Gynecology Clinic Research Articles

ASSOCIATION OF HAEMATOLOGICAL INFLAMMATORY PARAMETERS WITH MISCARRIAGES

Purpose: We aimed to find out whether the systemic immune inflammatory index and the pan-immune inflammatory score can be used as markers for predicting continuation of pregnancy in the prediction of threatened abortion. Materials and Method: This case-control study was conducted retrospectively in the Obstetrics and Gynaecology Clinic of Ankara Etlik City Hospital. Patients who were admitted to our hospital due to bleeding or pain and were hospitalised with a diagnosis of abortus imminens or were treated as outpatients were divided into two groups. The indices derived from the haemogram results were compared between the patients whose pregnancy did not result in miscarriage (Group I) and those whose pregnancy resulted in miscarriage (Group II), and the performance of the indices in predicting the continuation of pregnancy was evaluated. Results: We recruited 232 cases (abortus imminens) and 232 controls (healthy pregnant), matched for age, body mass index, and parity. When complete blood count derived indices were evaluated to determine whether the pregnancy would result in miscarriage or not, only SII had discriminative power among SII, SIRI, PIV, NLR, PLR and MLR. (cut-off: > 720; p: 0.039, sensitivity: 63%, specificity: 52%. Conclusion: High SII levels in maternal blood can predict continuation of pregnancy in patients diagnosed with threatened miscarriage. This emphasises the importance of maternal immune tolerance and the immune system in maintaining pregnancy. In patients with high SII, pregnancy can be maintained with additional treatments. However, further studies are needed to confirm our results.

A mixed-methods evaluation of an HIV pre-exposure prophylaxis educational intervention for healthcare providers in a NYC safety-net hospital-based obstetrics and gynecology clinic

ABSTRACT Cisgender women and transgender men are less likely to be assessed for PrEP eligibility, prescribed PrEP, or retained in PrEP care. Thus, this pilot PrEP educational intervention was tailored for healthcare providers (HCPs) in obstetrics/gynecology who provide care to cisgender women and transgender men in an academically-affiliated, public hospital women’s health clinic. The three-lecture educational curriculum designed for HCPs focused on PrEP eligibility and counseling, formulations and adherence, and prescription and payment assistance programs. Pre- and post-intervention surveys assessed HCP knowledge and barriers to PrEP counseling and prescription. Among n = 49 participants (mean age = 32.8 years; 85.7% cisgender women, mean years practicing = 4.2 years) pre-intervention, 8.7% had prior PrEP training and 61.2% felt very/somewhat uncomfortable prescribing PrEP. Post-intervention, knowledge of PrEP contraindications, eligibility, follow-up care, and assistance programs all increased. HCPs identified key barriers to PrEP care including lack of a dedicated PrEP navigator, culturally and linguistically appropriate patient materials on PrEP resources/costs, and PrEP-related content integrated into EHRs. Ongoing PrEP educational sessions can provide opportunities to practice PrEP counseling, including information on financial assistance. At the institutional level, incorporating PrEP screening in routine clinical practice via EMR prompts, facilitating PrEP medication monitoring, and enhancing telehealth for follow-up care could enhance PrEP prescription.

Promoting Reproductive Justice in the Office: LARC Removal Counseling at Time of Insertion

