Gynecologic Service Research Articles

Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa

To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.

Autopercepción sobre la apariencia genital en pacientes con diferentes grados de protrusión de labios menores

Objective: To evaluate the self-perception of genital appearance, in patients with different degrees of protrusion of the labia minora in the Gynecology Service of the Central Hospital of Maracay, between June-November 2021. Methods: This is a descriptive and correlational study, with a field design, cross section and prospective. The sample was deliberate non-probabilistic, made up of 132 patients whose gynecological examination showed protrusion of the labia minora. Self-perception was measured using the Modified Lip Cosmetic Procedures Screening Scale (COPS-L). Results: a mean age of 36.67 years ± 1.02 was recorded. Mostly housewives (59.09%); with symmetrical vaginal lips (78.03%) and with protrusion of the labia minora grade II (70.45%). A maximum lip length of less than 3.22 cm ± 0.07 was recorded. A moderate disagreement was found with the appearance of the genitals (42.42%); the sample did not consider a surgical treatment necessary to correct your labia minora (41.67%). Functional (16.67%) and aesthetic (15.91%) reasons are among the reasons why surgical treatment is justified. Conclusion: A statistically significant association was found between conformity with the appearance of the genitalia and symmetry, with the degree of protrusion and with the need for surgical treatment (p < 0.05).

Brain Derived Neurotrophin Factor (BDNF) as a clinical marker of endometriosis

Background: Endometriosis is a chronic, multifactorial disease of unknown etiology that affects approximately 10% of all women of childbearing age. It is characterized by dysmenorrhea and chronic pelvic pain, often associated with other symptoms (dyspareunia, dyschezia, rectal bleeding, dysuria, among others) and in 30-40% of cases it is associated with infertility. The presence of pelvic pain is related to the process of neuroangiogenesis, with the presence of BDNF being a key piece in its development. Several recent studies have shown that BDNF levels are elevated in the serum of patients with endometriosis compared to patients without endometriosis. The objective of this study is to demonstrate if BDNF levels are higher in patients with endometriosis and if there is am correlation with the level of pain. Material and methods: The study included 59 patients diagnosed with ovarian endometriosis in the Gynecology service of the Garcia Orcoyen Hospital during the period from November 2021 to August 2022. A blood sample was taken before surgery and their BDNF blood levels were determined. The levels of BDNF were analyzed compared to the control group in 10 patients undergoing laparoscopic tubal ligation to establish if the levels were higher in the endometriosis group and if there was a correlation with the intensity of pain.

Nursing care in post-surgical patient of adnexal cystectomy in the Obstetrics and Gynecology Service of a national hospital of Chincha, 2023

The ovarian cyst is a sac with a collection of fluid that forms in the ovary or the wall of adjacent organs. The objective was to manage the nursing care process (PAE) for a post-surgical patient of adnexal cystectomy with right salpingo-oopherectomy with release of adhesions. The study has a qualitative approach, a single case type, the methodology was the PAE, which included a 22-year-old patient, in which the five stages were applied: in the assessment stage, the guide with the 11 functional patterns was applied by Maryori Gordon, 6 altered patterns were found, three being prioritized: cognitive perceptual, exercise activity and metabolic nutritional; In the diagnosis stage, it was developed based on taxonomy II of NANDA-I, 10 nursing diagnoses were identified, prioritizing three: Acute pain, Risk of surgical wound infection and Obesity, according to the SSPFR format (signs and symptoms, problem, related factor/risk factor/associated); In the planning stage, the care plan was developed based on the NOC, NIC Taxonomy; In the execution stage, specific care was provided according to the plan; and in the evaluation the differe nce between the final and baseline scores respectively was assessed, resulting in a score of +2, +1 and+1. In conclusion, the nursing care process for the patient was managed, which allowed quality and holistic care to be provided.

