Gynecologic Research Research Articles

RETRACTION: Oncologic, Fertility, and Obstetric Outcomes With MPA Therapy in Women with Endometrial Cancer and Atypical Endometrial Hyperplasia.

A. Takeda , Y. Yamamoto , K. Tamura , H. Aoki , H. Noguchi , S. Minato , S. Kamada , R. Arakaki , T. Kaji , and T. Iwasa , "Oncologic, Fertility, and Obstetric Outcomes With MPA Therapy in Women with Endometrial Cancer and Atypical Endometrial Hyperplasia," The Journal of Obstetrics and Gynaecology Research 50, no. 4 (2024): 633-638, https://doi.org/10.1111/jog.15872. The above article, published online on 28 December 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors; the journal Editor-in-Chief, Hiroaki Kajiyama; and John Wiley & Sons, Australia, Ltd. The retraction has been agreed upon following an investigation into concerns raised by a third party, which revealed major conceptual overlap and significant primary data redundancy with a previously published article by an overlapping group of authors. Such publishing practice is against the journal's policy and Wiley's Best Practice Guidelines on Research Integrity and Publishing Ethics.

Disciplinary Imbalances in Urology and Gynecology Research Publications within Functional Urology.

(1) Background: This study aimed to quantify and evaluate the publication rate and discrepancies of functional urology abstracts from international conferences, and to explore the interdisciplinary contributions of urology and gynecology to the field. (2) Methods: A retrospective bibliometric and content analysis was conducted on abstracts presented between 2015 and 2019 at the EAU and ICS congresses, focusing on functional-urological keywords. A discrepancy scoring system ranging from 0 (minor discrepancies) to 3 (significant discrepancies) assessed the consistency between conference abstracts and full-text publications, and an in-depth analysis determined the disciplinary origin of these publications. (3) Results: Between 2015 and 2019, 53% of EAU and 57% of ICS congress abstracts were published as full-text articles, with minor discrepancies in 38% of EAU and 49% of ICS publications, and significant discrepancies in 17% from both. Urology departments dominated publications, contributing 68% at EAU and 55% at ICS, whereas gynecology contributed only 1% at EAU and 12% at ICS. (4) Conclusions: This study illuminates the need for improved reporting standards and interdisciplinary collaboration in functional urology, as well as increased gynecology research in functional urology-related fields, suggesting that addressing these issues is crucial for advancing the field and enhancing patient care.

National and International Comparisons of Gynecological Research in Germany Based on a Bibliometric Analysis of Publications.

Recent years have seen a considerable shift from male doctors to female doctors in the field of gynecology. Female doctors are traditionally more involved with planning and maintaining their family. For gynecology, this could be associated with a risk that research activities will decrease, particularly if results are published in scientific journals. In view of this shift, a comparative observational study was carried for 2022 in which 1306 publications were matched to 1786 female and male doctors reported on the websites of the 44 locations of university gynecology departments in Germany. In addition, the volume of publications issued between 2014 and 2022 was compared for Germany, France, the United Kingdom, and the United States. In Germany, the volume of publications in Gynecology was additionally compared with the publication outputs of the specialties Urology and Trauma Surgery. Since 2014, the increase in the numbers of publications in the field of Gynecology in Germany was lower (225%) than that of the countries with which it was compared (238%/252%/260% for F/UK/USA). When Gynecology was compared with other medical specialties in Germany, the number of publications in Urology were found to have increased at a lower rate (196%) while the number of publications in the field of Trauma Surgery increased by more (286%) than that of Gynecology. At the start of 2023, the percentage of women who were working as doctors at the lowest hierarchical level (junior doctor) was 81%. The publication output per capita of female doctors working at lower levels in the medical hierarchy, i.e., working as junior doctors and senior physicians, was between 40% and 80% lower than that of male doctors working at the same level. However, female directors published as much as male directors did. In the lower hierarchy levels, men were up to 14% more likely to be without an academic title. Predictors for more extensive publication activities by young female and male doctors include the extent and quality of publications by doctors in senior positions, the presence of a comprehensive cancer center or an institute for human genetics at the location where the young doctors were working, and joint publications with foreign authors. For the German Society of Gynecology and Obstetrics, the results suggest a number of approaches to promote young researchers. The support provided to young female doctors is especially important as this should help to retain them as junior researchers over the long term.

