155 Volume 155 Supplement 1 October 2021 ISSN 0020-7292

S1

International Journal of

GYNECOLOGY

International Journal of Gynecology & Obstetrics Vol. 155/S1 (2021) 1–134

&OBSTETRICS
International Journal of
EDITORIAL BOARD
Editor-in-Chief: M. Geary (Ireland) GYNECOLOGY
OBSTETRICS
Deputy Editor-in-Chief: E. Stringer (USA)

&
Editor Emeritus: R.M. Adanu (Ghana)
Past Editors: T.R.B. Johnson (USA)
J.J. Sciarra (USA)

Regional Representa ves:

Africa–Middle East: C. Chibwesha (South Africa)
Asia–Oceania: F. Begum (Bangladesh)
P. Wang (Taiwan)
Europe: M. Geary (Ireland)
P.P. Fogarty (Ireland)
Laࢼn America: J.G. Ceca (Brazil)
A. Ramirez (Mexico)
North America: L. Rahangdale (USA)
L. Gien (Canada)

Public Health Obstetric Consultant: E. Stringer (USA)

Ethical and Legal Issues in B. Dickens (Canada)

Reproduc ve Health: R. Cook (Canada)
C. Ngwena (South Africa)

Contemporary Issues in E. Stringer (USA)

Women’s Health: A. Nabhan (Egypt)

FIGO Cancer Staging: S. Kehoe (UK)

Sta s cal Consultant: A. Vahra an (USA)

Systema c Reviews Editor: A. Nabhan (Egypt)

Trainee Associate Editor (WATOG): P. Roy (India)

G. Topcu (Turkey)

Head of Publishing: A. Goggins (UK)

Journal Development Editor: I. La f (UK)
FIGO Cancer Report 2021
Assistant Editor: F. Harris (UK)
Guest Editors: Sean Kehoe and Neerja Bhatla
Editorial Office: FIGO Secretariat, FIGO House
Suite 3 - Waterloo Court,
10 Theed Street,
London, SE1 8ST, UK
Tel: +44 20 7928 1166
Fax: +44 20 7928 7099
E-mail: ijgo@figo.org
This journal is available online at Wiley Online Library. Visit
wileyonlinelibrary.com to search the articles and register
for table of contents and e-mail alerts.

IJGO_v155_s1_cover.indd 1 10/1/2021 6:52:04 PM

 SUMMARY OF AUTHOR GUIDELINES
(Full guidelines are available online at h p://obgyn.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)1879-3479/about/author-guidelines.html)

