

Objective: The study aims to equip both Obstetricians and Gynaecologists with the knowledge of clinical conditions that will benefit from interventional radiology, equipment and materials that are commonly used, benefits, complications and the side effects of these techniques. Methods: It was a single-centre, retrospective cohort study with examples from hospital practice during the period of 2015 to 2021, acquired through computerised database including all obstetrics and gynecological cases in which interventional radiology techniques were used. No statistical analysis of data was applicable as it was a single-centre retrospective analysis of cases. Results: We had a total of 35 cases, including but not limited to placenta accreta spectrum disorders, fibroid, pelvic congestion syndrome and arteriovenous malformation who underwent various interventional radiological procedures ranging from embolization of uterine artery, peripheral angiography, embolization, and internal iliac artery balloon placement to ovarian vein embolization and coil insertion. Conclusion: Increased collaborative efforts between interventional radiology and gynaecology would allow patients to be fully informed on the complete spectrum of surgical and nonsurgical treatment options available to them. [ABSTRACT FROM AUTHOR]

Introduction: Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women. Method: Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks. Results: Models predict that EEF should be performed at age <37 years and to achieve a 70% chance of live birth, women would need 14, 15 and 26 mature oocytes at ages 30-34, 35-37 and >38 years, respec-tively. An antagonist stimulation protocol with an agonist trigger would minimise ovarian hyperstimulation syndrome and duration of stimulation without affecting outcomes. Oocyte vitrification in comparison to slow freezing increases thaw survival, fertilisation and clinical pregnancy rates. No increased risks exist for the woman, future pregnancy or child when compared with conventional IVF. Conclusion: EEF is a viable option for single women desiring fertility preservation. Financial costs are significant, but returns are worthwhile if oocytes are utilised. [ABSTRACT FROM AUTHOR]

Introduction: Two decades after the Rotterdam 2003 consensus workshop, there have been considerable advances in elucidating the pathophysiology and epidemiology of polycystic ovary syndrome (PCOS). This has prompted the re-examination of the features that characterise this common condition. Current definitions have led to great heterogeneity in the prevalence of PCOS and have contributed to inconsistent treatment protocols and assessment of therapeutic outcomes. Diagnosis is further complicated by the lack of universal agreement on threshold cut-offs for ovarian dysfunction and ethnic differences in hirsutism; both of which are key features in the definitions that are commonly used currently. These challenges often result in dissatisfaction with medical care among PCOS patients and their physicians. Method: Our factor analysis mathematically identified anti-Mullerian hormone (AMH), associated polycystic ovarian morphology (PCOM) and serum testosterone as the only significant cluster associated with menstrual cycle length variability. Results and Conclusion: As such, we propose a simplified criteria wherein the presence of at least 2 of the 3 features below would be sufficient to define PCOS: (1) chronic oligo-ovulation or anovulation as indicated by oligomenorrhea (cycle lengths >35 days) or amenorrhea; (2) PCOM: raised AMH ≥37.0 pmol/L instead of transvaginal ultrasound assessment of ovaries; and (3) Androgen excess, or raised serum androgens above the laboratory reference for women. Further studies are required to examine whether the proposed criteria would reduce diagnostic confusion and improve care and outcomes, especially among patients of East Asian ethnicities. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess patient and clinician satisfaction and identify any differences between the two with the use of video consulting (VC) in the fields of obstetrics and gynaecology (O&G) and fertility in Wales. Design A retrospective electronic survey study. Setting All public hospitals in Wales that used virtual methods for delivery of fertility and/or O&G appointments during and after the COVID‐19 pandemic between August 2020 and March 2022. Population Patients awaiting an appointment on the National Health Service, who have attended virtual fertility or O&G appointments in Wales, and fertility and O&G clinicians who have conducted appointments virtually. Methods Analysis of patient and clinician responses to a VC satisfaction survey delivered after their consultation taking place between August 2020 and March 2022. Main Outcome Measures Patient and clinician satisfaction rates with the use of virtual consultation in fertility and O&G appointments. Results In satisfaction data collected from 420 patients and 161 clinicians, 83% of patients and 63% of clinicians reported their VC quality to be ‘very good’ or ‘excellent’. Difficulties when using VC were experienced by a minority of patients (1%–9%) and clinicians (1%–8%) and most patients (52v82%) and clinicians (34%–67%) found several aspects of VC to be ‘very beneficial’. Fertility patients rated their VC experience more positively than O&G patients. Conclusions Most patients and clinicians were satisfied with their VC experience. Patients were more satisfied with the use of VC than clinicians. Fertility patients were more satisfied with the use of VC than O&G patients.

ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009-2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p

Abstract Context Effective clinical medical student education includes attention to teaching approaches. This study assessed the impact of a new multi-element teaching mode that utilizes Bite-Sized Teaching, flipped classroom, and MOOC on learner perception in an Obstetrics and gynaecology clerkship. Methods A Two-stage crossover design study was conducted of a multi-element teaching mode compared to traditional teaching mode in an academic year. Participants included Ninety-six medical students practicing obstetrics and gynecology in our hospital, randomly divided into two groups respectively underwent multi-element teaching mode and traditional teaching mode. After each semester, a final test (including theoretical and clinical practical test) was conducted.When an academic year was completed, post intervention survey assessed learner perceptions of the intervention. Result In order to comprehensively test students’ performance after study, we take theoretical and practical examinations. The theoretical examination mainly tests students’ grasp of basic knowledge points, while the practical examination focuses on the examination of students’ diagnosis and treatment of diseases. There were statistically significant differences both in the theoretical and clinical practical scores between the new multi-element integrated teaching mode and the traditional teaching mode, specifically as follows: In the end of first semester, the theoretical scores of the two groups were respective 43.75 ± 3.42 vs. 42.07 ± 2.90, and clinic practical test scores were respective 44.93 ± 2.42 vs. 43.37 ± 2.52; In the end of second semester, the theoretical scores of the two groups were respective 44.30 ± 2.69 vs. 42.25 ± 3.39, and clinic practical test scores were respective 43.79 ± 2.25 vs. 41.93 ± 2.80.(p

