General Gynecology Research Articles

Provision of contraceptives by Brazilian general gynaecologists: a nationwide online survey

Objective To assess the provision of contraceptives by Brazilian obstetricians and gynaecologists (Obst/Gyns) during medical consultation and associated factors. Methods An anonymous online survey was conducted with Obst/Gyns regarding age, gender, training, method counselling about and provision of long-acting reversible contraception (LARC). Results Of 16,000 Obst/Gyns, 610 (3.8%) answered the survey. After multiple regression analysis, female Obst/Gyns (reference) (OR male was 0.53 [95%CI 0.28–0.98], p = 0.044) and Obst/Gyns aged between 20 and 39 were more likely to provide an IUD. For hormonal-IUDs, Obst/Gyns who had had theoretical training in hormonal-IUD insertion (reference no training) (OR = 2.13 [95%CI 1.14–3.99], p = 0.018), those who work in a private facility or public hospital, and those that allowed more time during consultations (reference) (OR short time = 0.33 [95%CI 0.17–0.63], p < 0.001) were more likely to provide them. Obst/Gyns who were hands-on trained were more likely to provide subdermal implant (OR = 2.04 [95%CI 1.45–2.87], p < 0.001). Conclusions There is a gap between theoretical and practical training received by this cohort of Obst/Gyns regarding LARCs, mainly contraceptive implants and hormonal-IUDs. The identification of barriers to offering contraceptives is essential to providing client-centred contraceptive care.

Pattern of Aerobic Bacterial Pathogens Causing Wound Infection at a Tertiary Teaching Hospital in Bangladesh with Special Reference to Methicillin Resistant Staphylococcus aureus and Extended Spectrum Beta Lactamases

Background: Wound infection gaining utmost importance day by day because of emergence of drug resistant bacteria. Objective: This study was carried out to see the pattern of aerobic bacterial pathogens along with MRSA and ESBL producing strains causing wound infection. Methodology: This cross sectional study was conducted from May 2010 to April 2011. Wound swabs were taken from the patients suffering from wound infections admitted in the different surgical wards of Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study place was the department of Microbiology of Rajshahi Medical College, Rajshahi and department of General Surgery, Orthopedic Surgery and Gynaecology &amp; Obstetrics of Rajshahi Medical College Hospital, Rajshahi. Two wound samples were collected from each patient with, one for microscopy and other for culture. Gram staining and culture of collected wound swab were done for isolation and identification of MRSA and ESBL Bacteria. Antimicrobial susceptibility testing of the isolates were performed by using modified Kirby-Bauer technique using Mueller-Hinton agar and commercially available antimicrobial discs manufactured by Oxoid Diagnostic. Results: A total of 300 samples were collected. Culture yielded growth of 175(58.33%) cases, of which 138 (78.86%) were gram negative. From total 138 of gram negative bacteria 52(37.68%) were ESBL positive and they were distributed as K. pneumoniae 05(55.56%), E. coli 35(54.68%), Pr. mirabilis 05(20.83%) and Ps. aeruginosa 05(17.00%). All the ESBL producers were 100.0% resistant against ampicillin, cotrimoxazole, ceftriaxone and ceftazidime. Ciprofloxacin was 80.0 to 88.6%, gentamicin was 40.0 to 60.0%, aztreonam was 60.0 to 100.0% and netilmycin was 20.0 to 60% resistant. All the MRSA were 100.0% resistant against ampicillin, co-trimoxazole and cloxacillin. None showed resistance against vancomycin. Conclusion: Drug resistant ESBL producing bacteria and MRSA are quite high among the isolated pathogens with resistant to most of the antimicrobial agent. Bangladesh Journal of Infectious Diseases, June 2022;9(1):15-24

Women's Experiences of Urinary Tract Infections and Impact on Life: An Exploratory Qualitative Study.