Molar Pregnancy–Induced Hyperthyroidism: The Importance of Early Recognition and Timely Preoperative Management

Abstract Hyperthyroidism due to gestational trophoblastic disease (GTD) is a rare but potentially life-threatening condition. Optimal perioperative management is crucial for favorable outcomes and prevention of thyroid storm. However, scarce data exist defining the ideal approach to this complex clinical presentation. This case report describes a first-time pregnant 32-year-old woman who was found to be biochemically hyperthyroid in the context of a 10-week gestation molar pregnancy. Despite her biochemical values, the patient remained clinically asymptomatic of her thyroid disease. The Gynecology and Anesthesiology services urgently consulted Endocrinology, and empiric treatment for prevention of potential impending thyroid storm was initiated prior to operative uterine evacuation. After 2 uneventful dilation and curettages with chemotherapy and a transient prescription of antithyroid medication, the patient normalized her human chorionic gonadotropin (hCG) level and recovered to biochemical euthyroidism. Other than a pruritic rash that may have been due to propylthiouracil, the patient's hyperthyroidism improved without further complications. This case highlights the importance of recognizing the link between GTD and thyrotoxicosis to allow for timely initiation of appropriate preoperative treatment. Fortunately, the multidisciplinary approach facilitated management to prevent evolution to thyroid storm.

Knowledge of and Attitudes to Female Genital Mutilation Among users of the Gynaecology and Obstetrics Service at the Reference Health Center of Commune I of Bamako, Mali

Female genital mutilation is harmful to girls and women in many ways. First and foremost, it is painful and traumatic, and the removal of normal, healthy genital tissue interferes with the body's natural functioning. They have a variety of immediate and long-term health consequences. The aim of this study was to investigate the knowledge and attitudes of female genital mutilation users (women) in the obstetrics and gynaecology department of the commune I reference health centre in the Bamako district. Methodology: This was a cross-sectional, prospective, descriptive study designed to investigate users' (women's) knowledge of and attitudes towards female genital mutilation. It took place from 1 November 2019 to 30 April 2020, a period of 6 months, in the gynaecology and obstetrics department of the reference health centre in Commune I of the Bamako district. We included all women admitted to the department for gynaecological or obstetric consultation after informed consent had been obtained. Result: Out of a total of 188 female users, 176 of them were excised, a frequency of 93.6%. Female users reported having been excised as children in 93.9% of cases. Most users (59.6%) want to excise their daughters for traditional and religious reasons. Female genital mutilation (FGM), although practised by traditional excisers, is still being medicalised. The reason for FGM was unknown to 25.0% of the women surveyed. In 44.8% of cases, the users (women) had suffered a perineal tear during childbirth.

Knowledge about Cervical Cancer Prevention and Screening in Women with Cervical Cancer Attending Gynecological Services in Southern Mozambique.

Mozambique has high rates of cervical cancer and cancer-related deaths among women. A high rate of refusal and low acceptance of treatment is observed among cervical cancer patients. The extent of their knowledge of the disease is unknown. To assess knowledge about this disease (prevention, risk factors, and the possibilities of early diagnosis) in women with cervical cancer attended in gynecological services in Gaza province, Mozambique. This cross-sectional study took place in the city of Xai-Xai at the Provincial Hospital of Xai-Xai (HPXX) in the southern province of Gaza (Mozambique). Non-probability convenience sampling was used. Eligible patients (women) aged 35-50 years, diagnosed with cervical cancer and followed at the HPXX in the second quarter of 2021 (n = 60), took part in the survey during their scheduled consultations. Descriptive statistics were calculated using SPSS statistical software (version 16). The study included 60 women, 39 (65%) HIV positive. More than half (55.0%) believed that having a single sexual partner was an effective form of prevention; 50.0% reported that excessive alcohol consumption and having many sexual partners could cause the disease, and 46.7% affirmed that having many children increased the risk. Thirty-eight (63.3%) women reported that early diagnosis of cervical cancer was important for receiving prompt treatment, and 54 (90.0%) said regular visits to the gynecologist were important for an early diagnosis. Thirty-five (58.3%) mentioned acetic acid screening as a diagnostic test. There are significant gaps in awareness of cervical cancer among high-risk groups.

