Federation Of Obstetrics Research Articles

Federation of Obstetric and Gynecological Societies of India Consensus Recommendations for the Management of Postpartum Anemia with Specific Reference to Usage of Ferric Carboxymaltose

Federation of Obstetric and Gynecological Societies of India Consensus Recommendations for the Management of Postpartum Anemia with Specific Reference to Usage of Ferric Carboxymaltose

Joint Statement on Comprehensive Education for Adolescents and Young People to Support their Healthy Development and Well-being: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association.

Joint Statement on Comprehensive Education for Adolescents and Young People to Support their Healthy Development and Well-being: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association.

Respectful Abortion Care initiative: How a large-scale virtual training for providers in India increased knowledge of the new 2021 Medical Termination of Pregnancy Act.

In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.

Role of hysteroscopy in categorization of abnormal uterine bleeding in a multispecialty hospital in Bahrain

Background. Abnormal uterine bleeding is a broad term involving various irregularities of the menstrual cycle. Previously various terms were used to define abnormalities in menstrual bleeding. To create a universally accepted system of nomenclature, the Federation of Obstetrics and Gynecology proposed the new terminology PALM-COIEN. The current study is aimed to classify cases of abnormal uterine bleeding as per PALM-COEIN. Materials and Methods. It is a retrospective, observational study using the data from 110 patients, who underwent hysteroscopic evaluation and endometrial biopsy and were categorized based on PALM-COIEN. Patients were grouped under these categories after detailed history, examination, investigations, hysteroscopic findings, and histopathology. Results. Polyp was the commonest group (n=45, 40.9%) in our study, which was followed by leiomyoma (n=30, 27.27%), ovulatory disturbances (n=28, 25.45%), adenomyosis (n=5, 4.54%), malignancy (n=2, 1.81%) respectively. Conclusions. Hysteroscopic evaluation is a simple and useful tool to find out the structural pathologies of PALM-COIEN classification. Further histopathological confirmation of clinical diagnosis can enhance the diagnosis and treatment modalities.

Joint Statement on Comprehensive Education for Adolescents and Young People to Support Their Healthy Development and Wellbeing: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association

Joint Statement on Comprehensive Education for Adolescents and Young People to Support Their Healthy Development and Wellbeing: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association

Joint Statement on Comprehensive Education for Adolescents and Young People to Support their Healthy Development and Well-being: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association.

Joint Statement on Comprehensive Education for Adolescents and Young People to Support their Healthy Development and Well-being: Adolescent Health Academy, Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India, Indian Association of Preventive and Social Medicine, and Indian Public Health Association.

Tracking Care-Seeking Pathways: A Qualitative Study of Maternal Complications in Uttar Pradesh, India

To understand the referral pathways followed by families, the highest level of health facility reached for care, the time taken to receive that level of maternal healthcare, and families’ experiences of care received, we conducted a qualitative study of six maternal deaths, 10 perceived postpartum hemorrhage, and 14 frontline health workers. Thematic analysis of the data showed that of the six maternal death cases, one went directly to a secondary care public hospital, four women visited four to five hospitals before they died. One of them died after visiting four hospitals in over 30 h. Of the 10 women who experienced postpartum hemorrhage, six never went to a hospital, three went to two hospitals, and one was in the hospital when the event occurred. Time taken from the first step of care-seeking outside the home to initiation of care at the highest level ranged from 11 h to 8 days. The providers of the public health system followed a hierarchical 'referral pyramid' irrespective of whether the next level hospital could provide appropriate care or not. This research provides evidence to the ‘outer setting’ domain of the Consolidated Framework for Implementation Science from families’ perspectives about their needs and the referral network. Providing information about emergency obstetric care services to all the hospitals within a district and developing a communication system through the Federation of Obstetric and Gynaecological Societies of India for care continuum through referral would help reduce mortality and improve family’s experience with the health system.

