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1.
Arch Gynecol Obstet ; 303(4): 871-876, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33558990

RESUMO

BACKGROUND: The rapid technical development and portability of ultrasound systems over recent years has had a profound impact on the area of point-of-care-ultrasound (POCUS), both in general medicine and in obstetrics and gynecology. The use of POCUS enables the clinician to perform the ultrasound scan either at the medical office or the patient's bedside and used as an extension of the physical examination. Real-time images can immediately be correlated with the patient's symptoms, and any changes in a (critical) patient's condition can be more rapidly detected. POCUS IN OBGYN: POCUS is also suitable for time-critical scenarios, and depending on the situation and its dynamics, the course and results of any therapy may be observed in real time. POCUS should be considered to be a routine extension of practice for most OB/GYN clinicians as it can give immediate answers to what could be life-threatening situations for the mother and/or baby. With its proven usefulness, the applications and use of POCUS should be incorporated in teaching programs for medical students, OBGYN residents and emergency physicians.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/métodos , Humanos , Exame Físico
2.
J Ovarian Res ; 14(1): 35, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602258

RESUMO

China and the rest of the world are experiencing an outbreak of the 2019 novel coronavirus disease (COVID-19). Patients with cancer are more susceptible to viral infection and are more likely to develop severe complications, as compared to healthy individuals. The growing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Ovarian debulking surgery combined with the frequent need for chemotherapy is most likely why ovarian cancer was rated as the gynecologic cancer most affected by COVID-19. Therefore, ovarian cancer presents a particular challenging task. Concerning the ovarian cancer studies with confirmed COVID-19 reported from large-scale general hospitals in Wuhan, we hold that the treatment plan was adjusted appropriately and an individualized remedy was implemented. The recommendations discussed here were developed mainly based on the experience from Wuhan. We advise that the management strategy for ovarian cancer patients should be adjusted in the light of the local epidemic situation and formulated according to the pathological type, tumor stage and the current treatment phase. Online medical service is an effective and convenient communication platform during the pandemic.


Assuntos
/prevenção & controle , Neoplasias Ovarianas/terapia , /isolamento & purificação , /epidemiologia , China/epidemiologia , Feminino , Ginecologia/métodos , Hospitais Gerais , Humanos , Oncologia/métodos , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Pandemias , /fisiologia
3.
Rev Med Suisse ; 17(720-1): 38-41, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443829

RESUMO

In Switzerland, tobacco smoking is a major public health problem, especially among pregnant women. Health problems encountered by pregnant women and their fetuses require specific care to assist smoking cessation. A specific consultation to support smoking cessation during pregnancy was created in May 2019 at the maternity ward of the University Hospitals of Geneva, with the support of the Fondation Privée des Hôpitaux Universitaires de Genève and Carrefour addictionS/CIPRET-Genève. The creation of a network of health professionnals trained in smoking cessation is an important step to support women during their cessation process.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Gestantes , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Feminino , Humanos , Gravidez , Suíça
4.
J Assist Reprod Genet ; 38(3): 621-626, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33447949

RESUMO

PURPOSE: The objective of this study was to evaluate the perception of the initial ASRM COVID-19 recommendations for infertility treatment held by women's health providers within varying subspecialties, as well as their attitudes toward pregnancy and fertility during this time. METHODS: An electronic survey was sent to all women's healthcare providers, including physicians, mid-level providers and nurses, in all subspecialties of obstetrics and gynaecology (Ob/Gyn) at a large tertiary care university-affiliated hospital. RESULTS: Of the 278 eligible providers, the survey response rate was 45% (n = 127). Participants represented 8 Ob/Gyn subspecialties and all professional levels. Participants age 18-30 years were significantly more likely to feel that women should have access to infertility treatment despite the burden level of COVID-19 in respective community/states (p = 0.0058). Participants within the subspecialties of general Ob/Gyn, maternal foetal medicine and gynecologic oncology were significantly more likely to disagree that all women should refrain from planned conception during the COVID-19 pandemic, in comparison to those in urogynecology and reproductive endocrinology and infertility (p = 0.0003). CONCLUSIONS: Considering the immediate and unknown long-term impact of the COVID-19 pandemic on fertility care delivery, a better understanding of perceptions regarding infertility management during this time is important. Our study shows overall support for the initial ASRM recommendations, representing a wide spectrum of women's health providers.


