College Of Obstetricians Research Articles

An initiative to improve theatre recovery care for obstetric patients: an obstetric checklist and escalation pathway

Background: High-quality care of the obstetric patient should extend beyond hospital discharge, and not just until delivery of the baby. A preliminary survey of our theatre recovery staff revealed that 44% had never received training specific to the obstetric patient, and 50% had never received Trust-training specific to the obstetric patient. With obstetric patients representing a high proportion of the general theatre recovery workload (30%), we highlighted this as an area for improvement. Unfortunately, one patient had eclamptic seizures upon discharge to the ward after the onset of raised blood pressure post-delivery in theatre recovery. Methods: We designed a recovery checklist, detailing the pertinent points regarding intra-recovery care, and handover upon arrival to and discharge from recovery of the obstetric patient. The risk factors, abnormal physiological parameters, and abnormal examination findings help staff recognise the deteriorating patient (relating to conditions including maternal sepsis, pre-eclampsia,1 major haemorrhage,2 and epidural haematoma3), and provide an appropriate pathway for escalation. This was launched in conjunction with a 1-h teaching session (performed three times to capture all staff) to reinforce learning around these topics, and aid appropriate utilisation of the checklist. Staff surveys before and after intervention were performed to assess their confidence levels in identifying obstetric patients with these conditions. Results: Post-intervention confidence levels in recognition of particular obstetric conditions showed a general increase. More staff were very or extremely confident in recognising a bleeding patient (75% pre vs 100% post), maternal sepsis (63% pre vs 81% post), pre-eclampsia (38% pre vs 75% post), and epidural haematoma (31% pre vs 63% post). Overall, feedback was positive with 100% of staff finding the checklist and teaching very or extremely useful. Comments included requests for ‘more teaching for recovery staff’ and longer teaching sessions to ‘discuss past experiences for reflection’. Conclusions: The introduction of our checklist, supplemented by additional teaching, has markedly improved the confidence levels of our recovery staff when managing obstetric patients, particularly pertaining to recognition of pre-eclampsia and epidural haematoma. The checklist will serve as an aide memoire to support good multidisciplinary care, including handover and communication to both ward staff at discharge and to senior staff in the event of a deteriorating patient. This will improve our postoperative recovery care of obstetric patients and reduce the incidence of obstetric emergencies occurring on the postnatal ward. 1.Burton GJ, Redman CR, Roberts JM, Moffett A. BMJ 2019; 366: I23812.Royal College of Obstetricians. BJOG 2016; 124: e106–493.Yentis SM, Lucas DN, Brigante L, et al. Anaesthesia 2020; 75: 913–9

P-735 Exploring representation and inclusivity in fertility and reproductive health societies’ leadership

