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American Journal of Obstetrics and... Mar 2024The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been...
The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.
Topics: Pregnancy; Humans; Female; Parturition; Delivery, Obstetric; Maternal Health Services; Attitude of Health Personnel; Violence
PubMed: 37806611
DOI: 10.1016/j.ajog.2023.10.003 -
The Journal of the American Academy of... Feb 2024Pelvic ring injuries occur in varying severity and in vastly different patient demographics. Knowledge regarding which of these injuries require surgical intervention... (Review)
Review
Pelvic ring injuries occur in varying severity and in vastly different patient demographics. Knowledge regarding which of these injuries require surgical intervention and which can be managed nonsurgically continues to evolve. Previous studies have shown validated criteria for sacral fractures and the posterior ring, explored the role of examination under anesthesia, and other forms of dynamic imaging. Although there is substantial information available, a comprehensive synthesis of this information is lacking. This article provides a comprehensive review of radiographic markers suggestive of stability, discusses treatment strategies, and proposes a treatment algorithm that is easily understood and applicable to not only those with a trauma background but also the general orthopaedic surgeon who will see these injuries frequently while on call.
Topics: Humans; Anesthesia; Fractures, Bone; Pelvic Bones; Spinal Fractures
PubMed: 37816188
DOI: 10.5435/JAAOS-D-23-00470 -
Human Fertility (Cambridge, England) Dec 2023Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both... (Review)
Review
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
Topics: Male; Humans; Female; Varicocele; Embolization, Therapeutic; Pelvic Pain; Pelvis; Venous Insufficiency
PubMed: 37190955
DOI: 10.1080/14647273.2023.2212846 -
Forensic Science, Medicine, and... Dec 2023Women sexual violence as a gynecological, social-criminological and gynecological problem has no declining trend in developing and developed countries, including in...
PURPOSE
Women sexual violence as a gynecological, social-criminological and gynecological problem has no declining trend in developing and developed countries, including in Croatia.
METHODS
From my own 23-year forensic-gynecological expertises practice, along with the results of legally completed examples of sexual abuses, as a contribution to this problem, which is also read from other works.
RESULTS
Of the cases of sexual abuses (n = 31) with a median age of 37 years, gynecological-forensic expertise proved and confirmed 67.7% of sexual abuses criminal cases with a significant problem of inadequate primary gynecological procedure, most often due to insufficient gynecological examination and medical documentation in high 64.5%, as well as late sexual abuses report in 51.6%. Of all cases of sexual abuses, 6 (19.4%) required primary surgical care due to bleeding and lacerations of the genitals, there were no reported cases of sexual abuses in pregnancy, and no deaths related to sexual abuses. The problems that can affect the forensic-gynecological evaluation of sexual abuses victims are: inadequate and insufficient primary medical documentation immediately after sexual abuses, late reports of sexual abuses, after several days, months and years in the reproductive age of women, with a late primary examination and an almost difficult to prove objective gynecological examination and inadequate education of gynecologists in primary examination.
CONCLUSION
In conclusion, it should be mentioned that the mentioned medical problems can be solved by constant education of all professional medical participants, permanent court experts with experience, coordination and subordination of expert gynecological and forensic societies in cooperation with the state attorney's office, courts and police, and social service.
Topics: Pregnancy; Female; Humans; Adult; Sex Offenses; Police; Documentation; Forensic Medicine; Lacerations
PubMed: 37148439
DOI: 10.1007/s12024-023-00626-1 -
Journal of Gynecologic Oncology Jan 2024Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in... (Review)
Review
Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer is controversial. Nodal status provides useful prognostic data, and allows to tailor the need of postoperative treatments. However, two independent randomized trials showed that the execution of (pelvic) lymphadenectomy increases the risk of having surgery-related complication without improving patients' outcomes. Sentinel node mapping aims to achieve data regarding nodal status without increasing morbidity. Sentinel node mapping is the removal of first (clinically negative) lymph nodes draining the uterus. Several studies suggested that sentinel node mapping is not inferior to lymphadenectomy in identifying patients with nodal disease. More importantly, thorough ultrastaging sentinel node mapping allows the detection of low volume disease (micrometastases and isolated tumor cells), that are not always detectable via conventional pathological examination. Therefore, the adoption of sentinel node mapping guarantees a higher identification of patients with nodal disease than lymphadenectomy. Further evidence is needed to assess the value of various adjuvant strategies in patients with low volume disease and to tailor those treatments also on the basis of the molecular and genomic characterization of endometrial tumors.