Purpose: While access to receiving LARC devices is increasing, it is not apparent if there is an infrastructure for providing equal access to LARC removal. The purpose of this study was to assess how patients perceive LARC counseling by providers at the time of insertion. In addition, explore the information that providers include in their LARC removal counseling at the time of insertion. Methods: The study population included participants of both patients and providers. Our patient participants included people between the ages of 18 to 50 years old who have or previously have had any form of intrauterine contraceptive device or subdermal contraceptive implant. Subjects will be recruited from the Texas Tech El Paso Obstetrics and Gynecology Clinics. The provider participants included residents, attending OB/GYNs, and nurse-midwives in the Texas Tech Health Science Center at El Paso Department of Obstetrics and Gynecology. Patients completed an anonymous survey depending on which type of device they had. If they have had both the intrauterine contraceptive device and the subdermal contraceptive implant, they were eligible to complete one survey for each device. Participants completed surveys on an iPad. Providers were surveyed once, either through paper surveys or emailed surveys. Survey responses were anonymous. Data was analyzed using SAS 9.4 software. Results: Overall, 246 participants reported having a subdermal implant (45.5%) or IUD (54.5%), majority of the participants were between the ages of 18-30 (72.8%), Hispanic (78.9%), had insurance or grant accessibility (67.5%). There were 17 providers consisting of medical residents, physicians, and nurse midwives who completed the survey. Based on provider surveys, 80.0% of providers counseled patients at 100% of visits about getting device removed. In addition, 80.0% of providers informed their patients to return to the office for device removal. About 93.3% of providers never discuss the cost of removing the device. Regarding the patient surveys, in response to the question, “How well do you understand the process of getting the device removed,” results were reported into two groups: ’extremely poorly/poorly/neutral” and “somewhat well/very well.” There was no statistically significant difference among the patients with an IUD who either poorly understood the process or understood the process as least somewhat well. For patients with a subdermal implant, 73.68% of those who poorly understood the process of removal stated that providers did not discuss the cost of removing the device versus 37% of those who understood the process well where providers did not discuss the cost of device removal (p < 0.001). About 68.42% of patients with a subdermal implant who poorly understood the process of device removal stated that providers did tell them they needed to come back to the office for device removal; 94.62% of patients with a subdermal implant who understood the process of device removal well stated that providers told them to return to the office for removal (p < 0.001). On whether providers discussed insurance coverage for device removal, 63.44% of patients who understood the process well states yes versus only 21.44% of patients who poorly understood the process of device removal. Conclusions: In patients with subdermal implants, a low percentage of providers discussed the cost of removal and whether or not insurance covered the cost of removal. Results implicate a need for an infrastructure to increase access for LARC removal services. However, further studies with larger patient and provider pools would be necessary for statistically significant results, particularly for IUDs.

Female Adolescents’ Experiences with Contraceptive Method Decision-Making, Access, and Continuation: Qualitative Research

Objective: Because of early sexual activity that starts in adolescence, critical problems such as unwanted pregnancies arise. The aim of this study was to examine the experiences of female adolescents in decision making, accessing, and maintaining contraception. Methods: The study was conducted as a case study with a phenomenological design and a qualitative approach. The study included adolescents who had contraception experience and were present in the gynecology clinic(s) of the hospital to receive any care service. Participants (n=22) was selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed, and analyzed using the approach, content, and descriptive analysis. Results: Through the analysis of in-depth interview data with female adolescents examining their experiences related to contraceptive method use, four themes were identified: "reasons for using and deciding on pregnancy prevention methods, accessibility to pregnancy prevention methods, experiences during the use of pregnancy prevention methods, and continuity of pregnancy prevention method use." Conclusion: In this study, it was determined that female adolescents faced some difficulties in deciding on, accessing, and maintaining contraceptive methods. In this context, units such as youth centers where adolescents can apply can be established. Unwanted pregnancies can be prevented by regulations regarding the provision of counseling and contraceptive services to adolescents.

Prevalence of Vitamin D Deficiency among Libyan Pregnant Women

Vitamin D deficiency is a common health concern worldwide. We aim to assess the prevalence of vitamin D deficiency among sample of Libyan pregnant patients. A cross-sectional retrospective study was conducted in May 2024 to examine vitamin D status level among Libyan pregnant women. Data on vitamin D status were analyzed from available sample for 97 women collected from different gynecological clinics in Tripoli city, Libya. Our results showed that the average vitamin D level in all women was 15.72±10.5 ng/mL. Pregnant women showed differences in BMI, parity, and daily sunlight exposure. The number of women was higher in the insufficient group, and their mean vitamin D level was lower (15.13±2.34) than sufficient groups (33.95±20.71 ng/mL). Supportive programme should be implemented and more widely promoted, and physicians should be better informed about the program's content during pregnancy.