Assuntos
/epidemiologia , Pessoal de Saúde/psicologia , Medicina Reprodutiva/métodos , Saúde da Mulher , Adulto , Atitude do Pessoal de Saúde , Feminino , Ginecologia/métodos , Humanos , Masculino , Obstetrícia , Pandemias , Percepção/fisiologia , Inquéritos e Questionários
5.
Gynecol Oncol ; 160(3): 649-654, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33358197

RESUMO

BACKGROUND: Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care delivery. AIM: To evaluate the effects of mitigating plans implemented on the delivery of gynecological cancer surgery during the COVID-19 pandemic. METHODS: A comparative cohort study of patients treated in a high-volume tertiary gyneoncological centre in the United Kingdom. Prospectively-recorded consecutive operations performed and early peri-operative outcomes during the same calendar periods (January-August) in 2019 and 2020 were compared. RESULTS: In total, 585 operations were performed (296 in 2019; 289 in 2020). There was no significant difference in patient demographics. Types of surgery performed were different (p = 0.034), with fewer cytoreductive surgeries for ovarian cancer and laparoscopic procedures (p = 0.002) in 2020. There was no difference in intra-operative complication rates, critical care admission rates or length of stay. One patient had confirmed COVID-19 infection (0.4%). The 30-day post-operative complication rates were significantly higher in 2020 than in 2019 (58 [20.1%] versus 32 [10.8%]; p = 0.002) for both minor and major complications. This increase, primarily from March 2020 onwards, coincided with the first peak of the COVID-19 pandemic in the UK. CONCLUSIONS: Maintaining surgical throughput with meticulous and timely planning is feasible during the COVID-19 pandemic but this was associated with an increase in post-operative complications due to a multitude of reasons.


Assuntos
/prevenção & controle , Assistência à Saúde/organização & administração , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/organização & administração , Oncologia Cirúrgica/organização & administração , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Assistência à Saúde/métodos , Feminino , Ginecologia/métodos , Pessoal de Saúde , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Programas de Rastreamento , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Equipamento de Proteção Individual , Complicações Pós-Operatórias/epidemiologia , Quarentena , Medicina Estatal , Oncologia Cirúrgica/métodos , Centros de Atenção Terciária , Reino Unido
6.
Obstet Gynecol ; 136(5): 987-994, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030868

RESUMO

OBJECTIVE: To assess whether a pediatric and adolescent gynecology electronic learning (eLearning) module improves knowledge and clinical performance among obstetrics and gynecology residents. METHODS: We conducted a multi-institutional, single-blinded, randomized controlled trial across four university programs; three had pediatric and adolescent gynecology rotations, and two had pediatric and adolescent gynecology fellowship-trained faculty. Applying permutated block randomization, residents were randomized to no intervention or completion of a validated eLearning module on prepubertal bleeding. All residents subsequently completed a pediatric and adolescent gynecology-related knowledge assessment that queried understanding of prepubertal bleeding and an objective structured clinical examination that assessed history collection, performance of a prepubertal genital examination, vaginal culture, and vaginoscopy for a pediatric patient. Objective structured clinical examinations were videotaped and reviewed by two faculty, blinded to randomization group; interrater reliability score was 97%. We calculated descriptive frequencies and compared randomization groups using χ analyses and Fisher exact tests for categorical variables, and median tests for continuous variables; a value of P<.05 was considered significant. RESULTS: From July 2018 to June 2019, we invited 115 residents to participate; 97 (83%) completed both objective structured clinical examination and follow-up knowledge assessments. Most were female (91%) and the majority reported limited pediatric and adolescent gynecology didactic or clinical experience, with 36% reporting prior didactics on prepubertal vaginal bleeding and 33% reporting prior exposure to the prepubertal genital examination. Forty-five participants (46%) were randomized to the module and groups were similar across training levels. Residents assigned to the module scored significantly higher on the knowledge assessment (4/5 vs 2/5, P<.001) and objective structured clinical examination (13/16 vs 7/16, P<.001) and were more likely to avoid a speculum in the examination of a pediatric patient (95.6% vs 57.7%, P<.001). CONCLUSION: Our pediatric and adolescent gynecology eLearning module resulted in improved short-term resident knowledge and simulated clinical skills among obstetrics and gynecology residents. Applying this learning technique in other programs may help address deficiencies in pediatric and adolescent gynecology education and training.