Despite high incidences of urinary tract infections (UTIs), little is known about how bothersome symptoms are and the effects on women's life and sexual activity, leaving a gap in our understanding of the physical and emotional effects of UTIs on women. This initial exploratory and descriptive study analyzes women's experiences of UTI and their perceived impact on quality of life. Qualitative interviews were undertaken with 23 women who had experienced at least 1 UTI, recruited from different settings-primary care, general gynecology clinics, urogynecology clinics, and online via social media. Data were analyzed thematically. Three themes described women's experiences of UTI: Women in all groups reported a wide range of physical symptoms and described the financial and psychological effects of UTIs. These effects seemed worse in women recruited via social media who also reported experiencing strong emotions and worries about close family members. Urinary tract infection support groups were considered useful, with women being grateful for consultations with alternative health practitioners and presuming safety of natural products. Having a UTI appeared to affect women in a variety of ways, ranging from having different physical symptoms to being psychologically affected by these symptoms, which affected their quality of life in different ways. This research contributes to the growing evidence on how UTIs affect women, specifically further expanding on the impact on women in a range of settings-in the community and different health care settings.

Prescribing of Outpatient Antibiotics Commonly Used for Respiratory Infections Among Adults Before and During the Coronavirus Disease 2019 Pandemic in Brazil.

The coronavirus disease 2019 (COVID-19) pandemic may have impacted outpatient antibiotic prescribing in low- and middle-income countries such as Brazil. However, outpatient antibiotic prescribing in Brazil, particularly at the prescription level, is not well-described. We used the IQVIA MIDAS database to characterize changes in prescribing rates of antibiotics commonly prescribed for respiratory infections (azithromycin, amoxicillin-clavulanate, levofloxacin/moxifloxacin, cephalexin, and ceftriaxone) among adults in Brazil overall and stratified by age and sex, comparing prepandemic (January 2019-March 2020) and pandemic periods (April 2020-December 2021) using uni- and multivariate Poisson regression models. The most common prescribing provider specialties for these antibiotics were also identified. In the pandemic period compared to the prepandemic period, outpatient azithromycin prescribing rates increased across all age-sex groups (incidence rate ratio [IRR] range, 1.474-3.619), with the greatest increase observed in males aged 65-74 years; meanwhile, prescribing rates for amoxicillin-clavulanate and respiratory fluoroquinolones mostly decreased, and changes in cephalosporin prescribing rates varied across age-sex groups (IRR range, 0.134-1.910). For all antibiotics, the interaction of age and sex with the pandemic in multivariable models was an independent predictor of prescribing changes comparing the pandemic versus prepandemic periods. General practitioners and gynecologists accounted for the majority of increases in azithromycin and ceftriaxone prescribing during the pandemic period. Substantial increases in outpatient prescribing rates for azithromycin and ceftriaxone were observed in Brazil during the pandemic with prescribing rates being disproportionally different by age and sex. General practitioners and gynecologists were the most common prescribers of azithromycin and ceftriaxone during the pandemic, identifying them as potential specialties for antimicrobial stewardship interventions.

Gynecologists and Obstetricians Prefer Practical Training; A Need to Revisit Continuing Medical Education Program

Objectives: To investigate the preferred method and education subjects among gynecologists and obstetricians to find the gaps between the current and expected states of continuing medical education (CME). Methods: An online self-administered questionnaire was sent to Iranian gynecologists and obstetricians. Three main parts of the questionnaire were demographic information, general skills such as stress management, legal knowledge, and documentation, and specialized skills such as medical and surgical management. The level of clinical capability, the need for further training, and the preferred training method, virtual, theoretical, or bedside in private or academic centers, were asked and reported. Results: Two hundred and eighty-six general gynecologists and obstetricians participated in this survey. The majority (87.3%) of them were not academic staff. Nearly 70% of the participants could perform common procedures in obstetrics, general gynecology, infertility, oncology, and urogynecology, although more than two-thirds felt they needed more training. The lowest level of preparedness was in urogynecology skills, while the highest level of educational needs was reported in infertility. Surprisingly, the preferred method of education for the most specialized skills was bedside training in academic centers. Conclusions: Despite time constraints and COVID-19 restrictions, most clinicians are keen to receive more education, and in most cases, their preferred method is bedside training in academic centers. Therefore, proper strategic planning based on different fields of obstetrics and gynecology to design practical and bedside CME courses seems necessary.

