Conflict of Interest Policy | European Gynecology & Obstetrics

CONTENTS

Scope and purpose
Definitions
Categories of financial conflict of interest
Categories of non-financial conflict of interest
Conflict of interest specific to gynecology and obstetrics research
Institutional conflict of interest
Sponsor influence and access to study data
Declaration obligations: authors
Publication of author conflict of interest statements
Declaration obligations: reviewers
Declaration obligations: editorial leadership and editorial board
Handling of editorial conflicts of interest: manuscript management procedures
Declaration obligations: Guest Editors
Conflict of interest and the Publisher
The appearance standard
Thresholds, risk classification, and management of declared conflict of interest
Handling of undisclosed conflict of interest identified before publication
Handling of undisclosed conflict of interest identified after publication
Conflict of interest in complaint, appeal, and investigation proceedings
Confidentiality of conflict of interest declarations and data protection
Data retention
Sanctions
Annual public reporting
Review and update of this Policy
Cross-references within the Editorial Policy Framework
Normative references

1. SCOPE AND PURPOSE

This Conflict of Interest Policy establishes the obligations of transparency, declaration, and management of conflicts of interest applicable to all parties involved in the editorial process of European Gynecology and Obstetrics (EGO), including authors, peer reviewers, members of the editorial leadership, members of the Editorial Board, Guest Editors, and Edikta S.r.l. acting as Publisher. Edikta S.r.l. issues the Policy in its capacity as Publisher of the Journal on behalf of the European Society of Gynecology (ESG).

The Policy is designed to ensure that every participant in the scientific publication process can exercise judgment free from undisclosed secondary interests, and that readers have the information necessary to assess the credibility and independence of published research. The guiding principle is that perceptions of conflict of interest are as important as actual conflicts: the Journal adopts the standard that, in any case of doubt, declaration prevails over non-disclosure.

This Policy applies to all manuscripts submitted to the Journal from the date of its entry into force, and to all members of the editorial leadership whose appointment is active at that date. It is consistent with, and operationally develops, the conflict of interest provisions referred to in the Editorial Policy Statement, the Publication Ethics Policy, the Peer Review Policy, the Authorship Policy, the Editorial Board Charter, and the Artificial Intelligence Policy. These documents form a coordinated editorial policy framework. On matters concerning the definition, declaration, assessment, management, correction, and sanctioning of conflicts of interest, this Policy is the controlling document. Other policies remain applicable to their respective subject matter. The external standards cited in Section 26 inform interpretation of this Policy; they do not override the express procedural rules of this Policy unless expressly incorporated by reference.

2. DEFINITIONS

For this Policy, the following definitions apply:

• Conflict of interest: a situation in which a party involved in the editorial process holds financial, personal, professional, institutional, or other interests that may - or may be reasonably perceived to - influence their judgment concerning the submission, review, editorial handling, or publication of a manuscript, independently of whether the interest has in fact influenced the outcome.

• Financial conflict of interest: any form of financial relationship between the party and an entity with a direct or indirect interest in the subject matter of the manuscript, including but not limited to employment, consultancy, paid advisory board membership, stock ownership or options, patent ownership or pending applications, royalties, honoraria, speaker fees, travel reimbursement, in-kind support, and research grants. Financial interests of the party's spouse, domestic partner, or financially dependent relatives are subject to the same disclosure obligations.

• Non-financial conflict of interest: any personal, professional, intellectual, advocacy, ideological, religious, or institutional relationship that may compromise or reasonably appear to compromise the independence of judgment of the party, including personal friendships or rivalries, academic competition, mentor-mentee relationships within the preceding 36 months, ideological or advocacy commitments, religious convictions, expert witness activities, and membership of bodies with a stated position on the scientific question under evaluation.

• Institutional conflict of interest: a situation in which the institution or organization to which the party is affiliated holds a financial or material interest in the subject matter of the manuscript, such as equity stakes, patent licensing agreements, or sponsored research agreements creating an institutional incentive that may influence the party's judgment.

• Lookback period: the 36 months immediately preceding the submission of a manuscript, the acceptance of a reviewer assignment, or the acceptance or renewal of an editorial appointment. This period applies to employment, consultancy, advisory board membership, honoraria, travel support, grants, collaborations, mentorship, institutional affiliation, and comparable relationships. Patents, patent applications, royalties, licensing arrangements, equity interests, stock options, and other continuing financial interests must be disclosed. At the same time, they remain current or capable of generating benefit, regardless of when they originated. Older relationships outside the lookback period must be disclosed where a well-informed reasonable external observer would regard them as still materially relevant to the manuscript or editorial decision.

• Undisclosed conflict of interest: a conflict of interest that a party was obligated to declare under this Policy but did not disclose, whether through omission, oversight, or deliberate concealment.

• Editorial leadership: the Editor-in-Chief, Deputy Editor-in-Chief (if appointed), Associate Editors, Section Editors, and any other individual who participates in the decision-making process regarding submission, review, or publication of manuscripts.

• Appearance standard: the principle that the existence of a plausible reasonable perception of conflict on the part of a well-informed external observer is sufficient to trigger the disclosure obligation, regardless of whether the party considers the interest to be material. The appearance standard is further defined in Section 15.

• Disclosure threshold: the low threshold that determines whether a relationship, activity, or interest must be declared. The disclosure threshold is intentionally broad and is governed by the appearance standard. It is triggered by reasonable perception and does not require proof that judgment has been affected.

• Management threshold: the threshold used by the Editorial Direction to determine what action is required after a conflict of interest has been declared or identified. Management is based on risk, directness, recency, role in the editorial process, manuscript type, and the availability of safeguards. It is distinct from the disclosure threshold.

• Material conflict of interest: a declared or identified conflict that is sufficiently direct, recent, significant, or connected to the manuscript subject matter to create an objective risk of bias, an appearance of compromised independence, or a risk to the integrity or credibility of the editorial process.

• Manageable conflict of interest: a conflict that can be adequately addressed through disclosure, independent review, recusal from specific decisions, additional methodological checks, or other documented safeguards.

• Non-manageable conflict of interest: a conflict for which transparency and safeguards are insufficient to protect editorial independence or research integrity. Non-manageable conflicts may require recusal, reassignment, suspension of review, rejection, correction, Expression of Concern, Retraction, or institutional referral, depending on timing and severity.

• Waiver: a documented decision by the responsible editor to permit a conflicted person to perform a limited role despite a declared minor conflict. A waiver is not available where this Policy requires mandatory abstention, recusal, or exclusion.

• Heightened scrutiny: an enhanced editorial assessment applied to manuscripts or editorial situations presenting elevated conflict of interest risk. It may include verification of the sponsor role, data access certification, protocol and registry checks, independent statistical and methodological reviews, additional conflict-free reviewers, or confidential review of sponsor agreements.

• Reasonable awareness: the standard applied to interests of family members, dependants, institutions, or organizations. A party is not required to conduct unlimited investigations into unknown interests. Still, it must disclose interests actually known to them, interests they should reasonably know in the ordinary course of their professional or personal relationships, and interests they would become aware of by making ordinary good-faith inquiries. Deliberate avoidance of knowledge does not excuse non-disclosure.

3. CATEGORIES OF FINANCIAL CONFLICT OF INTEREST

The following financial relationships and activities constitute grounds for mandatory declaration under this Policy, where they involve an entity with a direct or indirect interest in the subject matter of the work:

• Employment: current or recent (within the lookback period) employment with or remunerated service for an organization that has a financial interest in the research.

• Consultancy: any paid consultancy arrangement with a commercial entity related to the subject matter of the manuscript, including regulatory consultancy, scientific advisory services, and clinical development consultancy.

• Advisory board membership: remunerated or unremunerated membership of a scientific, clinical, or business advisory committee of a commercial entity with interest in the research area.

• Equity interests: ownership of stocks, shares, or options in any entity that has a financial interest in the subject matter of the work, excluding diversified mutual funds and passive index funds beyond the party's control.

• Patent ownership and applications: ownership of, or pending applications for, patents related directly or indirectly to the research or to products and methods evaluated in the manuscript.

• Royalties: receipt of royalties from any commercial entity with an interest in the subject matter or results of the research.

• Honoraria and speaker fees: any remuneration received for lectures, presentations, or expert testimony in contexts related to the subject matter of the research.

• Research funding: grants or other forms of financial support received from commercial entities, government bodies, foundations, or other funders with a potential interest in the research outcomes, including indirect support (equipment, facilities, laboratory costs) and direct payments to the research institution.

