Author Interviews, Infections, JAMA, OBGYNE / 19.03.2014

Shamez Ladhani, MRCPCH PhD Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, LondonMedicalResearch.com Interview with: Shamez Ladhani, MRCPCH PhD Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London   MedicalResearch.com: What are the main findings of the study? Dr. Ladhani: Pregnancy was associated with an increased of serious infection by a bacterium called Haemophilus influenzae which is usually associated with respiratory tract infections. Nearly all the H. influenzae were unencapsulated; that is, they did not have an outer sugar capsule which is often required to make the bacterium more virulent. The encapsulated H. influenzae type b (Hib), for example, was the most common cause of bacterial meningitis in your children prior to routine immunisation. We also found that infection with unencapsulated H. influenzae was associated with poor pregnancy outcomes, including miscarriages, stillbirth and premature birth. (more…)
AHA Journals, Author Interviews, Diabetes, Heart Disease, OBGYNE / 18.03.2014

Erica P. Gunderson, PhD, MS, MPH Senior Research Scientist, Cardiovascular and Metabolic Section Division of Research, Kaiser Permanente Northern California Oakland, CA 94612-2304MedicalResearch.com Interview with: Erica P. Gunderson, PhD, MS, MPH Senior Research Scientist, Cardiovascular and Metabolic Section Division of Research, Kaiser Permanente Northern California Oakland, CA 94612-2304 MedicalResearch.com: What are the main findings of the study? Dr. Gunderson: The study found that: -   Gestational diabetes is a pregnancy complication that reveals a woman’s greater risk of future heart disease. -   Women who experience gestational diabetes face an increased risk of subclinical atherosclerosis (early heart disease) even if they do not develop type 2 diabetes or the metabolic syndrome years after pregnancy. -   Study participants with a history of gestational diabetes who did not develop diabetes or metabolic syndrome showed a greater carotid artery wall thickness (marker of early atherosclerosis) compared to those who never experienced gestational diabetes.  The vessel narrowing also could not be attributed to obesity or other risk factors for heart disease that were measured before pregnancy. -   Weight gain and blood pressure elevations in women with gestational diabetes were responsible for these differences in the artery wall thickness. (more…)
Author Interviews, BMJ, OBGYNE / 12.03.2014

MedicalResearch.com Interview with: Dr Josefin Vikström Division of Obstetrics and Gynecology Department of Clinical and Experimental Medicine Faculty of Health Sciences Linköping University, Linköping, Sweden MedicalResearch.com: What are the main findings of the study? Dr. Vikström: Our study showed that women with a female infertility factor were more than two times more likely to have been born with a low birth weight (less than 2500g) or small for gestational age compared to women where the cause of infertility was unknown and/or male. (more…)
Alcohol, Author Interviews, BMJ, OBGYNE / 12.03.2014

Camilla Nykjaer, PhD Student School of Food Science and Nutrition University of Leeds, Leeds, UKMedicalResearch.com Interview with: Camilla Nykjaer, PhD Student School of Food Science and Nutrition University of Leeds, Leeds, UK   MedicalResearch.com: What are the main findings of the study? Answer: In our study, there was an association between the mother drinking alcohol during early pregnancy and being born preterm or small for gestational age. Babies of women who drank more than 2 units of alcohol per week in the first trimester were more likely to be born preterm, small for gestational age and with lower birth weight compared to non-drinkers, even after adjusting for a range of confounders including cotinine levels as a biomarker for smoking status. The association with preterm birth was present even in those mothers who reported drinking less than 2 units/week. (more…)
Author Interviews, BMJ, Nutrition, OBGYNE / 05.03.2014