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

Assessment of Maternal Infant and Young Child Nutrition (MIYCN) Knowledge and Practices Among Obstetricians and Pediatricians in Private Health Facilities in India

Objectivesi) To assess current MIYCN knowledge and practices among obstetricians and pediatricians in private facilities ii) To identify bottlenecks to adopting evidence- based MIYCN guidelines in private facilities MethodsThe study used an observational cross-sectional design and mixed methods for an online self-administered survey with 360 pediatricians and 99 obstetricians (members of the Indian Academy of Pediatrics and Federation of Obstetric and Gynaecological Societies of India). The study included onsite interviews with 55 obstetricians and 59 pediatricians selected randomly during assessments in 114 private health facilities where they provided services across 3 purposefully selected cities in each of the 5 states (Uttar Pradesh, Bihar, Gujrat, Maharashtra and Karnataka). States were purposefully selected for high burden of undernutrition and high number of private practitioners. ResultsHalf of obstetricians knew the recommended dosage of iron supplementation during pregnancy, while 42% knew recommendations postpartum. Knowledge around weight gain during pregnancy and dietary requirements was limited. 75% of providers reported delayed initiation of breastfeeding in C-section deliveries. Over 90% of pediatricians knew about exclusive breastfeeding; but 40% of obstetricians and 11% of pediatricians had prescribed breastmilk substitutes. Only one third of pediatricians understood the importance of dietary diversity in complementary feeding. 70% of facilities had no maternal nutrition protocols. Roadblocks to optimal practices were lack of training and of evidence-based protocols, as well as non- recruitment of lactation counselors and dieticians. Half of the obstetricians and pediatricians reported ever being trained on MIYCN. ConclusionsFindings reveal a need to improve private obstetricians and pediatricians’ knowledge on MIYCN and prioritize nutrition in medical associations’ continuing education. Data support calls to action to institutionalize the integration of MIYCN into MNCH service protocols in private health facilities. Funding SourcesBill & Melinda Gates Foundation through Alive & Thrive FHI Solutions.

Staging locally advanced cervical cancer with FIGO 2018 versus FIGO 2008: Impact on overall survival and progression-free survival in the OUTBACK trial (ANZGOG 0902, RTOG 1174, NRG 0274).

5531 Background: The International Federation of Obstetrics and Gynecology staging system for cervical cancer (FIGO 2008) was revised in 2018 to incorporate lymph node involvement (FIGO 2018). OUTBACK is an international, randomized phase 3 trial of adjuvant chemotherapy versus observation after standard of care treatment with chemoradiation for women with locally advanced cervical cancer. OUTBACK found no benefit from the addition of adjuvant chemotherapy. We evaluated the effects of classifying participants with these 2 staging systems in the OUTBACK trial population. Methods: OUTBACK recruited April 2011 to June 2017 and staged participants according to FIGO 2008. Lymph node status, smoking status, age, race and histological subtype were documented at trial entry as important prognostic factors. We assessed the effects of stage grouping into stage I, II, and III/IVa with FIGO 2008 versus FIGO 2018, on progression-free survival (PFS) and overall survival (OS) at 5 years using Kaplan-Meier estimates, and in univariable proportional-hazards regression analyses, and in multivariable analyses adjusting for important prognostic factors and randomly allocated treatment. Results: All 919 study participants had complete data for staging according to the 2 staging systems and most prognostic factors for adjustment. Among all participants, the 5-year outcomes were PFS = 62% and OS = 72%. Classification according to FIGO 2018 rather than FIGO 2008 yielded higher 5-year PFS and OS in each stage group (see table for numbers of participants, PFS and OS for each stage group). Predictors of PFS in multivariable analysis included squamous vs non-squamous histology (HR 0.71 for FIGO 2008 and 0.74 for FIGO 2018), but not nodal involvement when FIGO 2018 was used. Both staging systems were the only independently significant prognostic factors in both univariable and multivariable analyses (all p < 0.0001) for both PFS and OS. Conclusions: Compared to FIGO 2008, reclassifying pts by FIGO 2018 staging resulted in more pts being classified as stage 3 due to the incorporation of nodal status. Staging locally advanced cervical cancer using FIGO 2018 rather than FIGO 2008 resulted in higher PFS and OS in each stage grouping that reflected stage migration, not a true improvement in outcomes. FIGO stage remains the strongest predictor of overall survival after CRT but survival outcomes by stage in trials using the old vs new staging system are not comparable. Clinical trial information: ACTRN12610000732088. [Table: see text]

Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association

When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.

Case Comment: Federation of Obstetrics and Gynaecological Societies of India (FOGSI) V. Union of India and Ors.