• In-kind support: non-monetary support received from entities with an interest in the research, including provision of materials, reagents, laboratory equipment, software licenses, administrative assistance, literature searching services, or medical writing services provided without charge or at a reduced rate. In-kind support must be disclosed regardless of its monetary value.

• Travel and accommodation support: reimbursement of travel, accommodation, or attendance costs at conferences or events, funded by commercial entities with an interest in the research area, within the lookback period.

• Dependency relationships: financial interests of the spouse, domestic partner, or financially dependent relatives of the party where those interests are known to the party or fall within the reasonable awareness standard defined in Section 2.

These categories are mandatory minimum categories and are not exhaustive. All financial relationships directly related to the manuscript subject matter, the product, intervention, device, diagnostic test, software, sponsor, or commercial entity evaluated in the work must be disclosed regardless of monetary value. Financial value, when requested by the Editorial Direction, is used only for internal management assessment and risk classification; it is not a precondition for disclosure. Parties are required to apply the appearance standard (Section 15) when assessing whether a financial relationship not explicitly listed above requires disclosure.

4. CATEGORIES OF NON-FINANCIAL CONFLICT OF INTEREST

Non-financial conflicts of interest may be equally relevant to editorial independence and are subject to the same disclosure obligations. The following categories apply:

• Personal relationships: close personal friendship or personal rivalry with an author, reviewer, or editor involved in the same manuscript; family relationships.

• Academic and professional competition: active competition with the author for research priority, grant funding, academic positions, or scientific recognition in a directly related area; possession of an unpublished manuscript substantially competing in topic or findings with the manuscript under review.

• Supervision and mentorship: a current or recent (within the lookback period) mentor-mentee relationship, doctoral supervisor relationship, or equivalent relationship implying dependency or loyalty.

• Collaboration: co-authorship on a publication within the lookback period, or active collaboration on a research project or a joint grant application, with any of the authors of the manuscript under consideration.

• Intellectual, ideological, and religious convictions: publicly stated positions, advocacy roles, organizational affiliations, or personal convictions (political, religious, or ideological) that may reasonably be perceived to create a bias toward or against the findings, methods, or conclusions of the manuscript. Declarations of conviction-based conflict of interest are expected where the conviction is directly and materially relevant to the subject matter of the manuscript and where a reasonable external observer would perceive it as a potential source of bias.

• Expert witness activity: having acted or currently acting as an expert witness in legal, regulatory, or administrative proceedings whose subject matter is directly related to the topic of the manuscript under submission or review, including proceedings concerning pharmaceutical products, medical devices, clinical practices, or scientific claims evaluated in the manuscript.

• Institutional loyalty: situations in which the party's primary institutional affiliation creates a strong incentive to favor or disfavor the work of authors from the same or a competing institution.

• Membership of bodies with stated positions: membership of scientific societies, professional associations, or advocacy bodies that have issued formal positions on the scientific question evaluated in the manuscript.

• Coercive citation: any situation in which a reviewer or editor conditions a favorable editorial recommendation on the citation of specific works - including the reviewer's or editor's own publications - for reasons unrelated to the scientific merit of the manuscript. Coercive citation constitutes a non-financial conflict of interest and a reportable act of peer review misconduct under the Complaints, Appeals and Whistleblowing Policy.

• Relationship with non-profit organizations and funding bodies: paid or unpaid relationships with non-governmental organizations, research institutions, charities, or patient advocacy groups with a stated or material interest in the topic of the manuscript.

Non-financial conflicts do not automatically preclude participation in the editorial process. Their management depends on the risk classification set out in Section 16. Where a non-financial conflict is declared and assessed as low-risk or manageable, the responsible editor may proceed with disclosure and documented safeguards. Where the conflict creates an objective risk of bias, involves a decision-making editor, or falls within a mandatory abstention category, recusal or reassignment applies.

Where a single circumstance falls into more than one non-financial category, the party must disclose the underlying facts once, identifying the relationship, role, activity, affiliation, or commitment. Classification into personal, professional, intellectual, advocacy-related, institutional, or other conflict-of-interest categories is performed by the Editorial Direction for management purposes. It does not affect the obligation to disclose. Multiple classifications may be recorded where they assist risk assessment.

5. CONFLICT OF INTEREST SPECIFIC TO GYNECOLOGY AND OBSTETRICS RESEARCH

European Gynecology and Obstetrics (EGO) recognizes that the field of gynecology and obstetrics presents specific and recurrent categories of conflict of interest that require heightened attention. The following situations require mandatory declaration and, where applicable, heightened editorial scrutiny:

• Pharmaceutical industry relationships: financial or advisory relationships with manufacturers of products relevant to gynecology and obstetrics, including hormonal contraceptives, hormone replacement therapy, fertility treatments, injectable contraceptives, medications for endometriosis or gynecological cancers, drugs used in obstetrics (tocolytics, uterotonic agents, antibiotics), and any other product whose indication, efficacy, or safety is directly relevant to the subject matter of the manuscript.

• Medical device industry relationships: financial or advisory relationships with manufacturers of devices relevant to gynecological or obstetric practice, including intrauterine devices, surgical robots, laparoscopic and hysteroscopic instruments, diagnostic equipment, fetal monitoring devices, assisted reproduction technology devices, and any other device whose use is directly relevant to the subject matter of the manuscript.

• Reproductive health advocacy: formal membership, paid or unpaid leadership roles, or publicly stated advocacy positions in organizations that have a stated stance on contested topics in reproductive health, including but not limited to access to abortion services, contraception policy, assisted reproduction, surrogacy, gender-affirming care in gynecology, and population health policy. Such advocacy positions constitute non-financial conflicts of interest that must be declared under Section 4 when the manuscript addresses any such contested area.

• Diagnostic testing and laboratory services: financial relationships with commercial providers of diagnostic tests, genetic testing services, prenatal screening services, or laboratory platforms evaluated or recommended in the manuscript.

• Digital health and clinical decision support: financial relationships with developers of digital health applications, clinical decision support tools, or artificial intelligence systems used in gynecological or obstetric diagnosis or treatment, where such tools are evaluated or compared in the manuscript.

For manuscripts reporting clinical trials, systematic reviews, or meta-analyses in which the primary endpoint involves the performance, safety, or comparative effectiveness of a pharmaceutical product or medical device, the Editor-in-Chief applies the additional scrutiny provisions set out in Section 16.7.

6. INSTITUTIONAL CONFLICT OF INTEREST

An institutional conflict of interest exists when the institution or organization with which the author, reviewer, or editor is affiliated holds a financial or material interest in the subject matter or outcome of the research. Institutional conflicts of interest are subject to the same disclosure obligations as individual financial conflicts of interest.

Examples of institutional conflicts of interest that must be disclosed include: the institution's ownership of equity in a company whose product is evaluated in the research; licensing agreements between the institution and a commercial entity concerning technology described or validated in the manuscript; sponsored research agreements between the institution and a funder with a financial interest in the research outcomes; and institutional policies or programs that create an economic incentive tied to the specific results of the research.

Authors are responsible for disclosing institutional conflicts of interest of which they are aware or should reasonably be aware under the reasonable awareness standard defined in Section 2. The Editorial Direction may request a formal statement of no institutional conflict of interest from authors of manuscripts involving sponsored research, technology evaluation, clinical practice guidance, or commercial product assessment. Where an institutional conflict is disclosed, the Editorial Direction assesses whether adequate safeguards are in place, including independent data verification, independent statistical analysis, independent methodological review, and disclosure of sponsor role, before proceeding to peer review.

Where the same circumstance may be characterized as an institutional conflict of interest, institutional loyalty, non-profit affiliation, advocacy relationship, or personal professional relationship, it must be disclosed once with sufficient factual detail. The Editorial Direction records the applicable classification or classifications for management purposes.

7. SPONSOR INFLUENCE AND ACCESS TO STUDY DATA

Consistent with the ICMJE Recommendations (January 2026 update), authors must not enter into agreements with study sponsors - whether commercial or non-commercial - that restrict authors' independent access to all study data, that interfere with authors' ability to analyze and interpret the data independently, or that grant the sponsor control over the decision to publish or not to publish the results.

Any contractual arrangement that purports to grant a sponsor approval rights, a right of delay, a right to suppress negative results, or a right to prior review before journal submission is incompatible with this Policy and constitutes a reportable conflict of interest. Authors are required to warrant, at the time of submission, that no such restrictive agreement is in place.

In collaborative research involving academic and non-academic (commercial) contributors, at least one author affiliated with an academic or independent research institution must certify that they had direct and unimpeded access to the primary dataset and played an active role in the analysis. This certification is submitted with the manuscript through the official editorial platform.

