International Journal of Gynecology & Obstetrics

A vision for FIGO 2009–2012

Gamal I. Serour — 2009-12-02

Professor Gamal Serour, Egypt. FIGO President 2009–2012.

A prospective multicenter audit of labor-room episiotomy and anal sphincter injury assessment in the Netherlands

2009-11-18

Abstract: Objective: To assess the length and angle of mediolateral episiotomies performed by midwives and resident gynecologists at 3 teaching hospitals in the Netherlands, and determine the incidence of obstetric anal sphincter injury.Methods: In this prospective audit conducted between February and September 2008, all women delivered at the 3 hospitals were examined in the labor room for perineal injury. When an injury was assessed as being grade 2 or higher, it was re-evaluated. The incidence of anal sphincter injury was then compared with that reported in the preceding year.Results: Of 1979 women delivered, 420 (21.2%) were given an episiotomy and 58 (2.9%) sustained anal sphincter injury. The episiotomies formed a mean angle of 40° with the perineal midline. There was no difference in length or angle between the episiotomies performed by resident gynecologists and those performed by midwives, and the angle of most episiotomies was sufficiently wide. Compared with the preceding year, the rate of anal sphincter injury was significantly higher.Conclusion: The quality of episiotomies did not differ when performed by midwives or resident gynecologists. To improve the recognition and classification of obstetric anal sphincter injuries, audits based on an internationally accredited classification could easily become a part of routine hospital practice.

Trends and determinants of pregnancy-related domestic violence in a referral center in southern Nigeria

Biodun Olagbuji, Michael Ezeanochie, Adedapo Ande, Ekop Ekaete — 2009-11-26

Abstract: Objective: To describe the trend and identify associated risk factors for pregnancy-related domestic violence.Methods: In a cross-sectional study of 502 women attending the sixth week postnatal clinic in a tertiary hospital in urban Nigeria, participants completed semi-structured questionnaires on experience of domestic violence before and during pregnancy, and in the puerperium. Multivariate logistic regression was used to assess risk factors associated with experiencing violence.Results: The prevalence of domestic violence was 43.5% during the 12months before the pregnancy, 28.3% during the pregnancy, and 4% in the puerperium. Psychological violence was the commonest form of violence experienced. All forms of violence were least common in the puerperium. Experience of violence in the 12months before pregnancy (P<0.0001, odds ratio 274.34 [95% CI, 66.4–1133.8]), HIV seropositivity (P=0.02, odds ratio 2.81 [95% CI, 1.2–6.5]), and regular alcohol intake (P<0.0001, odds ratio 11.60 [95% CI, 3.8–35.1]) significantly increased the likelihood of experiencing domestic violence.Conclusion: Pregnancy-related domestic violence is an important health problem in this community in southern Nigeria. Experience of violence before the pregnancy, HIV infection, and regular alcohol consumption are risk factors.

Four-dimensional sonographic assessment of inter-twin contact late in the first trimester

Mutsuko Sasaki, Toshihiro Yanagihara, Naoko Naitoh, Toshiyuki Hata — 2009-11-26

Abstract: Objective: To evaluate the total number of inter-twin contacts between monochorionic diamniotic (MD) and dichorionic diamniotic (DD) twins using four-dimensional (4D) sonography late in the first trimester of pregnancy.Method: Six MD and 8 DD pregnancies were studied for 30minutes with 4D sonography at 10–11 and 12–13weeks of gestation. A total of 10 types of inter-twin contact was evaluated.Results: There was a significant difference in the total number of all contacts between MD and DD twins at the 10–11weeks of gestation (P<0.05). There was also a significant difference in the total number of contacts between 10–11 and 12–13weeks of gestation in DD twins (P<0.05).Conclusion: Four-dimensional sonography provides a means of evaluating inter-twin contact in the first trimester of pregnancy and could be an accurate and reliable tool in studies of inter-twin behavior.