A clinic doctor transferring a patient as a coauthor of a case report: A preliminary study.

Contribution to the authorship, including that for case reports, should be appropriately evaluated. I have noticed a scarcity of case reports with clinic doctors listed as coauthors, prompting this investigation. I sought to offer suggestions on the possible reasons for this trend. I checked case reports published in the Journal of Obstetrics and Gynaecology Research, the Journal of Medical Case Reports, and the BMJ Case Reports. I identified case reports listing a clinic doctor as a coauthor. I consulted eight professors at Jichi Medical University to ascertain whether case reports from their departments included clinic doctors as coauthors and, if not, the reasons. Among 65 case reports from Japanese institutes published in the Journal of Obstetrics and Gynaecology Research, only one paper lists a clinic doctor as a coauthor. Of 100 and 50 papers published in the Journal of Medical Case Reports and BMJ Case Reports, respectively, none listed a clinic doctor as a coauthor. Six out of eight professors admitted to never considering the idea of including clinic doctors as coauthors. The scarcity of case reports with clinic doctors as coauthors extends beyond Japanese obstetrics and gynecology, encompassing various specialties worldwide. Center doctors do not think of the idea that a clinic doctor should be a coauthor. A clinic doctor who transferred the patient should be considered as a candidate coauthor depending on his/her scientific contribution. Such an approach could foster an environment encouraging doctors to contribute to academic writing, regardless of their workplace.

Global research hotspots and trends on robotic surgery in obstetrics and gynecology: a bibliometric analysis based on VOSviewer.

Over the last two decades, the quantity of papers published in relation to robotic surgery in obstetrics and gynecology has continued to grow globally. However, no bibliometric analysis based on VOSviewer has been performed to evaluate the past and present of global research in the field. In this study, we aimed to analyze the bibliometric characteristics of papers on robotic surgery in obstetrics and gynecology to reveal research hotspots and trends in this field. The Web of Science Core Collection was searched for scientific papers on robotic surgery in obstetrics and gynecology published between January 1, 1998 and December 31, 2023. Bibliometric metadata of each selected paper was extracted for analysis. The results were visualized by VOSviewer (version 1.6.18). A total of 1,430 papers met the inclusion criteria. The United States had the highest total link strengths and contributed the most papers (n = 793). The Mayo Clinic produced the largest number of papers (n = 85), and Professor Pedro T Ramirez contributed the most papers (n = 36). The number of citations ranged from 0 to 295 with a total sum of 29,103. The Journal of Minimally Invasive Gynecology published the most relevant papers (n = 252). Keywords were classified into six clusters based on co-occurrence data, of which cluster 1, cluster 4 and cluster 6 had more main keywords with the largest average publication year. This is the first VOSviewer-based bibliometric analysis of robotic surgery research in obstetrics and gynecology. The United States was the leading country, and the Journal of Minimally Invasive Gynecology was the most productive journal in the field. Scientists and institutions from around the world should push their boundaries to bring about deep collaboration. The main research topic has always been the use of robotic surgery in the treatment of gynecologic malignancies. More randomized controlled trials need to be conducted to compare surgical outcomes of robotic surgery with other surgical approaches. Robotic sacrocolpopexy for pelvic organ prolapse has become a new research hotspot, and robotic surgery for sentinel lymph node detection in gynecologic malignancies are more potential directions for future research.