The Editorial Direction may verify sponsor independence by requesting, on a confidential basis, the relevant funding agreement, sponsor contract, trial protocol, registry entry, statistical analysis plan, data access statement, or written certification identifying the author or authors with direct and unimpeded access to the primary dataset. The Journal may also compare the submitted manuscript with the trial registry, protocol, statistical analysis plan, funding statement, and Competing Interests statement where available. Refusal or inability to provide the requested documentation may result in suspension of peer review, rejection before external review, or a post-publication investigation, depending on the timing and severity.

Funding sources that are not restrictive but that create a financial relationship between the authors and the funder must be declared in the Competing Interests statement in accordance with Section 8. The presence of commercial funding, in and of itself, does not preclude publication but is subject to appropriate disclosure and, in the case of sponsored clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines, the heightened scrutiny provisions of Section 16.

8. DECLARATION OBLIGATIONS: AUTHORS

All authors of manuscripts submitted to the Journal are required to declare all relationships and activities that may constitute a conflict of interest, as defined in Sections 2 to 7 of this Policy. The declaration obligation applies to all manuscript types published by the Journal, including original research articles, review articles, meta-analyses, case reports, editorials, commentaries, letters, brief communications, and any other type. Invited editorials and invited reviews are not exempt from the declaration obligation.

The corresponding author is responsible for coordinating the collection of declarations from all co-authors and for ensuring that all individual declarations are complete and accurate before submission. Where co-authors disagree about the characterization of a relationship or interest, the principle of precautionary disclosure applies: the relationship must be declared. Each author completes an individual disclosure using the ICMJE Disclosure Form for Disclosure of Interests (current version, available at www.icmje.org) or an equivalent form designated by the Publisher through the official editorial platform. The form must cover all interests within the lookback period and, without temporal limitation, all patents and equity interests held at the time of submission.

Authors who are current members of the Editorial Board of the Journal are required to declare their board membership in the Competing Interests statement of every manuscript they submit, regardless of whether they participate in the editorial handling of their own submission. This declaration enables readers and editors to verify that the independent management procedure established in Section 12.3 has been applied.

The declaration obligation arises at the time of submission and applies to all revised versions of the manuscript submitted in response to peer review. Where a new conflict of interest arises after initial submission - such as the execution of a consultancy agreement, acceptance of a research grant, or acquisition of equity during the peer review process - the corresponding author must notify the Editorial Direction within 5 working days of the new interest arising, and must submit an updated declaration. Failure to update the declaration constitutes an undisclosed conflict of interest and is subject to the provisions of Sections 17 and 22.

The declaration must include, at minimum: the full name of the entity in which the interest is held; the nature of the interest (employment, consultancy, grant, stock, patent, in-kind support, expert witness activity, etc.); the approximate time period; the relationship between the interest and the manuscript subject matter; and, where financial value is involved and requested by the Editorial Direction, an indication of scale sufficient to support risk classification. Authors are not required to disclose the specific monetary value of financial interests in the published article. Still, they must provide sufficient information for editors and readers to assess relevance, materiality, and independence.

Standard wording for no conflict of interest: "The authors declare that they have no financial or non-financial conflicts of interest relevant to this work."

Standard wording for declared conflict: "[Name] has received [nature of interest] from [entity] during the [period]. The remaining authors declare no conflicts of interest."

9. PUBLICATION OF AUTHOR CONFLICT OF INTEREST STATEMENTS

The Competing Interests statement of all published articles is made publicly available to readers as a designated section of the published article, positioned after the Acknowledgments section and before the References. The statement either reports the declarations of interest for each named author or provides a collective declaration of no conflicts of interest.

For articles funded in whole or in part by commercial sponsors, the Funding section of the article specifies the identity of the funder, the nature of the funding relationship, and any role the funder played in study design, data collection, analysis, interpretation of results, or preparation of the manuscript. Where the funder had no role in any of these activities, this must be explicitly stated.

The Competing Interests statement and the Funding statement are permanent parts of the Version of Record and are indexed through CrossRef's Crossmark mechanism. Any post-publication update to these statements is processed in accordance with the Correction and Retraction Policy.

The Journal does not accept statements that are ambiguous with respect to the nature or materiality of declared interests. The Editorial Office may request clarification or expansion of statements that do not provide sufficient information for editorial assessment or public understanding.

10. DECLARATION OBLIGATIONS: REVIEWERS

Peer reviewers invited by the Journal are required to declare to the responsible Associate Editor, before accepting the review assignment, any circumstance that may constitute a conflict of interest with respect to the manuscript, its authors, or the subject matter of the work. This obligation applies regardless of whether the review process is double-anonymized or whether the reviewer has identified the authors.

The following circumstances constitute grounds for mandatory abstention from review:

• Competitive or financial relationships with the authors: current or recent co-authorship within the lookback period, active collaboration on an ongoing research project, shared or joint grant application, or known competitive relationship in the same specific research area, including possession of an unpublished competing manuscript substantially overlapping with the submitted work.

• Direct financial interest in the subject matter: financial relationships (as defined in Section 3) with an entity whose products, methods, or services are evaluated in the manuscript; financial interest in the commercial exploitation of the findings.

• Institutional affiliation: current affiliation with the same institution as any of the named authors, or recent (within the lookback period) affiliation with the same institution.

• Supervisory and mentorship relationships: current doctoral supervisor or supervisee relationship, or equivalent mentorship relationship within the lookback period.

• Prior review of the manuscript: prior review of the same manuscript for another journal, where the reviewer's identity and opinion are not anonymous to the authors; prior review of a substantially identical earlier version.

• Personal relationships: close personal friendship or personal rivalry of a nature that would reasonably compromise the reviewer's objectivity; family relationships.

• Expert witness activity: having acted as expert witness for any party in legal or regulatory proceedings directly related to the subject matter of the manuscript.

Where a potential conflict is minor or not immediately decisive, the reviewer declares it to the responsible Associate Editor, who assesses on a case-by-case basis whether to confirm or revoke the assignment. For reviewers, a minor conflict is a disclosed, remote, non-financial or indirect relationship that is not connected to the product, intervention, sponsor, author group, institution, or contested question under evaluation, and that a well-informed reasonable external observer would not regard as likely to affect the substance of the review. A waiver may be granted only for such minor conflicts and must be documented in the editorial record. Waiver is not permitted where the mandatory abstention categories listed above apply. The guiding principle remains the appearance standard: in case of doubt, abstention prevails.

A reviewer conflict-of-interest waiver record must identify the declared relationship, the reason the conflict was assessed as minor, the safeguards applied, and the person who approved the waiver. Where the manuscript concerns a commercially funded clinical study, medical device, pharmaceutical product, diagnostic test, digital health tool, or clinical practice guideline, waiver should be exceptional. The Editor-in-Chief or a conflict-free delegate must approve it.

Reviewers are further required to notify the Editorial Direction if they identify a conflict of interest after having accepted the review assignment (for example, upon identifying the authors from internal textual evidence). In such cases, the procedures set out in the Peer Review Policy (Section 10) apply.

Reviewers must not use unpublished materials, data, methods, or ideas disclosed in a submitted manuscript for their own research or for any purpose other than the review, without the express written consent of the corresponding author. This prohibition applies for the duration of the review and indefinitely thereafter with respect to information not subsequently made public by the authors.

A 12-month cooling-off period applies to individuals who have recently concluded a paid consultancy or employment relationship with a commercial entity before acting as reviewers for manuscripts concerning that entity's products or services. Reviewers in this situation must declare the prior relationship and may be excluded from the review at the discretion of the Associate Editor.

11. DECLARATION OBLIGATIONS: EDITORIAL LEADERSHIP AND EDITORIAL BOARD

All members of the editorial leadership and the Editorial Board are required to declare, at the time of appointment and annually thereafter, all financial and non-financial interests that may constitute a conflict of interest in the exercise of their editorial functions. The declaration is made using the ICMJE Disclosure Form for Disclosure of Interests or an equivalent form designated by the Publisher and submitted through the official editorial platform or, for new appointments, as part of the written appointment agreement pursuant to Section 8 of the Editorial Board Charter.

The annual re-declaration obligation is mandatory and cannot be discharged by reference to the absence of material changes since the previous declaration. Each year, the member submits a complete updated form. Changes in interests arising between annual declarations must be reported to the Editor-in-Chief (or, for the Editor-in-Chief, to Edikta S.r.l.) within 10 working days of the change arising.