MedicalResearch.com Interview with: Dr Linda Englund-Ögge Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Sahlgrenska Academy, Sahlgrenska University Hospital Gothenburg, SwedenDr Linda Englund-Ögge Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Sahlgrenska Academy, Sahlgrenska University Hospital Gothenburg, Sweden MedicalResearch.com: What are the main findings of the study? Answer: Women adhering to a prudent* or a traditional** dietary pattern during pregnancy had a significantly reduced risk of preterm delivery, even after adjusting for a range of confounders. The prudent pattern was also significantly associated to lower risk in the nulliparous, in spontaneous and in late preterm delivery. *, characterized by high intake of e.g. vegetables, fruit, whole grains and water to drink. **, characterized by high intake of e.g. boiled potatoes, fish and cooked vegetables. (more…)
Author Interviews, OBGYNE, PLoS / 21.02.2014

Prof. Nicholas J. Wald Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry Queen Mary University of London London, United KingdomMedicalResearch.com Interview with: Prof. Nicholas J. Wald Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry Queen Mary University of London London, United Kingdom MedicalResearch.com: What are the main findings of the study? Prof Wald: The percentage of women who become pregnant without having taken folic acid supplements to reduce the risk of a neural tube defect declined from a relatively low proportion (35%) to an even lower one (31%) between 1999 and 2012. Moreover such use of folic acid in some groups of the population is much lower for example 17% in Afro-Caribbean women and 6% in women aged under 20. (more…)
Clots - Coagulation, OBGYNE, Stroke / 20.02.2014

Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City.MedicalResearch.com Interview with: Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City. MedicalResearch.com: What are the main findings of the study? Dr. Kamel: The risk of thrombotic events remains higher than normal for twice as long after childbirth as previously thought. However, the absolute risk in any given patient is low, especially after the first 6 weeks. (more…)
Alcohol, Author Interviews, OBGYNE, PLoS / 18.02.2014

MedicalResearch.com: Interview with: Sylvia Lui Tommy’s Maternal and Fetal Health Research Centre The University of Manchester MedicalResearch.com: What are the main findings of the study? Answer: The research shows women who drink alcohol at moderate or heavy levels in the early stages of their pregnancy might damage the growth and function of their placenta – the organ responsible for supplying everything that a developing infant needs until birth (more…)
Author Interviews, CMAJ, OBGYNE / 10.02.2014

MedicalResearch.com Interview with: Dr. Sharon Daniel MD, MPH Physician, Intern in pediatrics at Soroka Medical Center, Beer-Sheva, Israel PhD Candidate and Prof. Amalia Levy (MPH, PhD Epidemiologist, Head of the Department of Public Health Principle Investigator. Ben-Gurion University of the Negev in Beer-Sheva, Israel, MedicalResearch.com: What are the main findings of the study? Answer: We tested the risk for miscarriage following the use of NSAIDs (ibuprofen, diclofenac, naproxen, indomethacin, etodolac) on the first trimester of pregnancy. We did not find increased risk among women who took those drugs during the first trimester of pregnancy, although we did find increased risk after the use of indomethacin. We found higher risk after the use of specific NSAIDs (Celecoxib, Rofecoxib, Etoricoxib) which are usually used to treat inflammatory diseases, only the exposure group was very small. (more…)
Author Interviews, BMJ, OBGYNE, Pediatrics / 16.01.2014

Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women's Mood and Anxiety Clinic: Reproductive Transitions, Fellowship Director, Sunnybrook Health Sciences Centre, Scientist, Sunnybrook Research Institute Adjunct Scientist, Women's College Research Institute, Associate Professor, Faculty of Medicine, University of TorontoMedicalResearch.com Interview with: Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women's Mood and Anxiety Clinic:  Reproductive Transitions, Fellowship Director, Sunnybrook Health Sciences Centre, Scientist, Sunnybrook Research Institute Adjunct Scientist, Women's College Research Institute, Associate Professor, Faculty of Medicine, University of Toronto MedicalResearch.com: What are the main findings of the study? Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy (but not early) are at risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains high in the lungs following birth and which results in breathing difficulties.  The symptoms can range from mild to severe, but the condition can be managed successfully typically after SSRI exposure. It is important to note that the baseline risk for PPHN in the general population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy (increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to 351 women would have to be treated with an SSRI during late pregnancy in order to result in 1 additional case of PPHN. (more…)
Author Interviews, MRSA, OBGYNE / 10.01.2014