Core Stability Exercise on Low Back Ache, Back Endurance and Health Related Quality of Life in Primary Dysmenorrhea-A Single Group Experimental Study

Objective: To analyze the effect of core stabilization exercises on LBA, back endurance, and HRQoL in primary dysmenorrhea. Method: 58 subjects were included in a single group experimental study based on selection criteria from gynecology hospitals and clinics in Bangalore. Subjects underwent 8 weeks of core stability exercise in a 45 min session. The data was analyzed using a paired t test, descriptive analysis, and frequency distribution. Findings: A significant difference was seen in the pre- post test score for low back ache following 4 weeks. A similar reduction in LBA was seen following 8 weeks of treatment, with a p value= .001. A significant improvement was also noted in trunk endurance and HrQoL, with a p value = 0.001. Novelty: This study is one of its kind wherein the effect of core stability exercise focusing on improvement in back endurance and thereby impacting low back ache and health related quality of life in primary dysmenorrhea is studied in a relatively larger group. Conclusion: Core stability exercises improved back endurance and reduced low back ache, as well as improved the HRQoL in primary dysmenorrhea. Keywords: painful period, low back ache, back endurance, health-related quality of life, core stability exercise

Determinants of Quality of Life in Serbian Infertile Couples

Background: This study aimed to examine the quality of life and the factors that determine the quality of life of infertile couples. Methods: The research was conducted as a cross-sectional study at the Gynecology and Obstetrics Clinic "Narodni Front" in Belgrade, the Special Gynecology Hospital "Ferona" in Novi Sad, the Special Hospital for the Treatment of Sterility and In Vitro Fertilization "Spebo Medikal" in Leskovac and the General Hospital in Valjevo, Serbia in 2022, on a sample of 378 infertile couples. The data were collected by means of a questionnaire, the integral part of which is the standardized FertiQoL scale. Independent t-test and one-way ANOVA were used to determine differences. A value of P<0.05 was considered statistically significant. Results: Women achieve a significantly lower score on the quality-of-life questionnaire (69.34±11.05) compared to men (73.96±9.87). Women exhibit significantly lower scores in the area of physical, emotional and social functioning (P<0.05). Men who live in the countryside show a lower quality of life score in the emotional (P=0.029) and social (P=0.042) domains. In addition, men over 40 years of age and with a high level of education have a lower quality of life (P=0.08). Conclusion: Women have a lower quality of life, as do men from rural areas and over 40 years of age. A multidisciplinary approach and community education, as well as the provision of social support with a special emphasis on emotional and material support, would significantly contribute to improving the quality of life of infertile couples.

Factors infl uencing delivery in women with multiple fetus pregnancy.

This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022. Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

Dyslipidaemia in women with polycystic ovary syndrome referred to a teaching hospital in Cape Town, South Africa.

The polycystic ovary syndrome (PCOS) imparts health risks including dyslipidaemia, diabetes and cardiovascular disease that are amenable to lifestyle adjustment and/or medication. We describe dyslipidaemia in women referred to a gynaecological endocrine clinic. Clinical data and endocrine and lipoprotein investigations comprising fasting triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and calculated low density lipoprotein cholesterol (LDLC) were studied along with electrophoresis patterns of apolipoprotein B-containing lipoproteins. The 1721 participants comprised black, mixed ancestry, white and Indian individuals (9.8%, 83.2%, 5.8% and 1.2%, respectively). The mean ± standard deviation of the age, body mass index (BMI) and waist/hip ratio were 26.0 ± 5.9 years, 32.3 ± 8.3 kg/m2 and waist/hip ratio 0.88 ± 0.11, respectively. Overweight status (BMI 26-30 kg/m2) and obesity (BMI >30 kg/m2) involved 272 (15.8%) and 1010 (58.7%) individuals, respectively. Morbid obesity (BMI >40 kg/m2) was present in 309 (17.9%) individuals. The TG, TC, HDLC and LDLC concentrations were 1.22 ± 0.86, 4.77 ± 1.02, 1.3 ± 0.36, 2.94 ± 0.94 mmol/L, respectively. LDL hypercholesterolaemia occurred in 753 (43.7%) and exceeded 5 mmol/L in 39 (2.3%) women. Low HDLC (<0.9 mmol/L) affected 122 (7%), hypertriglyceridaemia (>1.7 mmol/L) affected 265 (15.4%) and exceeded 2.5 mmol/L in 91 (5.3%) women. Mixed hyperlipidaemia (TG >1.7, TC >5.0 mmol/L) occurred in 176 (10.2%). Electrophoresis revealed small LDL particles in 79 (4.6%) and dysbetalipoproteinaemia in 13 (0.76%) of the cohort. Small LDL associated with obesity, blood pressure, TG and glucose concentration and higher androgenic state. Many women with PCOS had unfavourable lipoprotein results: mostly moderate changes in TG, HDLC and LDLC. Small LDL is not rare, may aid risk assessment and is best determined directly. Incidental monogenic disorders of lipoprotein metabolism included dysbetalipoproteinaemia, familial hypercholesterolaemia and severe hypertriglyceridaemia. Dyslipidaemia in PCOS requires more careful diagnosis, individualised management and research.