Topics: Female; Humans; Sentinel Lymph Node Biopsy; Sentinel Lymph Node; Lymphatic Metastasis; Neoplasm Staging; Lymph Nodes; Lymph Node Excision; Endometrial Neoplasms
PubMed: 37973163
DOI: 10.3802/jgo.2024.35.e29 -
Journal of Gynecology Obstetrics and... Dec 2023Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and... (Review)
Review
OBJECTIVE
Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and students, because of its intimate nature. Consequently, education has shifted from a traditional approach to a simulation-enhanced education. This literature review summarizes the level of evidence for these not-so-new training modalities.
METHODS
For this systematic review, the Pudmed database have been consulted using the following keywords: (Pelvic examination OR Vaginal examination) AND simulation. Eligible studies had to be published in French or English within the past 20 years and investigate simulation training for pelvic examination in the field of gynecology and obstetrics. For each paper, the following outcomes were analyzed: Competence, confidence and communication, and were classified according to the Kirkpatrick hierarchy.
RESULTS
About competence, in initial training, one meta-analysis (9 studies of which 4 randomized studies) about pelvic examination teaching on procedural simulators have shown a significant benefit of simulation. One meta-analysis and one systematic review also demonstrated that Gynecological Teaching Associates (GTAs) teaching, who exist in Northern America and Scandinavian countries, was better that pelvic task trainers in terms of technical competence, and comfort. For the vaginal examination of women in labor, two randomized trials also showed a positive impact of pelvic task trainer on students' accuracy.
CONCLUSION
Simulation-enhanced education of pelvic examination brings a significant benefit in comparison to a classic education without simulation in terms of competence, confidence and communication. GTAs have the best impact on competence and communication, but they do not exist currently in France. Hybrid simulation (a patient actor combined with a pelvic task trainer) could be a solution to teach both technical skills and communication.
Topics: Female; Humans; Pregnancy; Education, Medical, Undergraduate; Gynecological Examination; Gynecology; Patient Simulation; Simulation Training
PubMed: 37739264
DOI: 10.1016/j.jogoh.2023.102666 -
Medicina (Kaunas, Lithuania) Oct 2023Giant ovarian tumors are rare, as most cases are diagnosed during routine gynecological check-ups or abdominal ultrasound examinations. They are a challenge for...
Giant ovarian tumors are rare, as most cases are diagnosed during routine gynecological check-ups or abdominal ultrasound examinations. They are a challenge for gynecologists and surgeons. Diagnosis in such patients is difficult due to the limitations of the medical apparatus. Perioperative management requires specialized anesthetic medical care and is associated with high mortality. The paper presents the case of a 23-year-old woman with a giant ovarian serous tumor, characterized by an enlargement of the abdominal circumference, periodic abdominal pain, irregular menstruation, and infertility. The patient attributed these nonspecific symptoms to obesity; therefore, she was hesitant to schedule a doctor's appointment. The patient underwent laparotomy, and the cyst originating from the left ovary was removed along with part of the organ. An intraoperative examination was performed. After confirming the benign nature of the lesion, the operation was completed. In our work, we concentrated on the multidisciplinary care of the patient who required enhanced medical care from the internal medicine, cardiology, anesthesiology, rehabilitation medicine, and gynecology specialists. There were no hemodynamic changes in the heart during hospitalization. There were no significant early or late postoperative complications. In this case, we also paid attention to compression symptoms resulting from a giant ovarian tumor and the high risk of intraoperative complications resulting from its resection.
Topics: Female; Humans; Young Adult; Adult; Ovarian Neoplasms; Ultrasonography; Cysts; Anesthesiology
PubMed: 37893550
DOI: 10.3390/medicina59101833 -
Journal of Clinical Pathology Feb 2024Macroscopic specimen examination is often critical for accurate histopathology reporting but has generally received insufficient attention and may be delegated to... (Review)
Review
Macroscopic specimen examination is often critical for accurate histopathology reporting but has generally received insufficient attention and may be delegated to inexperienced staff with limited guidance and supervision. This review discusses issues around macroscopic examination of some common urological specimens; highlighting findings that are critical for patient management and others that are clinically irrelevant. Macroscopic findings are of limited value in completely submitted radical prostatectomy specimens but may be critical in orchidectomy specimens where identification of focal non-seminomatous components can significantly impact patient management. The maximum tumour dimension is often an important prognostic indicator, but specimen dimensions are generally of little clinical utility. Specimens should be carefully examined and judiciously sampled to identify clinically important focal abnormalities such as sarcomatoid change in a renal cell carcinoma and a minor non-seminomatous component in a predominant testicular seminoma. Meticulous macroscopic examination is key as less than 0.2% of the specimen (or macroscopically abnormal area) would be histologically examined even if the entire specimen/abnormal area is submitted for microscopic examination. Retroperitoneal pelvic lymph node dissection specimens for testicular cancer must be handled very differently from other lymph nodal block dissections. Current sampling protocols for transurethral resection of prostate specimens that are based on pre-MRI era data need to be reconsidered because they were specifically designed to detect occult prostate cancer, which would amount to histological cancer screening. Prostatic sampling of cystoprostatectomy specimens should be directed at accurately staging the known bladder cancer rather than detection of incidental prostate cancer.