Abstract Aims To examine the factors influencing compassion fatigue and compassion satisfaction in obstetrics and gynaecology nurses and to explore the combined results of multiple factors. Design An online cross‐sectional study was conducted. Review Methods Data were collected from 311 nurses using a convenience sampling method from January to February 2022. Stepwise multiple linear regression analysis and mediation tests were performed. Results Compassion fatigue in obstetrics and gynaecology nurses was in the moderate to high levels. Physical status, number of children, emotional labour, lack of professional efficacy, emotional exhaustion and the none‐only‐child can influence compassion fatigue; lack of professional efficacy, cynicism, social support, work experience, employment status and night shift were predictive of compassion satisfaction. Social support partially mediated between lack of professional efficacy and compassion fatigue/compassion satisfaction; emotional labour moderated in the mediated analysis model. Conclusion Moderate to high levels of compassion fatigue was present in 75.88% of obstetrics and gynaecology nurses. Some factors affect compassion fatigue and compassion satisfaction. Thus, nursing managers should consider factors and construct a monitoring system to reduce compassion fatigue and improve compassion satisfaction. Implications for the Profession The results will provide a theoretical basis for improving job satisfaction and the quality of care in obstetrics and gynaecology nurses. And this may raise concerns about the occupational health of obstetrics and gynaecology nurses in China. Reporting Method The study was reported according to the STROBE. Patient or Public Contribution The nurses spent time filling out the questionnaires during the data collection phase and answered the questions sincerely. What does this article contribute to the wider global clinical community? Obstetrics and gynaecology nurses with 4–16 years of experience are prone to experience compassion fatigue. The effect of lack of professional efficacy on compassion fatigue and compassion satisfaction can be improved by social support. Relevance to Clinical Practice Reducing nurse compassion fatigue and improving compassion satisfaction are important for providing quality nursing care to obstetrics and gynaecology patients. In addition, clarifying the influencing factors of compassion fatigue and compassion satisfaction can improve nurses' work efficiency and job satisfaction, and provide theoretical guidance for managers to implement interventions.

Introduction: Disruptions of the postgraduate (PG) teaching programmes by COVID-19 have encouraged a transition to virtual methods of content delivery. This provided an impetus to evaluate the coverage of key learning goals by a pre-existing PG didactic programme in an Obstetrics and Gynaecology Specialty Training Programme. We describe a three-phase audit methodology that was developed for this. Methods: We performed a retrospective audit of the PG programme conducted by the Department of Obstetrics and Gynaecology at National University Hospital, Singapore between January and December 2019 utilising a ten-step Training Needs Analysis (TNA). Content of each session was reviewed and mapped against components of the 15 core Knowledge Areas (KA) of the Royal College of Obstetrics & Gynaecology membership (MRCOG) examination syllabus. Results: Out of 71 PG sessions, there was a 64.9% coverage of the MRCOG syllabus. Four out of the 15 KAs were inadequately covered, achieving less than 50% of knowledge requirements. More procedural KAs such as “Gynaecological Problems” and those related to labour were poorly (less than 30%) covered. Following the audit, these identified gaps were addressed with targeted strategies. Conclusion: Our audit demonstrated that our pre-pandemic PG programme poorly covered core educational objectives i.e. the MRCOG syllabus, and required a systematic realignment. The COVID-19 pandemic, while disruptive to our PG programme, created an opportunity to analyse our training needs and revamp our virtual PG programme.

Context: Effective clinical medical student education includes attention to teaching approaches. This study assessed the impact of a new multi-element teaching mode that utilizes Bite-Sized Teaching, flipped classroom, and MOOC on learner perception in an Obstetrics and gynaecology clerkship. Methods: A Two-stage crossover design study was conducted of a multi-element teaching mode compared to traditional teaching mode in an academic year. Participants included Ninety-six medical students practicing obstetrics and gynecology in our hospital, randomly divided into two groups respectively underwent multi-element teaching mode and traditional teaching mode. After each semester, a final test (including theoretical and clinical practical test) was conducted.When an academic year was completed, post intervention survey assessed learner perceptions of the intervention. Result: In order to comprehensively test students' performance after study, we take theoretical and practical examinations. The theoretical examination mainly tests students' grasp of basic knowledge points, while the practical examination focuses on the examination of students' diagnosis and treatment of diseases. There were statistically significant differences both in the theoretical and clinical practical scores between the new multi-element integrated teaching mode and the traditional teaching mode, specifically as follows: In the end of first semester, the theoretical scores of the two groups were respective 43.75 ± 3.42 vs. 42.07 ± 2.90, and clinic practical test scores were respective 44.93 ± 2.42 vs. 43.37 ± 2.52; In the end of second semester, the theoretical scores of the two groups were respective 44.30 ± 2.69 vs. 42.25 ± 3.39, and clinic practical test scores were respective 43.79 ± 2.25 vs. 41.93 ± 2.80.(p < 0.05). The results of questionnaires demonstrated that 80.21% of the students showed preference for the new multi-element integrated teaching mode comparing to traditional teaching methods. Conclusion: The new multi-element integrated teaching mode is well accepted by the students and can improve the students' mastery of knowledge, and can improve the students' clinical comprehensive ability. The new multi-element integrated teaching mode is shown more preference than traditional teaching mode in the teaching of Obstetrics and Gynaecology. Further long term study is needed carried out to consolidate our conclusion. The new multi-element integrated teaching mode may have positive effects on clinical teaching of Obstetrics and Gynaecology. [ABSTRACT FROM AUTHOR]