Abstract Study question How diverse is the board-level executive leadership of the leading fertility and reproductive health societies in Europe, Australia and North America? Summary answer There is good gender diversity among the reproductive health societies included in the study, with limited ethnic diversity. What is known already Reproductive health societies promote understanding and interest in reproductive biology and medicine. They are leading authorities, providing guidelines, opinions, and direction to practitioners, policy makers and the public. Membership on these societies’ board is a marker of influence and prestige. Many societies have clear Equality and Diversity Statement on their website, suggesting that they value representation of members from whom they obtain fees. This study presents a quantification of the executive leadership demographic diversity of major fertility and reproductive health societies in Europe, Australia and North America to evaluate diversity in governance. Study design, size, duration We conducted a review of the websites of ten leading fertility and reproductive health societies in the Europe, Australia and North America to quantity gender and ethnic diversity. Data analysis was conducted on the information obtained in January 2022. We included the executive leadership team /governing board members but excluded subgroup leaders or special interest group coordinators. Participants/materials, setting, methods Organisations reviewed include: American College of Obstetricians and Gynaecologists(ACOG), American Society for Reproductive Medicine(ASRM), British Fertility Society(BFS), Canadian Fertility and Andrology Society(CFAS), European Society of Human Reproduction and Embryology(ESHRE), The Fertility Society of Australia and New Zealand(FSA), International Federation of Obstetrics and Gynaecology(FIGO), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists(RANZCOG), Royal College of Obstetricians and Gynaecologists (RCOG), and The Society of Obstetricians and Gynaecologists of Canada(SOGC). Main results and the role of chance Proportion for each demographic group at the time of the study are summarised below; where n = total number of board members; Gender: W= women, M= Men; ethnicity: Wh = White, B = Black and A = Asian. In total, the number of board level/executive leadership members, responsible for governance in the societies reviewed were 112. Gender diversity was 41% Men, 59% Women, while ethnic diversity was 82% White, 3% Black and 15% Asian. It is encouraging to see the gender parity in the executive leadership of the organisations review, there remains an important need to improve ethnic diversity in order to better represent the membership and wider community they serve. This has implications for role-modelling, equity, minimising the negative impact of groupthink and reaching/giving underrepresented group a voice. Limitations, reasons for caution Results presented are based on a snapshot at the time of review. Organisations periodically change leadership. Additionally, gender identification is based on self-identification in individual’s profile biography. Wider implications of the findings As reproductive health organisations continue make extensive contributions to the field, it is important for their leadership to represent the diversity of members and wider population they serve. There remains a need to move beyond diversity and equality statement to actively deploy policies and processes to improve and monitor representation. Trial registration number not applicable

The Effect of Different Doses of Intraamniotic Digoxin on the Timing of Fetal Demise in Second Trimester Medical Abortions

OBJECTIVES: The World Health Organization recommends feticide for termination of pregnancy after 20 weeks of gestation, and the Royal College of Obstetricians & Gynecologists after 21 weeks and 6 days. Digoxin is a commonly used feticidal agent. This retrospective study aimed to show the effect of different doses of digoxin on the timing of fetal demise when used for feticide. STUDY DESIGN: Our retrospective cohort study included 57 patients who underwent feticide by routine intra-amniotic digoxin 0.75 mg or 1 mg between 2016 and 2018 at the Ataturk University Medical Faculty Research Hospital. The patients were administered undiluted digoxin 0.75 mg (3 ccs) or 1 mg (4 ccs) with a 20-gauge spinal needle inserted through the amniotic membrane. After digoxin administration, the fetal heartbeat was monitored every hour by ultrasound, and recorded. RESULTS: In this retrospective study, we reviewed the data of 61 patients who underwent feticide by intra-amniotic digoxin 0.75 mg and 1 mg. Digoxin 3 ccs (n=23) and digoxin 4 ccs (n=34). The two groups were not significantly different in terms of age, gestational week, and termination indications. We reviewed the medical records of all subjects and noted any side effects. CONCLUSIONS: In our study, we investigated the effect of different doses of intra-amniotic digoxin on the fetal demise in accordance with the literature. Despite our small sample size, we conclude that a higher dose of digoxin will reduce the time to asystole and minimize the mental burden of the procedure on the patient.

Abstract 37: Understanding the social determinants of guideline-based mammography adherence across race/ethnicity: Results from the 2016 California Health Interview Survey