Assuntos
Competência Clínica/estatística & dados numéricos , Ginecologia/educação , Internato e Residência/estatística & dados numéricos , Pediatria/educação , Treinamento por Simulação/métodos , Adolescente , Adulto , Criança , Currículo , Avaliação Educacional , Bolsas de Estudo/métodos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Ginecologia/métodos , Humanos , Internato e Residência/métodos , Pediatria/métodos , Reprodutibilidade dos Testes , Método Simples-Cego
7.
J Gynecol Oncol ; 31(6): e92, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33078597

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changes in cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), and the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity of gynecologist oncologists and to assess the implementation of containment measures against COVID-19 diffusion. METHODS: The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020, and was closed on April 20, 2020. RESULTS: Overall, 604 participants completed the questionnaire with a response-rate of 70%. The results of this survey suggest that gynecologic oncology units had set a proactive approach to COVID-19 outbreak. Triage methods were adopted in order to minimize in-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concerned about COVID-19 outbreak. Although 73% of the participants stated that COVID-19 has not significantly modified their everyday practice, 21% declared a decrease of the use of laparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adopted specific protection against COVID-19. Additionally, responders suggested to delay cancer treatment (10%-15%), and to perform less radical surgical procedures (20%-25%) during COVID-19 pandemic. CONCLUSIONS: National guidelines should be implemented to further promote the safety of patients and health care providers. International cooperation is of paramount importance, as heavily affected nations can serve as an example to find out ways to safely preserve clinical activity during the COVID-19 outbreak.


Assuntos
Infecções por Coronavirus/prevenção & controle , Ginecologia/métodos , Controle de Infecções/métodos , Oncologia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/transmissão , Feminino , Neoplasias dos Genitais Femininos/terapia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Cooperação Internacional , Itália , Pneumonia Viral/transmissão , Sociedades Médicas , Inquéritos e Questionários , Triagem/métodos , Triagem/estatística & dados numéricos
8.
Obstet Gynecol ; 136(5): 1074, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093424

RESUMO

Travel is an increasingly common aspect of modern life, and the practicing obstetrician-gynecologist needs a good understanding of the health- and safety-related issues it presents for patients. This monograph examines the environmental data that support individual risk assessment and provides guidance on how to eliminate or mitigate those risks, including recommendations for immunization and chemoprophylaxis for women traveling to areas with endemic infectious disease. Management approaches for travel-related diseases, such as traveler's diarrhea, altitude sickness, and location-specific diseases, are reviewed as are special considerations for pregnant and breastfeeding women and women who are attempting pregnancy. Evaluation and management of the returned traveler also is addressed. The recommendations in this document cite resources available from the United States federal government; therefore, they are applicable to women seeking care in the United States.


Assuntos
Medicina Preventiva/métodos , Atenção Primária à Saúde/métodos , Medicina de Viagem/métodos , Doença Relacionada a Viagens , Saúde da Mulher , Adulto , Feminino , Ginecologia/métodos , Humanos , Obstetrícia/métodos , Gravidez , Viagem , Estados Unidos
9.
Obstet Gynecol ; 136(4): 868-869, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976376

RESUMO

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.


Assuntos
Serviços de Saúde do Adolescente , Ginecologia/métodos , Obstetrícia/métodos , Serviços Preventivos de Saúde , Saúde Reprodutiva , Adolescente , Comportamento do Adolescente , Saúde do Adolescente , Serviços de Saúde do Adolescente/ética , Serviços de Saúde do Adolescente/organização & administração , Feminino , Humanos , Serviços Preventivos de Saúde/ética , Serviços Preventivos de Saúde/métodos , Saúde Reprodutiva/educação , Saúde Reprodutiva/ética , Educação Sexual/métodos , Comportamento Sexual , Estados Unidos
10.
Obstet Gynecol ; 136(4): e70-e80, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976378

RESUMO

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.