MedicalResearch.com Interview with: Dr. Andrea Parriott MPH, PhD Department of Epidemiology Fielding School of Public Health University of California Los Angeles

MedicalResearch.com: What are the main findings of the study? Dr. Parriott:  We wanted to know whether hospital and provider volume (i.e. the number of deliveries performed by each hospital and provider per quarter) and cesarean section rates were predictors of the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection before discharge from the hospital (after delivering a baby). We did not find an association between any of these variables and risk of MRSA infection. (more…)
Allergies, Author Interviews, JAMA, OBGYNE / 29.12.2013

MedicalResearch.com Interview with: Michael C. Young, M.D. Associate Clinical Professor of Pediatrics Harvard Medical School Division of Allergy & Immunology Children's Hospital Boston MedicalResearch.com: What are the main findings of the study? Dr. Young: We found an association between increased maternal peripregnancy consumption of peanuts/ tree nuts and reduced risk of nut allergies in the offspring. (more…)
Author Interviews, OBGYNE / 21.12.2013

MedicalResearch.com Interview with: Jean-Louis Serre EA 2493 ‘Pathologie Cellulaire and Génétique, de la Conception à la Naissance’, Université de Versailles, Saint Quentin en Yvelines, France SFGH (Société Française de Génétique Humaine), Villejuif, France and Jean-Pierre Siffroi Commission de Génétique, Fédération Française des CECOS, UMR S933 INSERM/Université Pierre et Marie Curie (UPMC), Paris, France MedicalResearch.com: What are the main findings of the study? Answers:
  • Anonymous sperm donation may lead to unions between relatives, especially between half-siblings and to an increase of both consanguinity and the frequencies of recessive diseases. We made an evaluation of the actual consequences of anonymous sperm donation in France and we concluded that they can be considered as negligible when compared to those due to false paternities, four times higher.
  • The risk of inadvertent unions between half-sibs is often advocated and we showed that it may be estimated to as few as one case every 10 years. Consequently, the main level of consanguinity in the French population is not modified and unions between first cousins within the sub-population from Mediterranean origin remain the main source of consanguinity.
(more…)
Author Interviews, Mental Health Research, OBGYNE / 19.12.2013

Rada K. Dagher, Ph.D. Assistant Professor, University of Maryland School of Public Health Department of Health Services Administration College Park, MD 20742MedicalResearch.com Interview with: Rada K. Dagher, Ph.D. Assistant Professor, University of Maryland School of Public Health Department of Health Services Administration College Park, MD 20742 MedicalResearch.com: What are the main findings of the study? Dr. Dagher: The main finding of this study is that taking leave from work up to six months after childbirth is associated with a decrease in maternal postpartum depressive symptoms; thus longer maternity leaves may protect against the risk of postpartum depression. We conclude that the 12 week leave duration provided by the Family and Medical Leave Act (FMLA) of 1993 may not be sufficient for women who are at risk or experiencing postpartum depression. Moreover, the unpaid nature of the FMLA makes it harder for mothers with limited financial means to take longer leaves; thus, many of these mothers may have to take leaves that are much shorter in duration than 12 weeks. (more…)
Author Interviews, NEJM, OBGYNE / 06.12.2013

MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women's Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What are the main findings of the study? Dr. Kulkarni: Our study estimates the contribution of fertility treatments and natural conception to multiple births. Fertility treatments include IVF and non-IVF treatments. Non-IVF treatments primarily include ovulation induction and ovarian stimulation coupled with timed intercourse or intrauterine insemination (IUI). All estimated proportions were adjusted for maternal age which makes this study unique. The incidence of twin births nearly doubled and the incidence of triplet and higher-order births quadrupled over the last 4 decades. Our study estimates that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments, after adjusting for maternal age. After initial increase, the incidence of triplet and higher order births decreased by 29% from 1998 to 2011. The decrease in triplet and higher order births has coincided with a 70% reduction in the transfer of 3 or more embryos during IVF and a 33% decrease in the proportion of triplet and higher order births attributable to IVF. The decline in the number of embryos transferred during IVF became possible due to monitoring of ART treatments and outcomes and the work of professional societies, which have repeatedly revised practice guidelines to include recommendations for lowering the number of embryos transferred. In contrast, non-IVF fertility treatments of ovulation induction and ovarian stimulation are estimated to contribute the increasing number of multiple births. Hence there is a need for surveillance of births from non-IVF fertility treatments. (more…)
Author Interviews, Autism, OBGYNE / 01.12.2013

MedicalResearch.com Interview with: Jakob Christensen Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Merete Juul Sørensen Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Denmark MedicalResearch.com: What are the main findings of the study? Answer: We found that the risk of autism spectrum disorder was increased by 50% in children of mothers who took antidepressants during pregnancy. However, when we controlled for other factors related to the medication, by comparing with children of mothers with a diagnosis of depression or with un-exposed siblings, the risk was smaller and not significantly increased. (more…)
Author Interviews, Cost of Health Care, General Medicine, JAMA, OBGYNE / 26.11.2013

dr_Deanna-KepkaMedicalResearch.com Interview with Deanna Kepka, PhD, MPH   Assistant Professor College of Nursing & Huntsman Cancer Institute University of Utah MedicalResearch.com: What are the main findings of the study? Dr. Kepka: Nearly two-thirds, 64.8% (95% CI: 62.2% - 67.3%) of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy and more than half,  58.4% (95% CI: 55.3% - 61.4%)  of women age 65 years and older without a hysterectomy reported a Pap test in the past three years.  Together, this represents approximately 14 million in the United States. (more…)
Author Interviews, Karolinski Institute, OBGYNE, Weight Research / 16.11.2013

MedicalResearch.com: Interview with: Olof Stephansson MD, PhD Associate professor, senior consultant in obstetrics and gynaecologyDepartment of Medicine, Clinical Epidemiology Unit, Karolinska InstitutetDepartment of Women’s and Children’s Health, Division of Obstetrics and Gynaecology Karolinska Institutet, Stockholm, Sweden MedicalResearch.com: What are the main findings of the study? Answer: Women with a history of bariatric surgery have an increased risk of preterm delivery, a doubled risk for small-for-gestational-age births and a reduction in large-for-gestational-age births. Also when considering maternal weight, education, age, parity and year of birth. There was no increased for stillbirth or neonatal mortality. (more…)
Author Interviews, Cancer Research, OBGYNE, Pediatrics / 09.11.2013

Alastair Sutcliffe M.D., Ph.D. From the Institute of Child Health University College LondonMedicalResearch.com  Interview with: Alastair Sutcliffe M.D., Ph.D. From the Institute of Child Health University College London   MedicalResearch.com: What are the main findings of the study?   Dr. Sutcliffe: Good NEWS for couples who need assisted conception. All the births (106,000) from Great Britain over 18 years were linked to the National Childhood Cancer Registry from the Human Fertilisation and Embryology Authority (which has recorded all births sine 1991 by law.)Those children who showed up on both registries, had IVF conception and childhood cancer. We predicted the number we would expect from the known national childhood cancer rates. We found ALMOST IDENTICAL rates 108 in our group and 109 predicted. NO INCREASED RISK OF CANCER AFTER IVF CONCEPTION IN OFFSPRING. (more…)
Author Interviews, Gastrointestinal Disease, OBGYNE / 29.10.2013

MedicalResearch.com Interview with Dr. Ketil Stordal Researcher/consultant paediatrician National Institute of Public Health Norway MedicalResearch.com: What are the main findings of the study? Dr. Stordal: Mothers who used iron supplementation during pregnancy had an increased risk for having children with a diagnosis of celiac disease. This association was not caused by maternal anemia during pregnancy, anemia was not a predictor of celiac disease in the offspring. The risk for celiac disease when the mother had used the highest doses and for the longest period. (more…)
JAMA, OBGYNE / 22.10.2013