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Grzegorz Raba, Joanna Skret-Magierlo, Andrzej Skret — 2009-11-05

Abstract: Objective: To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV.Methods: A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire.Results: Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30years age group residing in towns.Conclusion: These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.

Predictors of postpartum viral load rebound in a cohort of HIV-infected Brazilian women

2009-11-06

Abstract: Objective: To assess the postpartum viral load of HIV-infected women treated with potent antiretrovirals (ARVs) during pregnancy, and look for predictors of viral load rebound.Methods: Of 112 women who took potent ARVs during pregnancy, 60 took them as prophylaxis to prevent mother-to-child transmission of HIV. The remaining 52, who had AIDS, were treated continuously with ARVs before, during, and after pregnancy. Viral load was evaluated in the weeks before, just before, and after delivery. Viral load rebound was defined as a 0.5 log10 increase in viral RNA as measured 6months after delivery.Results: A viral load rebound affected women much more often in the prophylaxis than in the treatment group (84.7% vs 15.3%; P<0.001), and was associated with ARV discontinuation. The women with a viral load rebound had a higher decline in CD4 lymphocyte percentage 6months after delivery. On multivariate analysis, variables positively or negatively associated with a viral load rebound were a decline in CD4 lymphocyte count (P=0.01), the therapeutic use of potent ARVs (P<0.001), and the number of prenatal visits (P=0.03).Conclusion: Discontinuing the use of potent ARVs after delivery was associated with a decrease in CD4 lymphocyte count and a viral load rebound.

Effect of the “cough technique” on cryotherapy freezing temperature

2009-11-05

Abstract: Objective: To assess the impact of the cough technique on the tip temperature reached in a cryotherapy device commonly used to treat precancerous cervical lesions.Methods: During February to March 2009, bench testing was conducted in Peru on 3 Wallach LL100 cryotherapy units using locally obtained carbon dioxide as the refrigerant. The temperature at the cryo tip was measured continuously with a thermocouple. Mean temperatures recorded with and without the cough technique were compared across the 3 cryotherapy devices.Results: Higher mean temperatures were observed with the cough technique (–21.7°C [95% CI, –23.0 to –20.4]; –22.0°C [95% CI, –24.2 to –19.7]; –29.4°C [95% CI, –30.3 to –28.6]) compared with mean temperatures observed with the standard procedure (–38.6°C [95% CI, –44.8 to –32.4]; –36.0°C [95% CI, –43.5 to –28.5]; –41.4°C [95% CI, –49.8 to –33.0]). No test performed with the cough technique reached a temperature below –33°C.Conclusion: Higher temperatures were observed when the cough technique was used. Caution should be exercised by practitioners who use this procedure when performing cryotherapy because the temperatures obtained may not be sufficient to destroy precancerous tissue.

Cryotherapy for HPV clearance in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions

2009-11-05

Abstract: Objective: To compare the clearance rate of HPV infection among women aged older than 30years with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSIL) 1year after cryotherapy with the spontaneous clearance rate (observation).Method: HPV DNA typing by polymerase chain reaction and reverse line blot hybridization were used to identify 14 high-risk types and 23 low-risk types. HPV DNA sequencing was also used for other types.Result: Between December 2007 and March 2009, 100 women were recruited to the study and 60 cases had positive results on HPV testing. Twenty-nine patients were randomly allocated to the cryotherapy group and 31 to the observation group. At 1year, 89.7% (26/29; 95% CI, 78.6–100%) of the cryotherapy group and 90.3% (28/31; 95% CI, 79.9–100%) of the observation group had negative results on HPV testing (0.6% difference; 95% CI, –15.8 to 14.6%, P=0.94).Conclusion: Cryotherapy failed to increase the clearance of prevalent HPV infections among women with LSIL, although in both arms the clearance rates were above 80%. However, in coupling with visual inspection with acetic acid as a single visit approach, its effect on prevention of HSIL and cervical cancer is still promising. Therefore, cryotherapy should not be withdrawn from such programs. (ClinicalTrials.gov Identifier: NCT00566579).

Secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer

2009-11-05

Abstract: Objective: To determine the risks and benefits of secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer.Methods: Data were obtained retrospectively for all women with recurrent platinum-sensitive epithelial ovarian cancer who underwent a second debulking operation between 1998 and 2008 at the University of Texas Southwestern Medical Center. Survival analysis and comparisons were performed using the Kaplan-Meier method, log-rank test, and Cox multivariate proportional hazards model.Results: Optimal secondary cytoreductive surgery (<5mm of residual disease) was achieved in 32 of 40 patients (80%). Nine women (23%) developed major complications. Two variables, residual disease of less than 5mm vs 5mm or greater (median 63months vs 11months; P=0.003); and less than 5 vs 5 or more sites of disease relapse (median 63months vs 22months; P=0.009), were independently associated with survival and retained prognostic significance on multivariate analysis.Conclusions: Optimal secondary cytoreductive surgery was associated with a survival advantage and acceptable risks.

Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization

Anupama Bahadur, Neena Malhotra, Suneeta Mittal, Neeta Singh, Sumana Gurunath — 2009-11-05

Abstract: Objectives: To assess the efficacy of antitubercular treatment on the uterine cavity in infertile women diagnosed with genital tuberculosis using second-look hysteroscopy.Methods: A total of 70 women with genital tuberculosis who underwent second-look hysteroscopy were enrolled in the study. They were started on antitubercular drugs and followed up after 6months of therapy with second-look hysteroscopy. McNemar's χ2 test was used to compare the hysteroscopy findings before and after antitubercular treatment.Results: Antitubercular treatment improved hysteroscopy findings in women with thin or flimsy adhesions (grade I), singular dense adhesions (grade II), and occluding adhesions at the internal os (grade IIa) (P<0.01). Patients with extensive adhesions, extensive endometrial scarring, fibrosis, and a tubular cavity showed no improvement after antitubercular treatment. Mean endometrial thickness of the 70 patients on day 21 prior to starting drug therapy was 6.8mm, which increased to 8.1mm after 6months of treatment.Conclusion: Considering the exorbitant cost of assisted reproductive technology in low-resource countries, it is necessary to consider reassessment of the uterine cavity prior to beginning such treatment.

Assessment of the physical activity behavior and beliefs of infertile women during assisted reproductive technology treatment

Mert Kucuk, Fadime Doymaz, Bulent Urman — 2009-11-09

Abstract: Objectives: To understand the physical activity beliefs of infertile women, and their physical activity behavior before and during assisted reproductive technology (ART) treatment.Methods: Infertile women undergoing ART treatment completed a survey assessing their physical activity beliefs. In addition, the physical activity behavior of the participants was assessed via the Godin Leisure–Time Exercise Questionnaire.Results: The participants were significantly less physically active during the treatment period, with 80.1% reporting that they believed there would be a negative effect on the outcome of their treatment if they did not limit their physical activity.Conclusion: The present study showed that women's physical activity may decline during ART treatment because of the misconception that pursuing their pre-treatment physical activity routine would decrease their chance of conceiving.

Risk factors for unexplained recurrent spontaneous abortion in a population from southern China

Bi-Yun Zhang, Yi-Sheng Wei, Jian-Min Niu, Yi Li, Zhu-Lin Miao, Zi-Neng Wang — 2009-11-09