The conflict of interest declarations of the Editor-in-Chief, Deputy Editor-in-Chief, and Associate Editors are published on the Journal's website in an annually updated disclosure statement. This practice, consistent with standards adopted by leading medical journals including NEJM, BMJ, and JAMA, ensures that readers and authors can assess the independence of the editorial leadership. The disclosure statement covers financial and significant non-financial interests relevant to the Journal's subject matter.

Members of the editorial leadership must not use unpublished materials, data, or ideas from manuscripts they are handling for their own research or to inform their editorial positions at other journals, without the express written consent of the corresponding author. This prohibition extends beyond the editorial term.

Affiliations with artificial intelligence companies. Members of the editorial leadership who hold, or acquire during their term, financial or advisory relationships with companies developing, marketing, or licensing artificial intelligence systems used in clinical gynecology or obstetrics, or in research or publication workflows, are required to declare such relationships at appointment and at each annual re-declaration. Where a manuscript under the editor's management involves evaluation of an AI system in which the editor holds such a relationship, the recusal procedure of Section 12 applies. This provision operationalizes the cross-reference established in the Artificial Intelligence Policy, Section 23.

Members of the Editorial Board who act as reviewers are subject to the same reviewer conflict of interest obligations set out in Section 10 in addition to the editorial board declaration obligations of this section.

Simultaneous membership of editorial boards of journals with substantially overlapping aims and scope must be declared in accordance with Section 15 of the Editorial Board Charter. The Editor-in-Chief assesses, in consultation with Edikta S.r.l. where appropriate, whether simultaneous membership constitutes an unresolvable conflict incompatible with continued membership. The outcome is documented in the editorial record.

Training on conflict of interest recognition. Edikta S.r.l., in coordination with the Editor-in-Chief, provides newly appointed members of the editorial leadership with orientation materials on the recognition and management of conflicts of interest, consistent with COPE guidance on training in publication ethics. The orientation covers: the categories of conflict of interest defined in this Policy; the operation of the appearance standard; the declaration and recusal procedures; and the consequences of non-declaration. Annual reminders on conflict of interest obligations are issued to all active members of the editorial board.

12. HANDLING OF EDITORIAL CONFLICTS OF INTEREST: MANUSCRIPT MANAGEMENT PROCEDURES

When a member of the editorial leadership identifies a conflict of interest with respect to a manuscript assigned to them, they must immediately recuse themselves from all phases of the editorial management of that manuscript and notify the Editor-in-Chief (or, where the Editor-in-Chief is the conflicted party, the Deputy Editor-in-Chief or a designated conflict-free Associate Editor). The conflicted editor is excluded from all decisional communications regarding the manuscript, including access to reviewer reports, author responses, and editorial recommendations.

The following specific procedures govern recusal at different organizational levels:

12.1 Editor-in-Chief conflict of interest

Where the Editor-in-Chief has a conflict of interest in relation to a manuscript, including a manuscript of which the Editor-in-Chief is an author or co-author, the Editor-in-Chief recuses themselves at the earliest opportunity and notifies Edikta S.r.l. in writing.

The manuscript is assigned to the Deputy Editor-in-Chief or, where no Deputy Editor-in-Chief has been appointed, or the Deputy Editor-in-Chief is also conflicted, to a conflict-free Associate Editor designated by Edikta S.r.l. The designated editor exercises full and final decision-making authority over the manuscript, including reviewer selection. That authority is not subject to review, instruction, or reversal by the Editor-in-Chief.

The Editor-in-Chief is excluded, for the duration of the process, from access to the manuscript file on the editorial platform, from the identity of the reviewers, from the reviewer reports, from the author responses, and from all decisional communications. The exclusion is implemented through the editorial platform's access controls, where available, and, where they are not, by written instructions recorded in the editorial record.

Where the Editor-in-Chief is an author, the published article includes a provenance statement identifying the editor who managed the submission and confirming that the Editor-in-Chief had no involvement in the editorial process for that manuscript.

Where no conflict-free mechanism can be established, the conflict is classified at Level 4 under Section 16.3. The manuscript is declined without external review or, with the authors' consent, transferred to another journal without prejudice. The authors are informed that the decision is procedural and does not constitute an assessment of scientific merit.

12.2 Associate Editor conflict of interest

An Associate Editor who identifies a conflict of interest in relation to a manuscript assigned to them recuses themselves immediately and notifies the Editor-in-Chief, stating the nature of the interest. The manuscript is not held pending the notification.

The Editor-in-Chief reassigns the manuscript to a conflict-free Associate Editor or, where the subject matter requires it, assumes the handling personally. The recused Associate Editor is excluded from the manuscript file and from all decisional communications in accordance with Section 16.6.

Where the conflict emerges after reviewers have been invited or reports have been received, the reassigned editor reviews the reviewer selection and determines whether any reviewer was selected under circumstances affected by the recused editor's interest. Where that is the case, at least one additional independent reviewer is appointed before a decision is taken.

Recusal by an Associate Editor is a procedural act. It is recorded as such, does not constitute an adverse finding, and does not affect the standing of the editor within the editorial leadership.

12.3 Manuscripts submitted by editorial board members

Manuscripts authored or co-authored by a member of the Editorial Board are accepted for consideration and are handled under the independent management procedure established in this subsection. Membership of the Editorial Board confers no advantage and imposes no disadvantage in the editorial assessment.

The manuscript is assigned to a handling editor who has no conflict of interest with the author and who is not in a relationship of hierarchical dependency with them. The author is excluded from access to the manuscript file on the editorial platform, from reviewer selection, from the identity of the reviewers, and from all decisional communications concerning the manuscript.

Reviewers are selected independently by the handling editor. Reviewers affiliated with the same institution as the author, and reviewers falling within any mandatory abstention category listed in Section 10, are not invited.

The manuscript is subject to the same standards of assessment, the same reviewer requirements, and the same revision expectations as any other submission. Expedited handling, waiver of methodological requirements, and reduction of the number of reviewers are not permitted.

Membership of the Editorial Board is declared in the Competing Interests statement of the submission in accordance with Section 8. The published article includes a provenance statement identifying the handling editor and confirming that the author had no involvement in the editorial process for that manuscript.

The volume and the outcome of submissions by members of the Editorial Board are monitored under Section 12.5 and reported in aggregate under Section 23.

12.4 Manuscripts submitted by members of the European Society of Gynecology

Membership of the European Society of Gynecology does not in itself constitute a conflict of interest and does not attract any special procedure. Members of the Society submit manuscripts on the same terms as any other author.

A declaration is required, and the independent management procedure of Section 12.3 applies by analogy, where the author holds an office in the governing bodies of the Society, or where the manuscript concerns a guideline, position statement, consensus document, congress, or institutional activity of the Society, or evaluates its scientific output or its stated positions.

The European Society of Gynecology, as the scientific society on whose behalf the Journal is published, has no role in the selection of manuscripts, in the appointment of reviewers, or in any editorial decision. The relationship between the Society, Edikta S.r.l. as Publisher, and the editorial leadership is governed by the Editorial Policy Statement and by the Editorial Board Charter. The guarantees of editorial independence set out in Section 14 apply to the Society in the same terms in which they apply to the Publisher.

12.5 Monitoring of systematic conflict of interest patterns

The Editor-in-Chief and Edikta S.r.l. jointly monitor, at least annually, indicators capable of revealing systemic conflict of interest risk that is not apparent in the assessment of individual manuscripts. The indicators are:

• the proportion of published articles authored or co-authored by members of the editorial leadership or of the Editorial Board, and their acceptance rate compared with the acceptance rate of submissions from unaffiliated authors;

• the frequency and the distribution of editorial recusals across the editorial leadership;

• the concentration of review assignments on a limited number of reviewers, and any recurring pairing of specific reviewers with specific authors or institutions;

• the proportion of published articles reporting commercial funding, disaggregated by article type;

• patterns of citation to the work of editors or reviewers that are not explained by the subject matter of the manuscripts concerned, which may indicate coercive citation as defined in Section 4;

• the recurrence of declared interests involving the same sponsor across a series of manuscripts.

Where an indicator departs materially from the expected pattern, the Editor-in-Chief opens a documented review. The review may lead to a change in reviewer selection practice, a redistribution of editorial responsibilities, a revision of this Policy under Section 24, or proceedings under the Complaints, Appeals and Whistleblowing Policy.

The aggregate results of the monitoring are reported under Section 23. The monitoring does not create any presumption of misconduct in respect of individual editors, reviewers, or authors.

