Hasil untuk "Gynecology and obstetrics"

Albina Hasa, Merita Xhetani, Mirela Lika et al.

Breast cancer is the leading cause of cancer among women and remains one of the most prevalent contributors to cancer-related mortality worldwide. This study aims to evaluate biomarker expression in women with breast cancer and the correlations between them and other prognostic parameters. A retrospective analysis of 252 subjects was conducted at the Oncology Department of Mother Teresa University Hospital in Albania between 2021 and 2024. The highest rate of the disease was observed in the over-45 age group (92.5%). A family history of cancer was reported in 13.9% of patients. The most common histological type identified was ductal carcinoma (81.3%), which predominantly affected the left breast (57.1%) and was most frequently stage 2 (69.8%). A significant association (p < 0.001) was found between disease stage and expression of ER (Estrogen Receptors), PR (Progesterone Receptors), and HER2 (Human Epidermal Growth Factor Receptor 2), as well as between patient age and expression of ER, PR, and HER2 receptors (p = 0.02). HER2 and Ki-67 expression were inversely associated with ER and PR. Ki-67 was significantly correlated with age (p = 0.008) and stage (p < 0.001). Nodal metastasis correlated with Ki-67 (p = 0.02) and ER (p = 0.01).

Smit Bharat Solanki, Vineet V. Mishra, Arminder Singh Dhiman

BACKGROUND: Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored. OBJECTIVE: To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences. DESIGN AND SETTINGS: A single-center retrospective study PATIENTS AND METHODS: Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25–29.9, ≥30.0 kg/m2). MAIN OUTCOME MEASURES: Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates. SAMPLE SIZE: 60 patients (30 in each group) RESULTS: The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories (P <.001). Vault suturing time was shorter in the 3D HD laparoscopy group (P =.002), and total operative time was reduced in overweight patients (P =.015). Obese patients in the 3D group had lower haemoglobin drop (P =.01) and reduced blood loss compared to 2D laparoscopy group (P =.017). CONCLUSION: 3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis—highlighting its value in overcoming challenges of minimally invasive gynecologic surgery. LIMITATIONS: The study's retrospective design and modest sample size limit generalizability.

Ying Sha, Jianfen Zhu, Fangrong Shen

Abstract Objective Polycystic ovary syndrome (PCOS) is an endocrine gynecological disease affecting many women of reproductive age. Clomiphene is the first-line treatment for PCOS patients, but most individuals may be resistant to it. This study aims to assess the efficacy of dexamethasone and clomiphene in the treatment of PCOS patients, and to provide a theoretical basis for clinicians to study and treat PCOS. Methods Chinese and English databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Medical Network, and VIP Information Chinese Journal Service Platform (VIP) were searched from the inception to January 2023. Review Manager and Stata software were used for meta- analysis. The risk of bias of eligible studies were assessed using Cochrane’s risk of bias tool. Publication bias was assessed by funnel plots, Begg’s and Egger’s tests. Results A total of 12 literatures were finally included, with a total of 1270 PCOS patients. Compared with the control group, dexamethasone combined with clomiphene could significantly improve pregnancy (RR = 1.71, P < 0.00001), ovulation (RR = 1.30, P < 0.00001), luteinizing hormone level (SMD = -0.94, P < 0.00001), estradiol level (SMD = 0.99, P = 0.05), progesterone level (SMD = 5.08, P = 0.002) and testosterone level (SMD = -1.59, P < 0.00001). However, there were no significant effects on ovulation-stimulating hormone level (SMD = 0.15, P = 0.37), adverse reactions (RR = 1.30, P = 0.30), dizziness (RR = 1.50, P = 0.45), and vomiting (RR = 1.67, P = 0.48). Conclusion The treatment of dexamethasone combined with clomiphene is helpful to improve the ovulation and pregnancy rate in patients with PCOS, and improve the hormone levels of patients.