Abstract Purpose: There is not a consensus concerning recommendations about breast cancer screening which has generated confusion about when and how often to undergo mammography screening in the population, yet there is limited population-based data about the extent to which patients adhere to various mammographic screening guidelines in practice. Our purpose was to evaluate population-based adherence to mammographic screening using criteria from major guideline-producing organizations across race/ethnicity to understand what social determinants of mammography adherence are associated with each guideline producing institution. Methods: Women aged 45-79 in the 2016 California Health Interview Survey were included. Self-reported mammographic screening within 1 or 2 years, according to major guideline-producing organizations (American Cancer Society [ACS], US Preventative Services Task Force [USPSTF], American College of Radiology [ACR], American College of Obstetricians and Gynecologists [ACOG]) was calculated with logistic regression, adjusting for demographics, health care, insurance status, and BMI. Results: 7,551 women were included in this study. By age category, cross-sectional adherence to ACR/ACOG (annual screening) (65 to 67%) and USPSTF guidelines (biennial screening) ranged from 82-83% and with increasing age being generally associated higher adherence. The highest proportions of women undergoing mammographic screening were seen in women ages 60-69 (67% within last year, 85% within last 2 years). Statistically significant predictors of adherence to mammography screening included Latina race (OR 1.62, 0.18 SE), full time employment (OR 0.73, 0.09 SE), and not having a usual healthcare provider (OR 0.50, 0.12 SE), adjusted for demographics, health care, insurance status, and BMI. Conclusion: Frequency of screening increases with age with highest screening proportions in women ages 65-69 (66% within last year, 81% within last 2 years). For ACR/ACOG screening guidelines, adherence to mammography screening remains poorer in women with no usual source of care, given that their odds of exhibiting adherence was half that of women who did have a regular source of care and nearly 65 percent lower odds of those women with USPSTF mammography adherence. Key Words: Breast cancer, screening, race/ethnicity, guideline-based care Citation Format: Roman Johnson, Mieke Beth Thomeer. Understanding the social determinants of guideline-based mammography adherence across race/ethnicity: Results from the 2016 California Health Interview Survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 37.

Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives

The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.

Optimizing the menopause transition: Joint position statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on best practice recommendations for the care of women experiencing the menopause.

The British Menopause Society (BMS), Royal College of Obstetricians and Gynaecologists (RCOG) and the Society for Endocrinology (SfE) have produced a joint position statement providing best practice recommendations on menopause care This article is protected by copyright. All rights reserved.

044 European Pediatric and Adolescent Gynecology Post-specialty Training Curriculum

In the past years, several developments made the need for a European Pediatric and Adolescent Gynecology (PAG) Post-specialty Training Curriculum clearer. At first, the need of specialist care for young girls and adolescents is evident. EBCOG published European standards of care in PAG in 2014 to create awareness of this need. Even though, these standards of care do exist, healthcare services vary considerably across Europe. One of EURAPAG papers showed that PAG healthcare services can only improve if the professional skills are improved by education [ [1] Roos E.J. Vatopoulou A. on behalf of the European Association of Paediatric and Adolescent Gynaecology, European Board and College of Obstetrics and Gynaecology. Health care service in paediatric and adolescent gynaecology throughout Europe: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2019; 235: 110-115 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. Second, in 2018 EBCOG launched EBCOG-PACT to harmonize ObGyn training in Europe [ [2] Scheele F, Goverde AJ, van der Aa. Project for Achieving Consensus in Training by the European Board and College of Obstetrics and gynaecology (EBCOG-PACT). Version 2018. Google Scholar ]. And last, in some parts of Europe PAG is an officially recognized subspecialty and in other European countries it is a special field of interest. EURAPAG aims to improve and harmonize advanced PAG training with this Post-Specialty Training Curriculum [ [3] Stankovic Z.B. Tridenti G. Liassides M. Wood P.L. Roos E.J. on behalf of the European Association of Paediatric and Adolescent Gynaecology (EURAPAG) and European Board And College of Obstetrics and Gynaecology (EBCOG). The Future of Paediatric and Adolescent Gynaecology in Europe. European Journal Obst Gyn and Reprod Biol. 2019; 235: 121-124 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ].

