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India at present has 145,779 active coronavirus disease (COVID) cases and 8884 deaths. Being the largest tertiary care health facility under Delhi Government, our center was designated as a 2000 bedded dedicated COVID hospital. In addition to establishing areas for COVID management, COVID Obstetrics and Gynecology area requires a dedicated set up for delivering women, an operating room, and a neonatal care unit. A phased evacuation plan begins by curtailing non-emergency services and postponing elective surgeries, this process may take longer for obstetrics than other specialties on account of labor and postnatal care. The percentage reduction in the number of elective obstetric and gynecological surgeries was 73% and further fell by 98% (n = 4; category C, D) over a period of 1 month of the evacuation phase, whereas the reduction in emergency cases was only 15% (n = 200) in the beginning and fell to 89%. During the surge phase of COVID, we were able to increase the inpatient surge capacity by 8% (n = 100) as the bed occupancy increased exponentially from 30% to 88%. The start of evacuation of the facility until the endpoint of the surge marks the most dynamic phase of establishing a COVID facility during a pandemic. Pre-event planning for surge capacity at the inception of such pandemics should be based on the local and regional policies which depend on the competing demands of resources to maintain sustainability. These logistical demands are dynamic and vary as the pandemic progresses through its phases.

Despite major setbacks to its health infrastructure and health workforce capacity, Liberia began its first post-graduate training program for physicians in 2013. Specialty training in Internal Medicine, Pediatrics, General Surgery and Obstetrics and Gynecology were the four inaugural Residency programs that recruited graduates from the country's only medical school, A.M. Dogliotti College of Medicine. The Obstetrics and Gynecology residency program was designed to combat the rising maternal mortality and strengthen health systems to improve maternal care. The program adapted in the face of challenges posed by limited financial support, lack of specialist-faculty and general physician shortages and the Ebola virus outbreak. The manuscript discusses the challenges and successes of the program and demonstrates how the shortage of teaching faculty was addressed by developing a collaboration between local government and educational communities, a United States (US) academic institution and volunteers from the Global Health Service Partnership.

Collaboration is essential to manage complex real world problems. We used phenomenologic methods to elaborate a description of collaboration between two departments at an academic medical center who considered their relationship to represent a model of effective collaboration. Key collaborative structures included a shared vision and commitment by leaders, rigorous quality improvement, clear delineation of roles with built-in flexibility, ongoing commitment to formal and informal communication channels and conflict resolution, relationship development grounded in respect and responsiveness, and shared training in a supportive learning environment with legitimate participation fostering skill development. This study reveals the complexity and resources required for collaboration which both explains why collaboration is not as easy to achieve and identifies processes that foster collaboration.

Uteroplacental apoplexy or Couvelaire uterus is a rare complication in the spectrum of the life-threatening placental abruption. We report a 29-year-old pregnant woman who had a placental abruption complicated with the rare condition of Couvelaire uterus, with an delivery per uterus-sparring cesarean section. The early diagnosis and proper medical management of placental abruption through uterus-sparring cesarean section present the best outcome for mother and child.

The increasing incidence of obesity, a significant health problem worldwide, represents a major socio-economic burden with a high impact on the quality of life. It is considered a risk factor for multiple medical conditions. More than half of women from developed countries are overweight or obese, this comorbidity can affect them from puberty through the reproductive period and then in the menopausal period, involving multiple medical and surgical specialties. It has a significant impact on the onset of puberty, the menstrual cycle, ovulation, fertility rate, and pregnancy outcome. In postmenopausal women, obesity represents an important risk factor for breast cancer, endometrial cancers or polyps, fibroids, pelvic organ prolapse, or stress urinary incontinence in addition to a higher risk of post-operative complications and also to some types of fragility fractures, especially if diabetes mellitus is associated. Pelvic floor disorders include pelvic organ prolapse, urinary or fecal incontinence. Obese patients seem more affected compare with normal-weighted females. We introduce a single-center, retrospective study on 74 patients (admitted between 2016 and 2019) with pelvic organ prolapses that were referred for surgical correction, and further on they were evaluated after one month, respective after 6 months since procedure. On admission, the subjects, aged between 41-82 years (median of 57 years) showed a strong correlation between the symptomatology caused by the prolapse degree and obesity (40.54% of them), as it appears that the discomfort and symptoms are significantly higher in the women with higher body mass index. In the reevaluation form, the patients with obesity complaint more frequently compared to the non-obese females about urinary and colorectal distress and low sexual desire and interest. The use of surgical treatment for pelvic organ dysfunctions is a contributor to improved quality of life in adult obese females.

