Gynecological Society Research Articles

Availability, Quality, and Implementability of Canadian Clinical Practice Guidelines for Female Sexual Dysfunction

ABSTRACT Introduction Sexual health problems are common among Canadian women, though they often go unaddressed and untreated in clinical settings. Clinical practice guidelines (CPGs) are systematically developed statements that facilitate structured, evidence-based guidance for specific clinical circumstances. Their potential benefits to patients and practitioners are dependent upon comprehensive guideline development processes that consolidate best available evidence, and guide successful implementation into practice. Little is known about the curation, availability, quality, and implementability of Canadian CPGs for women's sexual health problems and female sexual dysfunction (FSD). Objective i) To determine the availability of protocols guiding the curation of Canadian CPGs ii) To assess the availability, quality, and implementability of Canadian CPGs for women's sexual health concerns and FSD. Methods A systematic search for publicly available documents referencing Canadian CPG development processes was conducted. Websites associated with provincial and national health bodies, in addition to relevant professional medical organizations, and electronic databases PubMed and Google Scholar were searched. A separate search was conducted to retrieve Canadian CPGs specific to women's sexual health and FSD using similar methodology. FSD CPGs that met the criteria of including recommendations on FSD screening, management, and resources went on to subsequent analyses using the AGREE-II and AGREE-REX tools to assess CPG quality and implementability, respectively, and qualitative content analysis to identify the scope and thematic content of the CPGs. Results Two national guidelines for Canadian CPG development were identified. 3/13 Canadian provinces and territories had protocols outlining processes for general CPG development. National and provincial documents varied in their recommended methodologies for CPG curation and updating evidence suggesting a lack of standardization. Two Canadian CPGs specific to FSD and sexual concerns were identified: one from the Canadian Urological Association, and one from the Society of Obstetrics and Gynecology of Canada (SOGC). Only the SOGC guideline contained information regarding screening, management, and resources for FSD, and thus underwent subsequent analysis. The SOGC guideline scored highly with respect to the domains of Scope and Purpose (79%), and Clarity of Presentation (86%), though it did not sufficiently address the remaining AGREE-II domains, scoring lowest in Applicability (44%) and Editorial Independence (13%). AGREE-REX scoring was 58%, suggesting it was moderately implementable. Qualitative analysis revealed a focus on the importance of healthcare providers ensuring they have the necessary skills and knowledge to assess and manage sexual health problems, though the details of these skills and knowledge were not consistently defined. Conclusions There is a lack of standardization of the process of CPG curation in Canada and limited Canadian CPGs guiding best practices for screening and management of FSDs, and provision of additional resources. This study highlights the strengths and deficiencies in the current Canadian CPGs for FSD. Canadian CPG developers should consider FSD a topic of priority and continue to make attempts to curate comprehensive, evidence-based CPGs in this field that are implementable in all local Canadian contexts. The ISSWSH Process of Care for the Identification of Sexual Concerns and Problems in Women may serve as a valuable resource in improving Canadian-specific FSD CPGs. Disclosure No

Women's Health Care Committee, Japan Society of Obstetrics and Gynecology: Annual report-2022.

The Women's Health Care Committee was instituted in 2010 with the goal of improving women's health. In the current academic year, there are 6 subcommittees focusing on conducting the following surveys: (1) Current status of pregnancy-associated breast cancer in Japan; (2) Surgery for disorders of sex development; (3) Diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder; (4) Obstetrics and gynecology-based treatment for patients with eating disorders in Japan; (5) Multi-drug-resistant bacterial infections in the field of obstetrics and gynecology; and (6) Changing methodology of treatment of dysmenorrhea and continuing medical education. The activities of each subcommittee are detailed below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2022;74(6): XXX-XXX).