Pregnancy is a frequently applied exclusion criteria for many forms of research. Common justifications for this exclusion include the potential for teratogenicity, as well as the potential for physiologic changes in pregnancy to impact the research itself. The systematic exclusion of pregnant persons from clinical studies has created a significant gap in knowledge regarding medication safety and efficacy in pregnancy, which continues to cause significant harm to pregnant persons in need of medical therapy. To produce meaningful data and facilitate effective knowledge translation to the clinical setting, special consideration to the pharmacology of pregnancy, as well as to outcomes of concern for this population is essential. The exclusion of pregnant participants from research is not ethically justifiable, as it violates the principles of autonomy, justice and nonmaleficence. While the inclusion of pregnant patients in research presents it's own challenges, with appropriate methodological, ethical, and clinical considerations, we may be able to narrow the knowledge gap and improve drug availability and safety for pregnant patients and their children. [ABSTRACT FROM AUTHOR]

On June, 2023, Vilnius University Hospital Santaros Klinikos started robotic-assisted operations using VERSIUS robotic surgery system (CMR, Cambridge, UK) and performed 29 robotic surgeries within the first 3 weeks. This surgical system was purchased with funding from the European Regional Development Fund. Comprehensive three-month-long learning courses were organized for a total number of 32 persons, forming 8 independent teams, each consisting of 2 surgeons and 2 nurses. Learning courses consisted of online theoretical training modules, a one-week learning course including technical skills training with a simulator and dry runs as well as cadaveric surgical cases. Furthermore, an additional learning module included dry runs in the operating room prior to the first surgeries, following live and online proctored surgical cases. This enabled a rapid and smooth introduction of the robotic surgical system into clinical practice without putting patients at risk. Abdominal surgeons, urologists, and gynecologists have already performed surgeries using the VERSIUS surgical system and no major complications have been reported. Thoracic surgeons are underway to begin thoracic robotic-assisted surgeries, completing the multidisciplinary VERSIUS surgical system implementation process. Our goal is to share initial experience with robotic VERSIUS surgical system and evaluate its implementation in Vilnius University Hospital Santaros Klinikos. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of a modified early warning system (MEOWS) for predicting severe maternal morbidity, taking intensive care unit admission as the reference standard. Study Design: Cross-sectional study. Setting and Duration of Study: Combined Military Hospital, Abbottabad Pakistan, from Nov 2019 to Apr 2020. Methodology: After getting approval from the Institutional Ethical Committee, pregnant women fulfilling the inclusion criteria were included from the Labour Room of Department of Obstetrics & Gynecology. A modified early obstetric warning system chart was used to assess all women, labelling them positive or negative as per the criteria. In case of a fatal outcome or development of severe morbidity warranting intensive care unit admission, the patient was labelled as positive. Women who developed severe morbidity were managed as per standard protocols. Results: The early warning chart showed sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as 69.44%, 90.97%, 64.10%, 92.76% and 86.91%, respectively, for predicting severe obstetric morbidity considering intensive care unit admission as gold standard. Conclusion: Modified early obstetric warning system chart effectively predicts severe obstetric morbidity. It could lead to better patient care, thus preventing severe obstetric morbidity in our local population if implemented as part of routine clinical evaluation.

Aims: To examine the factors influencing compassion fatigue and compassion satisfaction in obstetrics and gynaecology nurses and to explore the combined results of multiple factors. Design: An online cross‐sectional study was conducted. Review Methods: Data were collected from 311 nurses using a convenience sampling method from January to February 2022. Stepwise multiple linear regression analysis and mediation tests were performed. Results: Compassion fatigue in obstetrics and gynaecology nurses was in the moderate to high levels. Physical status, number of children, emotional labour, lack of professional efficacy, emotional exhaustion and the none‐only‐child can influence compassion fatigue; lack of professional efficacy, cynicism, social support, work experience, employment status and night shift were predictive of compassion satisfaction. Social support partially mediated between lack of professional efficacy and compassion fatigue/compassion satisfaction; emotional labour moderated in the mediated analysis model. Conclusion: Moderate to high levels of compassion fatigue was present in 75.88% of obstetrics and gynaecology nurses. Some factors affect compassion fatigue and compassion satisfaction. Thus, nursing managers should consider factors and construct a monitoring system to reduce compassion fatigue and improve compassion satisfaction. Implications for the Profession: The results will provide a theoretical basis for improving job satisfaction and the quality of care in obstetrics and gynaecology nurses. And this may raise concerns about the occupational health of obstetrics and gynaecology nurses in China. Reporting Method: The study was reported according to the STROBE. Patient or Public Contribution: The nurses spent time filling out the questionnaires during the data collection phase and answered the questions sincerely. What does this article contribute to the wider global clinical community?: Obstetrics and gynaecology nurses with 4–16 years of experience are prone to experience compassion fatigue.The effect of lack of professional efficacy on compassion fatigue and compassion satisfaction can be improved by social support. Relevance to Clinical Practice: Reducing nurse compassion fatigue and improving compassion satisfaction are important for providing quality nursing care to obstetrics and gynaecology patients. In addition, clarifying the influencing factors of compassion fatigue and compassion satisfaction can improve nurses' work efficiency and job satisfaction, and provide theoretical guidance for managers to implement interventions. [ABSTRACT FROM AUTHOR]