Adherence to risk-reducing salpingo-oophorectomy guidelines among gynecologic oncologists compared to general gynecologists

Risk-reducing bilateral salpingo-oophorectomy reduces mortality from high-grade serous carcinoma in patients with hereditary breast and ovarian cancer associated gene mutations. Ideal surgical management includes 5 steps outlined in 2005 by the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists. In addition, it is recommended that pathologic examination include serial sectioning of specimens. In practice, risk-reducing salpingo-oophorectomy is performed by both gynecologic oncologists and general gynecologists. To ensure optimal detection of occult malignancy, standardized adherence to outlined guidelines is necessary. This study aimed to evaluate the adherence to optimal surgical and pathologic examination guidelines and to compare the rate of occult malignancy at the time of surgery between 2 provider types. Institutional review board exemption was obtained. A retrospective review of patients undergoing risk-reducing bilateral salpingo-oophorectomy without hysterectomy from October 1, 2015, to December 31, 2020, at 3 sites within a healthcare system was conducted. The inclusion criteria included age ≥18 years and a documented indication for surgery being a mutation in BRCA1 or BRCA2 or a strong family history of breast and/or ovarian cancer. Compliance with 5 surgical steps and pathologic specimen preparation was based on medical record documentation. Multivariable logistic regression was used to determine differences in adherence between provider groups and surgical and pathologic examination guidelines. A P value of <.025 was considered statistically significant for the 2 primary outcomes after Bonferroni correction was applied to adjust for multiple comparisons. A total of 185 patients were included. Among the 96 cases performed by gynecologic oncologists, 69 (72%) performed all 5 steps of surgery, 22 (23%) performed 4 steps, 5 (5%) performed 3 steps, and none performed 1 or 2 steps. Among the 89 cases performed by general gynecologists, 4 (5%) performed all 5 steps, 33 (37%) performed 4 steps, 38 (43%) performed 3 steps, 13 (15%) performed 2 steps, and 1 (1%) performed 1 step. Gynecologic oncologists were more likely to document adherence to all 5 recommended surgical steps in their surgical dictation (odds ratio, 54.3; 95% confidence interval, 18.1-162.7; P<.0001). Among the 96 cases documented by gynecologic oncologists, 41 (43%) had serial sectioning of all specimens performed, compared with 23 of 89 cases (26%) performed by general gynecologists. No difference in adherence to pathologic guidelines was identified between the 2 provider groups (P=.0489; note: P value of >.025). Overall, 5 patients (2.70%) had occult malignancy diagnosed at the time of risk-reducing surgery, with all surgeries performed by general gynecologists. Our results demonstrated greater compliance with surgical guidelines for risk-reducing bilateral salpingo-oophorectomy in gynecologic oncologists than in general gynecologists. No considerable difference was determined between the 2 provider types in adherence to pathologic guidelines. Our findings demonstrated a need for institution-wide protocol education and implementation of standardized nomenclature to ensure provider adherence to evidence-based guidelines.

Clinical significance of diastasis recti: Literature review and awareness amongst health care professionals

A variety of physical complaints have been related to chronic diastasis recti (DR), including back pain, pelvic pain, and urinary incontinence. However, its clinical significance is still subject of debate, leaving many patients to feel unheard when experiencing symptoms. This study aims to assess current knowledge on DR, its potential treatments, and the awareness of this condition amongst involved health care professionals. A literature review was performed to analyze current available knowledge on DR and its treatment. Then, a survey was conducted to investigate the awareness on DR amongst general practitioners, midwives, gynecologists, general surgeons, and plastic surgeons. Over 500 health care professionals completed our survey, including 46 general practitioners, 39 midwives, 249 gynecologists, 33 general surgeons, and 74 plastic surgeons. Although the majority of respondents (>78% in all groups) reported to encounter DR in daily practice, opinions differed markedly on most significant symptoms, associated physical complaints, best first referral for treatment, and best treatment modality. Current literature is not unanimous on the relation between DR and physical complaints and on its most suitable treatment. This incongruity is corroborated by the variety of responses from involved health care professionals in our survey. More clinical data are needed to provide clarity on this issue.

