ObjectiveCancer is comorbidity, which can lead to progressive worsening of Covid-19 with increased mortality. This is a systematic review and meta-analysis to get evidence of adverse outcomes of Covid-19 in gynecologic cancer.MethodsSearches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021-19 February 2022). Newcastle-Ottawa Scale tool used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI), random-effects model were presented. This study was registered to PROSPERO (CRD42021256557).ResultsWe accepted 49 studies with (1994 gynecologic cancer with Covid-19). Covid-19 infection was lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.89, p 0.003). Severe Covid and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.52, CI 0.43-0.63, p <0.0001), (OR 0.65, CI 0.49-0.87, p 0.003) respectively. Increased Covid death is seen in gynecologic cancer vs breast, non-covid cancer, and non-cancer covid (OR 1.51, CI 1.20-1.90, p 0.0004), (OR 12.21, CI 8.39-17.77, p <0.0001), (OR 3.06, CI 2.32-4.04, p <0.0001) respectively.ConclusionGynecologic cancer had increased Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer had lowered Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. Lack of age and comorbidities stratification due to limited data were limitations. These findings may aid health policies and services during the ongoing global pandemic.SynopsisThis is a systematic review and meta analysis study that presents pooled evidence of outcome among gynecologic cancer patients infected with the Covid-19 infection. We manage to gather 49 studies involving 1994 gynecologic cancer patients with Covid-19, 220967 non cancer patients with Covid-19, 4080990 cancer patients without Covid-19 and 28658 non gynecologic cancer patients with Covid-19 for analysis. Meta analysis shows reduction of Covid-19 death with gynecologic cancer patients vs overall other cancer, lung cancer, and hematologic cancer (OR 0.84, CI 0.72-0.97, p 0.02), (OR 0.52, CI 0.43-0.63, p <0.0001), (OR 0.65, CI 0.49-0.87, p 0.003) respectively. On the contrary, increased risk of Covid-19 death occur to gynecologic cancer patients vs infected non cancer, non Covid cancer patients, and infected breast cancer patients (OR 3.06, CI 2.32-4.04, p <0.0001), (OR 12.21, CI 8.39-17.77, p <0.0001), (OR 1.51, CI 1.20-1.90, p 0.0004) respectively. Analysis from SARS-Cov-2 infection shows lower infection with gynecologic cancer patients vs hematologic cancer cohort (OR 0.71, CI 0.56-0.89, p 0.003). We hope the result of this meta analysis will be useful to providers practicing in cancer centers and tertiary cancer referral hospitals thus better practices and care services given to gynecologic cancer patients infected with / without the Covid-19 during the ongoing global pandemic can be achieved.To our knowledge this is the first systematic review and meta analysis which emphasizes on reporting the outcome of gynecologic cancer patients with the Covid-19 infection. We also found no publication bias across 49 studies we have gathered and used as meta analysis data.

Background: Cancer is a comorbidity that leads to progressive worsening of coronavirus disease 2019 (Covid-19) with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods: Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021–19 February 2022). The Newcastle-Ottawa Scale tool was used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI) and random-effects model were presented. Results: We accepted 51 studies (a total of 1991 gynecologic cancer patients with Covid-19). Covid-19 infection cases were lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90, p 0.005). Severe Covid-19 infection and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.52, CI 0.44-0.62, p <0.0001), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.63, CI 0.47-0.83, p 0.001) respectively. Increased Covid death was seen in gynecologic cancer vs population with breast cancer, non-Covid cancer, and non-cancer Covid (OR 1.50, CI 1.20-1.88, p 0.0004), (OR 11.83, CI 8.20-17.07, p <0.0001), (OR 2.98, CI 2.23-3.98, p <0.0001) respectively.    Conclusion: Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic. PROSPERO Registration: CRD42021256557 (22/05/21)

Objective Cancer is comorbidity, which can lead to progressive worsening of Covid-19 with increased mortality. This is a systematic review and meta-analysis to get evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021-19 February 2022). Newcastle-Ottawa Scale tool used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI), random-effects model were presented. This study was registered to PROSPERO (CRD42021256557). Results We accepted 49 studies with (1994 gynecologic cancer with Covid-19). Covid-19 infection was lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56–0.89, p 0.003). Severe Covid and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16–0.80, p 0.01), (OR 0.26, CI 0.10–0.67 p 0.005), (OR 0.52, CI 0.43–0.63, p < 0.0001), (OR 0.65, CI 0.49–0.87, p 0.003) respectively. Increased Covid death is seen in gynecologic cancer vs breast, non-covid cancer, and non-cancer covid (OR 1.51, CI 1.20–1.90, p 0.0004), (OR 12.21, CI 8.39–17.77, p < 0.0001), (OR 3.06, CI 2.32–4.04, p < 0.0001) respectively. Conclusion Gynecologic cancer had increased Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer had lowered Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. Lack of age and comorbidities stratification due to limited data were limitations. These findings may aid health policies and services during the ongoing global pandemic.