Racial disparities between measures of area deprivation and financial toxicity, and uterine volume in myomectomy patients

BackgroundAt time of myomectomy, a surgical procedure to remove uterine fibroids, Black women tend to have larger uteri than White women. This makes Black patients less likely to undergo a minimally invasive myomectomy which has been shown to have less postoperative pain, less frequent postoperative fever and shorter length of stay compared to abdominal myomectomies. The associations between individual financial toxicity and community area deprivation and uterine volume at the time of myomectomy have not been investigated.MethodsWe conducted a secondary data analysis of patients with fibroids scheduled for myomectomy using data from a fibroid treatment registry in [location]. We used validated measures of individual-level Financial Toxicity (higher scores = better financial status) and community-level Area Deprivation (ADI, high scores = worse deprivation). To examine associations with log transformed uterine volume, we used linear regression clustered on race (Black vs. White).ResultsBlack participants had worse financial toxicity, greater deprivation and larger uterine volumes compared with White participants. A greater Financial Toxicity score (better financial status) was associated with lower uterine volume. For every 10 unit increase in Financial Toxicity, the mean total uterine volume decreased by 9.95% (Confidence Interval [CI]: -9.95%, -3.99%). ADI was also associated with uterine volume. A single unit increase in ADI (worse deprivation) was associated with a 5.13% (CI: 2.02%, 7.25%) increase in mean uterine volume.ConclusionDisproportionately worse Financial Toxicity and ADI among Black patients is likely due to structural racism – which now must be considered in gynecologic research and practice.Trial RegistrationNot applicable.

Tubal Stump Ectopic Pregnancy with Acute Abdomen: A Rare Case Report

Ectopic pregnancy, characterized by the implantation of the gestational sac outside the uterine cavity, is a grave condition. The objective of this study is to report a case of recurrent ectopic pregnancy in the residual site of the same fallopian tube, which had undergone unilateral salpingectomy due to ectopic pregnancy five years prior. Despite its rarity in the literature, tubal stump ectopic pregnancy poses higher risks of maternal mortality and morbidity compared to other types of tubal ectopic pregnancies. It is important to note that a history of salpingectomy does not exclude the possibility of ipsilateral recurrent ectopic pregnancy. Furthermore, this is the first documented case of stump tubal ectopic pregnancy from Turkey.

A Rubric to Center Equity in Obstetrics and Gynecology Research.

The Steering Committee for the Obstetrics & Gynecology special edition titled "Racism in Reproductive Health: Lighting a Path to Health Equity" formed a working group to create an equity rubric. The goal was to provide a tool to help researchers systematically center health equity as they conceptualize, design, analyze, interpret, and evaluate research in obstetrics and gynecology. This commentary reviews the rationale, iterative process, and literature guiding the creation of the equity rubric.

Robotic surgery in obstetrics and gynecology: a bibliometric study.

We aimed to identify the trends and patterns of robotic surgery research in obstetrics and gynecology since its implementation. We used data from Clarivate's Web of Science platform to identify all articles published on robotic surgery in obstetrics and gynecology. A total of 838 publications were included in the analysis. Of these, 485 (57.9%) were from North America and 281 (26.0%) from Europe. 788 (94.0%) articles originated in high-income countries and none from low-income countries. The number of publications per year reached a peak of 69 articles in 2014. The subject of 344 (41.1%) of articles was gynecologic oncology, followed by benign gynecology (n = 176, 21.0%) and urogynecology (n = 156, 18.6%). Articles discussing gynecologic oncology had lower representation in low- and middle-income countries (LMIC) (32.0% vs. 41.6%, p < 0.001) compared with high income countries. After 2015 there has been a higher representation of publications from Asia (19.7% vs. 7.7%) and from LMIC (8.4% vs. 2.6%), compared to the preceding years. In a multivariable regression analysis, journal's impact factor [aOR 95% CI 1.30 (1.16-1.41)], gynecologic oncology subject [aOR 95% CI 1.73 (1.06-2.81)] and randomized controlled trials [aOR 95% CI 3.67 (1.47-9.16)] were associated with higher number of citations per year. In conclusion, robotic surgery research in obstetrics & gynecology is dominated by research in gynecologic oncology and reached a peak nearly a decade ago. The disparity in the quantity and quality of robotic research between high income countries and LMIC raises concerns regarding the access of the latter to high quality healthcare resources such as robotic surgery.