The practices of contemporary clinical decision-making and care rely heavily on racial biological essentialism, which is a set of ideas originating in modern science that describes populations as comprising distinct subpopulations with unique sets of essential, heritable characteristics and propensities (i.e., races) purportedly due to their biology.1 Racial biological essentialism exaggerates the relevance of biology to health inequities and promotes the misuse of race (e.g., ?Black race?) in clinical decision-making, care, and research. Decades of research and scholarship2?4 (e.g., human genome project which inadvertently established that more genetic variation exists within each U.S. racial category than between them) have shown that race is fundamentally not biological. A substantial body of evidence clarifies that race is a sociopolitical, not biological construct.5 Nevertheless, the harmful, unscientific practices of racial biological essentialism persist, which helps explain why the misuse of race in clinical decision-making, research, and education remains pervasive. For many years, medical trainees, health equity scholars, and public health physicians have explained how race consciousness (i.e., racism consciousness), which is the understanding of race as a sociopolitical construct, provides a more useful understanding for medicine and public health than racial biological essentialism does.6 This work has taken many forms, including the de-implementation of race-based algorithms used as clinical decision-making tools. In 2020, the Ways and Means Committee in the U.S. House of Representatives asked professional societies across medical disciplines to rethink their use of race-based clinical algorithms. The Committee sent a ?Request for Information? (RFI) to medical professional societies endorsing the elimination of race-based clinical algorithms. The study findings and RFI responses were captured in a 2021 report and captured responses from the professional societies as well as recommendations to improve clinical decision-making.7 The Agency for Healthcare Research and Quality (AHRQ) is also taking on this issue. At the time of this publication, AHRQ is undertaking a systematic review to provide Congress and the public responses to key questions on the impact of race-based clinical algorithms on health outcomes, and what can be done to address and/or mitigate racial bias on the development, validation, etc., of clinical algorithms.8 Since 2021, several professional societies have updated their positions on the inclusion of race in clinical algorithms within their respective specialties. The National Kidney Foundation and the American Society of Nephrology officially endorsed an estimated glomerular filtration rate (e-GFR) calculator without a race variable.9 The American College of Obstetrics and Gynecology no longer endorses a vaginal birth after caesarean calculator that uses race.10 Most recently, the American Thoracic Society issued updated recommendations in spirometry testing and the race-neutral reference equation for all patients, irrespective of race.11 As research continues to elucidate the harms and any benefits from including race in clinical algorithms, the urgency to address race-based algorithms is only intensifying. For instance, 35% of Americans suffering from renal failure are Black, while only representing 13% of the population.12 Many social and clinical factors contribute to this stark inequity, including the misuse of race to modify the e-GFR score, which is used in the diagnosis and treatment of chronic kidney disease (CKD). Race and other social factors have been linked to the e-GFR and other statistics, which has been associated with disproportionate suffering due to (CKD) and its sequalae among Black populations (e.g., higher rates of end-stage CKD diagnosis and lower rates of kidney transplantation eligibility among Black populations).13 Health equity experts agree to the implementation of nonrace-based clinical algorithms that cannot be subjected to the over 10-year timeframe typical for medical research and its adoption into practice.14 To meet the urgency of this moment, the NYC Department of Health and Mental Hygiene launched the Coalition to End Racism in Clinical Algorithms (CERCA). This coalition is a citywide initiative consisting of both safety-net hospitals and academic medical centers representing all five boroughs of NYC. Participation in CERCA requires that each coalition member commit to de-implement at least one race-based algorithm. Members are also required to furnish work, evaluation, and patient engagement plans regarding their de-implementation of race-based algorithms.15,16 In the summer of 2023, the NYC Department of Health and Mental Hygiene hosted the first annual New York City Anti-racism in Medical Education Symposium in partnership with the Josiah Macy Jr. Foundation, the American Academy of Medical Colleges, and the Fund for Public Health NYC. This symposium aimed to identify key stakeholders involved in anti-racism and curriculum development at NYC medical schools and understand the depth and breadth of anti-racism praxis incorporated into their educational programming.16 This special issue of Health Equity hopes to contribute to this growing body of knowledge regarding the de-implementation efforts needed to holistically address and eradicate race essentialism from practice and education. Specifically, this issue highlights scholarship in the following areas: Historical origins of race adjustment in medicine, clinical decision-making tools, and artificial intelligence tools in medicine; Current activities, successes, and challenges around removal of race from clinical decision-making tools at the institution- and system-level and its impact on patient outcomes; City, state, and federal policies and policy analysis supporting removal of race adjustment from clinical decision-making tools; and Programs, interventions, and policies intended to interrupt or end algorithmic racial discrimination in medicine and health care. We hope this publication captures the latest work in addressing race-based medicine and facilitate the adaptation and implementation of initiatives to correct and mitigate the harmful effects of racial discrimination in health care. As we chart the next steps of this movement?which include equitable transplantation access, federal changes in Medicaid and Medicare policy on use of race-based algorithms, biases in artificial intelligence, application of public health critical race praxis (PHCRP) in research, to name a few emerging areas?remaining abreast of current and needed work will be essential to realizing a more equitable, just, and healthy society. According to PHCRP, which is a health equity offshoot of Critical Race Theory, the first step toward advancing health equity is to acknowledge how the conventions of our field help reinforce inequities however well-intentioned our efforts may be. The use of arbitrary race corrections in clinical algorithms relies on and reifies racial biological determinism. It undermines the ability of clinicians to uphold their commitment to beneficence, nonmaleficence, and justice in the provision of care. Failure to uphold them harms minoritized patients and communities through, for instance, delayed or missed diagnoses and the exacerbation of racialized stigmata. A substantial body of scholarship and research now exists to promote more equitable clinical decision-making and care. Consistent with the PHCRP principle of disciplinary self-critique, this special issue documents the continued misuse of race in clinical algorithms. It also offers constructive alternatives that can be implemented immediately.17,18