043 The pediatric and adolescent training in obstetrics and gynecology in Europe

Objective: The purpose of this study is to evaluate the training of pediatric and adolescent gynecology in obstetrics and gynecology residency programs in Europe. Study design: This study is a cross-sectional explorative survey using an online questionnaire. The questionnaire comprised 19 questions. All questions were based on the pediatric and adolescent training in obstetrics and gynecology section of European Board & College of Obstetrics and Gynecology Project of Achieving Consensus in Training (PACT) training curriculum. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG social media and through the national representatives of ENTOG. Results: 90 Ob Gyn trainees from 33 different European countries responded to the questionnaire. More than half of these trainees were in the last 2 years of their 5-year training program with 40% in their last. Trainees were asked if they have a log book (curriculum) and if they have pediatric and adolescent gynecology (PAG) as an elective in their log book. 41% of the trainees replied stating they do not have PAG as an elective, 34% stated they do. Only 27% confirmed to have a PAG rotation during their training. Trainees were asked in which years during their training they received training on PAG. Highest rate was 4th year with 11%. 72% (n = 65) responded affirmatively to be able to provide information and advice regarding the diagnosis and its implications of prepubertal vaginal bleeding and adnexal masses in children and adolescents at the end of their training. 58% said they could determine indications for treatment of vulva, vagina, perineum and rectum. 58% of trainees said they will not be able to perform cystoscopy or vaginoscopy at the end of their training. Trainees were asked if they could determine indication for treatment, counsel and discuss all treatment options in 10 different situations. From these 10, highest positive responses were collected for ‘contraception in adolescents with health problems’ with 82%. Conclusion: Pediatric and adolescent gynecology training in Europe is open for improvement. Corrigendum to “043 The pediatric and adolescent training in obstetrics and gynecology in Europe” [Eur. J. Obstet. Gynecol. Reprod. Biol. 273 (2022) E16–E17]European Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 276PreviewThe authors regret that in the final publication not all contributors, but only the presenter to the abstract was mentioned. This does not honor the effort of all contributors, this corrigendum compensates this lack of honor. Full-Text PDF

042 PAG in EBCOG-PACT

The European Board and College of Obstetrics and Gynecology has recently revised its postgraduate training requirements, through a program called “Project for Achieving Consensus in Training”, known as EBCOG-PACT. The need for revision originated from feedback from the European Network of Trainees in Obstetrics and Gynecology concerning the disparities in postgraduate training across Europe [ [1] Aabakke A.J.M. Kristufkova A. Boyon C. Bune L.T. Van de Venne M. Workforce planning and training in Obstetrics and Gynaecology across Europe: a survey of national trainee societies. Eur J Obstet Gynecol Reprod Biol. 2017; 214: 156-161 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], as well as from the realization that changing societal demands of doctors necessitate changes in the training of gynecologists [ [2] Scheele F. Novak Z. Vetter K. Caccia N. Goverde A.J. Obstetrics and gynaecology training in Europe needs a next step. Eur J Obstet Gynecol Reprod Biol. 2014; 180: 130-132 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ].

The impact of virtual live education on the competence and knowledge of gynecologists caring for ovarian cancer patients.

e23003 Background: About 35% of ovarian cancer patients in the US have geographic-related disparities in their access to gynecologic oncologists. This disparity becomes more apparent as advances in the treatment of ovarian cancer continues to improve, particularly in regard to maintenance therapy (e.g., PARP inhibitors). Thus, it is critical for gynecologists who are most likely to see these patients over the span of their lives, have an intimate understanding of the management of these patients. Methods: CEC Oncology developed an educational initiative presented at four American College of Obstetricians and Gynecologists District Meetings, targeting obstetricians, gynecologists, and other health professionals. Education focused on PARP inhibitors in ovarian cancer, identification of those eligible for genetic testing and counseling, and strategies to improve patient outcomes. Evaluations were collected from attendees attending the District Meetings to assess impact on practice, increased competency, and intent to make a change in practice. This was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 183 clinicians were educated, practicing in academic settings (44%), community hospital settings (24%), private practice (25%), and government (7%). Attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity to assess knowledge about the DNA damage response pathway, genetic testing guidelines, and management of therapy toxicities. Knowledge increased from pre- to post-test and from pre-test to follow-up for all topics, with the greatest increase in the management of adverse events (41% increase from pre- to post-test; 50% increase from pre-test to follow-up; P< 0.01). Additionally, there was a 22% and 24% increase in confidence in identifying patients eligible for germline genetic testing and in recognizing toxicities with PARP inhibitors from pre-test to six-week follow-up, respectively. 60% of participants stated that there was a lack of patient education regarding the importance of genetic testing and counseling. At follow-up, 100% stated that they had educated patients on genetic testing and counseling, highlighting the value of educating gynecologists on this topic. Conclusions: Attendees of this educational initiative were eager to take back the knowledge learned to their clinical practices. While there was a measurable increase in knowledge with regard to different ovarian cancer related topics, educational gaps remain. Collectively, this particular audience stated that they care for > 1,000 ovarian cancer patients, elucidating the need for OB/GYNs to feel more comfortable regarding PARP inhibitor toxicities, as they become more prevalent in practice.

