More women gynecologists in Belgium: assessment of changes in the workforce—a survey

Context and objective

International data highlight the increasing participation of women in the workforce in the medical field and particularly among obstetricians and gynecologists (OB-GYN). Some studies reported a gender difference in work productivity and practice patterns. The aim of this study is to analyze whether disparities exist between male and female OB-GYN in their practices with potential consequences for the organization of the OB-GYN departments.

Methods

A survey of all active, Belgian OB-GYNs concerning their professional activity and well-being and a survey of the heads of OG departments evaluating the impact of feminisation on their department.

Results

The response rate was 43% (n?=?615). Women and men worked a similar number of half-days per week, respectively, 10.1?±?2.4 and 10.3?±?3.2 (p?=?0.26) but women treated less patients per week (80 versus 90, p?=?0.034). Pear year, women and men perform, respectively, 108 and 184 surgical procedures (p?=?0.0001) plus 114 and 100 deliveries (p?=?0.09). Female OB-GYNs have fewer children but the size of their family has no bearing on work hours. Qualitatively, most OB-GYN regardless of their gender, consider their profession to be gratifying. Dissatisfaction is related to organizational concerns for women and to pressure of competitiveness for men. Women are more concerned about their private life and men more focussed on their professional career. However, both expressed the primary importance of good health and quality of life. A majority (66%) of head of departments do not consider that the feminisation of their staff is problematic.

Conclusion

There was no difference in time spent at work between male and female OB-GYN. The number of patients treated by female OB-GYN per week is smaller which means that the time spent per patient is higher. The OG profession does not appear to be jeopardized by its feminisation according to this study and the opinion of the head of departments. Nevertheless, we need to take into account when organizing the future workforce that women tend to focus more on the time spent with patients than on surgical procedures.

     

The role of shear wave elastography in the assessment of placenta previa–accreta

Objective: To evaluate the value of shear wave elastography (SWE) in the prediction of morbidly adherent placenta.

Methods: Forty-three women with normal placental location and 26 women with anteriorly localized placenta previa were recruited for this case-control study. Placental elasticity values in both the groups were determined by SWE imaging.

Results: SWE values were higher in the placenta previa group in all regions than in normal localized placentas (p?p?>?.05).

Conclusions: Placental stiffness is significantly higher in placenta previa than normal localized placentas. However, we could not demonstrate any statistically significant difference in the elasticity values between the placenta previa with and without accreta.     

The investigation of the role of sirtuin-1 on embryo implantation in oxidative stress–induced mice

Journal of Assisted Reproduction and Genetics - Implantation is essential for a successful pregnancy. Despite the increasing number of studies, implantation is still an unknown process. This study...     

‘Breaking the rules’ in baby-feeding practice in the UK: deviance and good practice?

OBJECTIVE: to discover the views of midwives in relation to baby feeding. DESIGN AND METHOD: qualitative using grounded theory. Data collection used in-depth interviews with 30 midwives who volunteered to participate. Field notes of the interaction between the researcher and participant were also recorded as data. The constant comparison process was used to generate codes and subsequent conceptualisations from the data. SETTING: two maternity units in the North of England, UK. FINDINGS: the core category of this study is called 'surviving' baby feeding, and the findings reported here are a significant theme that emerged. These midwives described a management strategy termed 'breaking the rules' for supporting mothers with baby feeding. The concept 'breaking the rules' represented practices that were not congruent with evidence-based, baby-feeding policy and recommendations, or with some practices that were usual in the local working environment. These midwives were aware of their actions but described how they 'hid' their behaviour from mothers and from their peers. Some of the behaviour described showed that these midwives 'broke the rules' in relation to professional requirements and the facilitation of informed decision making about feeding practices with the women in their care. However, some midwives reported examples of practice that is woman-centred, and supportive of baby feeding, but this was not acceptable to others in the working environment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: deviant behaviour was described by these midwives in relation to informed decision making and options for mothers in baby-feeding practice. These midwives 'knowingly concealed' their deviant practices from others. These behaviours should be taken seriously as they risk being negligent in relation to UK statutory professional requirements. However, practices that depart from those that are normal in the local working environment are not always negative and detrimental to the recipients of care; they can be positive. There needs to be more research, open discussion and debate about midwifery practice that does not always 'fit in' with professional, and 'normal' expectations. In this study, the term 'baby feeding' relates to how babies' nutritional needs are met.     