FIGO Trustees
President: C. Füchtner (Bolivia)
INTRODUCTION LAYOUT OF MANUSCRIPTS
Vice-President: F. El Kak (Lebanon) Only original manuscripts that are submi ed Please refer to the online instruc ons for full
President-Elect: J. Conry (USA) exclusively to IJGO will be considered for publica on. details on how to structure your manuscript. All
Honorary Treasurer: R. Hale (USA)
The requirements of IJGO are in accordance with the submissions must be accompanied by a cover
Honorary Secretary: L. Regan (UK)
Past-President: C.N. Purandare (India) “Uniform Requirements for Manuscripts Submi ed to le er addressed to the Editor. The first page of the
FIGO Chief Execuࢼve M.A. Lumsden (UK)
Biomedical Journals” published by the Interna onal manuscript should contain the following: (1) tle; (2)
Commi ee of Medical Journal Editors (ICMJE). full names of authors; (3) affilia ons of authors; (4)
FIGO Council
Australia & New Zealand M. Permezel Japan A. Okamoto Editorial processes will adhere to the Commi ee of full contact details of the corresponding author; (5)
Brazil C.E. Fernandes Kenya R.J. Kosgei Publica on Ethics guidelines. a list of up to 8 keywords for indexing and retrieval;
Canada J. Blake Mexico E. Castelazo (6) a brief synopsis.
Chile M. Cuello Norway M. Steinholt SUBMISSION Clinical Ar cles and Review Ar cles require
Colombia J.D. Villegas Peru A. Celis
Ethiopia D.B. Mamo South Korea Y.T. Kim
IJGO will consider for publica on unsolicited an abstract of 200 words or fewer; Brief
France P. Descamps South Africa P. Soma-Pillay submissions of the following: Clinical Ar cles; Communica ons do not require an abstract.
Germany F. Louwen Sri Lanka H. Perera Review Ar cles; and Brief Communica ons Full length ar cles should be structured with
Guatemala E. Kestler Sudan S.M. Abdelkhair
(including Case Reports). All manuscripts should the following headings: Introduc on; Materials
India H. Divakar Sweden K.G. Danielsson
Ireland F. McAuliffe Tunisia N. Khaled be prepared according to the author guidelines and methods; Results; Discussion; Author
Italy R. Jura United Kingdom E. Morris available online. Manuscripts are submi ed to the contribu ons; Acknowledgments; Conflicts of
For informa on about FIGO: The Secretariat of FIGO is at FIGO House, Suite 3, Waterloo Court, 10 Theed Street, London, SE1 8ST UK. Tel.: +44 20 7928 1166; journal via the online service Editorial Manager interest; and References. Brief Communica ons
fax: +44 20 7928 7099. Email: figo@figo.org. Website: www.figo.org. All enquiries concerning FIGO may be sent to the Honorary Secretary at that address. (www.editorialmanager.com/IJG). Authors must first do not require headings for the main text, but
register for an account on Editorial Manager, ensuring should include the following sec ons: Author
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS (Print ISSN: 0020-7292; Online Disclaimer
that the details provided for the corresponding contribu ons; Acknowledgments; Conflicts of
ISSN: 1879-3479), is published monthly. US mailing agent: Mercury Media Processing, LLC, 1850 The Publisher, FIGO: The Interna onal Federa on of Gynecology and Obstetrics and Editors author are up-to-date so that all manuscript status interest; and References. Tables, figures, and
Elizabeth Avenue, Suite #C, Rahway, NJ 07065 USA. Periodical postage paid at Rahway, NJ. cannot be held responsible for errors or any consequences arising from the use of informa on
contained in this journal; the views and opinions expressed do not necessarily reflect those of the
no fica ons are successfully received. Authors can suppor ng informa on may also be submi ed.
Postmaster: Send all address changes to INTERNATIONAL JOURNAL OF GYNECOLOGY & OB- Publisher, FIGO: The Interna onal Federa on of Gynecology and Obstetrics and Editors, neither check the status of their manuscript during the
STETRICS, John Wiley & Sons Inc., C/O The Sheridan Press, PO Box 465, Hanover, PA 17331 USA. does the publica on of adver sements cons tute any endorsement by the Publisher, FIGO: The
Interna onal Federa on of Gynecology and Obstetrics and Editors of the products adver sed.
review process by logging into Editorial Manager. MANUSCRIPT CONTENTS
Copyright and Copying
Copyright © 2021 International Federation of Gynecology and Obstetrics. All rights re- Publisher
Queries rela ng to the submission process or to Where appropriate, statements on clinical trial
served. No part of this publication may be reproduced, stored or transmitted in any form INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS is published by John Wiley & journal procedures can be directed to the editorial registra on, Ethics Commi ee approval, and
or by any means without the prior permission in writing from the copyright holder. Au- Sons Ltd., 9600 Garsington Road, Oxford, OX4 2DQ, UK. Tel: +44 (0)1865 776868; fax: +44 office at ijgo@figo.org. informed consent should be included in the
thorization to copy items for internal and personal use is granted by the copyright hold- (0)1865 714591.
er for libraries and other users registered with their local Reproduction Rights Organisa- manuscript. Details of any sta s cal analysis
tion (RRO), e.g. Copyright Clearance Center (CCC), 222 Rosewood Drive, Danvers, MA
Journal Customer Services: For ordering informa on, claims and any enquiry concerning your
journal subscrip on please go to h ps://hub.wiley.com/community/support/onlinelibrary or
JOURNAL REQUIREMENTS conducted should be given in the methods. In line
01923, USA (www.copyright.com), provided the appropriate fee is paid directly to the contact your nearest office. Studies of pa ents, pa ent records, or volunteers with ICMJE standards, author contribu ons must be