Topics: Male; Humans; Testicular Neoplasms; Transurethral Resection of Prostate; Prostatic Neoplasms; Prostate; Prostatectomy; Kidney Neoplasms
PubMed: 38373783
DOI: 10.1136/jcp-2023-208831 -
World Journal of Urology Aug 2023Hysterectomy is one of the most common types of gynecological operations and it is associated with numerous postoperative complications. Few studies have reported a... (Observational Study)
Observational Study
Association between hysterectomy and kidney stone disease: results from the National Health and Nutrition Examination Survey 2007-2018 and Mendelian randomization analysis.
PURPOSE
Hysterectomy is one of the most common types of gynecological operations and it is associated with numerous postoperative complications. Few studies have reported a definitive association between hysterectomy and kidney stone disease (KSD). This study aimed to explore whether hysterectomy increases the risk of KSD.
METHODS
This is a cross-sectional study that used six continuous cycles of data obtained from the National Health and Nutrition Examination Survey from 2007 to 2018. The correlations between hysterectomy or age at hysterectomy and the prevalence of KSD were assessed using weighted multivariable-adjusted logistic regression. Further, five methods of two-sample Mendelian randomization (MR) were applied to decrease bias and infer causality in the observational study.
RESULTS
After adjusting for potential confounders, hysterectomy (OR: 1.37, 95% CI 1.04-1.81) was found to be positively associated with the prevalence of KSD, whereas age at hysterectomy was found to be negatively associated with the prevalence of KSD (OR: 0.96, 95% CI: 0.94-0.98). In the inverse-variance weighted method, MR analyses suggested that genetically predicted hysterectomy is causally associated with a higher risk of KSD (OR: 11.961, 95% CI 1.12-1.28E2).
CONCLUSIONS
Hysterectomy could increase the risk of KSD. Younger age at hysterectomy is associated with a higher risk of KSD. Further prospective cohort studies with larger sample sizes and longer follow-up times are needed.
Topics: Female; Humans; Mendelian Randomization Analysis; Cross-Sectional Studies; Nutrition Surveys; Prospective Studies; Kidney Calculi; Hysterectomy; Polymorphism, Single Nucleotide
PubMed: 37314571
DOI: 10.1007/s00345-023-04465-1 -
Frontiers in Nutrition 2023Pelvic inflammatory disease (PID) is a prevalent gynecological disorder. Dietary trace minerals play an important role in combating many chronic diseases including PID....
OBJECTIVE
Pelvic inflammatory disease (PID) is a prevalent gynecological disorder. Dietary trace minerals play an important role in combating many chronic diseases including PID. However, it is unknown whether dietary trace minerals and PID are related. This study aimed to examine the relationship between dietary trace minerals (copper, iron, selenium, and zinc) and PID.
METHODS
Data of women participants from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 were enrolled in this cross-sectional investigation. Univariate and multivariate linear regression analyses of the relationship between dietary trace minerals and PID were performed, and restricted cubic spline (RCS) analyses were applied to visualize those relationships.
RESULTS
In total, 2,694 women between the ages of 20 and 59 years participated in the two NHANES cycles. In the univariate analyses, a significant negative relationship was identified between PID and dietary copper intake [odds ratio (OR) = 0.40, 95% confidence interval (CI): 0.24-0.67, < 0.01] but not with iron (OR = 0.96, 95% CI: 0.90-1.03, = 0.25), selenium (OR = 1.0, 95% CI: 0.99-1.0, = 0.23), and zinc (OR = 0.94, 95% CI: 0.86-1.03, = 0.17) intake. Following the adjustment for age and race (model 1), a robust correlation was found between dietary copper intake and PID (OR = 0.23, 95% CI = 0.09-0.61, < 0.01), as indicated by the fully adjusted model 2 (OR = 0.29, 95% CI = 0.09-0.90, = 0.03). Simultaneously, a significant trend was found between copper intake and PID across the quintile subgroups ( for trends <0.05), suggesting a robust relationship. Furthermore, the RCS analysis demonstrated a linear correlation between PID and dietary copper intake (overall < 0.01, non-linear = 0.09).
CONCLUSION
Decreased dietary copper intakes are linked to PID. However, additional research is needed to fully investigate this relationship due to the constraints of the study design.
PubMed: 38089925
DOI: 10.3389/fnut.2023.1273509