Determinants of Obstetricians’ Pattern of Care for Sickle Cell Disease in Pregnancy

Pregnancy in sickle cell disease (SCD) is high risk. With improved comprehensive obstetric care, pregnant females with SCD can achieve successful pregnancy outcomes, especially in resource-poor settings. To determine the predictors of Obstetricians' pattern of care for SCD in pregnancy in Nigeria. Self-administered, pre-tested, pre-validated questionnaires containing 18 questions on demographic details of obstetricians, and their pattern of practice towards antenatal care for pregnant SCD patients were distributed to attendees of the 2018 conference of the Society of Obstetrics and Gynaecology of Nigeria (SOGON). Regression analysis was done to determine the possible predictors, and a significant level was <0.05. Almost all the respondents (98.4%) considered pregnancy in SCD as high risk, and 96.2% proposed for preconception care in a tertiary hospital. The majority, (62%) agreed that antenatal visits in the first and second trimesters should be more frequent. The majority (96.2%) reported they would routinely order urine tests among other investigations. Majority of respondents,74.9% and 98.4% knew that foetal medicine specialists and haematologists should be part of preconception care team, respectively. Respondents' practice centre and designation, significantly contributed to their "willingness to consult a haematologist" (P = 0.004)," and willingness to consult a foetal specialist" (P = 0.047), while practice centre and practice population significantly contributed to their response to "ideal centre for management of SCD pregnancy": (P = 0.049), (P = 0.024) respectively. Obstetricians' level of training, practice centre, and practice population of pregnant women with SCD are significant contributors to their pattern of care towards antenatal care for pregnancy in SCD.

A Summary of Chinese Expert Consensus on Fetal Growth Restriction (An Update on the 2019 Version)

Abstract Fetal growth restriction (FGR) is a common complication of pregnancy associated with higher rates of perinatal mortality and morbidity, as well as a variety of long-term adverse outcomes. To standardize the clinical practice for the management of FGR in China, Fetal Medicine Subgroup, Chinese Society of Perinatal Medicine, Chinese Medical Association and Maternal-Fetal Medicine Committee, Chinese Society of Obstetrics and Gynecology,Chinese Medical Association organized an expert committee to provide official consensus-based recommendations on FGR. We evaluated the evidence provided by relevant high-quality literature, performed a three-round Delphi study and organized face-to-face meetings with experts from multidisciplinary backgrounds. The consensus includes the definition, prenatal screening, prevention, diagnosis, monitoring and management of FGR.

CAPACITY BUILDING OF KENYAN HEALTH WORKERS IN PPH PREVENTION AND MANAGEMENT: SAVING MORE PARTURIENT LIVES

Introduction: Despite being largely preventable, postpartum hemorrhage (PPH) is the modal cause of maternal mortality globally and in Kenya. &#x0D; Methodology: During the 44th Annual Scientific Congress of the Kenya Obstetrical and Gynecological Society, a 2-day PPH workshop was held in Msambweni Sub-District Hospital in Kwale County to identify addressable gaps and to build local capacity. The participants sat a uniform pre- and post- test and evaluated the course. &#x0D; Results: The modal cadres present were clinical officer interns (8) and midwives (7). Out of the 28 participant responses analyzed, the pretest revealed low average level of knowledge (43.8%), with devascularization (31.8%) and resuscitation (39.7%) showing the lowest levels. The post-test revealed substantial improvement in overall average knowledge that was attributable to the training (75.2%, p=0.001). Three quarters of the participants rated the training as excellent, while a fifth rated the training as good. &#x0D; Discussion: PPH is known to be the most significant cause of maternal mortality. However, knowledge of its prevention, diagnosis and management were poor. The training resulted in significant improvement in knowledge, while the use of high-fidelity simulation drills enhanced emergency preparedness. &#x0D; Conclusion: Overall, there is a significant role for capacity building through in-service trainings. There is therefore a need to scale-up such trainings in order to further reduce contribution of PPH to maternal mortality in Kenya.

Determinants of Human Papillomavirus Vaccine recommendation among Middle Eastern and Lebanese Healthcare Providers

ObjectiveTo improve the knowledge, awareness, and attitude (KAA) among health care providers (HCPs) regarding Human Papilloma Virus vaccination (HPV-V), the Lebanese Society of Obstetrics and Gynecology (LSOG) has regularly organized educational meetings, symposia, and workshops. MethodsWe conducted two sets of surveys among attendees of the LSOG congresses in 2009 and 2018 to assess their KAA towards HPV-V. ResultsAround 30% (362) of LSOG attendees participated in our surveys in 2009 and 2018 (185 Vs.177 respectively). Most of them were obstetricians and gynecologists. Most HCPs considered that HPV-V can prevent cervical cancer (CC) [82% and 80% respectively, P = 0.73], however, around 60% were confident enough to convince their patients. HCPs who were confident about the efficacy of the HPV-Vs were more likely to believe that HPV-V can prevent CC (odds ratio = 22.5, p-value = 0.003). These HCPS were more likely to recommend HPV-V (OR = 6.6, p-value = 0.009). About 20% of HCPs who usually recommend HPV-V, reported cost as a main barrier compared to 76% of those who did not. ConclusionsBeing familiar with HPV, HPV-related diseases, CC, HPV vaccines and their effectiveness significantly influence whether a HCP recommends HPV-V. The KAA of HCPs did not significantly improve from 2009 to 2018.