RRO. This consent does not extend to other kinds of copying such as copying for general
distribution, for advertising or promotional purposes, for creating new collective works
Americas: Email: cs-journals@wiley.com; Tel: +1 781 388 8598 or +1 800 835 6770 (toll free
in the USA & Canada).
require Ethics Commi ee approval and informed listed and a conflicts of interest statement be made.
or for resale. Permissions for such reuse can be obtained using the RightsLink “Request Europe, Middle East and Africa: Email: cs-journals@wiley.com; Tel: +44 (0) 1865 778315. consent. In compliance with ICMJE requirements, References should be presented as per the journal’s
Permissions” link on Wiley Online Library. Special requests should be addressed to:
permissions@wiley.com
Asia Pacific: Email: cs-journals@wiley.com; Tel: +65 6511 8000. all clinical trials must be prospec vely registered style. The editors reserve the right to make any
Japan: For Japanese speaking support, Email: cs-japan@wiley.com.
Delivery Terms and Legal Title Visit our Online Customer Help at h ps://hub.wiley.com/community/support/onlinelibrary in a public trials registry. Purely observa onal necessary editorial changes.
Where the subscrip on price includes print issues and delivery is to the recipient’s address, Produc on Editor: Sathish Kannan Asokan (email: ijgo@wiley.com). studies (those in which the assignment of the
delivery terms are Delivered at Place (DAP); the recipient is responsible for paying any import
duty or taxes. Title to all issues transfers Free of Board (FOB) our shipping point, freight pre-
Wiley’s Corporate Ci zenship ini a ve seeks to address the environmental, social, economic, medical interven on is not at the discre on of the LICENSING
paid. We will endeavour to fulfil claims for missing or damaged copies within six months of
and ethical challenges faced in our business and which are important to our diverse stakeholder
groups. Since launching the ini a ve, we have focused on sharing our content with those in
inves gator) will not require registra on. Authors On acceptance, authors have the op on of
publica on, within our reasonable discre on and subject to availability. need, enhancing community philanthropy, reducing our carbon impact, crea ng global guide- wishing to use material that has already been publishing their manuscript under the terms of the
Informa on for subscribers lines and best prac ces for paper use, establishing a vendor code of ethics, and engaging our published must first obtain the permission of the journal’s standard copyright transfer agreement, or
colleagues and other stakeholders in our efforts. Follow our progress at www.wiley.com/go/
Internaࢼonal Journal of Gynecology & Obstetrics is published in 12 issues per year. Ins tu onal
subscrip on prices for 2021 are: ci zenship copyright holder(s). Authors will be expected to under open access terms made available via Wiley
Print & Online: US$5,233 (US and Rest of World), €4,759 (Europe), £3,514 (UK). Prices are ISSN 0020-7292 (Print) provide the relevant documenta on on request. OnlineOpen.
exclusive of tax. Asia-Pacific GST, Canadian GST/HST and European VAT will be applied at ISSN 1879-3479 (Online)
the appropriate rates. For more informa on on current tax rates, please go to h ps://online Wiley is a founding member of the UN-backed HINARI, AGORA, and OARE ini a ves.
library.wiley.com/library-info/products/price-lists/payment. The price includes online access They are now collec vely known as Research4Life, making online scien fic content avail- Typeset in India by SPS.
to the current and all online back files to January 1st 2016, where available. For other pricing able free or at nominal cost to researchers in developing countries. Please visit Wiley’s Printed in the UK by Hobbs the Printers Ltd.
op ons, including access informa on and terms and condi ons, please visit h ps://online Content Access – Corporate Ci zenship site: h p://www.wiley.com/WileyCDA/Sec on/ For submission instruc ons, subscrip on and all other informa on visit: wileyonlinelibrary.com/journal/ijgo
library.wiley.com/library-info/products/price-lists. Terms of use can be found here: h ps:// id-390082.html
onlinelibrary.wiley.com/terms-and-condi ons INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS is indexed by Academic OneFile (GALE Cengage); CAB Abstracts® (CABI); Centre for
OnlineOpen
Back issues: Single issues from current and recent volumes are available at the current sin- INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS accepts ar cles for Open Access Agriculture and Biosciences Interna onal (CABI); CINAHL: Cumula ve Index to Nursing & Allied Health Literature (EBSCO Publishing); Current
gle issue price from cs-journals@wiley.com. Earlier issues may be obtained from Periodicals publica on. Please visit h ps://authorservices.wiley.com/author-resources/Journal-Authors/ Contents: Clinical Medicine (Clarivate Analy cs); Embase (Elsevier); Family & Society Studies Worldwide (EBSCO Publishing); Gender Studies
Service Company, 351 Fairview Avenue – Ste 300, Hudson, NY 12534, USA. Tel: +1 518 822- open-access/onlineopen.html for further informa on about OnlineOpen. Collec on (GALE Cengage); Gender Studies Database (EBSCO Publishing); InfoTrac (GALE Cengage); MEDLINE/PubMed (NLM); Science Cita on
9300, Fax: +1 518 822-9305, Email: psc@periodicals.com Index Expanded (Clarivate Analy cs); SCOPUS (Elsevier); Web of Science (Clarivate Analy cs); Women’s Studies Interna onal (EBSCO Publishing).