Utility of telemedicine for providing Obstetrics and Gynecology services during the COVID-19 pandemic—A single center experience from a tertiary care teaching hospital located in South India

BACKGROUND: The COVID-19 pandemic greatly impeded the provision of public healthcare within a healthcare system that was already under considerable strain. Routine patient care services were impacted during that time, leading to the promotion of telemedicine as a means of maintaining uninterrupted healthcare services. Telemedicine involves the utilization of electronic technology and communication to provide health-related information and medical care to individuals who are physically separated from healthcare professionals. MATERIALS AND METHODS: To assess the feasibility of utilizing telemedicine for providing women's health services, we conducted a six-month analysis of data collected from the Department of Obstetrics and Gynecology's teleconsultation application at AIIMS, Mangalagiri. Our objective was to evaluate the practicality of telemedicine in delivering diverse healthcare services to women. Our institution offered two types of telehealth services: a “call-based”approach and an “app-based”approach. We examined several parameters within the data, including the distribution of ages, the geographic locations of teleconsultation registrations, whether the registrations were new or follow-up cases, the various presenting complaints, the recommended treatments, the number of consultations (single or multiple), and whether cases required in-person or hospital visits. Additionally, we also compared patient responses between these two modalities. RESULTS: The “call-based”consultation method was preferred by the majority of our patients (94%). The registered cases included both related to obstetrics and gynecology, with a higher proportion of complaints relating to gynecological issues (82.5%). We were able to make a diagnosis in 77% of cases, while in 20% of cases, additional physical examinations and diagnostic tests were necessary. Follow-up appointments were recommended for 53% of patients. The success rate of consultations for patients seeking obstetrics and gynecology services showed a statistically significant difference (P value < 0.001). The vast majority of patients (99%) expressed high satisfaction with the consultation process. CONCLUSION: During the COVID-19 pandemic, telemedicine proved to be an effective approach in mitigating the overcrowding of hospitals and preventing the spread of infection. Its success suggests that telemedicine can be a viable option for managing elective gynecology matters and low-risk obstetric cases in the future, thereby alleviating the strain on healthcare systems.

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

Histerectomía laparoscópica en patología benigna en un hospital universitario terciario. Análisis y evolución de un periodo de 8 años

ObjectiveTo reflect from the analysis of the data of the number of laparoscopic hysterectomies that each member of a gynaecology service of a tertiary hospital can perform on the convenience of limiting this procedure to a limited number of professionals. Material and methodsRetrospective, descriptive study on hysterectomies performed for any indication in our hospital in the period between May 1, 2014 and April 30, 2022. ResultsIn this period, we have performed 1548 hysterectomies of which 760 were performed laparoscopically and of these, 289 were indicated for benign pathology. Considering the total number of professionals that make up the pool of surgeons who perform surgery for benign pathology, the average number of laparoscopic hysterectomies per surgeon per year would be 1.4 cases. ConclusionsTo ensure adequate quality of surgery, the number of professionals performing laparoscopic hysterectomies in a tertiary hospital should be limited.

THU618 Adrenal Cell Carcinoma Presenting With Post-menopausal Bleeding And IGF-2 Induced Hypoglycaemia