Prevention of iatrogenic pelvic infection during in vitro fertilization—current practice in the UK

Uterine instrumentation can provoke pelvic inflammatory disease in women infected with Chlamydia trachomatis. During an IVF treatment cycle, a fine plastic catheter is passed into the endometrial cavity to transfer the embryos. The objective of this survey was to find out what measures are being taken by IVF clinics to prevent ascending infection. Postal questionnaires were sent to 75 clinics in the UK, asking about their sexually transmitted infection screening policies and their protocols on antibiotic prophylaxis. Seventy clinics (93%) responded, of which 37 (53%) neither screen the female partner for C. trachomatis, nor give appropriate antibiotic prophylaxis. Approximately half of UK IVF clinics make no attempt to either detect or treat chlamydial infection prior to embryo transfer. More research is required to evaluate whether embryo transfer does pose a significant risk factor for pelvic inflammatory disease.     

The role of hysteroscopy in the diagnosis of infertility in materials of the 2nd Gynecological Clinic of the Medical Academy in Lódź

Hysteroscopy is one of the routine methods use in gynaecology for diagnosis of "uterine factor" in infertility. The range of the indications for hysteroscopy is very wide and few side effects make it relatively safe. The main aim of the study was the retrospective evaluation of hysteroscopic results among patients with infertility. Physiologic shape of the uterine cavity was diagnosed in 57.1% patients. The number of adhesions inside uterine cavity was lower than described in literature. Different pathology of uterine cavity was diagnosed as frequently as described by other authors.     

The clinical utility of sonographic cervical length in the management of preterm parturition at 28–32 weeks of gestation

Objectives: The aim of this study was to evaluate the role of cervical length measurement in early third trimester (28–32 weeks) as a predictor of preterm delivery (PTD), in women presenting with preterm parturition.

Methods: Cervical length was measured prospectively, in singleton pregnancies at 28–32 weeks with preterm contractions (PTC). A multivariate linear regression model was performed to assess the association between cervical length and gestational age at delivery. Logistic regression analysis with PTD before 34 and 37 weeks of gestation as the outcome variable was performed to control for confounders.

Results: Fifty-six women were included, mean gestational week at presentation and at delivery were 29.88?±?1.13 and 37.05?±?2.86, respectively. There was a direct association between short cervical length at admission and gestational week at delivery (p?=?0.027). This association remained significant even after controlling for confounders. Short cervical length was significantly associated with PTD before 34 (p?=?0.045) or 37 (p?=?0.046) weeks of gestation.

Conclusions: Third trimester cervical length measurement in patients with PTC is associated with gestational week at delivery, as well as PTD prior to 34 and 37 weeks of gestation. Therefore, examining cervical length is clinically valuable and probably cost-effective during early third trimester.     

Why has the acceptance of laparoscopic hysterectomy been slow? Results of an anonymous survey of Australian gynecologists