Open access publication of obstetrics and gynecology research in Africa: A dalliance between poverty and paywalls.

SynopsisOpen access publishing remains a challenge in Africa due to poverty and poor research funding. There is a need for global action.

Consultants for The Journal of Obstetrics and Gynaecology Research 2022.

Journal of Obstetrics and Gynaecology ResearchVolume 49, Issue 3 p. 1057-1063 Consultant Consultants for The Journal of Obstetrics and Gynaecology Research 2022 First published: 05 March 2023 https://doi.org/10.1111/jog.15580Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume49, Issue3March 2023Pages 1057-1063 RelatedInformation

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Global Trends in Research on Cell-Free Nucleic Acids in Obstetrics and Gynecology during 2017-2021.

Objectives. The objectives of this study were to identify global trends in research on cell-free deoxyribonucleic acid (cfDNA) from a bibliometric perspective and provide researchers with new research hotspots. Methods. In all, we extracted 5038 pieces of literature from PubMed and 527 articles from the Web of Science Core Collection (WoSCC) database related to cfDNA published from 1 January 2017 to 31 December 2021. For PubMed literature, we employed co-word, biclustering, and strategic diagram analysis to describe the trends in research on cfDNA in the said five years. Then, we used VOSviewer analysis for the WoSCC database to display the trends in research on cfDNA in obstetrics and gynecology during 2017–2021. Results. Strategy diagram analysis of 95 major Medical Subject Headings terms extracted from 5038 pieces of literature indicated that cfDNA sequence analysis for non-invasive prenatal and genetic testing and its application in the fields of neoplasm genetics and diagnosis is a newly emerging immature theme of cfDNA. VOSviewer analysis of 527 articles showed the global trends in research on cfDNA in obstetrics and gynecology, for example, in terms of most influential authors, institutions, countries, journals, and five research hotspots: (1) cfDNA application in prenatal screening and prenatal diagnosis, (2) cfDNA application in assisted reproductive technology, (3) cfDNA application in pre-eclampsia, DNA methylation, etc., (4) cfDNA application in placental dysfunction and fetal growth restriction, and (5) cfDNA application in fetal chromosomal abnormalities (fetal aneuploidy). Conclusions. Comprehensive visual analysis provides information regarding authors, organizations, countries/regions, journals, research hotspots, and emerging topics in the field of cfDNA for obstetrics and gynecology research. This comprehensive study could make it easier to find a partner for project development and build a network of knowledge on this emerging topic.

A pre-operative radiological score to predict lymph node metastasis in advanced epithelial ovarian cancer

BackgroundLymphadenectomy is part of cytoreductive surgery for patients with advanced epithelial ovarian cancer (AEOC) in case of abnormal lymph nodes before and during surgery. The aim of this study was to develop and validate a pre-operative radiological score to predict pelvic and/or para-aortic lymph node metastasis (LNM) in patients with AEOC undergoing cytoreductive surgery. MethodsWe conducted a multicentre retrospective study. The construction sample was composed of 53 patients operated within two referral centers. The validation sample was composed of 39 patients operated in a third referral center. The score was built with a logistic regression model with internal validation by bootstrap. ResultsTwo variables were associated with the prediction of pelvic and/or para-aortic LNM at computerized tomography (CT) and/or positron emission tomography (PET/CT): “para-aortic lymph node involvement” (adjusted diagnostic odds ratio) (aDOR) = 8.77 95CI [1.42–54.09], p = 0.02) and “colon involvement” (aDOR = 7.97 95CI [1.28–49.58], p = 0.03). Bootstrap procedure showed that the model was stable. The 2-points LNM pre-operative radiological score was derived from these 2 radiological variables and a high-risk group was identified for a score ≥ 1: the probability of pelvic and/or para-aortic LNM was 76%, the specificity was 85.7% 95CI [67.3–96.0] and the positive likelihood ratio was 3.6 95CI [1.4–9.7]. In the validation sample, a score ≥ 1 had a specificity of 78.3% and a LR+ of 1.2. ConclusionLNM pre-operative radiological score could help the surgeon's decision to perform pelvic and para-aortic lymphadenectomy in patients with AEOC undergoing cytoreductive surgery. Trial registrationThe research protocol was approved by the Ethics Committee for Research in Obstetrics and Gynecology (CEROG 2016-GYN 1003).