Abstract Disclosure: E.M. Lonergan: None. L.J. Tan: None. E. Ali: None. C.M. Joyce: None. N. Conlon: None. A. O'Sullivan: None. D.J. O'Halloran: None. Background: Non-islet cell tumour hypoglycaemia (NICTH) as a result of IGF-2 secretion is rare with a few case reports associated with adrenal tumours. Clinical Case: We present the case of a 59-year-old female initially presenting to gynaecology services with post-menopausal bleeding due to endometrial hyperplasia. Serum testosterone, oestradiol and adrenal androgens were found to be elevated and LH and FSH suppressed. A subsequent CT adrenals demonstrated a 12.8 x 13.2 x 10.6cm left adrenal mass and she failed a 1mg overnight dexamethasone suppression test. In the interim, while undergoing evaluation, the patient presented to A+E Department with point-of-care confirmed hypoglycaemia with a capillary blood glucose of 1.6mmol/L and neuroglycopaenic symptoms. There was no history of diabetes mellitus, prolonged fasting, access to sulphonylureas or insulin. During a supervised fast, symptomatic hypoglycaemia occurred within 5 hours at 2.0mmol/L fulfilling Whipple’s triad. Results of samples taken during hypoglycaemia revealed an elevated IGF-2 : IGF-1 ratio of 60.7 (normal <10) with a low paired C-peptide, insulin and pro-insulin, consistent with a suspected IGF-2-secreting tumour. Hypoglycaemia was successfully managed with low glycaemic index foods and clinical nutrition input. Radical surgical excision was undertaken including left adrenalectomy, nephrectomy, partial pancreatectomy and splenectomy. Post-operative pathology revealed an adrenocortical carcinoma (ACC) measuring 16.4cm in maximum dimension; Ki67 12%; Weiss score 5; lymph nodes negative. Tissue has been stained for IGF-2-IR. Post-operative IGF-2 : IGF-1 ratio normalised to 3.4. The patient is under active follow up with 3-monthly surveillance CT-TAP and has declined Mitotane therapy at present. Conclusion: This is a rare case of ACC secreting multiple hormones, resulting in post-menopausal bleeding and IGF-2 mediated hypoglycaemia. Presentation: Thursday, June 15, 2023

Factors that Affect Performance of Clinical Breast Examination and Mammography Screening among Brazilian Women.

In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE), respectively, among women who used both types of public health service centers. The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables. Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030). Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

Risk Factors Associated With Maternity Blues and Postpartum Depression in Ecuadorian Women Going Through Their Immediate Puerperium During 2021: A Cross-sectional Study

IntroductionPerinatal factors such as lack of breastfeeding, complications during pregnancy or childbirth, and psychosocial factors such as maternal psychiatric history or socioeconomic status have been associated with the development of postpartum mood disorders. The combination of these factors during the peripartum can predict the development of maternity blues (MB) and postpartum depression (PD). ObjectiveTo characterize risk factors associated with MB and PD in Ecuadorian women going through their immediate puerperium in the gynecology and obstetrics service of “Hospital General San Francisco” in Quito-Ecuador. MethodA cross-sectional study was conducted, with a sample of 250 women attending their immediate puerperium. Data was collected using a self-applied questionnaire during the first 24 postpartum hours. Stein blues scale (SBS) was applied for MB screening and the Edinburgh Postpartum Depression Scale (EPDS) for PD screening. Informed consent and data confidentiality were explained to all participants. ResultsUsing the SBS, a probability of MB of 32.4% (n=81) was observed, while applying the EPDS, a PD probability of 17.6% (n=44) was established. MB and PD protective factors were rooming-in (OR .21, p<.001) (OR .21, p<.001), pregnancy planning (OR .13, p<.001) (OR .25, p<.001) and breastfeeding (OR .20, <.001) (OR .23, p<.001). Meanwhile MB and PD risk factors found were: breastfeeding difficulties (OR 5.88, p<.001) (OR 5.14, p<.001), complications during pregnancy (OR 8.39, p<.001) (OR 7.02, p<.001), complications during delivery (OR 5.29, p<.001) (OR 5.58, p<.001) and economic instability (OR 2.10, p .023) (OR 2.61, p .009). Discussion and conclusionThe risk and protective factors associated with MB and PD in the Ecuadorian population are similar to those described internationally. The recognition of risk factors by health personnel can improve early identification and timely management of puerperal mood disorders.