P-499 Facilitators and barriers for home-based monitoring to time frozen embryo transfers in IVF

Abstract Study question What are the facilitators and barriers concerning the implementation of home-based monitoring for natural-cycle-frozen-embryo-transfer (NC-FET) from perspective of patients and healthcare providers in the Netherlands? Summary answer Most important facilitator was optimal pregnancy chance, and most important barriers were risk of missing an ovulation for patients and laboratory capacity for healthcare providers. What is known already The number of FET cycles is increasing, mainly due to improvement in laboratory techniques. Based on current evidence, there is no difference in effectiveness when NC-FET is compared to artificial-cycle-FET (AC-FET) in ovulatory women. However, NC-FET is associated with lower risk of adverse obstetric and neonatal outcomes compared with AC-FET. NC-FET is performed based on ovulation monitoring, which can be hospital-based (ultrasounds and ovulation triggering) or home-based (LH-urine-tests). Home-based-monitoring has the advantage of being the most natural protocol for FET. A systematic approach for the implementation of home-based monitoring has to start with exploring the perspectives of all stakeholders. Study design, size, duration Both patients and healthcare providers participated in the present study. A panel of experts (n = 8) hypothesised on barriers and facilitators for the implementation of home-based-monitoring during the proposal phase of the Antarctica-2 randomised controlled trial. Two different questionnaires were developed in order to investigate facilitators and barriers for patients and for health care providers. Participants/materials, setting, methods The following stakeholders participated in the study: Patients – represented by the Dutch Patient Organisation for Couples with Fertility Problems. Healthcare providers – represented by gynaecologists (Netherlands Society of Obstetrics and Gynaecology), embryologists (Dutch Federation of Clinical Embryology) and fertility doctors. Based on our power analysis we aimed for 300 completed questionnaires for the patients and a 90 completed questionnaires for the health care providers. Facilitators and barriers were analysed using frequencies, mean (SD) and ranking. Main results and the role of chance A total of 311 patients filled out the questionnaire of whom 86.8% underwent FET previously. The facilitators and barriers were ranked on a scale of 1-10 with 10 being very important. The highest priority for the patients was to implement the strategy with the highest chance of pregnancy (mean 9.7; 95% CI 9.6 – 9.7) and the lowest priority risk of missing the ovulation (mean 8.4; 95% CI 8.2 – 8.6)). A total of 96 health care providers filled out the questionnaire. According to health care providers patients would accept the strategy when it causes less interference with patients’ work and private life (mean 7.5; 95% CI 7.1 – 8.0) and with a low risk of missing the ovulation (mean 7.6; 95% CI 7.1 – 8.0). The most important facilitator for implementation of home-based monitoring for health care workers was optimising cumulative pregnancy rates (mean 8.1; 95% CI 7.7 – 8.4) and most important barrier the lack of laboratory capacity and flexibility (mean 6.4; 95% CI 5.8 – 7.0). Limitations, reasons for caution The barrier lack of laboratory capacity especially in weekends might differ between centres. We did not identify the number of centres who might experience this problem. Furthermore, these results only apply for the applicability of NC-FET in the Netherlands. Wider implications of the findings Our interpretation is that NC-FET is the preferred treatment in ovulatory women. We gained insight in the facilitators and barriers for implementation of NC-FET. Discussing results of this study with all stakeholders involved should stimulate incorporation in guidelines, especially as key professionals in guideline development took part in this study. Trial registration number The Antarctica-2 RCT (NTR: 27578) is supported by a grant of the Netherlands Organisation for Health Research and Development (ZonMw 843002807).

Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral.

Objective:In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists.Materials and Methods:This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course.Results:Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%).Conclusion:Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.