Executive Summary of the Ovarian Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention awarded funding to the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about ovarian cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in February 2022. This article is the executive summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of ovarian cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

(525) Challenges in Management of Sexual Disorders in Rwanda

Abstract Introduction In Rwanda, it is not common to talk about sexual issues but these days there are remarkable increase in sexual disorders consultations especially in men where most are complaining of erectile dysfunction followed by ejaculatory disorders which make about 10% in public and 20% in private urological consultations. Top causes are psychogenic while organic causes include Diabetes mellitus and post chemotherapy and radiotherapy in females. Most patients present late distressed and desperate hence poor quality of life. Objective Highlight the challenges in management of sexual disorders in Rwanda Methods Narrative opinion. I will discuss in details those challenges from a perspective of a urologist interested in sexual medicine. Results There are neither andrologists nor specialized sexual therapist in Rwanda, hence difficulty in treating these patients. Most of patients are exposed to highly mediatized wrong information from practitioners who use herbal medicines to treat them without success in most of them. Others consult general practitioners or gynecologists who refer them to urologists. With the scarcity of urologists in the country (only 10) and lack of psychosexual therapists, limited treatment options (only some PDEIs and antidepressants available) and cultural barriers, there is a big gap in proper management of sexual disorders. Conclusions There is high need for capacity building of health professionals, special training of urologists, research, access to evidence-based information and management options to bridge the big gap. Disclosure No

ENDOMETRIOSIS OF THE CECUM AND APPENDIX: REVIEW OF LITERATURE.

Endometriosis is a benign, chronic, inflammatory and estrogen dependent pathology in which there is the implantation of functional extrauterine endometrial tissue. Pelvic and abdominal endometriosis are the most frequent presentations and, in these forms, ectopic endometrial implantation affects the lesser pelvis, uterosacral ligaments, ovaries, uterine tubes, urinary and gastrointestinal tracts. Some symptoms such as altered bowel habits, pelvic pain, infertility and bleeding during bowel movements are present. In this work the focus is on the manifestations of endometriosis in the appendix and cecum. The use of imaging tests, such as transrectal and transvaginal ultrasonography, magnetic resonance imaging and colonoscopy are important tools used, however, the gold standard is videolaparoscopy with biopsy to confirm the anatomopathological findings. The surgical strategy is related to the degree of impairment and must take into account the eradication of the disease together with the preservation of fertility. Therefore, the importance of evaluating and treating all areas that endometriosis affects is clear, with a multidisciplinary approach by general surgeons and gynecologists, in order to investigate, diagnose and correctly address the disease in an organized and correct way.&#x0D;

Impact of training level of the first surgical assistant on quality metrics for hysterectomy: A retrospective review

Evaluate impact of first-assist level of training on surgical quality outcomes for hysterectomies performed by general gynaecologists.

Fragility of statistically significant findings from randomized trials in comparing laparoscopic versus robotic abdominopelvic surgeries.

Utility of robotic over laparoscopic approach has been an area of debate across all surgical specialties over the past decade. The fragility index (FI) is a metric that evaluates the frailty of randomized controlled trials (RCTs) findings by altering the status of patients from an event to non-event until significance is lost. This study aims to evaluate the robustness of RCTs comparing laparoscopic and robotic abdominopelvic surgeries through the FI. A search was conducted in MEDLINE and EMBASE for RCTs with dichotomous outcomes comparing laparoscopic and robot-assisted surgery in general surgery, gynecology, and urology. The FI and reverse fragility Index (RFI) metrics were used to assess the strength of findings reported by RCTs, and bivariate correlation was conducted to analyze relationships between FI and trial characteristics. A total of 21 RCTs were included, with a median sample size of 89 participants (Interquartile range [IQR] 62-126). The median FI was 2 (IQR 0-15) and median RFI 5.5 (IQR 4-8.5). The median FI was 3 (IQR 1-15) for general surgery (n = 7), 2 (0.5-3.5) for gynecology (n = 4), and 0 (IQR 0-8.5) for urology RCTs (n = 4). Correlation was found between increasing FI and decreasing p-value, but not sample size, number of outcome events, journal impact factor, loss to follow-up, or risk of bias. RCTs comparing laparoscopic and robotic abdominal surgery did not prove to be very robust. While possible advantages of robotic surgery may be emphasized, it remains novel and requires further concrete RCT data.