Abstract: Objective: To determine risk factors for recurrent spontaneous abortion (RSA) in women from southern China.Method: We looked for associations between RSA and body mass index (BMI), family history of spontaneous abortion, smoking, exposure to environmental tobacco smoke (ETS [also known as passive smoking]), and alcohol and coffee consumption using an unconditional logistic regression model involving 326 patients with RSA and 400 controls.Results: Whereas smoking, alcohol consumption, and coffee consumption were not associated with increased risk of RSA, both short (<1hour/day) and long (≥1hour/day) periods of ETS were associated (adjusted odds ratio [OR], 2.30; 95% confidence interval [CI], 1.50–3.52 and adjusted OR, 4.75; 95% CI, 3.23–6.99, respectively). The increased risk of RSA was significant for participants with a BMI of 24.0 or greater (adjusted OR, 1.54; 95% CI, 1.12–2.14) and those with a family history of miscarriage (adjusted OR, 2.12; 95% CI, 1.28–3.49).Conclusion: We found ETS, a higher BMI, and a family history of RSA to be independent risk factors for RSA in our population.

Dysmenorrhea in a multiethnic population of adolescent Asian girls

Li Ping Wong, Ee Ming Khoo — 2009-11-30

Abstract: Objective: To determine the prevalence of dysmenorrhea, its impact, and the treatment-seeking behavior of adolescent Asian girls.Method: A cross-sectional study with 1092 girls from 15 public secondary schools and 3 ethnic groups in the Federal Territory of Kuala Lumpur, Malaysia.Results: Overall, 74.5% of the girls who had reached menarche had dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance. Ethnicity and form at school were significantly associated with the poor concentration, absenteeism, and restriction of social and recreational activities attributed to dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact, and management of dysmenorrhea.Conclusion: There is a need for culture-specific education regarding menstruation-related conditions in the school curriculum.

Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome

Hossam O. Hamed, Asmaa F. Hasan, Omyma G. Ahmed, Marwa A. Ahmed — 2009-11-05

Abstract: Objective: To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.Methods: A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n=55) or laparoscopic ovarian drilling (group 2, n=55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ2 test was used for comparisons of ovulation, pregnancy, and abortion rates.Results: Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P<0.001 vs P<0.001), and luteinizing hormone (P<0.05 vs P<0.001), while the glucose to insulin ratio was significantly increased (P<0.001 vs P<0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P<0.04; 50.8% [131/258] vs 33.5% [94/281], P<0.001; and 38.2% [21/55] vs 20.0% [11/55], P<0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.Conclusion: Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy.

Association of biochemical hyperandrogenism with type 2 diabetes and obesity in Chinese women with polycystic ovary syndrome

Xiaomiao Zhao, Junmin Zhong, Yaqin Mo, Xiaoli Chen, Yaxiao Chen, Dongzi Yang — 2009-11-26

Abstract: Objective: To evaluate the effect of hyperandrogenism on metabolic disorders among patients with polycystic ovary syndrome (PCOS) diagnosed using the Rotterdam criteria.Methods: A retrospective analysis of the clinical records of 883 women with PCOS and 717 premenopausal controls identified from the general population.Results: A total of 686 (77.7%) patients were classified with PCOS based on National Institutes of Health (NIH) criteria, and 164 out of 197 (83.2%) additional patients had no hyperandrogenism. Women with normal androgen levels exhibited lower frequencies of obesity, type 2 diabetes, acanthosis nigricans, genetic history of diabetes, and elevated Matsuda index compared with hyperandrogenic patients. Hyperandrogenemia, but not hirsutism, was independently associated with the risk for type 2 diabetes (odds ratio [OR] 5.7; P=0.028) and obesity (OR 1.7; P=0.005) among Chinese patients with PCOS.Conclusions: Hyperandrogenemia is associated with type 2 diabetes and obesity in Chinese women with PCOS and should be considered at first-line management of hyperandrogenism and infertility due to PCOS.

Reasons for low utilization of a maternity waiting home in rural Kenya

Lazarus Mramba, Faiza Ahmed Nassir, Charles Ondieki, Davies Kimanga — 2009-11-05

Maternal mortality is a severe problem in low-resource countries. Each year more than 500000 women die from pregnancy-related complications and 60million women deliver at home with no skilled care . Although the target of Millennium Development Goal 5 is to reduce maternal mortality by three-quarters between 2000 and 2015 , the number of maternal deaths has been increasing in Sub-Saharan Africa, indicating that this region may not meet this target .

