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1.
Obstet Gynecol ; 136(5): 981-986, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030879

RESUMO

Shortly after its inception, the Society for Academic Specialists in General Obstetrics and Gynecology recognized that no data described the composition and faculty activities of "academic generalist divisions." Consequently, in 2018, the Society for Academic Specialists in General Obstetrics and Gynecology appointed a presidential task force and conducted the current surveys of chairs and division directors and key informant interviews to understand the composition and faculty activities in divisions of academic specialists in departments of obstetrics and gynecology and propose criteria for excellence in each mission area to guide development of divisions. In 2014, with Society for Academic Specialists in General Obstetrics and Gynecology's guidance, these divisions were referred to as academic specialists divisions and the faculty within as academic specialists to emphasize that they provide specialized women's health care in academic settings. The divisions comprised approximately 30% of departments' full-time faculty (median 12). In 27% of the departments, these divisions contributed more than half of departmental revenue, and 49% contributed 26-50%. Nearly 90% of divisions provided a sizeable proportion of the department's total teaching efforts. Compensation relied more on clinical productivity than on seniority, quality, academic contributions, or academic rank. Subsequently, five performance domains were identified to help divisions define divisional excellence: clinical, education, research, service & advocacy, and academic environment. Furthermore, excellent divisions were characterized as those with outstanding clinicians and educators who emphasize scholarly productivity. Although academic specialists contribute significantly to their departments' financial, clinical, and educational productivity, many have limited opportunities for scholarly activity. Achieving divisional excellence likely will depend on the ability to recruit and retain faculty with career expectations that align with the division's prioritized performance domains.


Assuntos
Docentes de Medicina/tendências , Ginecologia/tendências , Obstetrícia/tendências , Especialização/tendências , Centros Médicos Acadêmicos , Comitês Consultivos , Docentes de Medicina/organização & administração , Feminino , Ginecologia/educação , Ginecologia/organização & administração , Humanos , Obstetrícia/educação , Obstetrícia/organização & administração , Gravidez , Sociedades Médicas
3.
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
4.
Obstet Gynecol ; 135(5): 1250, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332413

RESUMO

This monograph is intended to serve as a practical guide to the office assessment of the aging woman and recognizes the time constraints that characterize current office practice. Obstetrician-gynecologists are increasingly becoming the primary care providers to women in their practices and especially to older women who have been long-time patients. This monograph should serve as a guide to the many tools needed to assess the health and functional and cognitive status of the aging woman. Illustrative cases demonstrate how to use these tools in a time-efficient manner to achieve a positive effect on the well-being of the patient.


Assuntos
Ginecologia/tendências , Serviços de Saúde para Idosos/tendências , Serviços Preventivos de Saúde/tendências , Atenção Primária à Saúde/tendências , Saúde da Mulher/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/métodos , Atenção Primária à Saúde/métodos
6.
Obstet Gynecol ; 135(2): 371-382, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977782

RESUMO

OBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Telemedicina/métodos , Feminino , Ginecologia/tendências , Humanos , Obstetrícia/tendências , Gravidez , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/tendências
8.
Obstet Gynecol ; 135(2): 268-273, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923067

RESUMO

OBJECTIVE: To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database. METHODS: Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002-2003 and 2017-2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression. RESULTS: Hysterectomy data were collected from 18,982 obstetrics and gynecology residents in a median of 243 (interquartile range 241-246) ACGME-accredited programs. The number of graduating residents increased significantly over time (12.1/year, P<.001), whereas the number of residency programs decreased significantly (0.52 fewer programs per year, P<.001) over the 16-year period. For cases logged as "surgeon," the median number of abdominal hysterectomies decreased by 56.5% from 85 (interquartile range 69-102) to 37 (interquartile range 34-43) (P<.001). The median number of vaginal hysterectomies decreased by 35.5% from 31 (interquartile range 24-39) to 20 (interquartile range 17-25) (P=.002). The median total number of hysterectomies per resident decreased by 6.3% from 112 (interquartile range 97-132) to 105 (interquartile range 92-121) (P=.036). In contrast, the median number of laparoscopic hysterectomies increased by 115% from 20 (interquartile range 13-28) in 2008-2009 to 43 (interquartile range 32-56) in 2017-2018, despite the decrease in overall number of hysterectomies (P<.001). These trends were statistically significant. CONCLUSIONS: The total number of hysterectomies performed by obstetrics and gynecology residents in the United States is decreasing, and the routes are changing with decreases in abdominal and vaginal approaches, and an increase in use of laparoscopic hysterectomy.