IJGO_v155_s1_cover.indd 2 10/1/2021 6:52:04 PM

 SUMMARY OF AUTHOR GUIDELINES
(Full guidelines are available online at h p://obgyn.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)1879-3479/about/author-guidelines.html)

FIGO Trustees
President: C. Füchtner (Bolivia)
INTRODUCTION LAYOUT OF MANUSCRIPTS
Vice-President: F. El Kak (Lebanon) Only original manuscripts that are submi ed Please refer to the online instruc ons for full
President-Elect: J. Conry (USA) exclusively to IJGO will be considered for publica on. details on how to structure your manuscript. All
Honorary Treasurer: R. Hale (USA)
The requirements of IJGO are in accordance with the submissions must be accompanied by a cover
Honorary Secretary: L. Regan (UK)
Past-President: C.N. Purandare (India) “Uniform Requirements for Manuscripts Submi ed to le er addressed to the Editor. The first page of the
FIGO Chief Execuࢼve M.A. Lumsden (UK)
Biomedical Journals” published by the Interna onal manuscript should contain the following: (1) tle; (2)
Commi ee of Medical Journal Editors (ICMJE). full names of authors; (3) affilia ons of authors; (4)
FIGO Council
Australia & New Zealand M. Permezel Japan A. Okamoto Editorial processes will adhere to the Commi ee of full contact details of the corresponding author; (5)
Brazil C.E. Fernandes Kenya R.J. Kosgei Publica on Ethics guidelines. a list of up to 8 keywords for indexing and retrieval;
Canada J. Blake Mexico E. Castelazo (6) a brief synopsis.
Chile M. Cuello Norway M. Steinholt SUBMISSION Clinical Ar cles and Review Ar cles require
Colombia J.D. Villegas Peru A. Celis
Ethiopia D.B. Mamo South Korea Y.T. Kim
IJGO will consider for publica on unsolicited an abstract of 200 words or fewer; Brief
France P. Descamps South Africa P. Soma-Pillay submissions of the following: Clinical Ar cles; Communica ons do not require an abstract.
Germany F. Louwen Sri Lanka H. Perera Review Ar cles; and Brief Communica ons Full length ar cles should be structured with
Guatemala E. Kestler Sudan S.M. Abdelkhair
(including Case Reports). All manuscripts should the following headings: Introduc on; Materials
India H. Divakar Sweden K.G. Danielsson
Ireland F. McAuliffe Tunisia N. Khaled be prepared according to the author guidelines and methods; Results; Discussion; Author
Italy R. Jura United Kingdom E. Morris available online. Manuscripts are submi ed to the contribu ons; Acknowledgments; Conflicts of
For informa on about FIGO: The Secretariat of FIGO is at FIGO House, Suite 3, Waterloo Court, 10 Theed Street, London, SE1 8ST UK. Tel.: +44 20 7928 1166; journal via the online service Editorial Manager interest; and References. Brief Communica ons
fax: +44 20 7928 7099. Email: figo@figo.org. Website: www.figo.org. All enquiries concerning FIGO may be sent to the Honorary Secretary at that address. (www.editorialmanager.com/IJG). Authors must first do not require headings for the main text, but
register for an account on Editorial Manager, ensuring should include the following sec ons: Author
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS (Print ISSN: 0020-7292; Online Disclaimer
that the details provided for the corresponding contribu ons; Acknowledgments; Conflicts of
ISSN: 1879-3479), is published monthly. US mailing agent: Mercury Media Processing, LLC, 1850 The Publisher, FIGO: The Interna onal Federa on of Gynecology and Obstetrics and Editors author are up-to-date so that all manuscript status interest; and References. Tables, figures, and
Elizabeth Avenue, Suite #C, Rahway, NJ 07065 USA. Periodical postage paid at Rahway, NJ. cannot be held responsible for errors or any consequences arising from the use of informa on
contained in this journal; the views and opinions expressed do not necessarily reflect those of the
no fica ons are successfully received. Authors can suppor ng informa on may also be submi ed.