The Evaluation of Job Satisfaction in Healthcare Professionals Working in Obstetrics and Gynecology Services

Purpose: In this study, it was aimed to determine the job satisfaction of health professionals working in gynecology and obstetrics services.&#x0D; Materials and Methods: The population of the study consisted of all health professionals (29 doctors, 61 midwives and 22 nurses) working in the gynecology and obstetrics services of hospitals located in the city center. Data were collected from all health professionals participating in the study using the personal information form and the Minnesota Job Satisfaction Scale (MSQ).&#x0D; Results: In our study, it was found that health professionals had job satisfaction above the average, and that the general job satisfaction level was; It has been determined that it is higher in health professionals who are 45 years of age or older, have graduate education, are married, work in the institution for more than one year, and do not want to leave their profession and love it. It has been observed that as the level of internal satisfaction of the employees increases, their general job satisfaction also increases (p

Preservation of the reproductive health of military women: global experience and realities of Ukraine

A review of world literature and Ukrainian researches on the most common requests to gynecologists among military women, on the structure of pathology and treatment methods was made. Special attention is paid to the hormonal contraception, namely combined oral contraceptives (COCs) in the usual and continuous regime (avoiding the hormone-free interval) and the levonorgestrel-releasing intrauterine systems (LNG-IUDs).Cases of global practice of using COCs in extended regimen were considered, which showed that 47.2% of 1156 women chose a prolonged regimen of COCs, the main reason for this was the desire to avoid symptoms associated with menstruation. We consider this option very positive for military women, because some studies show that military women who took COCs in a continuous regimen were almost twice as favorable to their reception as those who used them in a regular mode.The positive aspects of the LNG-IUDs use in military women are presented, as a factor in the prevention of abnormal uterine bleeding, reducing the risk of iron deficiency in case of possible blood loss, and reducing the intensity of dysmenorrhea as a negative factor in the military conditions.Ways to increase compliance between a gynecologist and a military woman are also considered, using the example of global studies, which prove that insufficient awareness of patients about the possible ways and positive effects of using COCs in extended regimen reduced patients’ commitment to choosing new regimens.Conclusions. In today’s realities, the gynecological service in our country faces a number of new problems that require a strategic approach and solution. World practice and national studies prove that stress-induced hormonal disorders in military women, such as abnormal uterine bleeding, menstrual cycle disorders, dysmenorrhea, are negative factors in combat conditions, require the attention and resolution by doctors. One of the options for solving this problem can be the appointment of COCs according to the usual and extended scheme or appointment of LNG-IUDs.

Modern probiotics in the treatment of sexually transmitted infections. From the problem to its solution

This article is a review of current scientific publications that are devoted to the problem of sexually transmitted infections (STIs) and the importance of probiotics in their treatment. The article also analyzes the data of regulatory documents of the World Health Organization and statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine, which highlight the problem of the prevalence of STIs in the world and in Ukraine.Sexually transmitted infections have a serious negative impact on sexual and reproductive health worldwide. In the absence of treatment, they can have serious outcomes, including neurological and cardiovascular diseases, infertility, ectopic pregnancy, increased risk of infection with the human immunodeficiency virus. One of the serious factors which prevent the reduction of STDs increased rate in the world is the drug resistance for these infections. Infections caused by resistant strains of microorganisms are characterized by a more severe course, more often require hospitalization of the patient, increase the duration of the patient’s stay in the hospital, require the use of combined antibiotic therapy with the administration of reserve drugs.According to the results of scientific studies, Bacillus probiotics are an alternative for solving problems related to STIs and their outcomes. The innovative combination of the components of the drugs that contain the SirionProbioProtection probiotic formula helps to overcome such a problem as the resistance of STI pathogens to etiotropic antibiotic therapy. The use of alternative methods of exposure to STIs and their consequences add to success in providing obstetric and gynecological services.

Patient evaluation of gynaecological information provision and preferences.

To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. A descriptive cross-sectional survey design was used. A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data. Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information. Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information. Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information. This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions. The STROBE reporting method was used in the preparation of the manuscript. No patient or public contribution.