Differences in outcomes between premenopausal women and men with gastric cancer in the United States.

e16066 Background: Over the past decades, the incidence rate of gastric cancer has only dropped by 1.5% despite the identification of modifiable risk factors. Gastric cancer has a male predominance; the lower incidence in females may be associated with a protective hormonal effect. Studies reported the expression of estrogen receptor alpha (ERα) and beta (ERβ) in gastric cancer, yet their roles in incidence and prognosis remain inconclusive. We analyzed the hormonal association with the in-hospital outcomes using a cohort of premenopausal women and men with gastric cancer. Methods: Using Nationwide Inpatient Sample Database from 2016 to 2019, we selected adult women under age 51 as premenopausal as defined by the American College of Obstetricians and Gynecologists and compared to men of the same age group. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), thromboembolism, and gastrointestinal hemorrhage. Types of surgical interventions were also studied. Data were extracted using ICD-10 codes. Results: A total of 25,595 patients (based on a weighted sample) were included in the analysis; 44.6% were men, 7.5% were obese, and 13.7% were smokers. White race was most common (32.9% men vs 41.9% women), followed by Hispanic (34% vs 27.1%), African American (16.3% vs 16.1%), Asian (8.8% vs 7.7%), and Native American (1.3% vs 0.8%); p < 0.05. The prevalence of common comorbidities was consistent among men and women; 29.5% had hypertension, 10.4% had diabetes mellitus, 2% had coronary artery disease, and 2.8% had congestive heart failure (CHF). Men had higher in-hospital mortality (7.9% vs 6%; p < 0.05) and incidence of gastrointestinal hemorrhage compared to women (16.2% vs 9.7%; p < 0.05). The median LOS was 5 days (IQR: 3-9) in men and 5 days (IQR: 2-9) in women; p = 0.59. The incidence of venous thromboembolism was 8.2% (no difference among sex) and myocardial infarction was 0.6% (0.8% men vs 0.2% women; p < 0.05). Notably, in this younger population (age: 18-51), 63% patients had metastatic disease (62.8% men vs 63.4% women; p = 0.92). Among all patients, 27.8% underwent gastrectomy: partial gastrectomy (21.2%), total gastrectomy (4.9%), and robotic gastrectomy (1.7%). The multivariate logistic regression model adjusted for baseline demographics, comorbidities, metastatic disease, and socioeconomic status indicated that male sex (OR: 1.37; 95% CI: 1.07-1.73; p < 0.05), Asian race (OR: 1.64; 95% CI: 1.09-2.46; p < 0.05), CHF (OR: 4.05; 95% CI: 2.44-6.74; p < 0.05), and metastasis (OR: 3.84; 95% CI: 2.73-5.37; p < 0.05) were independent risk factors of in-hospital mortality. Conclusions: Our study shows that women have a lower incidence of gastric cancer and associated in-hospital mortality, which may support the protective role of estrogen. This highlights the need for translational and clinical studies on potential actionable mechanisms in gastric cancer management.

