The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system.

STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system. WHAT IS KNOWN ALREADY Until now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment. STUDY DESIGN, SIZE AND DURATION The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. MAIN RESULTS AND THE ROLE OF CHANCE The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system. LIMITATIONS, REASONS FOR CAUTION The review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare. WIDER IMPLICATIONS OF THE FINDINGS The comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care and research. STUDY FUNDING/COMPETING INTERESTS None.

Perseveration in a guessing task by laying hens selected for high or low levels of feather pecking does not support classification of feather pecking as a stereotypy.

Feather pecking is a behaviour by which birds damage or destroy the feathers of themselves (self-pecking) or other birds (allo feather pecking), in some cases even plucking out feathers and eating these. The self-pecking is rarely seen in domestic laying hens but is not uncommon in parrots. Feather pecking in laying hens has been described as being stereotypic, i.e. a repetitive invariant motor pattern without an obvious function, and indeed the amount of self-pecking in parrots was found to correlate positively with the amount of recurrent perseveration (RP), the tendency to repeat responses inappropriately, which in humans and other animals was found to correlate with stereotypic behaviour. In the present experiment we set out to investigate the correlation between allo feather pecking and RP in laying hens. We used birds (N = 92) from the 10th and 11th generation (G10 and G11) of lines selectively bred for high feather pecking (HFP) and low feather pecking (LFP), and from an unselected control line (CON) with intermediate levels of feather pecking. We hypothesised that levels of RP would be higher, and the time taken (standardised latency) to repeat a response lower, in HFP compared to LFP hens, with CON hens in between. Using a two-choice guessing task, we found that lines differed significantly in their levels of RP, with HFP unexpectedly showing lower levels of RP than CON and LFP. Latency to make a repeat did not differ between lines. Latency to make a switch differed between lines with a shorter latency in HFP compared to LFP (in G10), or CON (in G11). Latency to peck for repeats vs. latency to peck for switches did not differ between lines. Total time to complete the test was significantly shorter in HFP compared to CON and LFP. Thus, our hypotheses were not supported by the data. In contrast, selection for feather pecking seems to induce the opposite effects than would be expected from stereotyping animals: pecking was less sequenced and reaction to make a switch and to complete the test was lower in HFP. This supports the hyperactivity-model of feather pecking, suggesting that feather pecking is related to a higher general activity, possibly due to changes in the dopaminergic system.