Investigation and analysis of the implementation status of "Diagnosis and therapy guideline of preterm birth (2014)"

Objective: To understand the actual situation of the implementation of "Diagnosis and therapy guideline of preterm birth（2014）", "Guideline" for short, by front-line obstetricians, and to provide reference for the further update and supplement of the "Guideline". Methods: This study designed a structured questionnaire for the prominent problems in the prevention and treatment of preterm birth, which was determined by the expert team drafting the "Guideline". In October to November 2021, a cross-sectional survey was conducted among obstetricians, including members of the Perinatal Medicine Branch of Jiangsu Medical Association and the Obstetrics Subgroup,Chinese society of Obstetrics and Gynecology, Chinese Medical Association, on the implementation status of the "Guideline". The recommendations of the "Guideline" were used as standard answers to determine the implementation rate. A total of 328 valid questionnaires were collected. The total score of the questionnaire was 12 points. The questionnaire was divided into low executive ability group (<7 points) and high executive ability group (≥7 points) with a score of 7 as the threshold value, and the differences in baseline information such as hospital grade and professional title between the two groups were compared. Results: The score of 328 obstetricians was (7.6±1.6) points, including 250 (76.2%, 250/328) in the high execution group and 78 (23.8%, 78/328) in the low execution group. The execution rates of "the use of uterine contraction inhibitors for short courses"[97.0% (318/328)], "late umbilical cord breakage after birth of premature infants"[87.8% (288/328)] and "should preterm patients with intact membranes be treated with antibiotics"[86.6% (284/328)] were all over 80%, indicating good implementation. Multiple logistic regression analysis showed that hospital grade and professional title were independent factors influencing the performance of the "Guideline"(all P<0.05), and secondary hospitals had lower scores and worse execution than tertiary hospitals (OR=0.42, 95%CI: 0.23-0.77; P=0.005). Senior titles had higher scores and better execution than junior titles (OR=5.33, 95%CI: 2.35-12.07; P<0.001). When answering the question "gestational week at which premature infants could survive in your hospital", only 3.4% (11/328) answered 22 weeks, and 44.5% (146/328) answered 28 weeks, accounted for the highest proportion. The gestational week of surviving premature infants in tertiary hospitals was earlier than that in secondary hospitals (P<0.05). The gestational week of surviving premature infants answered by senior titles was earlier than that of junior titles (P<0.05). Conclusions: Obstetricians generally have a good implementation of the "Guideline", and their understanding of some recommended clauses in the guidelines needs to be improved. In the future, training of primary hospitals and physicians with junior titles should be strengthened.

A novel algorithm to implement the molecular classification according to the new ESGO/ESTRO/ESP 2020 guidelines for endometrial cancer

ObjectiveTo compare the risk class attribution with molecular classification unknown to those with molecular classification known, according to the European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society...

Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study

BackgroundThe Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan.MethodsA national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated.ResultsWomen with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013–2015) to 6.4% (2016–2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013–2015) to 14.1% (2016–2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001).ConclusionsThe efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage.

Epidemiologie, Risikofaktoren und Genetik des Endometriumkarzinoms

BackgroundEndometrial cancer (EC) is the fifth most common female malignancy and the most common pelvic malignancy. Effective strategies for early detection, prevention, and genetic assessment are discussed in this article.AimTo review the literature on epidemiology, risk factors, and genetics.Materials and MethodsThis article is based on the current recommendations of the German Society of Obstetrics and Gynecology for the diagnosis and treatment of women with EC. The current literature was summarized based on expert knowledge. Systematic searches in the Medline database and in Cochrane Reviews were performed. The quality of the evidence was rated according to the 2011 Oxford classification. Recommendations and statements were formulated by a representative group using structured consensus methods.ResultsIn Germany, 2.7% of cancer-specific deaths are due to EC. The incidence of EC increases with age and the disease is most often diagnosed in the age group of 75- to 79-year-old women. The lifetime risk of EC is 1.9%. Risk-modulating factors of EC include long-term use of estrogens, progestogen therapy, oral contraceptives, high body mass index, and impaired glucose metabolism. In addition, physical activity and dietary aspects, such as the amount of fat and red meat consumed, as well as soja foods, dietary fibers, vitamins, and specific beverages such as tea and coffee, play an important etiological role. EC also has a genetic component. Immunohistochemical and/or molecular screening is warranted for all patients with EC and has a significant impact on the genetic counselling of affected families as well as on treatment decisions.