Assuntos
Serviços de Saúde do Adolescente , Ginecologia/métodos , Obstetrícia/métodos , Serviços Preventivos de Saúde , Saúde Reprodutiva , Adolescente , Comportamento do Adolescente , Saúde do Adolescente , Serviços de Saúde do Adolescente/ética , Serviços de Saúde do Adolescente/organização & administração , Confidencialidade/normas , Feminino , Humanos , Planejamento de Assistência ao Paciente , Serviços Preventivos de Saúde/ética , Serviços Preventivos de Saúde/métodos , Saúde Reprodutiva/educação , Saúde Reprodutiva/ética , Educação Sexual/métodos , Comportamento Sexual , Estados Unidos
11.
J Obstet Gynaecol Res ; 46(11): 2237-2241, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32909322

RESUMO

AIM: A nationwide questionnaire survey was performed to evaluate how Japanese Society of Obstetrics and Gynecology (JSOG) members dealt with the coronavirus disease (COVID-19) pandemic during the declared nationwide emergency. METHODS: We sent questionnaires to members of JSOG via official email. Participants answered anonymously using Google forms. RESULTS: Two (0.08%) JSOG members had contracted COVID-19. There was a clear decrease in the number of patients scheduled for operation, not only for malignant but also for benign diseases. A decrease in the number of outpatients for infertility treatment was also observed. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was available in 20.4% of the facilities. Inpatients and outpatients were requested to wear masks, limit the number of contacts and check body temperature when visiting hospitals/clinics. During parturition care, caregivers and physicians wore gloves, masks (other than N-95), face shields and gowns. About 66% and 80% of the facilities decided to transfer pregnant women if they had asymptomatic and symptomatic infection, respectively. Cesarean section was typically chosen as delivery mode in infected women. CONCLUSION: The COVID-19 pandemic provoked significant changes in obstetrics and gynecology practices in Japan. Apparently, nosocomial infections were largely prevented due to these changes, although some of them might not have been necessary.


Assuntos
Infecções por Coronavirus/prevenção & controle , Ginecologia/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Betacoronavirus , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Feminino , Ginecologia/métodos , Humanos , Japão , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/virologia
12.
Curr Opin Obstet Gynecol ; 32(6): 456-460, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32889970

RESUMO

PURPOSE OF REVIEW: Amidst the worldwide coronavirus disease 2019 pandemic, a new medical landscape revolving around telemedicine has arisen. The purpose of this review is to describe and analyze current urogynecologic guidelines for optimizing usage of telemedicine when treating women with pelvic floor disorders. RECENT FINDINGS: Women managed by urogynecologists are on average older, and hence more likely to have comorbidities that make them susceptible to developing coronavirus disease 2019 with severe symptoms. Telemedicine is key in minimizing exposure without sacrificing treatments and quality of life. Recent studies published prior to the pandemic helped set the stage for successful components of virtual care. Nonsurgical options are crucial to beginning a treatment plan while elective surgeries are still restricted in many hospitals. Medication management and innovative technology, such as smart telephone applications, play a prominent role. The comprehensive literature review discussed here describes the degree of evidence supporting each management option, while also noting the limitations of telemedicine. SUMMARY: Telemedicine has opened a new door for the field of urogynecology allowing for continued safe, evidence-based care. The pandemic culture has tipped the balance away from surgery and toward nonsurgical treatments while attempting not to sacrifice outcomes or quality of care.


Assuntos
Infecções por Coronavirus , Ginecologia/métodos , Pandemias , Distúrbios do Assoalho Pélvico/terapia , Pneumonia Viral , Telemedicina/métodos , Urologia/métodos , Infecções por Coronavirus/prevenção & controle , Feminino , Ginecologia/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Telemedicina/normas , Urologia/normas
14.
J Perinat Med ; 48(9): 997-1000, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32628638

RESUMO

Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitais Universitários/organização & administração , Obstetrícia/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Parto Obstétrico/métodos , Feminino , Ginecologia/métodos , Ginecologia/organização & administração , Humanos , Itália/epidemiologia , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cuidado Pós-Natal/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos
15.
Arch Gynecol Obstet ; 302(2): 497-503, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32556531