Kadınların Pozitif Doğum Deneyimine İlişkin Memnuniyet Düzeyleri ve İlişkili Faktörlerin Belirlenmesi: Kesitsel Bir Çalışma

Objective: The aim of this study was to determine the satisfaction levels and related factors related to the positive birth experience of women. Methods: This study, using a quantitative approach, is a descriptive and cross-sectional study based on the general survey model. The sample of the study consisted of 276 women who gave normal birth in the gynecology and obstetrics services 24 hours after giving birth in a training and research hospital in a province in the south of Turkey between 17.05.2022 and 29.12.2022. The study included postpartum women who were over 37 weeks of gestation, had a healthy fetus, had no complications during pregnancy-birth-postpartum period, were healthy, could speak, understand and write Turkish, had no communication barriers and volunteered to participate in the study. The data were collected face-to-face with a questionnaire prepared using the literature. A series of chi-square analyzes were conducted to examine whether overall satisfaction with the birth experience differed depending on the characteristics of childbirth care. Results: The ages of the women ranged from 19 to 42 (mean: 28.67±5.25). 54.3% of the participants are under the age of 30, 46% are secondary school graduates and 47.8% are working. 52.2% stated that they were generally satisfied with the birth experience. It is observed that there are significant differences between the groups in all cases except when women are given the freedom to eat and drink during the contraction period and the baby is given to the lap as soon as the baby is born (p &amp;lt; .001). Conclusion: In our study, it was determined that more than half of the women were generally satisfied with the birth experience. The characteristics of the room where the mothers spent in labor, accompanying the birth of a person they want, receiving one-to-one midwife support, exposure of the personnel to negative behavior, being involved in the decision-making process at birth, receiving understandable information from the health personnel, respecting the privacy of being allowed to move in labor, ensuring the safety of the baby's life It was determined that providing breastfeeding in the first hour affected the satisfaction of the mothers. It is recommended to conduct large-scale, comprehensive studies evaluating the effect of positive birth experience on maternal satisfaction.

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience

ObjectiveThe objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. MethodsA cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. ResultsOut of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%). ConclusionsThe IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.

INFLUENCE OF THE WAR ON THE ORGANIZATION OF MEDICAL ASSISTANCE FOR ONCOLOGICAL DISEASES

The article discusses current issues of providing oncology medical care at the present time. Current legislation has been studied and modern approaches to the structure and features of the organization of providing medical care for malignant neoplasms during the war in Ukraine have been analyzed.&#x0D; Introduction. The war as a result of the Russian attack made it difficult for patients to access necessary medical services and medicines. The most problematic in the organization of cancer control in the regions are the timely detection of patients, adequate staging of the malignant process, registration of deaths, as well as the system of dispensary observation of cancer patients, without the establishment of which it is impossible to achieve success in increasing the survival rate of cancer patients. High levels of neglect of visual malignant neoplasms in many regions indicate that dental, gynecological and other services of the general hospital network of these regions do not take an active part in solving the problem of timely cancer diagnosis [1, 2, 4].&#x0D; During the war, the Medical Guarantee Program continues to operate, and cancer patients can receive government-provided treatment free of charge. Guarantees cover medical care at every stage of treatment: diagnosis, chemotherapy and radiological treatment, support in outpatient or inpatient settings, surgery, rehabilitation, palliative care. A patient can receive medical assistance free of charge upon a doctor's referral [2, 11].&#x0D; An analysis of the onco-epidemiological situation in Ukraine in recent years revealed a significant decrease in the number of both patients and deaths from cancer compared to previous years. The quantitative characteristics of morbidity were obviously affected by the epidemic of COVID-19 and the war in the country, which changed the organization of the diagnostic process and the patient's ability to get to a specialized oncology care facility [4].&#x0D; The purpose of the work is to study the organization of medical care for oncological diseases during the period of martial law.&#x0D; Research materials and methods. An analysis of the legal framework was carried out. The following methods were used: content analysis, systematic approach and analysis.