A global study on knowledge and perception of HPV and HPV vaccination among young obstetricians and gynecologists.

Objective: Our goal is to improve the understanding of human papillomavirus (HPV) and its vaccination among obstetrics and gynecology trainees and young specialists worldwide. Materials and Methods: This cross-sectional study was conducted through an online survey consisting of 28 questions by the World Association of Trainees in Obstetrics and Gynecology between February and August 2023. The questionnaire collected demographic data of the study participants and assessed the respondents' knowledge and perception of HPV, HPV vaccines, and vaccine dosing schedule. Results: Two hundred five Ob/Gyn trainees and young Ob/Gyns from 52 countries completed the survey. The majority of respondents were trainees (158, 77.1%). Most trainees and young Ob/Gyns learned about HPV for the first time during medical school (149, 72.6%). Almost all (204, 99.5%) Ob/Gyns responded that HPV was sexually transmitted. More than half of the respondents had not received HPV vaccination (110, 53.7%). The vaccine was recommended for respondents mostly by their Ob/Gyn senior colleagues (110, 53.7%). Most of the respondents knew how to manage HPV-positive patients (179, 87.3%). Conclusion: This study suggests that even though knowledge on HPV and its vaccination is satisfactory among trainees and young Ob/Gyns, HPV vaccination remains deficient. There is a need to understand, educate, and address the potential problem that lies underneath.

A multicenter study of the relationship between the compulsory time spent at home and sexual functioning.

OBJECTIVE: To investigate how sexual life is affected by the increase in the amount of time spent at home due to the restrictions of the coronavirus disease 2019 (COVID-19) pandemic, and the relationships among depression, anxiety, amount of stress, and sexuality. METHODS: This cross-sectional study was conducted in two cities, Istanbul (metropolitan city) and Rize (city in a rural area). All data were collected face to face in the gynecology outpatient clinics from patients who came in for benign gynecologic reasons or a check-up. The questionnaire comprised a sociodemographic form, the Arizona Sexual Experience Scale (ASEX) Scale, and the Depression Anxiety Stress Scale. RESULTS: A total of 459 participants took part in the study. Around half of the participants were living in an urban area. There was a statistically significant increase in weekly sexual intercourse frequency for both groups. Sexual desire and arousal scores were significantly higher in the rural groups. There was a significant decrease in sexual pleasure within urban groups. Depression, anxiety, and stress scores were significantly higher in urban groups. There was no statistically significant difference in ASEX total scores between groups. CONCLUSIONS: This study suggests that even though the rate of COVID-19 and restrictions did not differ between the compared areas, the lockdown may have had a greater effect on the sexual pleasure of women in urban areas.

Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives.

OBJECTIVE: The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. STUDY DESIGN: This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. RESULTS: Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." CONCLUSION: Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.

The implementation of the European Working Time Directive in Europe and its impact on training in obstetrics and gynaecology: A ten year follow-up.

OBJECTIVE: To reassess the compliance with the European Working Time Directive (EWTD) in the member countries of the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) and to investigate the impact of the EWTD on training. STUDY DESIGN: In this observational, cross-sectional study, an online questionnaire, containing multiple-choice questions and open questions, was distributed among Obstetrics and Gynaecology trainees in 33 ENTOG member countries. The questionnaire was designed as a follow-up of a similar survey conducted by ENTOG in 2009 and assessed the overall compliance with the EWTD, the adaptations needed to achieve this compliance, the impact of the EWTD on the quality of training and the well-being of trainees. The answers were analysed using descriptive statistics in Microsoft Excel. RESULTS: 59 responses from 28/33 (84.8%) ENTOG member countries were collected. Only 5 out of 28 (17.9%) countries were found to be nationally compliant with EWTD. There were no clear differences in the compliance between different types of the hospitals (university/teaching/district), but a trend was observed towards higher rate of implementation in smaller hospitals (<1500 deliveries per year). Regarding the changes needed to become EWTD-compliant and yet maintain high-quality training, the most common suggestions were: hiring extra junior doctors, restructuring training, having less doctors on duty simultaneously, consultants performing more hands on work, dedicated training sessions, reduction of administrative tasks and simulation training for surgical skills. The majority of trainees, 7 out of 12, (58.3%) in the EWTD-compliant hospitals experienced a positive effect on their training, whereas the majority of trainees in non-compliant hospitals, 31 out of 47, (66%) were uncertain about the impact of the EWTD on the quality of training. Among the positive changes, better work-life balance and more consultants available out of the daily working hours were listed. CONCLUSIONS: Despite the introduction and implementation of the EWTD over two decades ago, the compliance rates across Europe remain low and seem not to have altered in the last ten years. In order to ensure the quality of training and, most importantly patient safety, we suggest that European nations keep striving to implement the EWTD for doctors in training. We also suggest for nations that have yet to implement this directive to use the strategies as an exemplar in countries that follow EWTD.

The influence of the COVID-19 outbreak on European trainees in obstetrics and gynaecology: A survey of the impact on training and trainee.