Hysterectomy With a General Gynecologist vs Gynecologic-Oncologist in the Setting of Endometrial Intraepithelial Neoplasia: A Cost-Effectiveness Analysis

ABSTRACT Total hysterectomy performed by either general gynecologists or gynecologic oncologists is the standard of care treatment for endometrial intraepithelial neoplasia (EIN). Some patients with endometrial cancer found at the time of hysterectomy require a lymph node dissection (LND), which is only performed by gynecologic oncologists. When a general gynecologist performs the hysterectomy, the patient must wait until after the procedure for pathology results to determine if an LND is indicated. Undergoing a second surgery for LND is associated with increased negative outcomes, leading to discussion whether patients with EIN should be provided the option to receive the initial hysterectomy by a gynecologic oncologist. This cost-effectiveness analysis of hysterectomy by general gynecologists versus gynecologic oncologists for patients with EIN aimed to assist decision-making over initial surgical provider choice for patients with EIN. A theoretical cohort of 200,000 patients, the approximate number of individuals diagnosed with EIN each year in the United States, was used to carry out the cost-effectiveness analysis. For patients in the gynecologic oncologist branch, intraoperative frozen section revealed either cancer or EIN or less, whereas patients in the general gynecologist branch had postoperative pathology that reveal cancer or EIN or less. Cancer results were staged according to the “Mayo criteria,” and patients with ≥stage IA, grade 3 cancer received a full LND in the primary surgery with a gynecologic oncologist or in a second surgery in the general gynecologist group. Probabilities in this model were derived from the literature. Costs were obtained from the literature and adjusted to 2020 US dollars. Study outcomes included perioperative mortality, surgical site infection, costs, and quality-adjusted life years (QALYs). After determination of total costs and QALYs, the incremental cost-effectiveness ratio was calculated to compare the difference between the 2 strategies (general gynecologist vs gynecologic oncologist). An incremental cost-effectiveness ratio below $100,000 per QALY was considered cost-effective. Among the theoretical cohort, hysterectomy with a gynecologic oncologist was associated with a decrease of 10,811 second surgeries for LND, 87 surgical site infections (1611 vs 1698), and 9 perioperative mortalities (178 vs 187). The cost-effectiveness analysis revealed that hysterectomy with a gynecologic oncologist was considered the dominant strategy because it was associated with savings of $116 million and increased QALYs by 180. Multivariable sensitivity analysis of all probabilities, costs, and utilities showed that the model was cost-saving and associated with increased QALYs in 54.1% of simulations and cost-effective at the willingness-to-pay threshold of $100,000 per QALY in 54.8% of simulations. The results of this theoretical cost-effectiveness analysis reveal that hysterectomy for EIN with a gynecologic oncologist versus a general gynecologist was associated with cost savings, increased QALYs, and a reduction in morbidity and mortality primarily driven by a reduction in second surgeries.

Cannabis, endometriosis, and a high time?