Dr. Jennifer Fay Kawwaas MD Department of Gynecology and Obstetrics Emory University School of Medicine, Atlanta, GA, USAMedicalResearch.com Interview with: Dr. Jennifer Fay Kawwaas MD Department of Gynecology and Obstetrics Emory University School of Medicine, Atlanta, GA, USA MedicalResearch.com: What are the main findings of the study? Dr. Kawwaas: Using CDC National ART Surveillance System (NASS) data, we found an increasing trend from 2000 to 2010 in the number of donor egg cycles performed annually and in the percentage of donor cycles that resulted in a good outcome, defined as delivery of a full term infant weighing more than 5.5lbs. Donor and recipient ages remained relatively stable at 28 and 41, respectively, over the 11-year period. Elective single embryo transfer is recommended when the donor is under 35 years old, regardless of recipient’s age; transfer of a single day 5 embryo was associated with an increased chance of good perinatal outcome. Tubal or uterine factor infertility and non-Hispanic Black race were associated with a lower chance of good perinatal outcome. (more…)
Author Interviews, NEJM, OBGYNE / 09.10.2013

Associate scientist Sunnybrook Health Sciences Centre 2075 Bayview Ave., Room M4 172a Toronto, ON M4N 3M5MedicalResearch.com Interview with: Jon Barrett, M.B.Bch., FRCOG, MD, FRCSC Associate scientist Sunnybrook Health Sciences Centre 2075 Bayview Ave., Room M4 172a Toronto, ON M4N 3M5 MedicalResearch.com: What are the main findings of the study? Dr. Barrett: For twins at 32-38 weeks gestation where Twin A is presenting cephalic a policy of planned CS does not benefit the baby or the mother, compared to a policy of planned VB, and planned CS will result in delivery at a earlier gestational age. (more…)
Author Interviews, Lancet, OBGYNE / 20.09.2013

Prof Sally K Tracy DMid Midwifery and Women's Health Research Unit University of Sydney, Royal Hospital for Women Randwick, NSW, AustraliaMedicalResearch.com Interview with: Prof Sally K Tracy DMid Midwifery and Women's Health Research Unit University of Sydney, Royal Hospital for Women Randwick, NSW, Australia MedicalResearch.com: What are the main findings of the study? Prof. Tracy: We recruited 1748 pregnant women, of all risk types, from two tertiary teaching hospitals in different states in Australia and allocated them to receive either caseload midwifery care (871) or standard maternity care (877). The study found more women in caseload midwifery experienced an unassisted vaginal birth without pharmacological analgesia, and fewer women experienced an elective caesarean. While the trial findings did not show a statistically significant difference in the rate of caesarean sections between either group, the overall rate fell by more than 20 percent from pre-trial levels. Newborn infants in both groups achieved similar physical assessment scores (Apgar scores). A slightly lower number of pre-term births and neonatal intensive care admissions among the midwifery caseload group was not statistically significant. Important secondary findings of the study include:
  • 30 percent more spontaneous onset of labour
  • less induction of labour
  • less severe blood loss, and
  • stronger likelihood of breastfeeding at discharge from hospital.
These small differences accounted for an overall difference of AU$566.74 less with caseload midwifery than with standard care. Caseload midwifery appeared to alter some of the pathways that recurrently contribute to increased obstetric intervention.  Having this level of continuity of care works on the assumption that women will labour more effectively, need to stay in hospital less time and feel a stronger sense of satisfaction and personal control if they have the opportunity to get to know their midwife at the beginning of pregnancy. (more…)
Alcohol, Author Interviews, Breast Cancer, JNCI, OBGYNE / 30.08.2013