Postmaster: Send all address changes to INTERNATIONAL JOURNAL OF GYNECOLOGY & OB- Publisher, FIGO: The Interna onal Federa on of Gynecology and Obstetrics and Editors, neither check the status of their manuscript during the
STETRICS, John Wiley & Sons Inc., C/O The Sheridan Press, PO Box 465, Hanover, PA 17331 USA. does the publica on of adver sements cons tute any endorsement by the Publisher, FIGO: The
Interna onal Federa on of Gynecology and Obstetrics and Editors of the products adver sed.
review process by logging into Editorial Manager. MANUSCRIPT CONTENTS
Copyright and Copying
Copyright © 2021 International Federation of Gynecology and Obstetrics. All rights re- Publisher
Queries rela ng to the submission process or to Where appropriate, statements on clinical trial
served. No part of this publication may be reproduced, stored or transmitted in any form INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS is published by John Wiley & journal procedures can be directed to the editorial registra on, Ethics Commi ee approval, and
or by any means without the prior permission in writing from the copyright holder. Au- Sons Ltd., 9600 Garsington Road, Oxford, OX4 2DQ, UK. Tel: +44 (0)1865 776868; fax: +44 office at ijgo@figo.org. informed consent should be included in the
thorization to copy items for internal and personal use is granted by the copyright hold- (0)1865 714591.
er for libraries and other users registered with their local Reproduction Rights Organisa- manuscript. Details of any sta s cal analysis
tion (RRO), e.g. Copyright Clearance Center (CCC), 222 Rosewood Drive, Danvers, MA
Journal Customer Services: For ordering informa on, claims and any enquiry concerning your
journal subscrip on please go to h ps://hub.wiley.com/community/support/onlinelibrary or
JOURNAL REQUIREMENTS conducted should be given in the methods. In line
01923, USA (www.copyright.com), provided the appropriate fee is paid directly to the contact your nearest office. Studies of pa ents, pa ent records, or volunteers with ICMJE standards, author contribu ons must be
RRO. This consent does not extend to other kinds of copying such as copying for general
distribution, for advertising or promotional purposes, for creating new collective works
Americas: Email: cs-journals@wiley.com; Tel: +1 781 388 8598 or +1 800 835 6770 (toll free
in the USA & Canada).
require Ethics Commi ee approval and informed listed and a conflicts of interest statement be made.
or for resale. Permissions for such reuse can be obtained using the RightsLink “Request Europe, Middle East and Africa: Email: cs-journals@wiley.com; Tel: +44 (0) 1865 778315. consent. In compliance with ICMJE requirements, References should be presented as per the journal’s
Permissions” link on Wiley Online Library. Special requests should be addressed to:
permissions@wiley.com
Asia Pacific: Email: cs-journals@wiley.com; Tel: +65 6511 8000. all clinical trials must be prospec vely registered style. The editors reserve the right to make any
Japan: For Japanese speaking support, Email: cs-japan@wiley.com.
Delivery Terms and Legal Title Visit our Online Customer Help at h ps://hub.wiley.com/community/support/onlinelibrary in a public trials registry. Purely observa onal necessary editorial changes.
Where the subscrip on price includes print issues and delivery is to the recipient’s address, Produc on Editor: Sathish Kannan Asokan (email: ijgo@wiley.com). studies (those in which the assignment of the
delivery terms are Delivered at Place (DAP); the recipient is responsible for paying any import
duty or taxes. Title to all issues transfers Free of Board (FOB) our shipping point, freight pre-
Wiley’s Corporate Ci zenship ini a ve seeks to address the environmental, social, economic, medical interven on is not at the discre on of the LICENSING