13. DECLARATION OBLIGATIONS: GUEST EDITORS

Guest Editors coordinating Special Issues or Supplements are subject to the same conflict of interest declaration obligations applicable to members of the editorial leadership under Section 11, for the duration of their assignment. Before accepting the Guest Editor appointment, each candidate must submit a full ICMJE Disclosure Form covering all interests relevant to the subject matter of the Special Issue or Supplement.

Guest Editors must not act as handling editors for manuscripts submitted by their direct collaborators, co-investigators, or any author with whom they have a financial or personal conflict of interest as defined in Sections 3 and 4. Where a conflict emerges during the assignment, the Guest Editor declares it to the Editor-in-Chief, who manages the affected manuscript independently.

Manuscripts submitted by the Guest Editor to their own Special Issue or Supplement are excluded from the Guest Editor's management. They are handled by the Editor-in-Chief or a designated Senior Editor, with the Guest Editor completely excluded from the decision-making process. The published article includes a provenance statement identifying the managing editor and stating that the Guest Editor was not involved in the editorial process for that manuscript.

Commercial or industry-sponsored Special Issues generate a heightened risk of systemic conflict of interest. The Journal accepts Special Issues with commercial sponsorship only on the condition that: the editorial independence of the Guest Editor is contractually guaranteed; no sponsor representative participates in reviewer selection or editorial decisions; the commercial nature of the sponsorship is disclosed on the cover page and in each article of the Special Issue; and the Guest Editor confirms the absence of restrictive agreements of the type described in Section 7. Edikta S.r.l verifies these conditions before publication.

14. CONFLICT OF INTEREST AND THE PUBLISHER

Edikta S.r.l., acting as Publisher of the Journal, acknowledges that publishers may hold commercial interests that create potential conflicts with editorial independence. This section sets out the Publisher's commitments to the management of such conflicts.

The Journal operates under a diamond open access model with no article processing charges and no submission fees. This model eliminates the structural conflict of interest inherent in APC-funded journals, where acceptance decisions may be influenced by the economic incentive to collect processing fees. The absence of APC revenue ensures that there is no commercial pressure on the editorial leadership to maximize acceptance rates.

Edikta S.r.l. commits to maintaining a strict commercial firewall between advertising and sponsorship relationships and the editorial decision-making process. No editorial decision - acceptance, rejection, priority, or framing of a manuscript - is influenced by advertising relationships, sponsorship agreements, or the commercial interests of any third party. The specific provisions governing advertising and sponsorship are set out in the Advertising and Sponsorship Policy.

Edikta S.r.l. does not direct or influence the selection of manuscripts for publication, the assignment of reviewers, the interpretation of reviewer reports, or any other component of the scientific editorial process, which falls within the exclusive competence of the editorial leadership. Publisher communications to the editorial leadership regarding commercial, legal, or operational matters do not constitute editorial directions and are not binding on editorial decisions.

Staff of Edikta S.r.l. who hold responsibilities related to the editorial operations of the Journal are bound by the same confidentiality and non-use obligations as members of the editorial board. They must disclose to the Editor-in-Chief any financial or personal interest in a manuscript they are processing.

Where a member of the editorial leadership or the Publisher identifies a situation in which commercial interests of Edikta S.r.l. may create an apparent or actual conflict with editorial independence, the situation must be disclosed to the Editor-in-Chief and, where appropriate, addressed through the dispute resolution mechanism established in Section 22 of the Editorial Board Charter.

15. THE APPEARANCE STANDARD

The Journal adopts the appearance standard as the central operative principle of this Policy. Under the appearance standard, a conflict of interest requiring declaration exists whenever a well-informed, reasonable external observer - fully aware of the relationship or interest in question and of the relevant editorial context - would have reason to question the independence of the party's judgment, regardless of whether the party themselves considers the interest to have influenced their conduct.

The appearance standard is not a subjective test: it does not depend on the party's self-assessment of their own objectivity, nor on the party's conviction that the interest is not material. It is an objective test applied from the perspective of a hypothetical reasonable observer external to the relationship.

The appearance standard requires that:

• Any relationship or activity that a party is uncertain whether to declare must be declared.

• The non-materiality of an interest to the outcome of the work does not exempt the party from the declaration obligation.

• The passage of time since a relationship ended does not automatically eliminate the declaration obligation if the relationship falls within the lookback period or involves ongoing financial benefits (royalties, patents, etc.).

• Declaration is not an acknowledgment of bias. The Journal treats declarations as a routine act of transparency and does not draw negative inferences from their existence.

• A party who is in doubt about whether a specific situation requires declaration is encouraged to contact the Editorial Direction for guidance, without prejudice to their individual responsibility to apply the appearance standard.

The appearance standard determines whether disclosure is required; it does not, by itself, determine the management measure. Management is governed by Section 16 and depends on the directness, recency, financial significance, role of the conflicted party, manuscript type, subject matter, and the availability of safeguards that preserve editorial independence and research integrity.

16. THRESHOLDS, RISK CLASSIFICATION, AND MANAGEMENT OF DECLARED CONFLICT OF INTEREST

This Section establishes the framework by which the Editorial Direction classifies and manages conflicts of interest declared under Sections 8, 10, 11 and 13, or identified under Sections 17 and 18. The framework applies to authors, peer reviewers, members of the editorial leadership, members of the Editorial Board, Guest Editors, and staff of Edikta S.r.l. holding editorial responsibilities.

Classification determines the management measure to be applied. It does not affect the scope of the disclosure obligation, which is governed exclusively by the appearance standard set out in Section 15.

16.1 Separation of thresholds

The disclosure threshold and the management threshold are distinct and operate independently of each other.

The disclosure threshold is deliberately low. It is triggered by reasonable perception under the appearance standard and requires neither proof that judgment has been affected nor a determination that the interest is material. No party may withhold a declaration on the ground that, in their own assessment, the interest would not warrant a management measure.

The Editorial Direction applies the management threshold after a declaration has been made or an interest has been identified. It determines whether any action is required and, if so, which action. A declaration does not in itself imply a finding of bias, does not create a presumption against the declaring party, and does not automatically result in exclusion, recusal, rejection, or any other adverse consequence.

The converse also applies. The fact that an interest would be classified as low-risk under Section 16.3 never operates as an exemption from the obligation to declare it. Failure to declare is assessed under Sections 17, 18 and 22 irrespective of the management level that the interest would have attracted had it been declared.

16.2 General assessment factors

In assigning a management level under Section 16.3, the responsible editor assesses the declared or identified interest against the following factors, none of which is determinative in isolation:

• Directness: the proximity of the relationship to the specific product, intervention, device, diagnostic test, software, dataset, sponsor, institution, or contested question evaluated in the manuscript.

• Recency: the position of the relationship within or outside the lookback period defined in Section 2, and whether it continues to generate benefit.

• Financial significance: the scale of the interest, where information on scale has been requested for internal risk classification in accordance with Section 3.

• Role in the editorial process: whether the conflicted party is an author, a peer reviewer, a non-decisional contributor, or an editor holding decision-making authority over the manuscript. Decision-making authority weighs the assessment towards a higher level.

• Manuscript type: original research, systematic review, meta-analysis, clinical practice guideline, editorial, commentary, or narrative review, with greater weight given to article types that directly shape clinical practice.

• Subject matter: whether the manuscript addresses one of the contested areas of reproductive health identified in Section 5.

• Sponsor involvement: the presence of commercial funding and the extent of sponsor participation in the design, conduct, analysis, interpretation, or drafting of the study.

• Availability of safeguards: whether conflict-free reviewers, independent statistical review, independent methodological review, or an alternative handling editor can be secured without compromising the quality or the timeliness of the assessment.

• Cumulative pattern: whether the party has declared multiple related interests that, taken together, present a risk greater than that presented by any single relationship considered in isolation.

• Manner of disclosure: whether the interest was declared spontaneously and completely, or was identified by the Journal, by a reviewer, or by a third party.

Where the factors point to different levels, the higher level applies. The assessment and the factors that determined it are recorded in accordance with Section 16.9.

16.3 Management levels

Level 0 - no relevant conflict of interest: no declared or identified relationship relevant to the manuscript, authors, reviewers, editors, sponsor, institution, or subject matter. Management: proceed in accordance with standard editorial procedures.

Level 1 - disclosable low-risk conflict of interest: a remote, indirect, non-financial, or non-material relationship that is fully declared and would not reasonably be expected to affect judgment. Management: published disclosure where the party is an author; confidential record note where the party is a reviewer or editor; no additional safeguard required unless the responsible editor considers it prudent.