Assuntos
Ginecologia/educação , Histerectomia Vaginal/métodos , Histerectomia Vaginal/tendências , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Acreditação , Competência Clínica , Educação de Pós-Graduação em Medicina , Feminino , Ginecologia/tendências , Humanos , Histerectomia Vaginal/educação , Internato e Residência/tendências , Laparoscopia/educação , Laparoscopia/tendências , Obstetrícia/tendências , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
J Minim Invasive Gynecol ; 27(2): 452-461, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31816389

RESUMO

OBJECTIVE: Current estimates of endometriosis prevalence and incidence are highly variable, leading to uncertainty regarding true endometriosis frequency or validity of quantified changes over time. We present a comprehensive review of the prevalence, incidence, and stage of endometriosis worldwide as reported over the past 30 years. DATA SOURCES: We conducted a systematic search of observational studies using the PubMed, Web of Science, EMBASE, and CINAHL databases to identify research papers published in English between January 1989 and June 2019. Search terminologies were limited to titles containing endometriosis and prevalence or incidence, or epidemiology, or frequency, or occurrence, or statistics. METHODS OF STUDY SELECTION: Two independent reviewers screened abstracts for study eligibility, and data from included studies were abstracted. TABULATION, INTEGRATION, AND RESULTS: Overall, 69 studies describing the prevalence and/or incidence of endometriosis met the inclusion criteria. Among these, 26 studies involved general population samples, 17 of which were from regional/national hospitals or insurance claims systems. The other 43 studies were conducted in single clinic or hospital settings. Prevalence estimates for endometriosis widely varied from 0.2% to 71.4% depending on the population sampled. The prevalence reported in general population studies ranged from 0.7% to 8.6%, whereas that reported in single clinic- or hospital-based studies ranged from 0.2% to 71.4%. When defined by indications for diagnosis, endometriosis prevalence ranged from 15.4% to 71.4% among women with chronic pelvic pain, 9.0% to 68.0% among women presenting with infertility, and 3.7% to 43.3% among women undergoing tubal sterilization. A meta-regression was conducted with year as the predictor of prevalence. No trend across time was observed among "general population in country/region" studies (ß = 0.04, p = .12) or among "single hospital or clinic" studies (ß = -0.02, p = .34); however, a decrease over time was observed among general population studies abstracted from health systems or insurance systems (ß = -0.10, p = .005). CONCLUSION: As with all human studies, population sampling and study design matter. Heterogeneity of inclusion and diagnostic criteria and selection bias overwhelmingly account for variability in endometriosis prevalence estimated across the literature. Thus, it is difficult to conclude if the lack of observed change in frequency and distribution of endometriosis over the past 30 years is valid.


Assuntos
Endometriose/epidemiologia , Ginecologia , Doenças Peritoneais/epidemiologia , Endometriose/diagnóstico , Endometriose/história , Endometriose/patologia , Feminino , Ginecologia/história , Ginecologia/tendências , História do Século XX , História do Século XXI , Humanos , Incidência , Infertilidade/epidemiologia , Infertilidade/etiologia , Infertilidade/patologia , Estudos Observacionais como Assunto/estatística & dados numéricos , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Dor Pélvica/patologia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/história , Doenças Peritoneais/patologia , Prevalência , Índice de Gravidade de Doença
10.
J Obstet Gynaecol Res ; 46(1): 39-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31595599

RESUMO

Since 2010, the Women's Health Care Committee has continuously addressed issues closely linked to women's quality of life. The five agendas this committee has engaged for this academic year are as follows: (i) clinical study of urinary complications in perinatal and post-partum women's health care; (ii) enlightenment of infectious diseases in Obstetrics and Gynecology in Japan; (iii) educational activities regarding management guidelines for health care in female athletes; (iv) training program for women's health-care advisers; and (v) pregnancy- and lactation-associated osteoporosis (PLOP). The detailed activities of the five subcommittees are described herein. This report is based on the Japanese version of our annual report (Acta Obst Gynaec Jpn 2019;71(6): 889-898), which publicizes the activities of our committee.


Assuntos
Relatórios Anuais como Assunto , Ginecologia/organização & administração , Obstetrícia/organização & administração , Sociedades Médicas/organização & administração , Saúde da Mulher/tendências , Feminino , Ginecologia/tendências , Humanos , Japão , Obstetrícia/tendências , Gravidez
12.
Obstet Gynecol ; 134 Suppl 1: 34S-39S, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568039

RESUMO

OBJECTIVE: To assess the changing landscape in nontenured faculty, stratified by sex and underrepresented in medicine status, for obstetrician-gynecologists at all U.S. medical schools. METHODS: In this retrospective observational study, we used data from the Association of American Medical Colleges Faculty Roster to identify trends in career pathways of full-time faculty at all U.S. MD-granting medical schools from 1978 to 2017. Proportions of nontenured faculty were compared with other clinical departments, according to sex and race-ethnicity. Two-sample t-testing and simple linear regression were used for statistical comparisons. RESULTS: The number of full-time obstetrics and gynecology faculty increased from 1,688 to 6,347, with most being nontenured (from 535 to 4,951; 9.3-fold increase) rather than tenured (from 457 to 587; 1.3-fold increase) or tenure-eligible (from 397 to 514; 1.3-fold increase). The proportions of all faculty who were nontenured increased from 29.6% to 72.5% (a 2.5-fold increase; P<.010) for men and from 43.4% to 81.4% (a 1.9-fold increase; P<.01) for women. The proportion who were nontenured increased similarly for faculty who were underrepresented in medicine (from 27.4% to 83.5%; a 3.0-fold increase; P<.01) and for those who were not underrepresented in medicine (from 32.0% to 77.1%; a 2.4-fold increase; P<.01). Trends in the increased proportions of nontenured obstetrics and gynecology faculty were similar with those in other major clinical departments. CONCLUSIONS: The substantial rise in the number of obstetrics and gynecology faculty was largely among those who were nontenured, regardless of sex or underrepresented in medicine status. This finding signals the essential need for examining career development and academic accomplishment for promoting nontenured faculty.