RESUMO

PURPOSE: Laparoendoscopic single-site surgery (LESS), a promising innovation in minimally invasive surgery, has been used in treating gynecologic oncology diseases. There have been no reports in the literature regarding LESS for inguinal lymphadenectomy (LESS-IL) in gynecologic conditions. We aimed to evaluate the feasibility, safety, and outcomes of LESS-IL. METHODS: Six patients with vulvar or vaginal cancer underwent LESS-IL from July 2018 to March 2019. Data regarding the intraoperative and postoperative outcomes were analyzed. RESULTS: All patients successfully underwent a bilateral LESS-IL without conversion. LESS pelvic lymphadenectomy via an umbilical incision was also performed in a patient with vaginal cancer. The median operation time for the single-port laparoendoscopic inguinal lymphadenectomies was 105 min (range 70-134), with a median estimated blood loss of 108 ml (range 40-170). Median time of hospitalization was 7.5 days (range 5-10). A median of 11 (6-15) lymph nodes were dissected in a unilateral groin. The suction drains were removed after a median duration of 5 days (range 3-7). There were no skin-related or lymph-related postoperative complications. At a median follow-up period of 9 months, all the patients were alive and no recurrence was found. CONCLUSION: LESS-IL is a feasible and safe technique for the surgical management of gynecologic cancers.


Assuntos
Endoscopia/métodos , Ginecologia/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Int J Gynecol Cancer ; 30(8): 1101-1107, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513664

RESUMO

OBJECTIVE: COVID-19 has affected gynecologic cancer management. The goal of this survey was to evaluate changes that occurred in gynecologic oncology practice during the COVID-19 pandemic. METHODS: A anonymous survey consisting of 33 questions (https://sites.google.com/view/gyncacovidfmartinelli) regarding interaction between gynecologic cancers and COVID-19 was distributed online via social media from April 9 to April 30, 2020. Basic descriptive statistics were applied. Analytics of survey-diffusion and generated-interest (visualizations, engagement rates, response rate) were analyzed. RESULTS: The survey received 20 836 visualizations, generating an average engagement rates by reach of 4.7%. The response rate was 30%. A total of 86% of respondents completed the survey, for a total of 187 physicians surveyed across 49 countries. The majority (143/187; 76%) were gynecologic oncologists, and most were ≤50 years old (146/187; 78%). A total of 49.7% (93/187) were facing the early phase of the COVID-19 pandemic, while 26.7% (50/187) and 23.5% (44/187) were in the peak and plateau phases, respectively. For 97.3% (182/187) of respondents COVID-19 affected or changed their respective clinical practice. Between 16% (27/165) (before surgery) and 25% (26/102) (before medical treatment) did not perform any tests to rule out COVID-19 infection among patients. The majority of respondents did not alter indications of treatment if patients were COVID-19-negative, while treatments were generally postponed in COVID-19-positive patients. Treatments were considered priority for: early stage high-risk uterine cancers (85/187; 45%), newly diagnosed epithelial ovarian cancer (76/187; 41%), and locally advanced cervical cancer (76/187; 41%). Treatment of early stage low-grade endometrioid endometrial cancer was deferred according to 49% (91/187) of respondents, with hormonal treatment as the option of therapy (31%; 56/178). A total of 77% (136/177) of respondents reported no changes in (surgical) treatment for early stage cervical cancer in COVID-19-negative patients, while treatment was postponed by 54% (96/177) of respondent, if the patient tested COVID-19-positive. Neoadjuvant chemotherapy for advanced ovarian cancers was considered by over one-third of respondents as well as hypofractionation of radiation treatment for locally advanced cervical cancers. CONCLUSION: COVID-19 affected the treatment of gynecologic cancers patients, both in terms of prioritization and identification of strategies to reduce hospital access and length of stay. Social media is a reliable tool to perform fast-tracking, worldwide surveys.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias dos Genitais Femininos/terapia , Ginecologia/tendências , Oncologia/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/tendências , Adulto , Atitude do Pessoal de Saúde , Terapia Combinada , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Saúde Global , Ginecologia/métodos , Alocação de Recursos para a Atenção à Saúde/tendências , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/tendências , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Mídias Sociais
17.
Am J Obstet Gynecol ; 223(1): 3-8, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32416154