Yan Huang, Yi Cheng, Min Zhang et al.

Abstract Background Follicular microenvironment has been proposed as an important factor for oocyte grown and maturation. We sought to evaluate the oxidative stress and inflammatory levels in follicular fluid (FF) and association with embryo quality in patients with diminished ovarian reserve (DOR). Methods The current research included 46 DOR cases and 56 normal ovarian reserve (NOR) cases. Twelve representative oxidative stress markers and eight representative inflammatory factors were measured in the FF. Results Oxidative stress markers total GSH (T-GSH) was decreased in the FF from women with DOR compared with that in NOR group (P = 0.041). More modest differences were observed for reduced GSH (rGSH) and rGSH/GSSG. Women with DOR compared to controls had higher level of TNF-α (P = 0.000) and lower level of IL-18 (P = 0.013). Correlation analysis revealed that GSSG was negatively correlated with normal fertilization rate in NOR group (r = -0.358, P = 0.008), and reduced GSH was negatively correlated with normal fertilization rate in DOR group (r = -0.299, P = 0.049). Moreover, as the regression analysis data showed, the GSSG level was significantly associated with embryo quality indicator. Conclusions The FF in DOR patients was accompanied by increased oxidative stress and inflammatory levels. Follicular development of women with DOR might be influenced by unusual IL-18 and TNF-α levels in FF. And oxidative stress marker GSSG in NOR group was a negative predictor for embryo quality.