Gastrointestinal/genitourinary perforation and fistula formation with or without bevacizumab in patients with previously irradiated recurrent cervical cancer: a Korean multicenter retrospective study of the Gynecologic Oncology Research Investigators Collaboration (GORILLA) group (GORILLA-1001)

BackgroundThis study aims to evaluate the incidence of and identify risk factors for gastrointestinal (GI) and genitourinary (GU) fistula or perforation formation with or without bevacizumab in patients with recurrent cervical cancer who underwent pelvic radiation therapy (RT).MethodsMedical records of patients with recurrent cervical cancer who previously underwent pelvic RT between 2007 and 2020 were retrospectively reviewed. Clinicopathological factors were compared between groups that are stratified according to: 1) fistula/perforation (+) versus (-); and 2) bevacizumab plus conventional chemotherapy (BC) versus chemotherapy alone (C). Univariate and multivariate regression analyses were performed to identify risk factors for fistula/perforation. Overall survival (OS) was compared between the different groups.ResultsOf 219 participants, fistula/perforation of any grade occurred in 36 patients (16.4%); 27 fistulas and 9 perforations. Bevacizumab was more frequently used in Bevacizumab was more frequently used ( +) group than fistula/perforation (-) group (p = 0.015). Multivariate analysis showed that bevacizumab administration was the only independent risk factor for fistula or perforation (HR, 3.27; 95% CI, 1.18–9.10; P = 0.023). F/P was observed more frequently in women receiving BC (n = 144) than those receiving C (n = 75) (20.8% vs. 8.0%; P = 0.019). During median follow-up of 33.7 months (1.2–185.6 months), no significant OS difference was observed between fistula/perforation ( +) vs. (-) (hazards ratio [HR], 1.78; median 84.2 months [95% CI, 59.3–109.0] vs. 129.5 months [95% CI, 114.1–144.9]; P = 0.065) or BC vs. C (HR, 1.03; median 119.8 months [95% CI, 97.3–142.3] vs. 115.7 months [95% CI, 96.0–135.4]; P = 0.928).ConclusionsThis study suggests that incorporation of bevacizumab in chemotherapy regimens for treating recurrent cervical cancer in patients who underwent pelvic RT incurs considerable risk for GI/GU fistula or perforation. There were no other independent risk factors for developing GI/GU fistula or perforation in this study population.

Current controversies: Null hypothesis significance testing.

Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision-making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In particular, it was never intended for clinical significance to be inferred from statistical significance. The inference of clinical importance based on statistical significance (p < 0.05), and lack of clinical significance otherwise (p ≥ 0.05) represents misunderstanding of the original purpose of NHST. Furthermore, the limitations of NHST-sensitivity to sample size, plus type I and II errors-are frequently ignored. Therefore, decision-making based on NHST has the potential for recurrent false claims about the effectiveness of interventions or importance of exposure to risk factors, or dismissal of important ones. This commentary presents the history behind NHST along with the limitations that modern-day NHST presents, and suggests that a statistics reform regarding NHST be considered.

Critical Evaluation of Clinical Research in Obstetrics and Gynecology.

Within the evolving field of obstetrics and gynecology, providers should possess the ability to effectively and critically evaluate medical literature in order to best adapt and incorporate evidence-based practice. For both clinicians and researchers alike, we provide a systematic approach for reviewing a journal article published in the medical literature. We summarize the various types of study designs, with dedicated attention to observational and experimental studies, and examine sources of bias inherent to these study designs. Finally, we review important considerations when interpreting the validity and significance of the results and conclusions of a research study.