Introduction: Disruptions of the postgraduate (PG) teaching programmes by COVID-19 have encouraged a transition to virtual methods of content delivery. This provided an impetus to evaluate the coverage of key learning goals by a pre-existing PG didactic programme in an Obstetrics and Gynaecology Specialty Training Programme. We describe a three-phase audit methodology that was developed for this. Methods: We performed a retrospective audit of the PG programme conducted by the Department of Obstetrics and Gynaecology at National University Hospital, Singapore between January and December 2019 utilising a ten-step Training Needs Analysis (TNA). Content of each session was reviewed and mapped against components of the 15 core Knowledge Areas (KA) of the Royal College of Obstetrics & Gynaecology membership (MRCOG) examination syllabus. Results: Out of 71 PG sessions, there was a 64.9% coverage of the MRCOG syllabus. Four out of the 15 KAs were inadequately covered, achieving less than 50% of knowledge requirements. More procedural KAs such as "Gynaecological Problems" and those related to labour were poorly (less than 30%) covered. Following the audit, these identified gaps were addressed with targeted strategies. Conclusion: Our audit demonstrated that our pre-pandemic PG programme poorly covered core educational objectives i.e. the MRCOG syllabus, and required a systematic realignment. The COVID-19 pandemic, while disruptive to our PG programme, created an opportunity to analyse our training needs and revamp our virtual PG programme. [ABSTRACT FROM AUTHOR]

Obstetrics is a constraining specialty due to heavy workloads and repeated stressful situations. French maternity wards are facing many difficulties to recruit, as a consequence of the conversion of a significant number of Obstetrician-Gynecologists (OB-GYNs) to exclusive daily private practice. The aim of this study was to evaluate the quality of life (QOL) of OB-GYNs in order to identify burnout risk factors, develop prevention strategies and therefore ensure patient safety. A Google forms questionnaire assessing QOL and life/work balance was distributed by e-mail to 1 397 members of the National College of French OB-GYNs (CNGOF). This was a declarative multicenter cross-sectional survey. Four hundred sixty-one responses were collected (response rate 30%). A burnout episode was reported by 31.3% of respondents. Main burnout risk factors were limited staff on the on-call schedule (p = 0.008) and low salary (p < 0.001). On-call work was considered to have a negative personal life impact by 57.8% of the sample; 34.1% wanted to stop this practice and 81.3% believed that financial compensation would help reinforce its attractiveness. Medico-legal risks influenced the daily practices of 70% of respondents and 86.8% had been personally affected by media coverage of obstetrical violence. This report confirms a high burnout rate within a stressful profession, with major impacts from on-call activity, insufficient salary relative to the arduousness of this practice, high exposure to medico-legal actions and media attention. Revising shift duration to a maximum 12 h, better control over global workload, higher salary and renewed social recognition are urgent priorities. [ABSTRACT FROM AUTHOR]

Introduction: Endometriosis is a benign nevertheless a chronic condition which impacts greatly the quality of life through cyclic discomfort. We aim to report the case of umbilical endometriosis and a literature review of the different treatment modalities. Case Report: This was a case of a 43-year-old woman, with no history, who presented with a painful hemorrhagic umbilical swelling during the menstrual period associated with dysmenorrhea. Abdominal ultrasound revealed a subcutaneous umbilical mass of non-vascularized tissue nature confirmed on Doppler. Pelvic MRI which confirms the diagnosis of primary umbilical endometriosis. The patient underwent wide local excision of the endometriotic nodule with umbilical reconstruction. Histology confirmed the diagnosis of umbilical endometriosis. Resection margins were clear. Discussion: Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. Surgical management is currently described as gold standard. Laparoscopic approach is recommended as it allows better visual inspection for secondary localization of endometriosis. Medical management corresponds to combined oral contraceptives (COCs) or progestins for management of endometriotic implants decreasing inflammatory effects, or Gonadotropin-releasing hormone for long-course treatment. Malignant transformation of the umbilical nodule has been described in literature with a reported risk of malignant transformation to be 3%. Conclusion: Current management of extragenital endometriosis suggest radical surgery with wide local excision. Due to the rarity, there is a paucity of data on umbilical endometriosis and mostly reported from case reports. [ABSTRACT FROM AUTHOR]

Abstract Background There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. Methods This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. Results Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P

Aim: To examine factors that influence intrapartum health outcomes among Black childbearing persons, including cisgender women, transmasculine and gender‐diverse birthing persons. Background: Black childbearing persons are three to four times (243%) more likely to die while giving birth than any other racial/ethnic group. Black birthing persons are not just dying from complications but also from inequitable care from healthcare providers compared to their white counterparts. Design: Discursive paper. Method: Searching national literature published between 2010 and 2021 in PubMed, CINAHL, Embase and SCOPUS, we explored factors associated with poor intrapartum health outcomes among Black childbearing persons. Discussion Several studies have ruled out social determinants of health as sufficient causative factors for poor intrapartum health outcomes among Black birthing persons. Recent research has shown that discrimination by race heavily influences whether a birthing person dies while childbearing. Conclusions: There is a historical context for obstetric medicine that includes harmful stereotypes, implicit bias and racism, all having a negative impact on intrapartum health outcomes. The existing health disparity among this population is endemic and requires close attention. Impact on Nursing Practice: Nurses and other healthcare professionals must understand their role in establishing unbiased care that promotes respect for diversity, equity and inclusion. No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