Level 2 - manageable conflict of interest: a declared relationship with moderate or indirect relevance, including non-decision-making advocacy roles, non-current collaborations outside the lookback period that remain contextually relevant, indirect funding, or institutional relationships not involving the specific product or outcome under evaluation. Management: disclosure plus documented safeguards, which may include additional conflict-free reviewers, independent methodological review, independent statistical review, sponsor-role verification, or limitation of the conflicted person to a non-decisional role.

Level 3 - high-risk conflict of interest requiring exclusion from decision-making: a direct financial relationship with an entity whose product, device, diagnostic test, service, or software is evaluated; current or recent co-authorship, collaboration, same-institution affiliation, mentorship, supervisory relationship, personal rivalry, or close personal relationship with an author; or any conflict of interest affecting a decision-making editor. Management: mandatory reviewer abstention or editor recusal; reassignment to a conflict-free editor; independent reviewer selection; heightened scrutiny for author conflict of interest; and documentation in the editorial record.

Level 4 - non-manageable conflict of interest: sponsor control over data access, analysis, interpretation, publication, submission, or suppression of results; inability or refusal to certify independent access to data in a sponsored study; direct financial stake of a reviewer or decision-making editor in the outcome of the manuscript; intentional concealment of a material conflict of interest; or absence of any conflict-free mechanism to manage an Editor-in-Chief or Guest Editor conflict. Management: rejection, suspension of peer review, exclusion of reviewer reports, reassignment, Correction, Expression of Concern, Retraction, institutional referral, termination of appointment, or submission bar, as applicable under Sections 17, 18, and 22.

16.4 Management of author conflict of interest

A declared author conflict of interest is not a ground for rejection. Manuscripts are assessed on scientific merit; declared interests are managed through transparency and, where the assessed risk requires it, through verification.

Level 0 and Level 1 author conflicts are managed through publication of the Competing Interests statement in accordance with Section 9, without further measure.

Level 2 author conflicts are managed through the publication of the Competing Interests statement together with one or more documented safeguards, which may include the appointment of additional conflict-free reviewers, independent methodological and statistical reviews, or verification of the sponsor role under Section 16.8.

Level 3 author conflicts require, in addition to the measures available at Level 2, the heightened scrutiny procedure of Section 16.7 where the manuscript falls within its scope, and an explicit statement in the Funding section of the article identifying the role of the funder in study design, data collection, analysis, interpretation of results, and preparation of the manuscript.

Level 4 author conflicts are those in which the interest cannot be managed through disclosure and safeguards, in particular where a sponsor controls data access, analysis, interpretation, or the decision to publish, or where the authors are unable or unwilling to provide the certification required by Section 7. In such cases, peer review is suspended, and the manuscript is rejected before or during external review, in accordance with Sections 7 and 16.8.

Where an author is a member of the editorial leadership or of the Editorial Board, the procedures of Section 12 apply in addition to the measures established in this subsection.

16.5 Management of reviewer conflict of interest

A reviewer falling within a mandatory abstention category listed in Section 10 is excluded from the review. The exclusion is not subject to waiver and is recorded in the editorial record.

Level 0 and Level 1 reviewer conflicts are recorded confidentially by the responsible Associate Editor and the review proceeds. The record is not disclosed to the authors, in accordance with Section 20.

Level 2 reviewer conflicts may be managed through a documented waiver under Section 10, where the conflict is minor as defined in that Section. The waiver record identifies the declared relationship, the reason for which the conflict was assessed as minor, the safeguards applied, and the person who approved the waiver. Where the manuscript concerns a commercially funded clinical study, a medical device, a pharmaceutical product, a diagnostic test, a digital health tool, or a clinical practice guideline, the waiver requires the approval of the Editor-in-Chief or of a conflict-free delegate.

Level 3 reviewer conflicts require abstention and replacement. The assignment has been revoked, and a conflict-free reviewer is invited. Where a report has already been submitted, it is excluded from the editorial record, is not transmitted to the authors, and is not relied upon in the decision.

Level 4 reviewer conflicts, including a direct financial stake in the outcome of the manuscript and the intentional concealment of a material interest, result in exclusion of the report, re-examination of any decision already taken in accordance with the Peer Review Policy, and application of the measures established in Section 22.6.

Where a conflict of interest is identified after the review has been completed, the responsible Associate Editor determines whether the report may be retained. A report is excluded whenever the conflict falls within a mandatory abstention category or is classified at Level 3 or Level 4. Exclusion of a report requires appointing a replacement reviewer before a final decision is made.

16.6 Management of editorial conflict of interest

An editorial conflict of interest is assessed by reference to the decision-making authority held by the editor over the manuscript concerned.

Level 0 and Level 1 editorial conflicts are recorded confidentially, and the editor continues to handle the manuscript.

Level 2 editorial conflicts are managed by limiting the editor to a non-decisional role, by appointing an additional conflict-free editor to review the recommendation, or through other documented safeguards. In no case does the conflicted editor take the final decision.

Level 3 and Level 4 editorial conflicts require recusal and reassignment in accordance with Section 12. Recusal is complete: the conflicted editor is excluded from access to the manuscript file on the editorial platform, from reviewer selection, from the reviewer reports, from the author responses, and from all decisional communications concerning the manuscript.

Reassignment is made to a conflict-free member of the editorial leadership at the same or a higher level of responsibility. Where no conflict-free member of the editorial leadership is available, the Editor-in-Chief or, where the Editor-in-Chief is the conflicted party, Edikta S.r.l., appoints an independent external editor of appropriate standing under a written confidentiality undertaking. Where no such mechanism can be secured, the conflict is classified at Level 4, and the manuscript is declined without external review.

Every recusal is recorded in accordance with Section 16.9 and is counted in the annual report published under Section 23.

16.7 Heightened scrutiny for commercially funded or high-risk clinical research

Heightened scrutiny is applied by the Editor-in-Chief, on their own initiative or on the recommendation of the responsible Associate Editor, to the following categories of manuscript:

• clinical trials sponsored in whole or in part by a commercial entity;

• systematic reviews and meta-analyses in which the primary endpoint concerns the performance, safety, or comparative effectiveness of a pharmaceutical product or a medical device, as provided in Section 5;

• clinical practice guidelines and consensus statements;

• manuscripts evaluating a diagnostic test, a prenatal screening service, or a laboratory platform supplied by an entity with which any author holds a declared financial relationship;

• manuscripts evaluating a digital health application, a clinical decision support tool, or an artificial intelligence system used in gynecological or obstetric diagnosis or treatment;

• manuscripts in which an author has declared a Level 3 interest in the entity whose product, service, or intervention is evaluated.

Heightened scrutiny consists of one or more of the following measures, selected in proportion to the assessed risk:

• verification of the sponsor role in accordance with Section 16.8;

• comparison of the submitted manuscript with the trial registry entry, the protocol, and the statistical analysis plan, with any discrepancy in primary or secondary outcomes to be explained by the authors;

• independent statistical review by a statistician with no relationship to the authors, the sponsor, or the institutions involved;

• independent methodological review;

• appointment of at least one additional reviewer free of any declared or identifiable relationship with the sponsor;

• confidential review of the funding agreement or of the sponsor contract, in accordance with Section 16.8;

• verification of the contribution of any medical writer or editorial support service and of the entity that funded it, in accordance with the Authorship Policy.

The measures applied, and the reasons for their selection, are recorded in Section 16.9. Heightened scrutiny is a procedural safeguard. It is not communicated to the authors as an adverse finding and does not create a presumption against publication.

16.8 Sponsor independence verification

Where a manuscript reports research funded in whole or in part by a commercial sponsor, or where the declared interests indicate that a sponsor may have influenced the design, conduct, analysis, interpretation, or reporting of the study, the Editorial Direction may verify sponsor independence in accordance with Section 7.

Verification is conducted by requesting, on a confidential basis, one or more of the following: the funding agreement or sponsor contract; the trial protocol and any amendments; the registry entry; the statistical analysis plan; the data access statement; and written certification identifying the author or authors who had direct and unimpeded access to the primary dataset and who participated actively in the analysis.

Authors are given 10 working days to respond to a verification request, consistent with the ordinary response period established in Section 22 for pre-publication matters. The Editor-in-Chief may grant a documented extension for good cause.

Documents obtained under this subsection are used solely for the verification. They are accessible only to the Editor-in-Chief and to the persons expressly designated by them, are not transmitted to reviewers, and are retained in accordance with Sections 20 and 21.

The verification establishes whether at least one author affiliated with an academic or independent research institution had unimpeded access to the primary data; whether any agreement grants the sponsor approval rights, a right of delay, a right to suppress unfavorable results, or a right of prior review before submission; and whether the Funding statement accurately reflects the role of the sponsor.