The article proposing cannabis for the treatment of endometriosis is superficially argued and shows disdain for concerned patient care.1 For the medical profession, the addition of another dangerous drug into the mainstream medication market is a serious consideration. Maybe the authors proposing it is ‘high time’ for wider cannabis use have a warped sense of humour? Maybe they have not read about the psychotic-inducing and detrimental mental health issues associated with cannabis consumption. Or its intoxication with consequent poor short-term decision-making, hindered social coordination and mounting driving errors. Or its demotivation and links to educational drop-out rates, or its habituation, addiction, and cannabis disorder potential. In calling for debate on the pros and cons of medicinal cannabis in gynaecology, even the most myopic protagonists would concede there are dangers in cannabis use as an analgesic. In choosing to focus on the narrow use of cannabis as an analgesic for endometriosis, the authors avoid any perspective. Their ‘considerable’ mention of the demerits of medications to treat endometriosis is fair, but their failure to mention any immediate or long-term side-effects of cannabis is hardly even-handed. As researchers ‘undertaking randomised controlled trials’ they will surely present the drawbacks for readers' consideration? There is not a single word to suggest there may be side-effects of cannabis for treating the pain of endometriosis – let alone any dangers in general gynaecology and obstetrics. Solid pharmaceutical evidence for the use of cannabis in the treatment of endometriosis (or any other gynaecological condition) is lacking and the authors agree it is ‘urgently’ needed. However, they argue that such trials ‘are by no means an essential prerequisite prior to prescription’ - the rationale of this disregard being their replacement ‘by a diversity of approaches that involve analysing the totality of the evidence base.’ Say what? But the evidence base is clear – cannabis is a dangerous drug, so failing to accept the facts when they go against your premise is illogical and unprofessional. Prescribing one analgesic agent rather than another that has no effect on the underlying cause of the pain can only hope to persuade the patient to think she is ‘better’. Homeopathy claims that ‘if you think you are better, then you are better.’ Analgesic roulette is homeopathy and not what endometriosis suffers should be offered.2 Evidence-based medicine rests on three pillars, the best available evidence, clinical expertise, and patient preferences. The evidence produced in favour of cannabis thus far is equivocal and anecdotal. The clinical experience in Australia and New Zealand is minimal and unpublished, with patient preferences only, in the protagonists' words, ‘worthy of continued investigation’. The latest systematic review concludes that interpreting existing studies precludes ‘a definitive statement about cannabis for gynaecologic pain relief’.3 Asking doctors not to ‘wait for higher level evidence’ before prescribing cannabis in gynaecology or obstetrics is speculative at best, but against the principles of good medicine, especially in view of the evidence which is available which demands caution.4 Let us weigh the benefits and harms of any progress in our discipline and then – and then only – act in our patients' best interests.

Suspected fetal anomalies: an overview for general obstetricians and gynaecologists

Advances in fetal ultrasonographic assessment have led to improvements in the antenatal diagnosis of many structural anomalies. Approximately 60% of congenital fetal defects can be diagnosed during the 20 week anomaly scan. Some of them are so severe that the option of termination of pregnancy should be discussed. Some, can be successfully managed in utero, or postnatally. Most pregnancies affected by congenital fetal anomalies are cared for by a specialist team of fetal medicine doctors and midwives, with contributions from clinical geneticists, neonatologists and specialist paediatricians and paediatric surgeons. However, it is important that general obstetricians have a basic knowledge of suspected fetal anomalies in order to support women and their families during their first consultation following the initial diagnosis or suspicion of abnormality. Furthermore, they may well be part of the on call team when labour and birth occur. This article covers the most common structural fetal anomalies in a systematic manner, starting from head and brain abnormalities, and progressing through thoracic, abdominal wall, kidney and bladder malformations, and various skeletal and limb abnormalities. It is important that women are counselled adequately and referred to a fetal medicine centre in a timely manner.

In Reply

Department of Obstetrics and Gynecology, General Obstetrics and Gynecology, Washington University in St. Louis, Center for Outpatient Health, St. Louis, Missouri Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure Shelby M. Dickison disclosed that this article discusses off-label use of the double balloon catheter. Lauren Kus did not report any potential conflicts of interest.

Contemporary Review of Masses in the Canal of Nuck.