Daming Chu, Tengteng Liu, Yuan Yao

BackgroundUterine Cervical Carcinoma (UCC) is the most prevalent gynecological malignancy globally, with a rising incidence in recent years. Accumulating evidence indicates that specific viral infections, including human papillomavirus (HPV), Epstein-Barr virus (EBV), Hepatitis B and C viruses (HBV and HCV), and human herpesvirus (HHV), may contribute to UCC development and progression. Understanding the complex interplay between viral infections and UCC risk is crucial for developing novel preventative and therapeutic interventions.MethodsThis comprehensive review investigates the association between viral infections and UCC risk by examining the roles of various viral pathogens in UCC etiology and pathogenesis, and possible molecular mechanisms. Additionally, we evaluate current diagnostic methods and potential therapeutic strategies targeting viral infections for UCC prevention or treatment.ResultsThe prevention of UCC has been significantly advanced by the emergence of self-sampling for HPV testing as a crucial tool, allowing for early detection and intervention. However, an essential challenge in UCC prevention lies in understanding how HPV and other viral coinfections, including EBV, HBV, HCV, HHV, HIV, or their concurrent presence, may potentially contribute to UCC development. The molecular mechanisms implicated in the association between viral infections and cervical cancer development include: (1) interference of viral oncogenes with cellular regulatory proteins, resulting in uncontrolled cell proliferation and malignant transformation; (2) inactivation of tumor suppressor genes by viral proteins; (3) evasion of host immune responses by viruses; (4) induction of a persistent inflammatory response, contributing to a tumor-promoting microenvironment; (5) epigenetic modifications that lead to aberrant gene expression; (6) stimulation of angiogenesis by viruses; and (7) activation of telomerase by viral proteins, leading to cellular immortalization. Additionally, viral coinfections can also enhance oncogenic potential through synergistic interactions between viral oncoproteins, employ immune evasion strategies, contribute to chronic inflammation, modulate host cellular signaling pathways, and induce epigenetic alterations, ultimately leading to cervical carcinogenesis.ConclusionRecognizing the implications of viral oncogenes in UCC etiology and pathogenesis is vital for addressing the escalating burden of UCC. Developing innovative preventative and therapeutic interventions requires a thorough understanding of the intricate relationship between viral infections and UCC risk.

Luca Paun, Alexandre Lavé, Gianpaolo Jannelli et al.

Posterior fossa atypical teratoid rhabdoid tumor (ATRT) is a rare childhood tumor usually associated with a dismal prognosis. Although upfront surgical gross total resection (GTR) has classically been the first line of treatment, new multimodal treatments, including two-stage surgery, are showing promising results in terms of overall survival (OS) and complication rate. We present a case of a 9-month-old child treated with two-staged surgery and chemotherapy. When deemed risky, multimodal treatments, including staged surgeries, can be a safe alternative to reduce surgical mortality and morbidity. At 23 months old, the patient had normal global development and no major impact on quality of life. We, therefore, discuss the most recent advancements from a treatment perspective, including molecular targeting.

Sarah S. Hassan, Ayla K. Ghalib

Background: In situations of a morbidly adherent placenta, studies have shown that maternal serum alfa feto protein (AFP) is clinically high. Objective: To examine the association of morbidly adherent placenta (MAP) in pregnant women with placenta previa (PP) and their serum AFP biomarker. Methods: A prospective observational study that was conducted in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital, Kirkuk, Iraq during the period from Feb. till Nov. 2019. It included 82 pregnant women those between 14-20 weeks of gestation with singleton pregnancy, viable fetus, and diagnosed with low lying placenta, with and without vaginal bleeding. A blood sample from all women was taken to investigate for serum AFP level after confirming the diagnosis of low-lying placenta by early abdominal ultrasound (U/S) scan. All the enrolled pregnant women were followed by Doppler U/S at gestational age 28-32 weeks, underwent targeted screening for MAP and were divided into two groups according to the status of placenta: MAP group included 11 pregnant women and PP group alone included 71 pregnant women. Results: In this study, MAP was diagnosed in 13.4% of cases. Mean of serum AFP biomarker in women with MAP was significantly higher than that in women with PP. Serum AFP biomarker in early pregnancy >200 ng/ml is predictive for diagnosis of MAP in late pregnancy. Conclusion: Maternal serum AFP biomarker may play an important role at early pregnancy in prediction of placental adherence at late pregnancy in cases of early low-lying placenta. Keywords: Morbidly adherent placenta, alpha feto protein, previa, pregnancy, Iraq Citation: Hassan SS, Ghalib AK. Maternal serum alpha feto protein level may predict morbidly adherent placenta in women with placenta previa. Iraqi JMS. 2022; 20(2): 278-285. doi: 10.22578/IJMS.20.2.16

Alessandra Gallo, Attilio Di Spiezio Sardo, Antonietta Legnante et al.

Objective: The coronavirus disease 2019 (COVID-19) pandemic is a global public health concern. Health Care Facilities in every country have to deal with a complete reorganization of labor and delivery unit, and resource management. Aim of this review is to summarize the available literature data about the impact of COVID-19 on hysteroscopic surgery. Mechanism: A search on PubMed and Medline databases was performed until March 2021. Findings in brief: Most of evidence agree on complete cancellation of elective endoscopic gynecologic surgery, and on its deferring until the pandemic has been contained. When hysteroscopy is performed, precautions should be observed to prevent COVID-19 infection. Conclusions: We summarized all best practice to perform safe and effective hysteroscopic surgery in COVID-19 times and in the slow restore of normal activities.