RESUMO

Since December 2019, the outbreak of novel coronavirus disease 2019 became a major epidemic threat in China and later spread worldwide. During the coronavirus disease 2019 outbreak in mainland China, the Chinese Obstetricians and Gynecologists Association distributed guidelines regarding the care of gynecologic patients. These guidelines were developed by the Department of Obstetrics and Gynecology at the Peking Union Medical College Hospital and represent an effort to integrate infection control strategy and promote professionalism in medical practice. The guidelines represent collaboration with experts from 31 provinces and autonomous regions of mainland China over 2 weeks' time. With the implementation of these guidelines, no nosocomial infections of coronavirus disease 2019 have been identified at the Peking Union Medical College Hospital. We think these guidelines might be helpful to departments of obstetrics and gynecology internationally during these unprecedented times. In our guidelines, we describe basic infection precaution principles, an epidemiologic screening tool, prioritization of surgical procedures, and operating room requirements. Using these principles, we then review the management of gynecologic patients during the coronavirus disease 2019 epidemic in the outpatient and operative and nonoperative inpatient settings and in clinical trials.


Assuntos
Infecções por Coronavirus/epidemiologia , Ginecologia/métodos , Pneumonia Viral/epidemiologia , Betacoronavirus , China , Ensaios Clínicos como Assunto , Consenso , Infecções por Coronavirus/diagnóstico , Feminino , Procedimentos Cirúrgicos em Ginecologia , Hospitais , Humanos , Controle de Infecções , Salas Cirúrgicas/normas , Pandemias , Pneumonia Viral/diagnóstico , Gravidez
18.
South Med J ; 113(4): 164-167, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32239228

RESUMO

OBJECTIVES: Surgical site infection (SSI) is a preventable cause of postoperative morbidity. The appropriate use of perioperative antibiotics for prevention of SSIs is a well-established quality metric. Little is known about the adherence to guidelines-based antibiotic prophylaxis among Alabama obstetricians and gynecologists. Our aims were to determine their adherence to guidelines-based antibiotic prophylaxis and identify the factors that are predictive of nonadherence. METHODS: Online, self-administered survey of Alabama obstetricians and gynecologists. RESULTS: Providers reported not providing the indicated antibiotics and/or giving nonindicated antibiotics in almost all surgical scenarios. The exceptions included hysterectomies, in which almost all (96%) providers routinely gave indicated antibiotics. No providers reported giving antibiotics during intrauterine device placement or endometrial biopsies, which is appropriate. The only factor predictive of inappropriate antibiotic use was the absence of a standing antibiotic protocol. CONCLUSIONS: Alabama gynecologic surgeons can and should improve their compliance with guidelines-based antibiotic prophylaxis. More research is needed to determine which interventions would improve adherence in this provider population; our study suggests that the implementation of a standing antibiotic protocol may be a reasonable first step.


Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Fidelidade a Diretrizes/normas , Pessoal de Saúde/estatística & dados numéricos , Adulto , Alabama , Antibacterianos/uso terapêutico , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Ginecologia/métodos , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Inquéritos e Questionários
19.
Int Urogynecol J ; 31(6): 1063-1089, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32342112

RESUMO

INTRODUCTION AND HYPOTHESIS: The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. METHODS: We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. RESULTS: Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. CONCLUSIONS: We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.


Assuntos
Infecções por Coronavirus/prevenção & controle , Doenças Urogenitais Femininas/terapia , Ginecologia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Doenças Urogenitais Femininas/virologia , Humanos , Controle de Infecções/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
20.
Obstet Gynecol ; 135(5): 1242-1243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332410

RESUMO

Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/terapia , Doenças dos Genitais Femininos/terapia , Ginecologia/métodos , Adolescente , Criança , Anticoncepcionais/uso terapêutico , Aconselhamento/métodos , Gerenciamento Clínico , Epilepsia/complicações , Feminino , Doenças dos Genitais Femininos/etiologia , Humanos , Menarca , Gravidez , Adulto Jovem
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