Where the verification is satisfactory, the manuscript proceeds and the outcome is recorded. Where the authors refuse or are unable to provide the requested documentation, or where the documentation confirms a restrictive agreement of the type prohibited by Section 7, the conflict is classified at Level 4 and peer review is suspended, the manuscript is rejected before external review, or a post-publication investigation is opened under Section 18, according to the stage that the editorial process has reached.

16.9 Documentation of management decisions

Every management decision taken under this Section is recorded in the editorial record of the manuscript or, for declarations by members of the editorial leadership and of the Editorial Board, in the conflict of interest register maintained by Edikta S.r.l.

The record identifies: the date of the declaration or of the identification of the interest; the party concerned and their role in the editorial process; the nature of the declared or identified interest; the management level assigned under Section 16.3 and the factors of Section 16.2 that determined it; the person who carried out the assessment; the measures applied; any waiver granted, with the elements required by Section 10; the response of the party concerned, where a response was requested; and the editorial outcome.

Records are confidential and are governed by Section 20. They are retained for a minimum of 10 years in accordance with Section 21.

The records constitute the evidential basis for the aggregate figures published in the annual transparency report under Section 23, for the monitoring of systematic patterns under Section 12.5, and for the annual review of this Policy under Section 24. Aggregate reporting does not identify individual parties.

17. HANDLING OF UNDISCLOSED CONFLICT OF INTEREST IDENTIFIED BEFORE PUBLICATION

When an undisclosed conflict of interest in a submitted manuscript is suspected or identified before publication - whether by a reviewer, an editor, a third party, or through the Journal's own monitoring procedures - the Editorial Direction initiates the following procedure, consistent with the COPE Flowchart for handling suspected undisclosed conflict of interest in submitted manuscripts:

• The responsible Associate Editor or Editor-in-Chief contacts the corresponding author and requests a formal explanation and, where appropriate, a complete updated ICMJE declaration within 10 working days.

• If the author confirms the previously undisclosed interest, the Editorial Direction assesses whether the conflict is of a nature that could have materially affected the work, the review process, or the decision to publish.

• If the conflict is assessed as not material, the Editorial Direction may proceed with the review or editorial process with an updated declaration, or may add the missing disclosure to the manuscript before a final decision.

• If the conflict is assessed as material, or if the author does not respond within the specified deadline, the manuscript may be rejected without external review, or the process may be suspended pending clarification.

• If a reviewer identifies the undisclosed conflict after the review has been completed, the editorial record documents the situation. Any editorial decision based on a report subsequently found to have been conducted in the presence of an undisclosed conflict of interest of the reviewer is re-examined in accordance with the Peer Review Policy, Section 10.

The originator of the suspicion is not identified to the author unless the originator has expressly consented to such identification.

The pre-publication conflict of interest assessment record must identify the date of suspicion or identification, the person responsible for assessment, the deadline given to the author or reviewer, the response received, the materiality assessment, the management level applied under Section 16, and the editorial outcome. A non-material pre-publication omission does not automatically require rejection or sanction, but the corrected declaration must be completed before any final acceptance decision.

18. HANDLING OF UNDISCLOSED CONFLICT OF INTEREST IDENTIFIED AFTER PUBLICATION

When an undisclosed conflict of interest in a published article is suspected or identified after publication - whether through a reader report, a whistleblowing report under the Complaints, Appeals and Whistleblowing Policy, post-publication monitoring, or the Journal's own review - the Editorial Direction initiates the following procedure, consistent with the COPE Flowchart for handling undisclosed conflict of interest in a published article:

• The Editor-in-Chief contacts the corresponding author to request a formal explanation and a complete updated disclosure. The author is given 15 working days to respond.

• If the author confirms the undisclosed interest, the Editor-in-Chief assesses: (a) whether the undisclosed conflict of interest appears to have affected the integrity of the research; (b) whether the undisclosed conflict of interest appears to have affected the editorial process; (c) whether the undisclosed conflict of interest, even if not materially affecting the research, constitutes a significant violation of the Journal's disclosure obligations.

• In all cases where an undisclosed conflict of interest is confirmed, the published article's Competing Interests statement is updated through a published Correction in accordance with the Correction and Retraction Policy. The Correction is permanent, indexed via Crossmark, and clearly identifies the previously undisclosed interest.

• Where the assessment indicates that the undisclosed conflict of interest has materially affected the integrity of the research or the peer review process, the Editor-in-Chief may issue an Expression of Concern. At the same time, the investigation continues, or proceed to retraction in accordance with the Correction and Retraction Policy.

• Where the undisclosed conflict of interest raises concerns about institutional conduct, the Editor-in-Chief may refer the matter to the author's institution in accordance with COPE guidance on cooperation between journals and research institutions.

The Journal does not retroactively retract an article solely based on an undisclosed conflict of interest where the conflict of interest is confirmed to have not affected research integrity or the editorial process. The mandatory published Correction and, in serious cases, institutional referral, remain applicable regardless of impact on research integrity.

The post-publication conflict-of-interest assessment record must identify the source of the report, the author's response, the confirmed or unconfirmed nature of the conflict of interest, the assessment of the impact on research integrity and peer review, the selected corrective measure, and any institutional referral. Corrective action must be proportionate to both the seriousness of the omission and its impact on the reliability of the published record.

19. CONFLICT OF INTEREST IN COMPLAINT, APPEAL, AND INVESTIGATION PROCEEDINGS

All proceedings conducted under the Complaints, Appeals and Whistleblowing Policy are subject to a strict independence requirement: no person with a conflict of interest may participate in the handling, adjudication, or decision-making in any proceeding in which that person was directly involved in the events giving rise to the complaint, or in which the conflicted person is the subject of the complaint or the complainant.

Where a conflict of interest affecting a designated handler is identified at any stage of a proceeding, the handler recuses themselves and the proceeding is reassigned to a conflict-free person, in accordance with Section 23 of the Complaints, Appeals and Whistleblowing Policy. This principle applies to proceedings at all levels, including first-instance review, appeal, and COPE referral.

Where the subject of a misconduct allegation is the Editor-in-Chief, the entire management of the proceeding is assumed by Edikta S.r.l. in consultation with an independent editorial expert or, where appropriate, with COPE. No member of the editorial leadership participates in the proceeding.

20. CONFIDENTIALITY OF CONFLICT OF INTEREST DECLARATIONS AND DATA PROTECTION

Conflict of interest declarations submitted by authors, reviewers, and members of the editorial leadership are treated as confidential editorial communications. Individual declarations are not shared with parties outside the editorial process except where: (a) they are incorporated into the published article's Competing Interests statement as provided in Section 9; (b) they are shared with Edikta S.r.l. as part of a formal editorial audit or complaint investigation; (c) sharing is required by applicable law or by a binding request from a competent authority.

The processing of personal data contained in conflict of interest declarations is conducted in accordance with EU Regulation 2016/679 (GDPR) and applicable national data protection law. Such data is processed to ensure the integrity of the editorial process, verify compliance with this Policy, and respond to complaints and investigations. Edikta S.r.l. acts as data controller for conflict of interest declarations processed in the editorial process.

Conflict of interest declarations are not used for any purpose other than those specified above. Access to individual declarations is limited to the members of the editorial leadership directly responsible for the relevant manuscript and to Edikta S.r.l. staff with editorial oversight functions.

The Editorial Direction reviews Reviewer conflict-of-interest declarations for management purposes. Still, it does not disclose them to authors unless disclosure is required by law, an investigation, or the reviewer's consent. This protects peer-review confidentiality, reviewer anonymity where applicable, and the integrity of the editorial process. The non-disclosure of reviewer conflict-of-interest declarations to authors does not prevent the Journal from excluding conflicted reviewer reports or from documenting the management decision internally.

21. DATA RETENTION

All conflict of interest declarations are retained in the editorial record for a minimum of 10 years from the date of final editorial decision on the relevant manuscript, or from the date of the annual declaration for editorial board members. This retention period is consistent with the general document retention standard established in the Peer Review Policy and the Editorial Policy Statement.

Upon expiry of the retention period, declarations are deleted in accordance with the GDPR's data minimization and storage limitation principles. Deletion is carried out in coordination with the official editorial platform and is documented by Edikta S.r.l.

22. SANCTIONS

Violations of the declaration obligations established in this Policy are subject to proportionate sanctions applied by the Editorial Direction, in accordance with the nature, severity, and apparent intentionality of the violation.