The consequences of armed conflict on the health of women and newborn and sexual reproductive health – A position statement by the European Board and College of Obstetrics and Gynaecology (EBCOG)

Armed conflict brings about significant health-related consequences to the non-combatant population especially the elderly, women, and children. The consequences for women extend further than battle-related deaths. One important consequence of conflict is the population displacement resulting from individuals and families seeking safety in non-conflict zones. This forced migration places women at risk of gender-based violence during their journey and for this reason the host countries should ensure that the migrants are given access to reproductive health services, including providing emergency contraception and abortion. In the conflict zone, the collapse of all social support, including healthcare services, contribute towards a marked deterioration in the level of care provided to ensure reproductive health and safe motherhood. In addition, the community living the conflict zone is at an increased risk of community infectious disease and poor management of chronic illness. Women and children are almost always innocent victims of war. The international community must act effectively to primarily avoid conflict by sound diplomatic intervention and, when diplomacy fails, reduce the consequences of conflict.

Comprehensive analysis of recessive carrier status using exome and genome sequencing data in 1543 Southern Chinese

Traditional carrier screening has been utilized for the detection of carriers of genetic disorders. Since a comprehensive assessment of the carrier frequencies of recessive conditions in the Southern Chinese population is not yet available, we performed a secondary analysis on the spectrum and carrier status for 315 genes causing autosomal recessive disorders in 1543 Southern Chinese individuals with next-generation sequencing data, 1116 with exome sequencing and 427 with genome sequencing data. Our data revealed that 1 in 2 people (47.8% of the population) was a carrier for one or more recessive conditions, and 1 in 12 individuals (8.30% of the population) was a carrier for treatable inherited conditions. In alignment with current American College of Obstetricians and Gynecologists (ACOG) pan-ethnic carrier recommendations, 1 in 26 individuals were identified as carriers of cystic fibrosis, thalassemia, and spinal muscular atrophy in the Southern Chinese population. When the >1% expanded carrier screening rate recommendation by ACOG was used, 11 diseases were found to meet the criteria in the Southern Chinese population. Approximately 1 in 3 individuals (35.5% of the population) were carriers of these 11 conditions. If the 1 in 200 carrier frequency threshold is used, and additional seven genes would meet the criteria, and 2 in 5 individuals (38.7% of the population) would be detected as a carrier. This study provides a comprehensive catalogue of the carrier spectrum and frequency in the Southern Chinese population and can serve as a reference for careful evaluation of the conditions to be included in expanded carrier screening for Southern Chinese people.

Provision of antenatal care in Europe-A scientific study commissioned by European Board and College of Obstetrics and Gynaecology (EBCOG)

Differences in the way health care delivery across countries may have important impacts on health outcomes and can result in inequalities. A questionnaire survey of members of national societies through EBCOG and EAPM was carried out in 2021. A total of 53 responses were received from 26 countries. Most countries reported that routine antenatal care is primarily delivered by medical staff, involving obstetric specialists or family doctors mostly in government-run facilities. Women from minority groups are able to access antenatal care easily in most countries. Less than 10% of women did not attend antenatal care throughout the pregnancy. Most booking for antenatal care takes place in the first trimester and the number of visits range from 6 to 10 depending on parity. Most countries provide routine ultrasound with 2–3 reported scans performed by specifically trained health care professionals. Facilities for prenatal screening/diagnosis of malformations in both low- and high-risk cases varied across Europe. While antenatal care is relatively standardized throughout Europe, important differences still exist in care delivery and accessibility to care. Antenatal preventive strategies appear to be variably available throughout Europe.