Case Comment: Federation of Obstetrics and Gynaecological Societies of India (FOGSI) V. Union of India and Ors.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

TP53 mutants and non-HPV16/18 genotypes are poor prognostic factors for concurrent chemoradiotherapy in locally advanced cervical cancer

Targeted sequencing for somatic mutations across the hotspots of 50 cancer-related genes was performed using biopsy specimens to investigate whether clinicopathological factors and genomic alterations correlated with prognosis in locally advanced cervical cancer. Seventy patients diagnosed with International Federation of Obstetrics and Gynecology (FIGO) stage III to IVA cervical cancer underwent radiotherapy or concurrent chemoradiotherapy at the National Cancer Center Hospital between January 2008 and December 2017. Mutations were detected in 47 of 70 [67% of cases; frequency of genetic alterations was as follows: PIK3CA (51%), FBXW7 (10%), PTEN (7.1%), and TP53 (5.7%)]. The Cancer Genome Atlas (TCGA) datasets showed a similar distribution of somatic mutations, but PIK3CA mutation frequency was significantly higher in our cohort than in TCGA datasets (P = 0.028). Patients with TP53 mutation were significantly related to poor progression-free survival (PFS) (hazard ratio [HR] = 3.53, P = 0.042). Patients with tumor diameters > 70 mm were associated with poor prognosis (HR = 2.96, P = 0.0048). Patients with non-HPV16/18 genotypes had worse prognosis than those with HPV16/18 genotypes (HR = 2.15, P = 0.030). Hence, patients with locally advanced cervical cancer, TP53 mutation, large tumor diameter, and non-HPV16/18 genotype were independently correlated with poor PFS, despite concurrent chemoradiotherapy.

Diagnostic performance of two different maternal near-miss approaches in a High Obstetric Risk Unit

ABSTRACT Maternal near-miss (MNM) is a maternal quality care indicator. The World Health Organization (WHO) defines it as a state in which a woman nearly dies but survives due to a complication during pregnancy, birth, or puerperium. The Latin American Federation of Obstetrics and Gynecology (FLASOG) and the Colombian National Health Institute (INS) established recommendations for the event’s epidemiological surveillance; nonetheless, the operational definitions of the cases are different. This retrospective study examined the approaches of FLASOG and INS versus the WHO approach (gold standard) for the assessment of MNM in a high obstetric risk unit. Patients admitted with at least one criterion of the WHO, FLASOG, or INS approach for the definition of MNM from March 2016 to March 2017 were included. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were evaluated, as well as the Receiver Operating Characteristics (ROC) curve of the FLASOG and INS. MNM classification compared to WHO system as reference. The results highlight that the WHO classification establishes very high boundaries for some of the diagnostic criteria and the lack of standardization of the MNM criteria among the different proposals in Latin America hinders the applicability in Colombia and other countries with a similar situation.

The Study of Prevalence and Pattern of Thyroid Disorder in Pregnant Women: A Prospective Study

BackgroundThe most frequent thyroid disorder in pregnancy is maternal hypothyroidism. The geographical variation in the prevalence of hypothyroidism during pregnancy is very wide and ranges from 2.5% to 11%. The prevalence of hypothyroidism is more in Asian countries as compared to western countries. Thus, this study was conducted to find out the prevalence of thyroid disorder in pregnancy at our center.MethodsThe present study was conducted in the Department of Physiology in collaboration with the Department of Obstetrics & Gynecology, Index Medical College, Hospital and Research Center, Indore, MP, India over a period of one and a half years from October 2018 to March 2020. It was a cross-sectional study including 865 pregnant women. The patients' demographic profile was noted in all cases. A detailed history and thorough examination were done in all cases. Serum thyroid-stimulating hormone (TSH), Free T3, and Free T4 (FT3 and FT4) were done along with routine blood investigations as per The Federation of Obstetric and Gynaecological Societies of India-Indian College of Obstetricians and Gynaecologists (FOGSI-ICOG) good clinical practice recommendation.ResultsIn this study, the prevalence of thyroid dysfunction was 10.4%. Of these 90 patients with thyroid dysfunction, subclinical and overt hypothyroidism was found in 5.50% and 0.92%, respectively, whereas subclinical and overt hyperthyroidism was observed in 3.12% and 0.81% pregnant females, respectively. A significant association was found between thyroid dysfunction and maternal age, BMI, parity, and education.ConclusionsThe prevalence of thyroid dysfunction was 10.4% in this study. Hypothyroidism was more common than hyperthyroidism and subclinical thyroid disorders were more common than overt thyroid disorders in pregnancy. Therefore, we should include thyroid function tests with other routine investigations during pregnancy to detect thyroid dysfunction.

Indian Academy of Pediatrics Position Paper on Nurturing Care for Early Childhood Development

Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF).