Canal of Nuck masses is a rare occurrence that can cause swelling in the abdominal-inguinal region of females for various reasons. This condition arises due to an abnormal persistence of the processusvaginalis opening. Although Canal of Nuck pathology is not widely known among general surgeons or gynecologists due to its rarity, it has been associated with significant morbidity and requires further research. In this comprehensive review, we aim to summarize the embryology and anatomy of the Canal of Nuck, followed by a description of the various types of masses that can occur in this region. We discuss the clinical presentation and diagnostic workup of Canal of Nuck masses, including imaging modalities and differential diagnoses. Next, we review the surgical management of these masses, including open and laparoscopic approaches. Finally, we discuss the potential complications and long-term outcomes associated with Canal of Nuck pathology. This review aims to compile the presently accessible literature on anomalies occurring in the Canal of Nuck in females, with a particular focus on describing their pathological nature, diagnosis, and management. In summary, this review provides an up-to-date understanding of the pathology, diagnosis, and management of Canal of Nuck masses and aims to raise awareness of this under-recognized surgical challenge among healthcare providers.

Statewide assessment of telehealth use for obstetrical care during the COVID-19 pandemic

The COVID-19 pandemic started a period of rapid transition to telehealth in obstetrical care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. Although there is considerable literature on the use of telehealth in obstetrical care, there are limited data on widespread telehealth use among different practice types and patient populations during the pandemic and whether these are preferred technologies. This study aimed to describe variations in telehealth use for obstetrical care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aimed to delineate telehealth use among rural and micropolitan and metropolitan practices to better understand if telehealth use varied by practice location. A web-based survey was distributed to practice managers of obstetrical practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through assistance of the Community Care of North Carolina Pregnancy Medical Home program. Practice location was defined as rural, micropolitan, or metropolitan based on the county population. The survey assessed telehealth use before and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location. A total of 295 practice managers were sent a web-based survey and 98 practice managers responded. Responding practices represented 66 of 100 counties in North Carolina with 50 practices from rural and micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%), and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. A total of 40% of practices endorsed a preference for continued telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continuation of telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in the preferences for telehealth continuation or future needs by practice location. Telehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location in terms of modalities used, future preferences, or needs. This study assessed statewide uptake of and differences in obstetrical telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetrical care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.

Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?

Ureteral injury is a known complication of hysterectomies. Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies. Some studies have reported that as surgeon volume increases, urinary tract injury rates decrease. To our knowledge, no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy. To determine the incidence of urinary tract injury between urogynecologists, gynecologic oncologists, and general gynecologists. The study took place from January 1, 2016 to December 1, 2021 at a large community hospital in Detroit, Michigan. We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon's volume per year was calculated. Patient demographics, medical history, physician-dictated operative reports, and all hospital visits postoperatively were reviewed. Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group excluding urinary tract, bowel, or major vessel injury. High-volume surgeons had four (1%) patients with a complication and low-volume surgeons had 12 (4%) patients with a complication (P = 0.04). Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists, however our study was underpowered.

Measuring the Awareness of Polycystic Ovarian Syndrome (PCOS) among Women in Punjab, Pakistan

Polycystic ovarian syndrome (PCOS) is the most prevailing endocrine disorder among women of reproductive age, worldwide. Its prevalence is 52% in Pakistani women and the rate of infertility is gradually increasing. It can be treated through early diagnosis, management of symptoms, and a healthy lifestyle. This cross-sectional study aimed to determine the level of awareness and knowledge regarding PCOS in the women of Punjab, Pakistan. For this purpose, a total of 350 women between the ages of 16 and 50 years were included in the current study. data was obtained through a questionnaire and analyzed through SPSS (version 25). The results determined that 56% of women were found to have the knowledge of PCOS, while 44% had never heard about it. Furthermore, about 67% of 196 PCOS-aware women were unaware of its signs and symptoms. Moreover, in 14% of the cases, a friend was the source of knowledge regarding PCOS. Whereas, approximately 10% of these women had heard about the syndrome through education, 9% through their family, 7% through various media such as newspapers, television, and social media, and 17% through other sources including general physicians and gynecologists. It was concluded that only 33% of the participants who claimed to have heard of PCOS were aware of its symptoms, whereas 67% were unaware of them. A total of 152 women, out of 350, had never heard about PCOS.