MedicalResearch.com Interview with: Ying Liu, MD, PhD Instructor, Division of Public Health Sciences Department of Surgery Washington University School of Medicine 660 South Euclid Ave Campus Box 8100 St. Louis, MO 63110 MedicalResearch.com: What are the main findings of the study? Answer: Alcohol intake between menarche (first menstrual period) and first pregnancy was consistently associated with increased risks of breast cancer and proliferative benign breast disease. For every 10 gram/day alcohol intake (approximately a drink a day) during this specific time period, the risk for breast cancer increased by 11% and the risk for proliferative benign breast disease increased by 16%. (more…)
Author Interviews, NEJM, OBGYNE / 29.08.2013

MedicalResearch.com Interview with: Ms. Mølgaard-Nielsen Statens Serum Institut Artillerivej 5, 2300 Copenhagen S, Denmark MedicalResearch.com: What are the main findings of the study? Answer: Use of oral fluconazole during early pregnancy did not increase the risk of birth defects overall in common therapeutic doses. We also looked at 15 individual birth defects of previous concern and oral fluconazole was not associated with an increased risk for 14 of these birth defects.  However, we did see an increase in the risk of tetralogy of Fallot, an uncommon congenital heart defect, but the number of exposed cases was few. (more…)
Author Interviews, Diabetes, JCEM, OBGYNE, Obstructive Sleep Apnea, Sleep Disorders / 22.08.2013

Sirimon Reutrakul MD Section of Endocrinology Department of Medicine Rush University Medical Center Chicago, Illinois 60612MedicalResearch.com: Interview with Sirimon Reutrakul MD Section of Endocrinology Department of Medicine Rush University Medical Center Chicago, Illinois 60612   MedicalResearch.com: What are the main findings of the study? Answer: We found a strong association between obstructive sleep apnea and gestational diabetes mellitus. In pregnant women diagnosed with gestational diabetes, the risk of obstructive sleep apnea is increased nearly 7-fold compared to those without gestational diabetes.  In addition, we found that in non-diabetic women, pregnancy is associated with more disrupted sleep. (more…)
Author Interviews, BMJ, OBGYNE, Weight Research / 15.08.2013

MedicalResearch.com Interview with: Rebecca M Reynolds, Professor of Metabolic Medicine Endocrinology Unit, BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH14 6TJ, UK MedicalResearch.com: What are the main findings of the study? Answer: We found that the adult offspring of women who were obese at the start of pregnancy were 35% more likely to die prematurely than offspring of normal-weight women. We also found that children born to mothers who were overweight when they became pregnant had an 11% increased risk of premature death.  Adult offspring of mothers who were obese were also at increase risk of hospital admissions for cardiovascular events. (more…)
Author Interviews, Cancer Research, OBGYNE / 01.08.2013

Hemodialysis.com Interview with:: Marcela G. del Carmen, M.D., M.P.H Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology Massachusetts General Hospital, 55 Fruit Street, Yawkey 9 E Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Answer: The study sample included 7,973 women, including 7,363 (92.3%) whites and 610 (7.7%) AA, diagnosed with vulvar cancer from 1973 to 2009. African American women were younger and had a higher rate of distant metastasis compared to white women.  African American women were more likely to be treated by radiaton therapy and less likely to receive survival therapy. Although the study found that compared to white women, African Americans were more likely to be younger and have more advanced disease upon diagnosis, they had lower rates of vulvar cancer related mortality compared to white women. (more…)
Author Interviews, Menopause, OBGYNE / 26.07.2013

MedicalResearch.com Interview with: Catherine A. Matthews, MD Associate Professor and Division Chief Urogynecology and Reconstructive Pelvic Surgery University of North Carolina, Chapel Hill MedicalResearch.com: What are the main findings of the study? Dr. Matthews: Women under 50 should try and preserve their ovaries at the time of hysterectomy for benign disease; however, women over 50 should consider elective ovarian removal as a way to reduce ovarian cancer. There is no adverse impact on cardiovascular, bone or sexual health in women over 50 who elect ovarian removal. (more…)