OBJECTIVE: The purpose of this study is to evaluate how the obstetrics and gynaecology residency program and trainees have been affected by the Corona Virus Disease-19 (COVID-19) pandemic in Europe. STUDY DESIGN: This study is a cross-sectional explorative survey using an online questionnaire. The questionnaire comprised of 40 questions that were subdivided into 4 subjects; workload, specialist training aspects in obstetrics and gynaecology, health and safety of the trainee and women's health and maternal health issues. Inclusion criteria consisted of being a trainee in Obstetrics and Gynaecology (ObGyn) at the time of the COVID-19 pandemic in Europe or trainees who had recently finished their training during the time of the outbreak. Taking part in the survey was voluntary. The questionnaire was shared on the website of the European Network for Trainees in Obstetrics and Gynaecology (ENTOG), ENTOG social media, in the ENTOG-newsletter and through the national representatives of ENTOG. RESULTS: 110 ObGyn trainees from 25 different countries responded to the questionnaire. Almost all trainees (95 %, N = 105) reported an effect on their training due to COVID-19 pandemic. Training was interrupted in 21 % of cases (n = 23). Trainees observed a decrease in educational activities or lectures and a decrease in number of patients. The possibility of training surgical skills decreased, because 67 % (N = 74) trainees reported that surgeries were cancelled. Trainees expressed concerns about reaching the goals of their ObGyn specialist training in 60 % (n = 66) of cases. A decrease in workload was experienced during the first COVID-19 wave in Europe by 60 % (n = 66) of trainees. On average these trainees worked 33 % less hours compared to a normal workweek. Although 22 % (n = 24) were expected to be available continuously for 24 h a day and 7 days a week for unscheduled duties, 15 % (n = 16) were deployed to work on special COVID-units. Concerning preparation, 45 % of the trainees (n = 50) had not received any training for treating COVID-positive patients. Trainees claimed to have enough personal protective equipment (PPE), although problems were reported. Any form of psychosocial support was arranged for 65 % of trainees (n = 71) by the hospital or department. The results of the survey suggest that obstetric care was not affected much (92 % (n = 102) of the respondents said at least necessary care continued) while patients in need for reproductive medicine were affected the most; out of the 110 departments 58 % (n = 60) were closed and 35 % (n = 36) reduced their activities. Access to family planning and benign gynaecology were also significantly reduced; 77 % and 87 % respectively of the departments were less accessible or only open to emergency cases. CONCLUSION: COVID-19 pandemic has had a tremendous effect on the ObGyn training in Europe. Exposure to learning opportunities, surgeries and teaching has been decreased during the outbreak and may result in a decrease in quality of care provided to women in the future if impairment of training is not recovered.

The predictive nature of uterocervical angles in the termination of second trimester pregnancy.

AIM: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies. MATERIAL AND METHODS: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24 hours of induction and successful and failed terminations at the end of 48 hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°. RESULTS: In the 24-hour time frame group, the mean UCA was 105.50 ± 15.38 degrees in the successful termination group and was 100.22 ± 11.12 degrees in the failed group (p = .001). In the 48-hour time frame group, the mean UCA was 104.19 ± 13.51° in the successful termination group and was 93.52 ± 7.84° in the failed group (p = .007). The mean hour of induction was shortest in the UCA ≥105° group. CONCLUSIONS: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.

Comparing success rates of the Hayman compression suture and the Bakri balloon tamponade.

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality around the world. Medical treatments and uterus-sparing interventions including balloon tamponades and compression sutures are the first line options before the decision is made to perform a hysterectomy. Our aim is to compare the success rates of the Hayman compression suture and the Bakri balloon tamponade (BBT) in patients with PPH. Methods: We enrolled 82 patients who were diagnosed with uterine atony during their cesarean sections and failed to respond to uterotonic agents. The patients were treated with either a Hayman suture or a BBT. Results: The success rates of the both methods were similar (76.7% in the Hayman group and 74.4% in the BBT group). In both groups, the success rate increased with the addition of artery ligations (93% in the Hayman group and 87.2% in the BBT). Conclusion: The Hayman suture and the BBT's performances were identical in the management of PPH due to uterine atony. All methods have pros and cons and the choice of the intervention depends on a variety of factors including the severity of bleeding, experience of the surgeon and the accessibility of the tools.

Can uterocervical angles successfully predict induction of labor in nulliparous women?

PURPOSE: Induction of labor is a common practice in obstetrics. In recent years, a newer ultrasonographic parameter called the uterocervical angle (UCA) has been identified as a predictive tool for births. Our purpose is to investigate the role of UCA in predicting successful induction of labor. METHODS: The nulliparous term pregnancies (n:150) were grouped into successful/failed inductions of labor based on their progress into the active phase of labor after the administration of prostaglandin E2 (dinoprostone). The pre-induction cervical length (CL) and UCA were compared in the two groups. The study population was further grouped according to their modes of delivery and pre-induction UCAs were compared among the subgroups. RESULTS: The mean UCAs were not significant among the successful induction and failed induction groups (105.46 ±â€¯20.54 degrees in the successful group and 110.57 ±â€¯13.46 degrees in the failed group). However, UCAs significantly varied among the modes of delivery subgroups. The median UCA was significantly higher in patients who delivered vaginally after a successful induction of labor than in patients who delivered via cesarean section. The median UCA value was lowest in patients who had a successful induction of labor but ended up having a cesarean section (Fig. 2). Further, the duration of the active phase of labor negatively correlated with the UCA but not the CL (rho=-0.23, p = 0.02). There was also a negative correlation between the CL and the UCA in patients who delivered vaginally after successful induction of labor (rho= -0.21, p = 0.03). CONCLUSION: The UCA is a promising ultrasonographic marker in obstetrics. Although the pre-induction UCA did not predict the outcome of labor induction, patients with broader pre-induction UCAs were prone to have a shorter duration of active phase. The pre-induction CL and UCA are inversely corraleted in nulliparous women who delivered vaginally after a successful induction of labor.