467 Access to antenatal care in europe

Introduction: Differences in the way healthcare is delivered across countries or populations may have important impacts on health outcomes, and can result in inequalities. The European Board & College of Obstetrics and Gynaecology (EBCOG), the European Association of Perinatal Medicine (EAPM), and the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) formed a study group to investigate and review existing differences in the provision of antenatal care throughout Europe. Materials and methods: A questionnaire of 37 questions was developed by the study group and shared via email with the representatives of EAPM and EBCOG national scientific societies. Results: A total of 53 responses were received from 26 countries. The majority of countries [18/26] routine antenatal care is primarily delivered by medical staff, involving obstetric specialists or family doctors. Delivery of care in government-run facilities constitutes the largest proportion of antenatal care in most countries, usually combining peripheral and hospital outpatient clinics. Twenty countries had provision whereby the women could self-refer themselves for antenatal care in the government-run facilities. Almost all countries reported that women from minority groups can access public sector antenatal care services easily. Less than 10% women did not attend antenatal care throughout pregnancy. The larger majority of those booking for antenatal care [>60%] do so in the first trimester. The majority of countries provide antenatal care opportunities with 6-10 reported routine visits for low-risk nulliparous and multiparous cases. Life-style advice is generally given to the mother at her first antenatal visit. Conclusion: While antenatal care is relatively standardized throughout Europe, important differences still exist in the healthcare providers involved, access to care, and in the frequency of routine antenatal visits. Despite variations, antenatal care is primarily provided by medical practitioners across many European nations. Factors leading nonattendance require further exploration.

Mediolateral episiotomy and risk of obstetric anal sphincter injuries and adverse neonatal outcomes during operative vaginal delivery in nulliparous women: a propensity-score analysis

BackgroundThe potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery because of the difficulties to take into account the risk factors and clinical conditions at delivery; in addition, little is known about the potential benefits of mediolateral episiotomy on neonatal outcomes.The objectives were to investigate the associations between mediolateral episiotomy and both OASIs and neonatal outcomes, using propensity scores.MethodsWe performed a retrospective population-based observational study from a perinatal registry that includes all births in a French region between 2010 and 2017. All nulliparous women with singleton pregnancy delivering by operative vaginal deliveries at 37 weeks gestational age or later were included. Inverse-probability-of-treatment weighting with propensity scores was used to minimize indication bias. OASIs was defined as third and fourth-degree tears according to Royal College of Obstetricians and Gynecologists. Two neonatal outcomes were studied: condition at birth (5-min Apgar score less than 7 and/or umbilical artery pH less than 7.10), and admission to neonatal intensive care unit.ResultsThe study population consisted of 7589 women; 2880 (38.0%) received mediolateral episiotomy. After applying propensity scores, episiotomy was associated with a lower rate of OASIs in forceps/spatula delivery (2.3 vs 6.8%, Risk Ratio (RR) 0.38, 95% Confidence Interval (CI) 0.28–0.52) and in vacuum delivery (1.3 vs 3.4%, RR 0.27, 95% CI 0.20–0.38) as compared with no episiotomy. Mediolateral episiotomy was associated with better condition at birth in case of forceps/spatula delivery (4.5 vs 8.8%, RR 0.56, 95% CI 0.39–0.81). In cases of fetal distress (40.7%), mediolateral episiotomy was associated with better condition of infant at birth in women who delivered by forceps/spatula (4.2 vs 13.5%, RR 0.52, 95% CI 0.31–0.89). No association was found with neonatal unit admission (RR 0.93, 95% CI 0.50–1.74).ConclusionsUse of mediolateral episiotomy was associated with a lower rate of OASIs during operative vaginal delivery, and in infants it was associated with better condition at birth following forceps/spatula delivery.

Hypomenorrhea in Adolescents and Youths: Normal Variant or Menstrual Disorder? Revision of Literature and Personal Experience.