Evaluation of the Use of Blood and Blood Components of Etlik Zübeyde Hanım Gynecology and Obstetrics Clinics Training and Research Hospital Between 2021 and 2023

Evaluation of the Use of Blood and Blood Components of Etlik Zübeyde Hanım Gynecology and Obstetrics Clinics Training and Research Hospital Between 2021 and 2023

Comparison of serum levels of interleukin 33 in combination with serum levels of C-reactive protein, Immunoglobulin G, Immunoglobulin A, and Immunoglobulin M in recurrent pregnancy loss: A case-control study.

One of the critical cases of recurrent pregnancy loss is immunological factors, whereas obtaining effective prevention or treatment is necessary for cognition of reasons. In this study, we tried to evaluate some immunological factors related to recurrent pregnancy loss. This case-control study was conducted on 66 women at the age of 18-35 yr who were referred to the Clinic of Gynecology and Obstetrics, Ali Ibn Abi Taleb hospital, Zahedan, Iran, from August-December 2019. Interleukin 33 (IL-33) serum levels were measured using enzyme-linked immunosorbent assay. Immunoglobulin G, Immunoglobulin A, Immunoglobulin M (IgM), and C-reactive protein levels were measured by serology and hematology methods. The mean age of total participants was 30.8 3.80 yr. The mean serum IL-33 in the case group was 318.5 254.1 pg/ml and was lower than the control group (354.2 259.9 pg/ml), which was not statistically significant (p = 0.52). The level of C-reactive protein in the case and control was not significantly different (p = 0.27), and Immunoglobulin A and Immunoglobulin G in the case and control were also not significantly different (p = 0.46, and p = 0.16, respectively), but there were significant differences (p = 0.003) between the level of the IgM in the case and control groups. No statistically significant difference was observed in the IL-33 serum level, for at least 4-6 months after the last abortion in the case group and the final live birth in the control group. In contrast, serum levels of IgM were statistically significant. Finally, the need for more studies is felt according to the different results of the previous studies in this field.

To the 100th anniversary of the formation of the Kazan Society of Obstetricians and Gynecologists

In Kazan, training in the “midwifery art” has been carried out for more than 200 years. Scattered publications contain information about the influence of the St. Petersburg school of obstetricians and gynecologists on the formation of the Kazan school of obstetricians and gynecologists. It is of interest to establish connections, continuity and development of the Kazan school with the St. Petersburg school of obstetricians and gynecologists. The study of primary sources showed that from the moment the obstetric clinic was created in Kazan in 1833, its first leaders communicated with St. Petersburg colleagues, adopting their experience (Lentovsky A.E., Kozlov A.I.). Subsequently, obstetrics and gynecology department and clinic of the medical faculty of the Kazan Imperial University were led by students of the St. Petersburg Military Medical Academy (Slavyansky K.F., Florinsky V.M., Fenomenov N.N., Gruzdev V.S.). All of them at the end of the 19th and beginning of the 20th centuries made a lot of efforts for the scientific and practical development of obstetrics and gynecology in Kazan. A particularly noticeable mark was left by Professor V.S. Gruzdev, creating an independent scientific and practical school of Kazan obstetricians and gynecologists. Later his work was continued by student of V.S. Gruzdev — Professor P.V. Manenkov with his students.

Molecular Diagnosis of Chlamydia trachomatis in Women with Frequent Abortions

Background: Chlamydia trachomatis is the commonest cause of bacterial sexually transmitted infections. This research aimed at scrutinizing the Chlamydia trachomatis screening tests with vaginal samples and at investigating the correlation between Chlamydia trachomatis infection and the abortion incidence. Methods: The current Cross sectional study was done at gynecology clinic of Razi Hospital in Chalus, Iran between August 2017 and January 2018. Fifty vaginal swabs were collected and detecting C. trachomatis DNA was done. Chi-square test and Independent t-test compared the variables. P &lt;0.001 was significant Results: The total C. trachomatis infection prevalence was 5(10%) in endocervical swabs. A significant difference was found between duration of sexual activity and Chlamydia infection. No significant difference was detected between detection of Chlamydia l and abnormal vaginal discharged. Conclusion: Screening for Chlamydia trachomatis infection of the women experiencing a miscarriage should be done and, if positive, they should be treated to inhibit recurrent miscarriages.