180 A Translational Approach to Uterine Fibroids in Black Women and Latinas

OBJECTIVES/GOALS: Uterine fibroids (UF), non-cancerous myometrial neoplasms, affect 11 million women in the US. In qualitative research, experiences of Black women (BW) and Latinas (HL) with UF are understudied. UF etiology is poorly understood, and most symptoms are focused on decreasing UF symptoms. This study will showcase a translational approach in studying UF. METHODS/STUDY POPULATION: A community-engaged research process will be used throughout the study. We have a partnership with the Fibroid Foundation (FF), a UF advocacy organization. For our first aim, we have held community-engagement (CE) studios to provide insight for best practices in creating and implementing culturally appropriate studies with ethnoracially diverse women regarding topics of UF. Our CE studios set the foundation for the second aim, which will be in-depth interviews assessing the sociocultural impacts among pre-menopausal BW and HL with UF. The women will be recruited through the FFs social media platform. To address lack of treatment options in UF, we will be focusing on JAK 2/3 pathway. We will be performing immunofluorescence on tissue microarrays on over 100 patient samples with extensive clinical and survey data. RESULTS/ANTICIPATED RESULTS: We held two CE studios, one with BW with UF and another with HL without UF. These participants were chosen as patient stakeholders. One theme from the CE studio was that both groups mentioned a cultural impact around menstrual health and UF discussions. The participant stakeholders provided insight to other influences in their journey that will be used to develop the interview guide questions for Aim 2. We expect the individual interviews to show similar experiences as our CE studio experiences. We anticipate more in-depth conversations about the sociocultural and ethnoracial factors impacting UF treatment. For Aim 3, we hypothesize that there will be increased JAK 2/3 expression in UF of patients with higher sympton burden and larger fibroid volume. DISCUSSION/SIGNIFICANCE: Implementing a community-engaged research framework provides a foundation for qualitative and translational gynecologic research in BW and HL. This project will contribute insight to their UF experience. There is a lack of innovative treatments, and we have access to valuable patient tissue and data that can be used for potential molecular targets.

Considerations for the Use of Race in Research in Obstetrics and Gynecology.

The race variable in research has been the topic of debate in both research and clinical realms. The tension surrounding the discourse of the use of race in research stem from the difficulties in defining race, the limitations of the variable, and the implications for health and racial equity. In this review, we dissect the challenges faced when incorporating race into research and offer a guide for incorporating race in research in a manner that promotes racial and health equity.

Gender expression is associated with selection of uterine preservation or hysterectomy for pelvic organ prolapse surgery: Novel methodology for sex- and gender-based analysis in gynecologic research.

To explore whether patient characteristics were associated with gender expression, and to further determine impact of gender expression on patient selection of hysterectomy or uterine-preservation in pelvic organ prolapse (POP) surgery. Within a prospective cohort, a self-reported gender expression tool classified patients as expressing gender polar (i.e., reporting only feminine traits) or non-polar gender scores (i.e., reporting feminine and masculine traits). Multivariate modeling explored associations of gender expression with traditional socio-demographic variables, and with selection of hysterectomy or uterine-preserving surgery. Descriptive statistics of socio-demographic variables were reported by frequency, proportion and mean (SD). 177 participants completed the gender score questionnaire. Overall, the sample had a more feminine gender expression with the majority of respondents classified as gender polar (67.23%, n=119). Participants with non-polar gender scores were 2.53 times (95% 1.05-6.09) more likely to choose uterine preservation versus hysterectomy-based surgery. Gender polarity was weakly associated with age, but no other sociodemographic variables. Gender expression is not tightly associated with socio-demographic variables, and is thus a novel measurement in gynecologic research. Gender polarity appears to be associated with choice to undergo hysterectomy. Further research is required to understand this relationship and implications in clinical outcomes.