Improved implementation of aspirin in pregnancy among Dutch gynecologists: Surveys in 2016 and 2021.

To evaluate the implementation of low-dose aspirin in pregnancy for the prevention of utero-placental complications among gynecologists in the Netherlands between 2016 and 2021. In this timeframe, a national guideline about aspirin in pregnancy was introduced by the Dutch Society of Obstetrics and Gynecology. A national online survey among Dutch gynecologists and residents was performed. An online questionnaire was distributed among the members of the Dutch Society of Obstetrics and Gynecology in April 2016 and April 2021. Main outcome measure was the proportion of gynecologists indicating prescription of aspirin in pregnancy for high and moderate risk indications. In 2016, 133 respondents completed the survey, and in 2021 231. For all indications mentioned in the guideline there was an increase in prescribing aspirin in 2021 in comparison to 2016. More specifically, the percentage of gynecologists prescribing aspirin for a history of preeclampsia before 34 weeks, between 34 and 37 weeks and at term increased from respectively 94% to 100%, 39% to 98%, and 15% to 97%. Consultant obstetricians and respondents working in an university hospital did not more often indicate the prescription of aspirin for tertiary care indications in 2021. Future use of a prediction model was suggested in the narrative comments. Implementation of aspirin in pregnancy among Dutch gynecologists substantially improved after a five year timeframe in which the national guideline on aspirin during pregnancy was introduced and trials confirming the effect of aspirin were published.

014 Bleeding management of long-acting reversible contraceptives

The World Health Organization (WHO) and many gynecological societies have confirmed the safety of Long-Acting Reversible Contraceptives (LARCs) and recommend these contraceptives for adolescents. However, the high rates of unplanned adolescent pregnancies remain unexplained despite the proven efficacy of LARCs.

Editorial introduction.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITOR Emre SeliEmre SeliEmre Seli, MD, is Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, USA. Dr Seli received his medical degree from the University of Istanbul, Turkey, and completed his residency in obstetrics and gynecology at Yale University. His postdoctoral training included a fellowship in reproductive endocrinology and infertility as well as a research fellowship in molecular biology, both at Yale University. The primary focus of his research program is to understand and treat infertility. His laboratory characterized mechanisms regulating translational activation of gene expression in the oocyte. Dr Seli and his colleagues also made seminal contributions to our understanding of oocyte and embryo competence in IVF and the potential role of non-invasive diagnostic technologies in this context. Dr Seli is the recipient of many National Institutes of Health (NIH) and pharmaceutical industry-sponsored research grants. He has trained more than 50 pre- and post-doctoral fellows, published more than 100 scientific articles, and received numerous research awards, including the Ira and Ester Rosenwaks New Investigator Award from the American Society for Reproductive Medicine (ASRM), and the President's Achievement Award from the Society for Reproductive Investigation (SRI). Dr Seli's current research focuses on determinants of oocyte and embryo health, and mechanisms of ovarian ageing. Dr Seli is actively involved in professional societies and scientific journals. He served as the Program Director for SRI in 2016, where he is now the Program Committee Chair (2016–2021). He has also been a member of the ASRM Research Committee for the past five years, and served as a member of the SSR Program Committee, where he organized the Ovarian Workshop in 2016 and 2018. He is the Associate Editor for Molecular Human Reproduction, Reproductive Sciences, Journal of Assisted Reproduction and Genetics, and Reproductive Biomedicine Online, and is currently co-editor of Current Opinion in Obstetrics and Gynecology. As an educator, Dr Seli delivered more than 150 invited lectures nationally and internationally, and he is the recipient of the Association of Professors of Gynecology and Obstetrics (APGO) Excellence in Teaching Award based on evaluations of his lectures by Yale Medical Students. Dr Seli edited four books (Non-invasive Management of Gynecologic Disorders, Infertility, Fertility Preservation, and Human Gametes and Pre-implantation Embryos: Assessment and Diagnosis) and is currently co-authoring the 9th edition of the Speroff's Clinical Gynecologic Endocrinology and Infertility. Juan Antonio García VelascoJuan Antonio García VelascoProfessor Juan Antonio García Velasco is Director of IVI RMA-Madrid, Spain. He gained his degree in medicine at Complutense University, Spain, in 1990, before going on to train as a specialist in obstetrics and gynecology at La Paz Hospital, Spain, between 1992 and 1995. Professor García Velasco gained his PhD in medicine and surgery at Autónoma University, Spain, in 1995. He then became a sub-specialist in reproductive endocrinology and infertility at Yale University, USA, in 1998. Professor García Velasco has published 122 scientific articles in impact journals along with 22 chapters and four books. He is the Principal Investigator of projects funded by the Ministry of Education and the Ministry of Health. He is the Co-Editor of Reproductive Biomedicine Online (RBMO) and a member of the Editorial Committee of Fertility & Sterility (ASRM), Society for Gynecologic Investigation (SGI), European Society of Human Reproduction and Embryology (ESHRE), Spanish Society of Obstetrics (SEGO) and Gynecology and Spanish Society of Fertility (SEF).