paid. We will endeavour to fulfil claims for missing or damaged copies within six months of
and ethical challenges faced in our business and which are important to our diverse stakeholder
groups. Since launching the ini a ve, we have focused on sharing our content with those in
inves gator) will not require registra on. Authors On acceptance, authors have the op on of
publica on, within our reasonable discre on and subject to availability. need, enhancing community philanthropy, reducing our carbon impact, crea ng global guide- wishing to use material that has already been publishing their manuscript under the terms of the
Informa on for subscribers lines and best prac ces for paper use, establishing a vendor code of ethics, and engaging our published must first obtain the permission of the journal’s standard copyright transfer agreement, or
colleagues and other stakeholders in our efforts. Follow our progress at www.wiley.com/go/
Internaࢼonal Journal of Gynecology & Obstetrics is published in 12 issues per year. Ins tu onal
subscrip on prices for 2021 are: ci zenship copyright holder(s). Authors will be expected to under open access terms made available via Wiley
Print & Online: US$5,233 (US and Rest of World), €4,759 (Europe), £3,514 (UK). Prices are ISSN 0020-7292 (Print) provide the relevant documenta on on request. OnlineOpen.
exclusive of tax. Asia-Pacific GST, Canadian GST/HST and European VAT will be applied at ISSN 1879-3479 (Online)
the appropriate rates. For more informa on on current tax rates, please go to h ps://online Wiley is a founding member of the UN-backed HINARI, AGORA, and OARE ini a ves.
library.wiley.com/library-info/products/price-lists/payment. The price includes online access They are now collec vely known as Research4Life, making online scien fic content avail- Typeset in India by SPS.
to the current and all online back files to January 1st 2016, where available. For other pricing able free or at nominal cost to researchers in developing countries. Please visit Wiley’s Printed in the UK by Hobbs the Printers Ltd.
op ons, including access informa on and terms and condi ons, please visit h ps://online Content Access – Corporate Ci zenship site: h p://www.wiley.com/WileyCDA/Sec on/ For submission instruc ons, subscrip on and all other informa on visit: wileyonlinelibrary.com/journal/ijgo
library.wiley.com/library-info/products/price-lists. Terms of use can be found here: h ps:// id-390082.html
onlinelibrary.wiley.com/terms-and-condi ons INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS is indexed by Academic OneFile (GALE Cengage); CAB Abstracts® (CABI); Centre for
OnlineOpen
Back issues: Single issues from current and recent volumes are available at the current sin- INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS accepts ar cles for Open Access Agriculture and Biosciences Interna onal (CABI); CINAHL: Cumula ve Index to Nursing & Allied Health Literature (EBSCO Publishing); Current
gle issue price from cs-journals@wiley.com. Earlier issues may be obtained from Periodicals publica on. Please visit h ps://authorservices.wiley.com/author-resources/Journal-Authors/ Contents: Clinical Medicine (Clarivate Analy cs); Embase (Elsevier); Family & Society Studies Worldwide (EBSCO Publishing); Gender Studies
Service Company, 351 Fairview Avenue – Ste 300, Hudson, NY 12534, USA. Tel: +1 518 822- open-access/onlineopen.html for further informa on about OnlineOpen. Collec on (GALE Cengage); Gender Studies Database (EBSCO Publishing); InfoTrac (GALE Cengage); MEDLINE/PubMed (NLM); Science Cita on
9300, Fax: +1 518 822-9305, Email: psc@periodicals.com Index Expanded (Clarivate Analy cs); SCOPUS (Elsevier); Web of Science (Clarivate Analy cs); Women’s Studies Interna onal (EBSCO Publishing).