STUDY OBJECTIVE: To determine whether Australian gynecologists would like to increase the proportion of hysterectomies they perform laparoscopically and the factors that might limit their acceptance of laparoscopic hysterectomy (LH). DESIGN: Anonymous postal survey (Canadian Task Force classification III). SETTING: Department of obstetrics and gynecology of a major Australian medical school. PARTICIPANTS: Seven hundred ninety-six certified obstetrician/gynecologists in practice in Australia. MAIN RESULTS: Of 796 respondents, 654 (82%) reported that hysterectomy was part of their normal clinical practice. Of those, 206 (31%) did not perform LH. Respondents who reported performing the highest proportion of LH were those in urban, private hospital settings. Of those who performed hysterectomy, 62% (403/654) reported they did not wish to increase the proportion of LH they undertook. However, of those, 49% (197/403) already performed LH, with 20% (39/197) of that group performing 80% or more of all hysterectomies as LH. Overall, 38% (251/654) of respondents indicated a desire to perform an increased proportion of LH. The commonest factors cited as limited acceptance of LH were insufficient experience and training, lack of hospital equipment, and lack of support from colleagues. CONCLUSION: Many Australian gynecologists report a desire to increase their rate of LH, but those intentions are compromised by problems with training, equipment, and support.     

The role of TGFβ superfamily members in the pathophysiology of endometriosis

Abstract

The transforming growth factor-beta (TGFβ) superfamily comprises over 30 dimeric proteins with conserved structures, which play important roles in the control of cellular proliferation, differentiation and apoptosis. These proteins are expressed and finely regulated in human endometrium during the menstrual cycle, which is consistent with their effects on endometrial cell proliferation and tissue remodeling. This review is focused on summarizing the role of key members of the TGFβ superfamily in the pathophysiology of endometriosis. Evidence suggests that TGFβ, activins, inhibins, nodal, bone morphogenetic proteins, growth differentiation factors, and anti-Müllerian hormone are produced by endometriotic lesions and could be involved in the establishment and progression of the disease. Their receptors and signaling pathways may also be altered in the presence of endometriosis and may be potential targets to the development of therapeutic agents.     

The role of veno-venous anastomoses in twin–twin transfusion syndrome

The aim of this study was to investigate the independent role of veno-venous (VV) anastomoses in the development of twin–twin transfusion syndrome (TTTS). Thirty TTTS placentas and 41 non-TTTS placentas, routinely injected with colored dye, were enrolled in this study. We excluded all cases with arterio-arterial (AA) anastomoses and TTTS cases treated with laser surgery. The prevalence of VV anastomoses was significantly higher in TTTS cases compared to non-TTTS cases, 37% (11/30) and 7% (3/41), respectively (P < .01; odds ratio 7.3; 95% confidence interval: 1.8–37.1). Our findings suggest that, in the absence of AA anastomoses, VV anastomoses may enhance the development of TTTS.     

Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK

A postal questionnaire concerned with prescribing antenatal corticosteroids was sent to one named clinician at each of 279 obstetric units in the UK. They were asked whether their unit prescribed repeated courses, the indications for which these would be prescribed, the interval between courses, the drugs and regimens used and whether they would be willing to participate in a proposed randomised controlled trial. The response rate was 75%. Of the respondents, 98% prescribed repeated courses; the indications most commonly cited by units who prescribed steroids were prelabour spontaneous rupture of membranes (84.2%), and suspected preterm labour (81.8%). 70.6% of units were willing to participate in the proposed trial.     

Success of infertility treatments in Finland in the period 1992–2005

Objectives

The objective was to study the success rates of infertility treatments in the period 1992–2005 in public and private clinics.

Study design

Aggregate IVF statistics (1992–2005) and nationally representative cross-sectional survey (2002).

Results

The success rates of infertility treatments remained stable, despite a substantial increase in single-embryo transfers. In 2005, the clinical pregnancy rate was 23/100 initiated cycles and a live birth rate of 17/100 cycles. The proportions of term singletons and singletons weighing at least 2500 g improved over time and both rates were 14/100 in 2005. Pregnancy rates improved most among older women during the study period. The success rate in the private sector was significantly better than that in the public sector among women younger than 35 years.

Conclusion

The single-embryo policy has not decreased pregnancy and birth rates. The proportions of term singletons per initiated cycle and singletons weighing at least 2500 g per initiated cycle have improved over time. The higher success rate in the private sector may be because of different clientele.