Birth outcomes among pregnant women with genital warts

Ferenc Bánhidy, Nándor Ács, Erzsébet H. Puhó, Andrew E. Czeizel — 2009-11-05

Genital warts (condylomata acuminata) occur as pedunculated masses on the vulva, varying from the size of a pinhead to coverage of the entire vulva. The condition is caused by low-risk human papillomavirus (HPV) types 6 and 11, and rarely types 42, 43, 44, and 54 . The infection is commonly asymptomatic or atypical . Because approximately 40% of sexually active women are affected by HPV, genital warts can occur frequently in pregnant women . Although transplacental transmission of HPV is known, a high risk of structural birth defects in the fetus has not been recognized . The aim of the present study was to investigate the association between genital warts and congenital abnormalities using the large population-based Hungarian Case-Control Surveillance of Congenital Abnormalities database .

Maternal and child health research focusing on interventions that involve consumer participation

2009-11-05

Use of health institutions by mothers and their children in low-income countries has not shown major improvement in recent years . Many organizations have begun to investigate patient and family-centered models of care, considering consumer involvement as a key issue in improving population health. Evidence supporting the implementation of “community interventions”—interventions that do not take place in health facilities—to reduce maternal and perinatal mortality is increasing .

Acceptability of the intrauterine device among women in El Salvador

Raegan McDonald-Mosley, Kameelah Philips, Lauren Ditzian, Miriam Cremer — 2009-11-09

The intrauterine device (IUD) is a safe and effective form of contraception; however, it is used by only 4.1% of women in Latin America . In El Salvador, less than 1% of contraception users choose the IUD , with prior research indicating that myths regarding the safety of the method are significant barriers to its use among Salvadoran women . The aim of the present study was to investigate the comprehension and apprehension among rural Salvadoran women with regard to the IUD.

Intrauterine fallopian tube incarceration after vacuum aspiration for pregnancy termination

Claudia Trio, Dario Recalcati, Federica Sina, Robert Fruscio — 2009-11-18

Vacuum aspiration is the most widely used technique for surgical termination of pregnancy in the first trimester. Uterine perforation is a rare complication, occurring in approximately 0.09–2.8 per 1000 cases .

Administration of a pharmacophysiologic dose of recombinant human chorionic gonadotropin at menses promotes corpus luteum rescue

2009-11-09

Recombinant human chorionic gonadotropin (rhCG) can be administered during the late follicular phase of ovulation induction to promote selection and growth of the most competent follicle cohort . An elevated pregnancy rate was observed recently, following in vitro fertilization (IVF), when rhCG was administered on the first day of menses in an effort to reduce the recruitment of a secondary follicle cohort . This tactic is aimed at increasing the pregnancy rate and reducing the risk of ovarian hyperstimulation syndrome; however, rescuing a prior corpus luteum, which may result in the premature elevation of progesterone levels during ovulation induction, could be detrimental to IVF outcome by reducing endometrial receptivity and interfering with follicle development . Thus, the present study aimed to evaluate whether rhCG administration on the first day of menses promoted corpus luteum rescue and to determine the frequency of such rescue.

Failure of cabergoline to prevent severe ovarian hyperstimulation syndrome in patients with extremely high estradiol levels

Jiann-Loung Hwang, Yu-Hung Lin, Kok-Min Seow — 2009-11-09

Ovarian hyperstimulatilon syndrome (OHSS) is a life-threatening complication associated with ovarian stimulation. Among the several strategies to prevent OHSS, coasting—withholding gonadotropins and delaying administration of human chorionic gonadotropin (hCG)—is the most popular . Although the pathophysiology is not fully understood, vascular endothelial growth factor (VEGF) has been proposed to be the key mediator . Several studies have shown that cabergoline, which antagonizes VEGF effect on vascular permeability, effectively prevented OHSS . We report two patients at high risk for OHSS who developed the complication despite undergoing combined treatment with coasting and cabergoline.