Screening for uterine cancer.

e18578 Background: Endometrial cancer is the most common gynecologic malignancy. Historically, endometrial cancer would present at an early stage without disseminated disease. Presently, in certain populations endometrial cancer presents at a late stage and carries a mortality rate similar or even greater to that of ovarian cancer. This increase is tied to the increasing prevalence of risk factors and worsening disparities. Owing to data and trends from decades long past, routine endometrial cancer screening is not recommended by any gynecologic or oncologic society. It is now time to revisit the discussion on endometrial cancer screening in the modern era of the disease. In our community with advanced stage and 60% 5-year mortality, endometrial biopsy is a reasonable approach for those at highest risk for disease and the worse outcomes. Methods: Using nationally available datasets on endometrial cancer (NHANES, PLCO), we analyzed the most common risk factors associated with endometrial cancer to develop a risk assessment nomogram. The variables were age, body-mass index, race, concomitant medication usage (specifically hormone use), race, and prior obstetrical history. We bootstrapped our risk calculations to exclude data from the most recent year and used those cases as our testing set to test the ability of the nomogram to correctly predict endometrial cancer in those patients with known disease. We also tested our nomogram against unpublished endometrial cancer data from the population of an Atlanta safety net hospital. Results: For each learning data set (ie the bootstrapped patients from the NHANES and PLCO data), the association with the candidate variables was as expected. The magnitude of the associations was also consistent with previously reported univariate analyses. In the population of interest, there were 342994 women with 1076 (67.4/100,000) uterine cancers over 5 yrs (2015-20). The incidence rate ratio of cancer with the presence of known risk factors already contained in the population EMR was approximately 6x and 15:1 (15 high risk women identified with 1 expected cancer). Conclusions: Our nomogram was able to accurately predict the presence of cancer in patients included in both the national databases as well as the local safety net hospital community. Using a 100% sensitivity goal yielded a PPV of 6.7%. With these promising retrospective results, we intend to apply our risk assessment model in the clinical setting with a prospective study design to predict asymptomatic endometrial disease in at-risk patients, selecting those for further clinical investigation including triage to soliciting symptoms, ordering ultrasound or even performing endometrial sampling using shared decision making. Further directions for research include the results and subsequent effects on stage at diagnosis and survival of these additional clinical investigations in asymptomatic women identified as high-risk by this nomogram.

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.

Annual report of the committee on gynecologic oncology, the Japan Society of Obstetrics and Gynecology: Annual patient report for 2019 and annual treatment report for 2014.

To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2019 and the Annual Treatment Report for 2014, on the outcomes of patients who started treatment in 2014. The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2019 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial, and ovarian cancer in 2014 was analyzed by using the Kaplan-Meier, log-rank, and Wilcoxson tests. Treatment was initiated in 2019 for 7983 patients with cervical cancer, 12 631 with endometrial cancer, 7737 with ovarian, tubal, and peritoneal cancer, 2222 with ovarian borderline tumors, and with the others (251 vulvar cancer, 148 vaginal cancer, 476 uterine sarcoma, 43 uterine adenosarcoma, 175 trophoblastic diseases). This clinicopathological information was summarized as the Patient Annual Report. The 5-year survival rates of the patients with cervical cancer were 92.5%, 76.8%, 58.6%, and 29.5% for stages I, II, III, and IV, respectively. The 5-year survival rates for the patients with endometrial cancer were 94.5%, 87.3%, 70.2%, and 26.5% for stages I, II, III, and IV, respectively. The 5-year survival rates for the patients with ovarian cancer (surface epithelial-stromal tumors) were 90.72%, 80.4%, 53.4%, and 31.6% for stages I, II, III, and IV, respectively. The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan.