Comparison of Diagnosis Experiences of Adolescent and Young Adult Polycystic Ovary Syndrome Patients

Study objectiveThe manner in which an individual experiences a polycystic ovary syndrome (PCOS) diagnosis may affect prognosis and vary with age. This study aimed to evaluate and compare the diagnosis experiences of adolescent and young adult PCOS patients. MethodsPCOS patients from the same institution were divided into two groups according to age and clinic (adolescents diagnosed in the adolescent medicine clinic and young adults diagnosed in the obstetrics and gynecology clinic). Patients completed a questionnaire designed to assess the information and support received during diagnosis, their satisfaction with this information, existing concerns regarding PCOS symptoms, and support requirements. ResultsThirty-six patients were included in each group. Among the participants, 52.8% of the adolescents and 63.9% of the young adults reported that they had consulted more than one specialist before receiving a diagnosis. We found that 83.3% of adolescents and 63.9% of young adults were satisfied with their overall PCOS diagnosis experience. The highest ratio of information given in both groups was related to medical treatment (88.9% in both groups), and the lowest ratios were associated with emotional support (13.9% vs.5.6%). Irregular menstruation was reported to be the most disturbing concern in both groups (94.4% vs.86.1%), and the biggest difference between the two groups was related to body dissatisfaction, which was observed more in adolescents (33.3% vs 5.6%). ConclusionWhile overall diagnosis experiences and satisfaction levels were similar across both groups, we identified distinct differences that may warrant attention to address age-specific needs and preferences.

Improving feasibility and timeliness of hereditary cancer risk assessment with a brief patient-administered digital tool and rapidly available telehealth genetic counseling.

10614 Background: Multiple guidelines recommend hereditary cancer risk assessment for all adults, yet it rarely is performed. This is largely due to the time-consuming nature of such assessments and difficulty with access to genetic counseling for those at high risk. We designed a care model to address these issues that is suitable for both oncology and non-oncology settings. It includes a brief patient-administered and clinically validated digital hereditary cancer risk assessment tool, followed by immediate online self-scheduling features for telehealth genetic counseling, with appointments available within 48 hours. The digital tool uses a guideline-based algorithm to assess whether genetic testing for hereditary cancer risk is indicated. Here we aim to evaluate the effectiveness and timeliness of this model. Methods: We conducted a retrospective chart review of consecutive patients that engaged with this model from May 2021 to August 2023 at 32 obstetrics and gynecology clinics. We also used nationwide data from the National Society of Genetic Counselor's (NSGC) Professional Status Survey. To assess timeliness of genetic counseling appointments in this care model, we compared the time from scheduling the appointment to the start of the appointment to wait times at health systems for comparable non-urgent cancer genetic counseling appointments, from the NSGC data. Effectiveness was assessed via rates of completion of the tool and scheduling of genetic counseling. Results: 2538 patients (98% female, mean age 37 years, 3.9% with a personal history of cancer) initiated the care model and 95% (2415/2538) completed the risk assessment tool. A quarter (26% (628/2415)) met criteria for germline genetic testing. The median time to complete the tool was 2.7 minutes (IQR 2.9). At the end of the tool, patients could click a button to schedule an appointment with a genetic counselor to discuss hereditary cancer risk and genetic testing. 44% (274/628) booked an appointment. The median time from scheduling to genetic counseling appointment was 2.8 days (IQR 4.9 days), which is shorter than the median wait time for comparable genetic counseling appointments at health systems in the nationwide NSGC dataset (21 days (IQR 53 days); p&lt;&lt; 0.01). Conclusions: The tool completion rate, rate of patients meeting criteria, and uptake of genetic counseling indicate the model is effective. Timeliness was improved by this model, with the digital tool assessing risk in ~3 minutes, compared to previous reports of ~30 minutes for manual hereditary cancer risk assessment. In addition, the timeliness of genetic counseling appointments was markedly better than the current standard of care. These findings suggest that this care model can support physicians in providing timely guideline-recommended hereditary cancer risk assessment to their patients.