Assuntos
Mobilidade Ocupacional , Docentes de Medicina/estatística & dados numéricos , Docentes de Medicina/normas , Ginecologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Desenvolvimento de Pessoal/estatística & dados numéricos , Docentes de Medicina/tendências , Ginecologia/educação , Ginecologia/tendências , Humanos , Obstetrícia/educação , Obstetrícia/tendências , Fatores Raciais , Estudos Retrospectivos , Faculdades de Medicina/estatística & dados numéricos , Fatores Sexuais , Desenvolvimento de Pessoal/tendências , Estados Unidos/epidemiologia
13.
Curr Opin Obstet Gynecol ; 31(6): 447-451, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31652151

RESUMO

PURPOSE OF REVIEW: As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents. RECENT FINDINGS: Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. Long-acting reversible contraceptives should be offered as the first-line method of contraception in adolescents. SUMMARY: Family planning in adolescents presents unique challenges to obstetrician-gynecologists. Improved access to contraception and abortion services is significantly lowering unintended pregnancies rates in adolescents, but more data assessing the effectiveness of interventions in marginalized communities are needed.


Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Induzido/tendências , Medicina do Adolescente/tendências , Anticoncepção/tendências , Serviços de Planejamento Familiar/legislação & jurisprudência , Contracepção Reversível de Longo Prazo/tendências , Adolescente , Anticoncepção Pós-Coito/tendências , Tomada de Decisões , Feminino , Ginecologia/tendências , Humanos , Dispositivos Intrauterinos/tendências , Obstetrícia/tendências , Pais , Gravidez , Gravidez não Planejada
15.
Gynecol Oncol ; 155(2): 359-364, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575391

RESUMO

OBJECTIVE: To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS: We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS: The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION: The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo/tendências , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/educação , Oncologia/educação , Bolsas de Estudo/estatística & dados numéricos , Feminino , Florida , Procedimentos Cirúrgicos em Ginecologia/tendências , Ginecologia/tendências , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Oncologia/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
18.
In Vivo ; 33(5): 1547-1551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471403

RESUMO

An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology.


Assuntos
Inteligência Artificial , Ginecologia , Informática Médica , Obstetrícia , Feminino , Ginecologia/métodos , Ginecologia/normas , Ginecologia/tendências , Humanos , Informática Médica/métodos , Informática Médica/normas , Informática Médica/tendências , Obstetrícia/métodos , Obstetrícia/normas , Obstetrícia/tendências , Medicina de Precisão/métodos , Medicina de Precisão/normas
19.
Obstet Gynecol Clin North Am ; 46(3): 553-561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378295

RESUMO

The past 40 years have witnessed a major redesign of health care, largely driven by rampantly increasing costs and the perception of lack of better outcomes to justify those costs. Many demographic changes have also challenged the women's health care provider workforce, and evolving new payment systems are likewise a source of angst for these providers. Managed care is seeking to cut costs, and the challenge is to do so without sacrificing quality. Burnout is a new challenge in the present environment. There is now an opportunity to meet these challenges and provide the excellent care our patients deserve.


Assuntos
Ginecologia/tendências , Pessoal de Saúde/tendências , Obstetrícia/tendências , Assistência à Saúde/economia , Assistência à Saúde/tendências , Feminino , Ginecologia/economia , Humanos , Obstetrícia/economia , Atenção Primária à Saúde/tendências , Qualidade da Assistência à Saúde , Especialização , Estados Unidos , Seguro de Saúde Baseado em Valor , Saúde da Mulher
20.
J Obstet Gynaecol Res ; 45(10): 1975-1979, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31397512

RESUMO

The Japan Society of Obstetrics and Gynecology Reproductive Endocrinology Committee summarizes the activities of each subcommittee below from April 2017 to March 2019. Current important issues regarding reproductive medicine were examined and discussed from social, political, ethical and scientific viewpoints. A nation-wide survey targeted at OB/GYN facilities revealed the usual procedure in diagnosis and management of fertility-desiring POI patients and fertility outcomes of the patients. How to introduce and adapt FIGO AUB systems to obstetric and gynecologic practices in Japan was examined and discussed.


Assuntos
Endocrinologia/tendências , Distúrbios Menstruais/diagnóstico , Insuficiência Ovariana Primária/diagnóstico , Serviços de Saúde Reprodutiva/tendências , Relatórios Anuais como Assunto , Endocrinologia/normas , Endocrinologia/estatística & dados numéricos , Feminino , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Ginecologia/tendências , Humanos , Obstetrícia/normas , Obstetrícia/estatística & dados numéricos , Obstetrícia/tendências , Insuficiência Ovariana Primária/terapia , Serviços de Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Técnicas de Reprodução Assistida , Inquéritos e Questionários
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