Background: There is currently a gender imbalance 85:15 female/male in the intake into specialist training for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Aims: To determine the views and perceptions of Australian medical students, and junior doctors in the first five years of practice, toward obstetrics and gynaecology (O&G) as a career, including whether there are any perceived barriers to the pursuit of such a career. Materials and Methods: A semi‐structured questionnaire was developed with members of the RANZCOG Gender Equity and Diversity Working Group There were two separate studies: the first involved telephone interviews of medical students across three campuses of a medical school in North Queensland. The second study surveyed junior doctors in Queensland who are members of the Australian Medical Association. Responses were analysed and compared using quantitative and qualitative methods. Results: Both studies found that experiences with O&G as a medical student influenced the decision to pursue O&G as a career. Exclusion from clinical scenarios and difficulty establishing good relationship with midwives within busy birthing suites were some reasons deterring male students from O&G. In addition, students felt poorly informed about the specialty in their preclinical years, affecting their early decisions in choice of specialty. Post‐rotation, more female than male students reported positive experiences and were considering O&G as a career. Conclusions: Both groups see medical student experience as critical in attitudes toward the specialty as a possible career. This experience plays a significant role in encouraging female students toward a career in O&G and discouraging male students. More exposure to the specialty in the preclinical years, and attention to improving clinical rotations for all students, is required. [ABSTRACT FROM AUTHOR]

Objectives: To determine COVID‐19 antibody positivity rates over time and relationships to pregnancy outcomes in low‐ and middle‐income countries (LMICs). Design: With COVID‐19 antibody positivity at delivery as the exposure, we performed a prospective, observational cohort study in seven LMICs during the early COVID‐19 pandemic. Setting: The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population‐based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (two sites), and Guatemala. Population: Pregnant women enrolled in an ongoing pregnancy registry at study sites. Methods: From October 2020 to October 2021, standardised COVID‐19 antibody testing was performed at delivery among women enrolled in MNHR. Trained staff masked to COVID‐19 status obtained pregnancy outcomes, which were then compared with COVID‐19 antibody results. Main Outcome Measures: Antibody status, stillbirth, neonatal mortality, maternal mortality and morbidity. Results: At delivery, 26.0% of women were COVID‐19 antibody positive. Positivity increased over the four time periods across all sites: 13.8%, 15.4%, 21.0% and 40.9%. In the final period, positivity rates were: DRC 27.0%, Kenya 33.1%, Pakistan 32.8%, Guatemala 37.0%, Zambia 37.8%, Bangladesh 47.2%, Nagpur, India 57.4% and Belagavi, India 62.4%. Adjusting for site and maternal characteristics, stillbirth, neonatal mortality, low birthweight and preterm birth were not significantly associated with COVID‐19. The adjusted relative risk (aRR) for stillbirth was 1.27 (95% CI 0.95–1.69). Postpartum haemorrhage was associated with antibody positivity (aRR 1.44; 95% CI 1.01–2.07). Conclusions: In pregnant populations in LMICs, COVID‐19 antibody positivity has increased. However, most adverse pregnancy outcomes were not significantly associated with antibody positivity. [ABSTRACT FROM AUTHOR]

Persistent trophoblast after ectopic pregnancy has been demonstrated at the surgical site or as peritoneal implants. A 37-year-old woman (G5P2) experienced persistently low levels of beta-human chorionic gonadotropin (hCG) after surgical treatment for an interstitial pregnancy. Evaluation for persistent trophoblast, gestational trophoblastic neoplasm and heterophilic antibodies was negative. After 15 months without resolution, she elected for hysterectomy. We found four smooth, freely floating avascular cysts intraoperatively; pathological evaluation identified the cysts as trophoblastic tissue. Serum beta-hCG resolved postoperatively and remained negative at 1 year. Our case demonstrates the novel finding of trophoblastic tissue existing as free-floating cysts in the peritoneal cavity. With appropriate suspicion, these cysts can be identified on radiologic investigation and removed laparoscopically.

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Background: In absence of a dedicated teaching curriculum for non-PG residents in Obstetrics and Gynecology department, a concise teaching learning method, One-Minute Preceptor (OMP) with feedback being its core component may be introduced to translate their theoretical knowledge into clinical practice. Methods: This descriptive cross-sectional study included four faculty members and 20 residents. Each resident was exposed to three OMP sessions pertaining to common gynecological case scenarios with a gap of at least two days in between the sessions with faculties acting as preceptor and as observer. After three OMP sessions, feedback from residents and faculty regarding their teaching and learning experience after implementing this tool was obtained through separate pre-validated questionnaires graded on Likert's scale. Results: The satisfaction index of the residents and faculties for OMP was found to be 96.3% and 95%, respectively. All residents and faculty members had consensus that OMP addressed the learning gaps (mean score 4.45 ± 0.51 and mean score 4.5 ± 0.57, respectively) and expressed being highly satisfied with OMP in busy clinical settings as compared to traditional method of teaching with mean score of 4.9 ± 0.30 and 4.75 ± 0.5, respectively. The faculties had consensuses that OMP can assess all domains of learning (mean score 4.75 ± 0.5). All residents and faculties opined that the time allotted to address all micro-skills was less and 60% residents advocated allotting at least 5 min time to the teaching encounter. Conclusion: Our study indicates the beneficial role of OMP in time-constraint clinical environment and warrants further research to review the time frame keeping in view the learners' needs and the discipline. [ABSTRACT FROM AUTHOR]