Hanne Lefrère, Giuseppe Floris, Marjanka K. Schmidt et al.

Postpartum breast cancer (PPBC) - which according to new data, can extend to 5–10 years after the birth - are estimated to represent 35–55% of all cases of breast cancer in women younger than 45 years. Increasing clinical evidence indicates that PPBC represents a high-risk form of breast cancer in young women with an approximately 2-fold increased risk for metastasis and death. Yet, the exact mechanisms that underlay this poor prognosis are incompletely understood and, hence, it is unknown why postpartum breast cancer has an enhanced risk for metastasis or how it should be effectively targeted for improved survival. This article is an accompanying resource of the original article entitled “Breast cancer diagnosed in the post-weaning period is indicative for a poor outcome” and present epidemiological data that compare standard prognostic parameters, first site of metastatic disease and survival and metastatic rates in young women with primary invasive breast cancer diagnosed within two years postpartum (PP-BC), in young women diagnosed during pregnancy (Pr-BC) and nulliparous women (NP-BC). Via an international collaboration of 13 centres participating in the International Network on Cancer, Infertility and Pregnancy (INCIP), retrospective data of 1180 patients with primary invasive breast cancer, aged 25–40 years and diagnosed between January 1995 and December 2017 were collected. In particular, tumour-, patient, and therapy-related characteristics were collected. Furthermore, patient files were reviewed thoroughly to assess, for each parity, if and for how long breastfeeding was given. For PP-BC patients, breastfeeding history was used to differentiate breast cancers identified during lactation (PP-BCDL) from those diagnosed post-weaning (PP-BCPW). Primary exposures were prior childbirth or no childbirth, time between most recent childbirth and breast cancer diagnosis, time between cessation of lactation and breast cancer diagnosis and time between breast cancer diagnosis and metastasis or death. Distribution of standard prognostic parameters and first site of distant metastasis among study groups was determined applying fisher's exact, chi-squared, One-Way ANOVA or Kruskal-Wallis tests or logistic regression models, where applicable. The risks for metastasis and death were assessed using Cox proportional hazards models. A subgroup analysis was performed in PP-BCPW patients that never lactated (PP-BCPW/NL), lactated ≤3 months (PP-BCPW/Lshort) or lactated >3 months (PP-BCPW/Llong).

Cielo García-Montero, Oscar Fraile-Martínez, Coral Bravo et al.

Since the worldwide COVID-19 pandemic was declared a year ago, the search for vaccines has become the top priority in order to restore normalcy after 2.5 million deaths worldwide, overloaded sanitary systems, and a huge economic burden. Vaccine development has represented a step towards the desired herd immunity in a short period of time, owing to a high level of investment, the focus of researchers, and the urge for the authorization of the faster administration of vaccines. Nevertheless, this objective may only be achieved by pursuing effective strategies and policies in various countries worldwide. In the present review, some aspects involved in accomplishing a successful vaccination program are addressed, in addition to the importance of vaccination in a pandemic in the face of unwillingness, conspiracy theories, or a lack of information among the public. Moreover, we provide some updated points related to the landscape of the clinical development of vaccine candidates, specifically, the top five vaccines that are already being assessed in Phase IV clinical trials (BNT162b2, mRNA-1273, AZD1222, Ad26.COV2.S, and CoronaVac).

Lukas Ded, Jae Yeon Hwang, Kiyoshi Miki et al.