Menstrual health affects a large number of women throughout reproductive life since adolescence. Knowledge of the duration and variation of the menstrual cycle is necessary for patient education and to identify deviations from normal to guide clinical evaluation. The average duration of menstrual flow is between 4 to 6 days, with anormal range from 2 up to 8 days ; the mean blood loss per menstrual cycle is 25- 30 mL. In general, descriptive data falling outside the normal range are considered to be indicative of menstrual disorders. Although the American Academy of Pediatricshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710410/ - poi170032r27 and American College of Obstetricians and Gynecologistshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710410/ - poi170032r29 advocate for clinicians to consider the menstrual cycle as a vital sign in adolescents, the identification of subjects with hypomenorrhea is neither well defined nor routinely practiced. In this paper we have summarized the published prevalence of hypomenorrhea (lighter and/or shorter menstrual bleeding) in adolescents and youths in different countries and report the personal experience in four adolescents. (www.actabiomedica.it)

WOMEN’S HEALTH ISSUES: THE CONTINUING APPEAL FOR WOMEN HEALTH PHYSICAL THERAPY PRACTICE IN PAKISTAN

Women’s health in its widest definition includes study of whole body particularly examining biological characteristics unique to women, with a focus on reproductive organs, body structure, hormones, childhood development and genetics.1 In 2017, maternal mortality ratio was determined to be 211 deaths per 100,000 live birth globally and in Pakistan, the ratio was 186 deaths per 100,000 live births in 2021.2,3 Besides obstetrical health issues, Pakistani female are also facing gynecological maladies on a large scale as compared to other countries such as grade I and II pelvic organ prolapse that is likely to be managed through pelvic physical therapy as per National Institute for Health and Care Excellence (NICE) guidelines.4 Regrettably, the burden of disease is increased manifolds due to unavailability of expert women’s health physical therapist.5 Like many countries, Pakistan is signatory to several international commitments till now to empower the women. To overcome the lacking, women’s health issues should be fostered by a woman’s health physical therapist. A women health physical therapist evaluates, treats, and educates a woman throughout the stages of life starting form active child-bearing years, pregnancy, postpartum, perimenopause and post menopause.6 The area of practice has now spread to encompass all health concerns of a woman namely infertility, osteoporosis, fibromyalgia, rehabilitation following gynecological surgery, breast cancer rehabilitation, incontinence, dyspareunia, vulvodynia, pregnancy related musculoskeletal pain, lymphedema, wellness and exercise. A woman throughout the life span whether a childbearing woman, a menopausal and a young athlete or an elderly woman can obtain benefit from women’s health physical therapy (WHPT). The American College of Obstetricians and Gynecologists (ACOG) claims that conjoint care provided by physician and physical therapist can enormously improve treatment prognosis.7 An optimal quality of life for a woman can be ensured through clinical evaluation and assessment to plan physical therapy interventions incorporated with various modalities that are cautiously prescribed according to an individual’s scenario.8 It is about time to emphasize WHPT practice throughout the country. There is a prolonged schedule to fulfil all fundamental components of women’s health issues which demands the joint collaboration of health-care providers, governments, policy makers, and the overall population. This article shout-out to novice physical therapy professionals to get themselves enrolled in WHPT specialty degree for the betterment of women. It is the need of hour to incorporate the services of qualified and expert WHPT professional in large tertiary care hospitals whether public or private, so that the premium quality of medical services pertaining to women health is available to the masses of all walks of life.

Pelvic Examinations in the Adolescent and Young Adult Population: A Commentary on Why and When.

Various professional organizations have weighed in on the practice utility of speculum examinations. The US Preventive Services Task Force (USPSTF), American Academy of Pediatrics (AAP), and American College of Physicians (ACP) have recommended against internal pelvic examinations in asymptomatic patients, whereas the American College of Obstetricians and Gynecologists (ACOG) has encouraged shared decision making. Although a pelvic examination can be a stressful event for adolescents, studies have shown that early discussions and performing the examination in a trusting environment can mitigate the worries and improve the patient-provider relationship. In this commentary, we discuss the literature and conclude that performing a pelvic examination in the asymptomatic adolescent and young adult patient is ultimately a matter of shared decision making. The benefits of conducting the examination in a nonthreatening environment, minimizing "exceptionalization" of the female genitalia, and strengthening the patient-provider relationship should be highlighted during the discussions.

Antibiotic overuse in obstetric and gynecologic procedures at Zagazig university hospitals: A prospective observational study

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..