Introduction: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital. Caesarean section is a live saving procedure but when performed without appropriate indications can add risk to both mother and baby. As per WHO report, at population level, Caesarean section rates higher than 10% are not associated with reductions in maternal and new-born mortality rates. In India as per District level household survey 3 (DLHS) Caesarean section rate is 28.1% in private sector and 12% in public sector health care facilities. The close embryonic development and anatomical proximity of the urinary bladder and genital organs, are responsible for the urinary tract to injury during surgical procedures in the female pelvis. During LSCS bladder injury is demonstrated by the presence of gas filling up the Foley bag or visibly bloody urine in the Foley bag. Veress needle injuries and other small injuries to the bladder can be successfully managed conservatively by catheter drainage for seven to 14 days followed by cystography while large bladder injuries, such as from 5- or 10-mm trocar or surgical dissection usually require suturing the injuries closed. Risk factors for bladder injury during LSCS include previous operations, exposure to radiation, malignancy, chronic infection, and inflammation. Aims and objectives- The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022. Cases with the documented urological injuries during these procedures were analysed further Material And Methods: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period. In suspected cases of bladder injuries cystogram X-ray of the bladder after injection of contrast medium is performed. For extraperitoneal injuries (grade 2) without complicating factors, treatment is a insertion of Foley catheter for 7 - 14 days. grade 3 to grade 5 injuries generally require operative repair. Closed suction drains should be left in place after repairs. Suprapubic tube placement is not necessary in most cases. For injuries to the ventral bladder, dome, or posterior bladder, the mucosa is closed in a running fashion using 3-0 vicryl followed by a seromuscular running suture of 2-0 vicryl. The bladder is irrigated to ensure a watertight closure. A third layer in a Lembert fashion can be used in cases at high risk for fistula formation or when a leak is identified. In the laparoscopic setting, a one-layer closure is performed using 2-0 vicryl to close all layers of the bladder. An additional layer can then be added using a 2- 0 vicryl in a Lembert fashion for more extensive injuries. Results: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2018 to December 2019, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period. In this study mean age of bladder injury is 34.8 years and for ureteric injury 35 years. Parity for bladder injury 2.4 and for ureteric injury 3. Gestational age is similar for both is 37 weeks. In this study there are 2990 LSCS done and 10 peripartum hysterectomy done. Among all patients who underwent cesarean section 1.5% suffered from bladder injury, 0.01% ureteric injury and 0.01% for ureteric and bladder injury. Similarly, in peripartum hysterectomy, 40% suffered from bladder injury and no one have ureteric injury. Total 52 [1.5%] cases have injury. Among all patients who suffered from bladder injury, mostly cases are primigravida cases, which are 57% cases. 13% cases are more than two section patients. Others are previous two section 9%, Placenta previa and placenta accreta 7.6%, Previous history of myomectomy and hysterotomy 3.8% and 1.9% cases from 2nd stage labour and CPD patients. In bladder injury, most of the cases are bladder dome [81.5%], posterior wall [14%], lateral wall [4%] cases and none cases in bladder neck injury. Most bladder injury repaired by triple layers vicryl with SPC insertion [44%], without SPC [38%] and only catheterization only 11% cases. All ureteric injury repaired by DJ stent insertion with repair. SPC removed after 14 days. Conclusion: 1.5% of the bladder injuries were observed. Early detection and prompt management of bladder injury can decrease the morbidity and mortality in LSCS cases. The incidence urological injuries during obstetrics and gynaecological procedures are rare but the morbidity associated these are significant. There for surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel. [ABSTRACT FROM AUTHOR]

Background: There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. Methods: This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees' knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians. The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees' clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. Results: Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence. Conclusion: This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS. [ABSTRACT FROM AUTHOR]

The women’s sexual and reproductive healthcare sector, one of the largest employers delivering services globally, does not always commit to equality, diversity, and inclusion. There is objective, published evidence that not only care provision but also workforce treatment permits inequality and discrimination. The black and ethnic minority workforce in the women’s health specialty, compared to their white counterparts, is often treated unfavorably in appointments, is less often afforded academic development opportunities, is, at many sites, subjected to disproportionately greater disciplinary penalties, tends not have representation in positions of authority, and undertakes training in what is often perceived as a climate of fear due to racism. This problem deserves immediate action by professional bodies. They have the responsibility to remove feelings of exclusion and lack of belonging to all staff, the negative impact on wellbeing caused by unnecessary stress, and concerns over career progression among minority ethnic healthcare workforce and other workers who report discrimination. This duty is part of the societal responsibility to ensure fairness and eradicate discrimination under the equality, diversity and inclusion agenda.

Objective: To explore the perception of Obstetrics and Gynaecology (OB/GYN) postgraduates about the use of simulation in improving their clinical skills. Study Design: Explanatory sequential mixed method design. Place and Duration of Study: Obstetrics and Gynaecology department of Sharif Medical and Dental City (SMDC) Lahore Pakistan, from Jun to Oct 2019. Methodology: By using a homogenous purposive sampling technique eight postgraduate residents from Obstetrics and Gynaecology department were recruited. The study had two phases: In the first phase, quantitative data was collected and analyzed while in the second phase qualitative data were collected by following the quantitative phase and then analyzed. This framework was tracked through the procedure of instrumental delivery with vacuum application in a real-life situation. A survey was conducted before and after the simulation training by using a researcher-developed Likert scale questionnaire. After that in-depth qualitative interviews were conducted. The improvement in clinical performance was evaluated by pairedsample t-test and thematic analysis. Results: Significant performance improvement (p

Introduction: Obstetric and gynaecological care are undoubtedly one of the most important elements in protecting a woman’s health. From the period of puberty characterised by many hormonal changes, until late old age, every woman should be cared for depending on her age and state of health. However, women and girls living in rural areas have difficulties in accessing reproductive health care, especially public services that are financed by the National Health Fund (Narodowy Fundusz Zdrowia — NFZ). There is a significant gap in access to antenatal and gynaecological health care services between women living in urban and rural areas. Objective: The goal of this paper is to explore current state of knowledge and data from recent reports on access to reproductive health care services in rural areas of Poland with a special focus on people living with disabilities and to share recommendations and solutions to improve access to universal reproductive healthcare services. Conclusions: Family policy should be coordinated with health policy to ensure comprehensive, tailored and free maternal and child healthcare at primary, local and national levels. The observed insufficient access to obstetric and gynaecological care in rural areas is probably associated with increased outlays, and thus the more efficient functioning of health care facilities in large cities. Additional campaigns, introducing mobile clinics and quality improvement in fulfilling the national standards of antenatal and gynaecological care are pivotal to universal access of reproductive health services of Polish women. People living with disabilities are facing structural and information barriers in order to access reproductive health services they need and deserve. Efforts should be made in order to develop the standards of care in order to facilitate and increase access to obstetrics and gynaecological care.