A report on the reproductive health of women after the massive 2008 Wenchuan earthquake

Shujuan Liu, Juntao Han, Dan Xiao, Cuiling Ma, Biliang Chen — 2009-11-05

Abstract: Objective: To evaluate the reproductive health of women in the aftermath of the 2008 Richter scale 8.0 Wenchuan earthquake in China.Methods: Gynecologists surveyed 170 women using a questionnaire inquiring about symptoms of reproductive tract infection, menstruation disorders, satisfaction with sexual life, and desire for fertility.Results: The rates of symptoms of lower genital tract infection were higher after than before the earthquake (50.0% vs 26.5%), as were the rates for pelvic inflammatory disease (35.9% vs 19.4%) and menstruation disorders (51.8% vs 22.4%) (P<0.05 for all). At the same time, the women's satisfaction with their sexual life was markedly decreased; 89.4% of them said they would not pursue a plan to become pregnant; and 67.1% said they would request pregnancy termination if they became pregnant.Conclusion: The findings of this first population-based assessment of reproductive health following the massive Wenchuan earthquake may help in shaping public health measures benefiting women surviving large-sale disasters.

Costs of post-abortion care in low- and middle-income countries

Jessica C. Shearer, Damian G. Walker, Michael Vlassoff — 2009-12-25

Abstract: Objective: To evaluate the quality of costing studies of post-abortion care from low- and middle-income countries and to describe costs in various settings.Methods: A systematic review identified unit costs. Descriptive statistical analysis and univariate regression analysis identified drivers of unit costs of post-abortion care.Results: There are few cost studies from Asia or Eastern Europe. Data indicate that the cost (in 2007 international dollars) of post-abortion care in Africa and Latin America is $392 and $430, respectively, per case.Conclusion: Differences in post-abortion care costs were associated with region, procedure, facility level, case severity, and whether the study was operations research. Methods varied between studies, and efforts should be made in future research to improve consistency. Additional data are needed from Asia and Eastern Europe, as well as the costs of medical methods of uterine evacuation. These data justify improved access to contraception and safe, legal abortion.

The legal effects of fetal monitoring guidelines

Bernard M. Dickens, Rebecca J. Cook — 2009-11-24

Abstract: The new American College of Obstetricians and Gynecologists’ (ACOG) monitoring guidelines introduce a new category of interpretation of fetal heart rate tracings between reassuring and nonreassuring, namely intermediate. The purpose is to reduce unnecessary cesarean deliveries. The legal role of medical guidelines is ambivalent. Providers are expected to be familiar with such guidelines, but also to exercise clinical judgment in their patients’ interests. Practice departing from guidelines requires justification, but simple compliance without regard to patients’ circumstances may constitute negligence. Some courts defer to medical professional guidelines, but others hold that professional standards are set as a matter of law, not by the profession itself. Unlike conclusions in medical science, which are open to continuing review, courts determine facts in a case only once, at trial. Litigation to compel patients’ compliance with medical advice based on guidelines may fail, as may prosecutions, more common in the US, of patients who defy such advice.

Brain drain of healthcare workers: FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health

Jacques Milliez — 2009-11-24

The FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health considers the ethical aspects of issues that impact the discipline of obstetrics, gynecology, and women's health. The following document represents the result of that carefully researched and considered discussion. This material is intended to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Corrigendum to “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium” [International Journal of Gynecology and Obstetrics (2009) 105: 103–104]

Sergio Pecorelli — 2009-10-12

The Author regrets that errors occurred in the original . The corrected appears below:

John J. Sciarra Prize Paper Award for 2010

2010-02-01

International Calendar

2010-02-01