IJGO_v155_s1_cover.indd 2 10/1/2021 6:52:04 PM

 155 Volume 155 Supplement 1 October 2021 ISSN 0020-7292
S1

International Journal of

GYNECOLOGY

International Journal of Gynecology & Obstetrics Vol. 155/S1 (2021) 1–134

&OBSTETRICS
International Journal of
EDITORIAL BOARD
Editor-in-Chief: M. Geary (Ireland) GYNECOLOGY
OBSTETRICS
Deputy Editor-in-Chief: E. Stringer (USA)

&
Editor Emeritus: R.M. Adanu (Ghana)
Past Editors: T.R.B. Johnson (USA)
J.J. Sciarra (USA)

Regional Representa ves:

Africa–Middle East: C. Chibwesha (South Africa)
Asia–Oceania: F. Begum (Bangladesh)
P. Wang (Taiwan)
Europe: M. Geary (Ireland)
P.P. Fogarty (Ireland)
Laࢼn America: J.G. Ceca (Brazil)
A. Ramirez (Mexico)
North America: L. Rahangdale (USA)
L. Gien (Canada)

Public Health Obstetric Consultant: E. Stringer (USA)

Ethical and Legal Issues in B. Dickens (Canada)

Reproduc ve Health: R. Cook (Canada)
C. Ngwena (South Africa)

Contemporary Issues in E. Stringer (USA)

Women’s Health: A. Nabhan (Egypt)

FIGO Cancer Staging: S. Kehoe (UK)

Sta s cal Consultant: A. Vahra an (USA)

Systema c Reviews Editor: A. Nabhan (Egypt)

Trainee Associate Editor (WATOG): P. Roy (India)

G. Topcu (Turkey)

Head of Publishing: A. Goggins (UK)

Journal Development Editor: I. La f (UK)
FIGO Cancer Report 2021
Assistant Editor: F. Harris (UK)
Guest Editors: Sean Kehoe and Neerja Bhatla
Editorial Office: FIGO Secretariat, FIGO House
Suite 3 - Waterloo Court,
10 Theed Street,
London, SE1 8ST, UK
Tel: +44 20 7928 1166
Fax: +44 20 7928 7099
E-mail: ijgo@figo.org
This journal is available online at Wiley Online Library. Visit
wileyonlinelibrary.com to search the articles and register
for table of contents and e-mail alerts.