Objective: To predict outcome of delivery by using ultrasound measurements consisting  angle of progression, and head perineum distance.Methods: Sixtytwo parturients assigned in cohort prospective study. Ultrasound examination begin with identifying the cephalic position by placement of transducer on suprapubic region. The angle of progression is obtained trans-labially, head perineum distance and cervical dilation trans-perineally. Ultrasound findings of Nuchal cord, caput, moulding, occiput posterior position then compared with conventional findings. Labour is observed, outcomes are grouped into vaginal delivery and cesarean section.Results: Thirty-six women went for vaginal delivery, 26 underwent cesarean section. Independent T-test showed significant differences of the angle of progression (121.11o vs 88.85o) and head perineum distance (5.15 cm vs 7.26 cm) between the two groups. Linear regression test found a negative correlation on how the angle of progression affecting head perineum distance p-value <0.05 , R2 0.684, (r) – 0.827. Cervical dilation measurements both ultrasound and digital examination were assessed with the Bland-Altman reliability test with level of agreement (-1.0 cm) – (1.2 cm). Receiver Operating Characteristic curve showed cut-off value >101o angle of progression predicts vaginal delivery, area under curve 0.902 and positive likelihood ratio 4.4. Kappa reliability testing for nuchal cord, caput, moulding, and occiput posterior are 0.919, 0.938, 0.384, 0.681 respectively.Conclusion: Intrapartum ultrasound able to predict the outcome of delivery, digital examination of cervical dilation is the mainstay of measurement. Ultrasound able to rule out the presence of nuchal cord, caput, and occiput posterior.        Keywords: angle of progression, head perineum distance, intrapartum ultrasound.   Abstrak Tujuan: Mengetahui besar sudut penurunan kepala dan jarak kepala ke perineum dengan ultrasonografi intrapartum dalam memprediksi luaran persalinan. Metode: Enam puluh dua  ibu bersalin dilakukan pemeriksaan ultrasonografi intrapartum. Identifikasi posisi kepala dengan meletakan transduser di suprapubik, sudut penurunan kepala secara translabial, jarak kepala ke perineum dan nilai dilatasi serviks secara transperineal. Lilitan tali pusat, kaput, molase, dan oksiput posterior pada temuan ulstrasonografi dibandingkan dengan hasil pemeriksaan konvensional. Observasi persalinan dilakukan, di kelompokan untuk persalinan pervaginam dan seksio sesarea.Hasil: Didapatkan 36 persalinan pervaginam dan 26 seksio sesarea. Uji – t secara signifikan berbeda, nilai sudut penurunan kepala (121,11o vs 88,85o), jarak kepala ke perineum (5,15 cm vs 7,26 cm) pada kedua kelompok. Uji regresi linier sudut penurunan kepala dan pengaruhnya terhadap jarak kepala ke perineum berkorelasi negatif p <0.05, R2 0.684, (r) – 0.827. Batas kesepakatan nilai dilatasi serviks kedua metode diuji dengan uji reliabilitas Bland-Altman dengan batas kesepakatan sebesar (-1.0) cm – (1.2) cm. Sudut penurunan kepala memprediksi persalinan pervaginam sebesar  >101o, uji diagnostik dengan kurva Receiver Operating Characteristic didapatkan area dibawah kurva 0.902, rasio kemungkinan positif 4,4. Uji reliabilitas Kappa lilitan tali pusat, kaput ,molase, dan oksiput posterior berturut-turut (k) = 0.919, 0.938, 0.384, dan 0.681.    Kesimpulan: Penggunaan ultrasonografi intrapartum dapat memprediksi luaran persalinan, pemriksaan dalam tetap menjadi pemeriksaan utama dalam menilai dilatasi serviks, ultrasnografi mampu mendeteksi lilitan tali pusat, kaput, dan posisi oksiput posterior.Kata kunci: Jarak kepala ke perineum, sudut penurunan kepala, Ultrasonografi intrapartum.