Gynecological Surgeries in COVID-19 Pandemic Era

ABSTRACT Introduction During the coronavirus disease-2019 (COVID-19) pandemic era, different types of emergency gynecological surgeries were performed in the Department of Obstetrics and Gynecology of our tertiary care teaching hospital as per the standard guidelines issued from time to time by the Indian Council of Medical Research (ICMR) and the Federation of Obstetric and Gynecological Societies of India Good Clinical Practice Recommendations (FOGSI GCPR) guidelines for the safety of the patients and healthcare providers. Materials and methods A different variety of gynecological surgeries were performed on cases which were admitted in the Obstetrics and Gynecology ward of Sri Guru Ram Das Institute of Health Sciences and Research, Vallah, Amritsar, with effect from the first lockdown, i.e., March 22, 2020, to the end of lockdown, i.e., May 31, 2020 following standard guidelines for the safety of patients and healthcare providers in the COVID pandemic. The details of these cases are being presented in this article. Results A very few gynecological surgeries were taken up as they could not have been postponed to the post-COVID times. The use of medical and conservative approach to each possible situation has been tremendous. All cases of abnormal uterine bleeding (AUB), endometriosis, and fibroid uterus were continued to be on medical management. All minor diagnostic procedures were done under short general anesthesia with premedication. Conclusion The resumption of regular gynecological work is being regularized in phases. It is a long way before we come back to the original gynecology practice. How to cite this article Bala R, Kumar SS, Khullar U, et al. Gynecological Surgeries in COVID-19 Pandemic Era. AMEI's Curr Trends Diagn Treat 2020;4(2):61–64.

Diagnosis, management and care of hypertensive disorders of pregnancy (HDP): An Indian Expert Opinion

Aim: To develop a guiding tool for the screening, diagnosis, management and care of hypertensive disorders of pregnancy (HDP) by Indian expert panel consensus. Materials and Methods: Databases such as PubMed, Medline, the Cochrane library and Google Scholar were searched for literature on HDP. Guidelines on HDP from Sri- Lanka, Bahrain, Singapore, Malaysia, Federation of Obstetric and Gynecological Societies of India (FOGSI), Japan, Canada, Australia, US, Europe, and others were studied and discussed as reference documents. A 14 member committee of Gynecology and Obstetrics experts was formed in scientific collaboration with Wockhardt Ltd., Mumbai (India) to prepare an expert opinion on HDP for India. The panel discussed hypertension (HTN) for a) classification b) techniques of monitoring BP c) when to start antihypertensive d) diagnostic tests e) important management and type of medical care needed in pre, during and post pregnancy. The panel also compared the guidelines of different countries to discuss the differences and similarities in management of HTN mainly focusing preeclampsia (PE). Results: The panel recommended NICE guidelines to classify HTN. The panel also advised to follow the antenatal care (ANC) guidelines and perform thorough clinical examination of the patient on first visit preferably in first trimester and then subsequent visits during the pregnancy. The panel emphasized on the measurement of BP with standard mercury sphygmomanometer in the sitting posture. Since PE has a higher incidence in India, a minimum of four antenatal care visits and initial screening (BP and proteinuria) at 8 to 12 weeks of gestation for early diagnosis of hypertension are advised. The panel suggested that the target BP should be 130-150 / 80-100 mm Hg on antihypertensive therapy. Either labetalol or methyldopa should be used as first line treatment during third trimester of pregnancy. However, during second trimester methyldopa should be used as the first line treatmen

Assessing the risk of ovarian cancer relapse with special software: a clinical case

The article presents a clinical observation of a patient with ovarian cancer, stage IIIA according to FIGO (International Federation of Obstetrics and Gynecology), after completing the first-line combination therapy for whom we determined the risk of recurrence using a special software.&#x0D; The early prediction of the ovarian cancer relapse was based on calculated ARRNO index (Assessment of Risk of Relapse of Neoplasm of Ovary). As initial data the following characteristics were inserted into the program: disease stage according to FIGO, tumor differentiation stage (Grade), hystotype, state of residual tissue on ultrasound examination after the treatment, levels of СА-125 before the treatment, levels of НЕ-4 after the treatment. The ARRNO software calculated the individual risk of relapse in 3 limits: low (0 - 0,39), moderate (0,40 - 0,85) and high (0,86 - 1,0).&#x0D; Conclusion. The special software for assessing the risk of relapse of ovarian neoplasm proved to be simple to operate and allowed to predict the relapse with high probability.