Objective: The goal of this paper is to present the management of cases of deep endometriosis that affects the bladder, the ureters and the kidney. Materials and method: In this review we analyzed the sensitivity and specificity of imaging techniques for diagnosing deep infiltrating endometriosis, the optimal surgical technique and the surgical approach. Results: In patients with pelvic endometriosis in advanced stages the urinary tract is frequently involved. Preoperative work-up of patients with deep infiltrating endometriosis is aimed at evaluating the extension of the lesions in order to assess the complexity of the intervention and to choose the optimal approach. Conclusions: Laparoscopic and robotic management of these cases are good therapeutic alternatives. Ultrasound, sonovaginography with gel and MRI are useful imaging techniques for evaluating patients with deep infiltrating endometriois. The surgical management of patients with deep infiltrating endometriosis that involves the urinary tract consists of partial bladder resections, ureterolysis, ureteral resection and anastomosis and ureteral reimplantation.

Background: Although burnout levels and the corresponding risk factors have been studied in many nursing services, to date no meta-analytical studies have been undertaken of obstetrics and gynecology units to examine the heterogeneity of burnout in this environment and the variables associated with it. In the present paper, we aim to determine the prevalence, levels, and related factors of burnout syndrome among nurses working in gynecology and obstetrics services. Methods: A systematic review and meta-analysis of the literature were carried out using the following sources: CINAHL (Cumulative Index of Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Sciences Literature), Medline, ProQuest (Proquest Health and Medical Complete), SciELO (Scientific Electronic Library Online), and Scopus. Results: Fourteen relevant studies were identified, including, for this meta-analysis, n = 464 nurses. The following prevalence values were obtained: emotional exhaustion 29% (95% CI: 11–52%), depersonalization 19% (95% CI: 6–38%), and low personal accomplishment 44% (95% CI: 18–71%). The burnout variables considered were sociodemographic (age, marital status, number of children, gender), work-related (duration of the workday, nurse-patient ratio, experience or number of miscarriages/abortions), and psychological (anxiety, stress, and verbal violence). Conclusion: Nurses working in obstetrics and gynecology units present high levels of burnout syndrome. In over 33% of the study sample, at least two of the burnout dimensions considered are apparent. ; This research was funded by the Excellence Research Project (P11HUM-7771) provided by the Andalusian Government (Spain).

OBJECTIVE: The number of resident applicants in obstetrics and gynecology in South Korea is decreasing every year. Recently, the government legislated for obstetric no-fault compensation act which obligated obstetrics and gynecology doctors to pay for 50% of the budget to compensate for the unfavorable delivery outcome that the medical provider is not responsible for. The act was faced with obstetrics and gynecology doctors' and in-trainees' resentment for putting unfair financial burden on the shoulders of the medical providers and hospitals in the absence of malpractice. In light of this, the purpose of this study was to investigate the influence of the obstetric no-fault compensation act on the future career of obstetrics and gynecology residents as obstetricians. METHODS: We conducted a survey of 4th grade obstetrics and gynecology residents (n=59) on influence of the obstetric no-fault compensation act on the future career as obstetricians through questionnaire. RESULTS: The result from this survey showed that this act has driven the residents away from providing obstetrical care in the future which will inevitably lead to lack of delivery service in the rural areas. CONCLUSION: We do conclude that the enforcement ordinance of the obstetric no-fault compensation act should be revised. ; open