Objective: To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology. Design: Prospective, observational study. Settings Study NICUs in India and Pakistan. Population Preterm infants delivered in study facility. Methods: A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel. Main outcome measures: RDS and birth asphyxia. Results: Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia. Conclusions: NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians. Linked article: This article is commented on by Evelyn Verheijen, pp. 2001 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17245 [ABSTRACT FROM AUTHOR]

Litigation over medical mishaps – NHS Resolution – extent of damages and costs – the relationship between doctor and midwife – celebrated or notorious cases, Mid Staffs, Morecambe Bay, Northwick Park – informing patient of risks – meaning of wrongful birth – contemporary tests for negligence. [ABSTRACT FROM AUTHOR]

Streptococcal toxic shock syndrome (TSS) is a fulminant disease characterised by rapid progression to multiorgan failure. However, streptococcal TSS manifesting as uterine necrosis (UN) is unusual. Here, we present a case of a woman in her 30s with a constellation of symptoms, including abdominal pain, fatigue and fever. Despite an initially unclear clinical picture, she rapidly developed shock with radiographical evidence of intrabdominal arterial narrowing with spurious multiorgan infarctions and ischaemic colitis. Exploratory laparotomy uncovered unexpected UN requiring hysterectomy. Multiple complications ensued, marked by shock liver, acute renal failure, cutaneous desquamation and distal gangrene. This case highlights a unique presentation of streptococcal TSS as UN and emphasises the rapidly deteriorating nature of the disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Maternal sepsis is the third-leading cause of maternal death worldwide, and caesarean section is an important risk factor for developing maternal infection. In this case, we present a patient with peritonitis following a caesarean section in a low-resource setting. Severe infections are familiar to medical staff in such settings; however, there is insufficient evidence regarding their incidence and optimal management. The case highlights the problem of limited access to microbiological testing and antibiotic availability, restricting management options. Furthermore, suboptimal quality of care in healthcare facilities and delays in presentation hamper early detection and efficient treatment of maternal infections. These issues must be addressed to reduce cases of maternal infection following caesarean section in low-resource settings, and subsequent maternal morbidity and mortality., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8 weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6 days later with features of thyrotoxicosis. TVUS demonstrated a 198×110×165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the 'hook effect'. Following appropriate dilution, the hCG was reported as 4 573 344 mIU/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3 days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Females undergoing laparoscopic gynaecological surgeries have a high incidence of postoperative nausea and vomiting. Apart from the established risk factors, hormonal, psychological, genetic and ethnic factors may also contribute to postoperative nausea and vomiting. This study aimed to evaluate the relationship between preoperative anxiety and serum oestrogen level with postoperative nausea and vomiting in patients undergoing diagnostic laparoscopy - hysteroscopy for infertility., Methods: In total, 100 female patients, between the ages of 20-40 years, undergoing diagnostic laparoscopy - hysteroscopy for infertility were recruited for this study. Preoperative anxiety level was assessed using Depression, Anxiety and Stress Scale-21 (DASS-21) Questionnaire. Serum oestrogen samples were taken before anaesthesia. Postoperative nausea and vomiting grading was rated with 0-3 Likert-type scale. An association of anxiety and oestrogen levels to postoperative nausea and vomiting was done., Results: The analysis between median DASS 21 scores to postoperative nausea and vomiting grading showed no association between DASS 21 scores and postoperative nausea and vomiting grades. Comparing the mean oestrogen levels in patients among each grade of postoperative nausea and vomiting showed no significant difference in the mean oestrogen levels., Conclusion: Our study did not find evidence of a significant association between serum oestrogen levels, preoperative anxiety, and postoperative nausea and vomiting., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Preterm birth is associated with significant mortality and morbidity for mothers and babies. Women are identified as high risk for preterm birth based on either previous medical/pregnancy history or on ultrasound assessment of the cervix. Women identified as high risk can be offered a cervical cerclage (a purse string stitch) around the cervix (neck of the womb) to reduce the risk of preterm birth. In women who have a cervical cerclage, the procedure can be performed using either a monofilament (single-stranded) or braided (woven) suture material. Both suture materials are routinely used for cervical cerclage and there is uncertainty as to which is superior. Methods A multicentre, open, randomised controlled superiority trial of 2050 women presenting at obstetric units, deemed to be at risk of preterm birth and already scheduled to have a cervical cerclage as part of their standard care. Inclusion criteria include singleton pregnancies and an indication for cervical cerclage for either a history of three or more previous mid-trimester losses or premature births (≤ 28 weeks), insertion of cervical sutures in previous pregnancies, a history of mid trimester loss or premature birth with a (current) shortened (≤ 25 mm) cervix, or women whom clinicians deem to be at risk of preterm birth either by history or the results of an ultrasound scan. Exclusion criteria include women who have taken part in C-STICH previously, are aged less than 18 years old at the time of presentation, require a rescue cerclage, and are unwilling or unable to give informed consent and in whom a cerclage will be placed by any route other than vaginally (e.g. via an abdominal route). Following informed consent, women are randomised on a 1:1 basis to either monofilament or braided suture, by minimisation. The primary outcome is pregnancy loss (miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life), and secondary outcomes include the core outcome set for preterm birth trials. Discussion Optimising established interventions to prevent preterm birth is important in reducing perinatal mortality rates. Trial registration ISRCTN 15373349 . Registered before recruitment on 03 December 2014 prior to first recruit.

The Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) and the European Fellowship in Obstetrics and Gynaecology (EBCOG) exams are both well-renowned specialty qualifications that assess the competency of obstetricians and gynaecologists. In this article, an exam candidate shares his perspective on the changes made during the COVID-19 pandemic. Despite changing to an online format to allow candidates to take the exam remotely, the MRCOG Part 3 exam maintained its main exam structures: (1) simulated patient task to evaluate the candidates' interactions with well-trained patients in a tele-interview: (2) structure discussion with the clinical examiners based on some certain topics. In contrast, the EBCOG has created a brand new structure to suit the online model to assess the candidates' core clinical skills in broader aspects. Although it is unclear whether online exam will exist in future, this has been a unique experience for candidates during pandemic. [ABSTRACT FROM AUTHOR]

Prescribing error in obstetrics and gynaecology (O&G) poses harm to women and potentially to the foetus and new born. Pharmacists' interventions have been reported to prevent prescribing error from reaching the patients. Little is reported on the magnitude of prescribing error and pharmacist intervention in a subspecialised outpatient O&G setting. This study aimed to identify the prevalence of prescribing error and pharmacists' interventions at the O&G outpatient setting. This retrospective study involved screening of prescriptions for commission and omission errors. Acceptance, clinical significance and rationale for pharmacists' interventions were analysed. Of the 3883 prescriptions screened, 359 (9.2%) prescriptions contained prescribing error, mainly (52.4%) due to commission errors. Among the 395 interventions performed by the pharmacists, 207 (52.4%) were recorded for omission errors. All the interventions were accepted by the prescribers with 65.1% were categorised as 'very significant'. About 54% of the interventions were conducted to optimise treatment outcome. The prevalence of prescribing error and pharmacists' interventions on O&G outpatient prescriptions was found to be substantial in this study. Standard prescription writing guideline should be routinely regulated, monitored and educated among healthcare professionals. What is already known on this subject? Prescribing error rate in O&G was found lowest in outpatient setting as compared to inpatient and high risk settings. Pharmacists' intervention performed at the centralised inpatient pharmacy unit or on-ward has shown to reduce prescribing error in inpatient settings. What do the results of this study add? This study identified that the prescribing error rate in a subspecialised outpatient O&G setting was within the range reported in high risk O&G settings. The number of prescriptions to pharmacists' intervention ratio of 9.8:1 was reported. What are the implications of these findings for clinical practice and/or further research? Further research, preferably qualitative in nature, is recommended to explore, identify and address the factors that may hinder clear, accurate and complete prescription writing practices. [ABSTRACT FROM AUTHOR]

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can be used as an adjunct treatment in traumatic abdominopelvic haemorrhage, ruptured abdominal aortic aneurysms, postpartum haemorrhage (PPH), gastrointestinal bleeding and iatrogenic injuries during surgery. This needs assessment study aims to determine the number of patients eligible for REBOA in a typical Norwegian population.Methods: This was a retrospective cross-sectional study based on data obtained from blood bank registries and the Norwegian Trauma Registry for the years 2017-2018. Patients who received ≥4 units of packed red blood cells (PRBCs) within 6 hours and met the anatomical criteria for REBOA or patients with relevant Abbreviated Injury Scale codes with concurrent hypotension or transfusion of ≥4 units of PRBCs within 6 hours were identified. A detailed two-step chart review was performed to identify potentially eligible REBOA candidates. Descriptive data were collected and compared between subgroups using non-parametric tests for statistical significance.Results: Of 804 patients eligible for inclusion, 53 patients were regarded as potentially REBOA eligible (corresponding to 5.7 per 100 000 adult population/year). Of these, 19 actually received REBOA. Among the identified eligible patients, 44 (83%) had a non-traumatic aetiology. Forty-two patients (79%) were treated at a tertiary care hospital. Fourteen (78%) of the REBOA procedures were due to PPH.Conclusion: The number of patients potentially eligible for REBOA after haemorrhage is low, and most cases are non-traumatic. Most patients were treated at a tertiary care hospital. The exclusion of non-traumatic patients results in a substantial underestimation of the number of potentially REBOA-eligible patients. [ABSTRACT FROM AUTHOR]

Nexplanon is a single-rod contraceptive implant that should be placed subdermally at the inner side of the upper nondominant arm approximately 8–10 cm above the medial epicondyle of the humerus. Insertion guidelines were recently updated to place of insertion superficial of the triceps muscle to lower risk of insertion into vessels and nerves. If migration however occurs, it is most commonly around the insertion site. Migration above 2 cm is rarely reported [Ismail H, Mansour D, Singh M. Migration of implanon®. BMJ Sexual Reproduct Health. 2006;32:157–159]. This is a case report of a 24-year-old caucasian woman who presented with an impalpable Nexplanon implant that was, with the help of chest radiography and CT, located in a posterior basal subsegmental pulmonary artery in the left lower lobe of the lung. An attempt to remove the contraceptive implant by endovascular approach was unsuccessful. The implant remains in situ. Etonogestrel and oestradiol concentrations were followed over time. [ABSTRACT FROM AUTHOR]