IJGO_v155_s1_cover.indd 1 10/1/2021 6:52:04 PM

 Internaঞonal Journal of Gynecology & Obstetrics
Volume 155, Supplement 1, October 2021

FIGO Cancer Report 2021

Guest Editors: Sean Kehoe and Neerja Bhatla

Publica on of this Supplement was funded by FIGO

IJGO_v155_s1_issue info.indd 1 9/30/2021 10:18:04 AM

 International Journal of
GYNECOLOGY
&
OBSTETRICS
S. Kehoe, N. Bhatla
UK, India
A.B. Olawaiye, M.A. Cuello,
L.J. Rogers
USA, Chile, South Africa
T.S. Adams, L.J. Rogers,
M.A. Cuello
South Africa, Chile
N. Bhatla, D. Aoki, D.N. Sharma,
R. Sankaranarayanan
India, Japan, France
M. Koskas, F. Amant,
M.R. Mirza, C.L. Creutzberg
France, Belgium,
The Netherlands, Denmark
J.S. Berek, M. Renz, S. Kehoe,
L. Kumar, M. Friedlander
USA, UK, India, Australia
H.Y.S. Ngan, M.J. Seckl,
R.S. Berkowitz, Y. Xiang,
F. Golfier, P.K. Sekharan,
J.R. Lurain, L. Massuger
China, UK, USA, France, India,
The Netherlands
R. Manchanda, S. Oxley,
S. Ghaem-Maghami, S. Sundar
UK
S. Wilailak, M. Kengsakul,
S. Kehoe
Thailand, UK
IJGO_v155_s1_issue info.indd 2
CONTENTS
Volume 155, Supplement 1, October 2021
EDITORIAL
FIGO Cancer Report 2021 5
CHAPTERS
Cancer of the vulva: 2021 update 7
A useful update for trainees and specialists regarding the diagnosis, staging, treatment, and some
controversies in the management of vulvar neoplasms.
Cancer of the vagina: 2021 update 19
A review of the different histologic subtypes of primary vaginal cancer in terms of staging and role
of imaging, as well as treatment op ons and prognoses.
Cancer of the cervix uteri: 2021 update 28
Elimina on of cervical cancer is possible by vaccina on, screening, and treatment of precancers,
and management by surgery and radia on using the revised FIGO staging.
Cancer of the corpus uteri: 2021 update 45
The latest state-of-the-art treatment for endometrial cancer is described, incorpora ng the most
recent new data that influence its clinical management.
Cancer of the ovary, fallopian tube, and peritoneum: 2021 update 61
The 2014 FIGO staging incorporates ovarian, fallopian tube, and peritoneal cancer into the same
system. This review summarizes the updated staging and treatment of these malignancies.
Diagnosis and management of gestaঞonal trophoblasঞc disease: 2021 86
update
Gesta onal trophoblas c disease, although rare, needs special a en on because if managed
properly, likelihood of cure is almost 100%.
COVID-19 and the impact on gynecologic cancer care 94
This ar cle reviews the global changes introduced to gynecologic cancer care due to COVID-19,
and their impact on services and pa ents. Key lessons are considered for the recovery and future.
Worldwide iniঞaঞves to eliminate cervical cancer 102
A triple pillar interven on strategy of vaccina on, screening, and mely treatment has been
adopted to guide the global ambi on to eliminate cervical cancer.
9/30/2021 10:18:05 AM
 W.G. McCluggage
UK
T.C. Randall, S.P. Somashekhar,
L. Chuang, J.S.-Y. Ng,
K.M. Schmeler, M. Quinn
USA, India, Singapore, Australia
I.A. Wichmann, M.A. Cuello
Chile
IJGO_v155_s1_issue info.indd 3
Progress in the pathological arena of gynecological cancers 107
Review of significant new developments in the classifica on of gynecological tumors; many are
included in the 2020 World Health Organiza on Classifica on of Female Genital Tract Tumours.
Reaching the women with the greatest needs: Two models for iniঞaঞon 115
and scale-up of gynecologic oncology fellowship trainings in low-resource
seমngs
We describe two effec ve models to train gynecologic oncologists equipped to care for the
growing number of women with gynecologic cancers in low-resource se ngs.
Obesity and gynecological cancers: A toxic relaঞonship 123
This review focuses on how obesity impacts cancer hallmarks in gynecologic malignancies, thus
affec ng the diagnosis, management, treatment, and prognosis of these diseases.
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