Barricades to aiding cascading: Patient-reported barriers to uptake in the context of clinician-facilitated cascade testing for hereditary cancer syndromes.

e13533 Background: Cascade testing extends genetic testing to relatives of individuals with known pathogenic variants. Cascade testing can prompt lifesaving cancer surveillance, however, up to two thirds of at-risk relatives do not complete recommended genetic testing. Previous studies suggest that a clinician-mediated approach of direct relative contact can increase testing rates. As part of an ongoing clinician-facilitated cascade testing intervention, we investigated the barriers to completion of cascade testing. Methods: All patients with a known cancer-associated germline mutation presenting to a gynecologic oncology clinic from 11/2023-2/2024 were offered clinician-facilitated cascade testing, an intervention whereby the genetics team was granted permission to contact designated at-risk relatives by telephone, review the familial mutation, and assist with accessing genetic testing. Patients that declined were asked about their decision and responses were analyzed using the socio-ecological model. Results: Ninety patients were offered clinician-facilitated cascade genetic testing and 50 (55%) declined. Of the patients that declined: median age was 45 (range 23-84), 41 (82%) self-identified as non-Hispanic, 38 (76%) as White, 23 (46%) were of Ashkenazi Jewish heritage, 23 (46%) had a personal history of cancer. There were no significant differences in any of the above variables when comparing those that declined and accepted the intervention. Twenty-nine (58%) patients declined because all family members were already tested. The most common barriers were “limited access to care” (5, 10%) at the healthcare community level, and “perceived readiness of relatives” (5, 10%) at the interpersonal relationship level. While these were the most common, most barriers were at the individual level including “perceived lack of responsibility” (3, 6%), “limited knowledge” (2, 4%), and “emotional burden” (2, 4%) (Table). Stated barriers were not associated with any demographical group. Conclusions: Although clinician-facilitated cascade testing has been shown to increase rates of relative testing uptake, several barriers persist at all levels of the socio-ecological model. While facilitated interventions should be individualized, our findings suggest that future interventions should focus efforts at all socio-ecological levels. Clinical trial information: NCT04613440 . [Table: see text]

Factors influencing postpartum depression in Saudi women: a cross-sectional descriptive study.

This study aimed to investigate the prevalence of postpartum depression (PPD) and stress, as well as factors influencing PPD, among women in Saudi Arabia. This study employed a cross-sectional online survey and recruited participants during postpartum visits to the Clinic of Gynecology and Obstetrics in Al-Khobar, Saudi Arabia. Data collection was done using Arabic versions of the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, and a sociodemographics and obstetric history questionnaire. Descriptive and inferential analyses were conducted, including multiple linear regression using a stepwise method. Data from the 270 participants showed low levels of postpartum depressive symptoms with a mean score of 2.54±4.5 and low levels of perceived stress with a mean score of 2.49±6.2. While 94.4% of the participants reported low levels of stress and PPD, 5.6% reported elevated levels (≥10 for PPD, ≥14 for stress). The stepwise regression analysis showed significant results (p<.001), accounting for 34% of the variance in PPD. The factors significantly influencing PPD included the type of family, stress, number of abortions, disease during pregnancy, and family income. Importantly, perceived stress emerged as a factor influencing PPD. Although the majority of participants exhibited low levels of PPD, about 1 in 18 showed elevated levels. The identification of significant influencing factors highlights the need for targeted interventions to effectively address mental health concerns in postpartum women.

Analysis of molecular marker expression in cutaneous lesions and cervical carcinoma associated with HPV infection.

The study sought to systematically compare the expression of molecular markers in benign cutaneous lesions and squamous cell cervical carcinoma associated with HPV infection to better understand the pathophysiological mechanisms involved in HPV-related lesions and their progression to malignancy. We included 200 patients recruited from a gynecological clinic divided into two groups: 100 patients with positive HPV tests presenting with cutaneous lesions and 100 patients diagnosed with squamous cell cervical carcinoma and testing positive for HPV. The participants were selected to ensure diverse ethnic and demographic representation. The study utilized different statistical analyses, including Chi-square tests to assess associations between categorical variables and logistic regression to evaluate factors influencing lesion progression and compare marker expressions across different lesion types. The results indicated significant differences in the expression of specific molecular markers between cutaneous lesions and cervical carcinomas, highlighting distinct molecular pathways involved in HPV-related lesion development. Notably, markers such as p16, p53, and E-cadherin showed varying expression, suggesting their potential role in distinguishing between benign and malignant lesions. The findings emphasize the significance of molecular marker profiling in improving diagnostic and therapeutic strategies for HPV-related lesions. The differential expression of molecular markers can offer valuable insights into the pathogenesis of HPV-induced lesions and help develop targeted interventions to prevent malignant transformation. Further research is necessary to validate these markers in larger cohorts and diverse populations.