Out of millions of ejaculated sperm, a few reach the fertilization site in mammals. Flagellar Ca2+ signaling nanodomains, organized by multi-subunit CatSper calcium channel complexes, are pivotal for sperm migration in the female tract, implicating CatSper-dependent mechanisms in sperm selection. Here using biochemical and pharmacological studies, we demonstrate that CatSper1 is an O-linked glycosylated protein, undergoing capacitation-induced processing dependent on Ca2+ and phosphorylation cascades. CatSper1 processing correlates with protein tyrosine phosphorylation (pY) development in sperm cells capacitated in vitro and in vivo. Using 3D in situ molecular imaging and ANN-based automatic detection of sperm distributed along the cleared female tract, we demonstrate that spermatozoa past the utero-tubal junction possess the intact CatSper1 signals. Together, we reveal that fertilizing mouse spermatozoa in situ are characterized by intact CatSper channel, lack of pY, and reacted acrosomes. These findings provide molecular insight into sperm selection for successful fertilization in the female reproductive tract.

S. Nagase, T. Ohta, Fumiaki Takahashi et al.

To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2015 and the Annual Treatment Report for 2010 on the outcomes of patients who started treatment in 2010.

Elena V Sibirskaya, Gulnoza M Turgunova

Today, premenstrual syndrome (PMS) remains one of the relevant issues of adolescent gynecology. The difficulty in treatment of PMS in adolescent girls is associated with a large number of factors. The combination of hormonal, neuro-vegetative, metabolic, mental and emotional deviations requires a comprehensive and more differentiated approach to the treatment of this disease. Aim. Assessment of clinical efficacy and safety of using drospirenone 3 mg and ethinylestradiol 20 µg combination for the treatment of PMS in adolescent girls aged 14-18. Outcomes and methods. The study included female 50 patients who met the criteria: age of 14 to 18 years, no severe extragenital pathology, the menstrual cycle duration within 6 months - 25-32±2 days. Based on examination data, all patients were prescribed a drug containing 3 mg of drospirenone and 20 μg of ethinylestradiol. The duration of therapy was 6 months. Results. Under the drug therapy, a significant decrease in the intensity of PMS manifestations occurred. Conclusions. The use of drospirenone 3 mg and ethinylestradiol 20 µg combination for 3 months in patients with PMS has a beneficial effect on the autonomic nervous system, significantly reduces the rate of pain before and during menstruation, helps to decrease the number and intensity of menstrual flow and ultimately significantly improves the quality of patient life.

M. Irahara, A. Kuwahara, T. Iwasa et al.

The Japan Society of Obstetrics and Gynecology implemented a registry report system for the clinical practice of assisted reproductive technology in 1986. The aggregated results from 1992 to 2014 are reported herein.

O. Ishihara, S. Jwa, A. Kuwahara et al.

The Japan Society of Obstetrics and Gynecology started an online cycle‐based assisted reproductive technology (ART) registry system in 2007. This report presents the characteristics and treatment outcomes of ART registered for the cycles practiced during 2016.

Mathew Leonardi, A. Murji, Rohan D'Souza

Around the world, ultrasound in the specialty of obstetrics and gynecology (Ob/Gyn) has been performed and interpreted by a spectrum of healthcare providers: obstetrician-gynecologists, radiologists, sonographers, midwives and nurses. Depending on training and tradition, and practice differs not only between countries, but even within countries.

Layan Alrahmani, E. Codsi, K. Borowski

H. Brown, S. Carson, H. Lawrence

OBJECTIVE To identify the current challenges in obstetrics and gynecology residency education and propose solutions to overcome these obstacles. METHODS The American College of Obstetricians and Gynecologists (ACOG) hosted the first National Summit on Women's Health on May 31 and June 1, 2017, with a follow-up meeting December 20-21, 2017, at ACOG headquarters in Washington, DC. Invitees from 20 related societies briefly presented their organizations' perspectives and discussed focused questions about specific challenges, proposed solutions, and anticipated obstacles. Finally, participants summarized their top two recommendations to improve current residency training. RESULTS Summit participants identified four primary areas of focus: 1) align curriculum with relevant topics to practice, 2) ensure faculty have the necessary resources and time to teach effectively, 3) consider using the final months of medical school to get a jump start on residency fund of knowledge and skills, and 4) use better assessments during the course of residency. CONCLUSION Representatives of the Council on Resident Education in Obstetrics and Gynecology, the American Board of Obstetrics and Gynecology, and the Accreditation Council for Graduate Medical Education must work together to address these priorities and reach consensus on the curricular content of core training in obstetrics and gynecology.