Facilitators and barriers for home-based monitoring to time frozen embryo transfers in IVF among women and healthcare providers.

STUDY QUESTIONWhat are the facilitators and barriers concerning the implementation of home-based monitoring for natural cycle frozen embryo transfer (NC-FET) from the perspectives of patients and healthcare providers in the Netherlands?SUMMARY ANSWERThe most important facilitator was optimal pregnancy chance for both the patients and healthcare providers, and the most important barriers were the risk of missing an ovulation for the patients and laboratory capacity for the healthcare providers.WHAT IS KNOWN ALREADYThe share of FET cycles in IVF treatments is increasing and, therefore, it is important to optimize protocols for FET. Monitoring of ovulation, which is used in NC-FET, can be hospital-based (ultrasounds and ovulation triggering) or home-based (LH urine tests). Home-based monitoring has the advantage of being the most natural protocol for FET and provides the feeling of empowerment and discretion for patients. A systematic approach for the implementation of home-based monitoring has to start with an exploration of the perspectives of all stakeholders.STUDY DESIGN, SIZE, DURATIONStakeholders (patients and healthcare providers) involved in the implementation process in the Netherlands participated in the present study. Patients were represented by the Dutch Patient Organisation for Couples with Fertility Problems (FREYA) and healthcare providers were represented by gynaecologists and their society (The Netherlands Society of Obstetrics and Gynaecology), embryologists and their society (The Dutch Federation of Clinical Embryology) as well as fertility doctors. A panel of experts hypothesized on barriers and facilitators for the implementation of home-based monitoring during the proposal phase of the Antarctica-2 randomized controlled trial (RCT).PARTICIPANTS/MATERIALS, SETTING, METHODSAll stakeholders were represented during the study. Two different questionnaires were developed in order to investigate facilitators and barriers for the patients and for healthcare providers. The facilitators and barriers were ranked on a scale of 1–10 with 10 being the most important. Based on our power analysis, we aimed for a minimum of 300 completed questionnaires for the patients and a minimum of 90 completed questionnaires for the healthcare providers. Facilitators and barriers were analysed using frequencies, mean (SD) and ranking.MAIN RESULTS AND THE ROLE OF CHANCEA total of 311 patients filled out the questionnaire of whom 86.8% underwent FET previously. The most important facilitator for the patients was to implement the strategy with the highest chance of pregnancy (mean 9.7; 95% CI 9.6–9.7) and the most important barrier was risk of missing ovulation (mean 8.4; 95% CI 8.2–8.6). A total of 96 healthcare providers filled out the questionnaire. According to healthcare providers, patients would accept the strategy when it causes less interference with their work and private life (mean 7.5; 95% CI 7.1–8.0) and has a low risk of missing the ovulation (mean 7.6; 95% CI 7.1–8.0). The most important facilitator for the implementation of home-based monitoring for healthcare providers was optimizing cumulative pregnancy rates (mean 8.1; 95% CI 7.7–8.4) and the most important barrier was the lack of laboratory capacity and flexibility (mean 6.4; 95% CI 5.8–7.0).LIMITATIONS, REASONS FOR CAUTIONFacilitators and barriers were selected based on expert opinion. Currently, there are no validated questionnaires that aim to assess facilitators and barriers for the implementation of treatments in fertility care.WIDER IMPLICATIONS OF THE FINDINGSDuring our study, we gained insight into barriers and facilitators for the implementation of home-based monitoring of NC-FET at an early phase. Early sharing and discussion of the results of this study with all stakeholders involved should stimulate a fast incorporation in guidelines, especially as key professionals in guideline development took part in this study. Also, based on our results, we can advise guideline developers to add tools to the guideline that may help overcome the implementation barriers.STUDY FUNDING/COMPETING INTERESTSThe Antarctica-2 RCT is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw 843002807). No authors have any competing interests to declare.TRIAL REGISTRATION NUMBERTrial NL6414 (NTR6590).

Guideline of guidelines: management of recurrent urinary tract infections in women.

To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy. PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI. Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.