PREVALENCE AND ATTITUDE OF WOMEN REGARDING CESAREAN SECTION IN DUHOK CITY-KURDISTAN REGION

Background: The decision of pregnancy delivery mode is important for both mother and fetus health. Although the advancement in surgical approach of cesarean section, the cesarean section has a negative impact on mothers and fetuses health. Objective: To assess the rate of cesarean section in a sample of women in Duhok city and their attitudes toward cesarean section. Methodology: Present study was a descriptive cross sectional that carried out in Obstetrical &amp; Gynecological Clinics of Maternity Hospital, Primary Health Care Centers, Internally Displaced and Refugee Camps and Private Obstetrics Clinics at Duhok city-Kurdistan region/Iraq through duration period of one year from first of November, 2021, to 31st of October, 2022 on sample of four hundred pregnant women. The decision of previous cesarean section for studied women was done by Senior Obstetrician &amp; Gynecologist according to different reasons (clinical or non-clinical). Results: The history of previous cesarean section was positive in 39.8% of pregnant women, with a common frequency of one cesarean section (58.5%). Most pregnant women perceived that normal delivery is better, while 9% perceived that cesarean section is better. In the same way, 87% of pregnant women preferred normal delivery, while 13% preferred cesarean section. Only 20% of pregnant women believed that cesarean section is the normal way of delivery, while 68% of them thought that mother with a history of cesarean section has a normal delivery in the future. However, 79% of pregnant women believed that mother had a risk of death during cesarean section. Conclusions: The cesarean section rate in Duhok city is higher than acceptable recommended rate, although the positive attitude of pregnant women toward normal vaginal delivery.

Feasibility of universal breast cancer risk assessment in a diverse, publicly insured obstetrician gynecology clinic.

e13759 Background: Breast cancer is the most diagnosed cancer among women in the United States. Established breast cancer risk assessment (BCRA) tools can estimate a woman’s lifetime risk and inform the need for enhanced breast screening which can improve cancer-associated morbidity and mortality. Currently, critical disparities exist both in breast cancer prognosis and screening uptake. We aimed to evaluate the feasibility of routine BCRA in a diverse, publicly insured obstetrician gynecology clinic. Methods: All patients presenting to the obstetrician gynecology clinic were offered a BCRA using the Tyrer Cuzick (TC) risk model. Patients completed paper surveys and the information was input into the TC model to generate lifetime risk estimates. Printed evidence-based management guidelines were reviewed with and provided to those at ≥ 20% lifetime breast cancer risk and shared with the patient’s provider. Results: Between June 2023 and February 2024, 300 patients were approached and 208 (69.3%) completed the survey. One hundred seven (51.4%) survey respondents were presenting for obstetrical care and 101 (48.6%) for gynecologic care. Respondents had a median age of 33 years (IQR: 12). Ninety-six (46.2%) responding patients self-identified as Hispanic, 45 (21.6%) as Black, 25 (12.0%) as Asian, 28 (13.5%) as Non-Hispanic White, and 14 (6.7%) did not identify in these categories. One hundred eighty-nine (90.9%) survey respondents were publicly-insured. Ten (4.8%) patients were assisted by an interpreter. Overall, 12 (5.8%) patients had an elevated lifetime breast of breast cancer, defined as ≥ 20% based on the TC model (6 (50.0%) among obstetrical patients and 6 (50.0%) among gynecology patients). All patients at elevated risk were referred to a genetics clinic for counseling on options for enhanced breast surveillance. Conclusions: As leaders in women’s cancer care, gynecologic oncologists can lead and support programs to identify those women at highest risk for cancer, especially among historically underserved populations. Our feasibility study demonstrated that 69.3% of patients were willing to complete a BRCA and this tool identified 5.8% of patients to have a significantly elevated lifetime breast cancer risk. Providers should consider incorporating such tools in gynecologic oncology and obstetrical/gynecology clinics.