For procedural predictability, the following ordinary response periods apply unless the Editor-in-Chief grants a documented extension for good cause: 5 working days for authors to update a new conflict of interest arising during peer review; 10 working days to respond to a suspected undisclosed conflict of interest identified before publication; 15 working days to respond to a suspected undisclosed conflict of interest identified after publication; and 10 working days for editorial leadership or board members to report changes arising between annual declarations. These time limits reflect the different urgency of pre-publication and post-publication situations and do not alter the substantive risk classification in Section 16.

Sanctions are not imposed solely because a conflict of interest exists. They are imposed where a declaration obligation has been breached, where a party fails to cooperate with reasonable editorial requests, where the omission is material or intentional, or where the undisclosed conflict of interest has affected or may reasonably appear to have affected research integrity or editorial independence. Except where urgent action is necessary to protect the published record or the integrity of peer review, the affected party may respond before a sanction is finalized.

22.1 Pre-publication omission without material impact

Where an omitted declaration is identified before publication, and the assessment conducted under Section 17 concludes that the interest is not material, the corresponding author completes a corrected and complete declaration before any final acceptance decision is taken.

The Editorial Direction issues a written reminder of the disclosure obligations established by this Policy. The omission and its correction are recorded in the editorial record. No further sanction is applied.

A second omission by the same author within a period of 36 months is assessed under Section 22.2, irrespective of the materiality of the second interest.

22.2 Pre-publication omission with material impact

Where an omitted declaration is identified before publication, and the assessment conducted under Section 17 concludes that the interest is material, or where the author fails to respond within the period established in this Section, the manuscript is rejected without further review.

The decision states the ground of rejection and is communicated to all co-authors, and not to the corresponding author alone.

Where the omission appears intentional, the Editor-in-Chief may in addition refer the matter to the institution of the author concerned, in accordance with COPE guidance on cooperation between journals and research institutions, and impose a bar on submission to the Journal by that author for a period of up to 36 months, proportionate to the severity of the concealment.

The Editor-in-Chief decides a submission bar in consultation with Edikta S.r.l., is notified in writing with reasons, and is appealable under the Complaints, Appeals and Whistleblowing Policy.

22.3 Post-publication omission without material impact on research integrity

Where an undisclosed conflict of interest is confirmed after publication and the assessment conducted under Section 18 concludes that it has not affected the integrity of the research or the editorial process, the Competing Interests statement of the published article is updated through a published Correction.

The Correction is permanent, is linked to the Version of Record, is indexed through Crossmark, and identifies the previously undisclosed interest. It is issued notwithstanding any impact on research integrity; the update of the public record is not discretionary.

The Editorial Direction issues a written notification to all authors recalling the disclosure obligations established by this Policy. The article is not retracted.

Repeated omissions by the same author across separate articles are assessed as a pattern under Section 22.4, irrespective of the individual materiality of each omission.

22.4 Post-publication omission with material impact or evidence of intentional concealment

Where the assessment conducted under Section 18 indicates that the undisclosed conflict of interest has materially affected the integrity of the research or of the peer review process, or where there is evidence of intentional concealment, the Editor-in-Chief applies one or more of the following measures:

• publication of an Expression of Concern while the investigation continues, in accordance with the Correction and Retraction Policy;

• retraction of the article, where the reliability of the findings or the integrity of the editorial process cannot be sustained, with a retraction notice stating the reason;

• referral to the institution of the author concerned or, where applicable, to the competent research integrity body or funder;

• a bar on submission to the Journal by the author concerned for a period of up to 36 months, and permanently in cases of repeated intentional concealment;

• notification to other journals where the same undisclosed interest may affect articles published elsewhere, in accordance with COPE guidance.

The party concerned may respond before any measure other than an Expression of Concern is finalized. An Expression of Concern may be published without a prior response when necessary to protect the published record pending the outcome of the investigation.

Measures adopted under this subsection are recorded under Section 16.9 and are appealable under the Complaints, Appeals and Whistleblowing Policy.

22.5 Editorial board members

Breach by a member of the editorial leadership or of the Editorial Board of the declaration obligations of Section 11, of the recusal obligations of Section 12, or of the confidentiality and non-use obligations of Sections 11 and 20, is subject to the following graduated measures:

• a written reminder recorded in the conflict of interest register, for a first omission that has had no impact on an editorial decision;

• mandatory repetition of the orientation on conflict of interest recognition provided under Section 11;

• suspension of editorial functions for a defined period, where the omission has affected the handling of one or more manuscripts;

• termination of the appointment, under the procedure established in the Editorial Board Charter, where the omission is material, repeated, or intentional, or where it concerns a relationship with a commercial entity whose product has been evaluated in a manuscript handled by that member;

• re-examination of the editorial decisions taken by the member while the undisclosed interest subsisted, and correction of the published record where required under Sections 22.3 and 22.4.

The Editor-in-Chief determines the measure in consultation with Edikta S.r.l. Where the person concerned is the Editor-in-Chief, the proceeding is conducted in its entirety by Edikta S.r.l. in accordance with Section 19, and no member of the editorial leadership participates in it.

Where an omission by a member of the editorial leadership has affected published articles, the fact that corrective action has been taken is disclosed in the annual report under Section 23 in a form that does not identify the individual, unless a published Correction or Retraction has already made the matter public.

22.6 Reviewers

Breach by a reviewer of the declaration obligations of Section 10 is subject to the following measures:

• exclusion of the report from the editorial record and from the basis of the decision;

• appointment of a replacement reviewer and, where a decision has already been taken based on the affected report, re-examination of that decision in accordance with the Peer Review Policy;

• removal from the reviewer database of the Journal for a defined period, or permanently in cases of intentional concealment;

• notification to the authors where the affected report has influenced a decision already communicated to them, in a form that preserves reviewer anonymity where the review model requires it, unless disclosure of identity is required by law or by an investigation;

• referral to the institution of the reviewer where the conduct involves misappropriation of unpublished material, coercive citation, or deliberate obstruction of a competing manuscript.

Coercive citation as defined in Section 4, and the use of unpublished material in breach of Section 10, are treated as peer review misconduct and are handled under the Complaints, Appeals and Whistleblowing Policy in addition to the measures established in this subsection.

Measures under this subsection are decided by the Editor-in-Chief on the proposal of the responsible Associate Editor and are recorded under Section 16.9.

23. ANNUAL PUBLIC REPORTING

Edikta S.r.l., in coordination with the Editor-in-Chief, publishes an annual conflict of interest transparency report as part of the Journal's general editorial performance report. The report includes the following elements:

• The number of manuscripts for which at least one author declared a financial or non-financial conflict of interest, expressed as a percentage of total submissions and of total accepted articles.

• The number of manuscripts in which a previously undisclosed conflict of interest was identified before publication, and the measures taken.

• The number of post-publication cases in which an undisclosed conflict of interest was confirmed and a Correction or other corrective measure was issued.

• The number of reviewer recusals due to declared conflict of interest.

• The number of editorial recusals by members of the editorial leadership.

• The disclosure statements of the Editor-in-Chief, Deputy Editor-in-Chief, and Associate Editors, updated annually on the Journal's website.

The annual conflict of interest transparency report is published on the Journal's official website and included in the public editorial transparency report described in the Peer Review Policy, Section 22.

24. REVIEW AND UPDATE OF THIS POLICY

This Policy is reviewed annually by the Editor-in-Chief and Edikta S.r.l. The annual review assesses: (a) updates to the ICMJE Recommendations, COPE guidelines, and other relevant international standards; (b) experience in applying the Policy, including recurring ambiguities or gaps identified in practice; (c) developments in the research landscape of gynecology and obstetrics that may give rise to new categories of conflict relevant to the Journal's scope; (d) developments in the regulation of AI tools and their relevance to editorial conflict of interest.

Material revisions to this Policy are communicated to authors, reviewers, and editorial board members through the Journal's official communication channels. A versioned record of all editions of this Policy is maintained and publicly accessible on the Journal's website.

25. CROSS-REFERENCES WITHIN THE EDITORIAL POLICY FRAMEWORK

This Policy is part of the integrated editorial policy framework of European Gynecology and Obstetrics. The following cross-references apply:

• Editorial Policy Statement, Section 13: establishes the foundational principle that all parties involved in the editorial process are required to declare conflicts of interest; refers to this Policy for detailed provisions.

• Publication Ethics Policy, Section 7: identifies conflict of interest transparency as a core pillar of editorial ethics; refers to this Policy for detailed provisions.

• Peer Review Policy, Section 10: sets out the operational procedure for reviewer conflict of interest declaration and abstention; this Policy governs the definition of conflict of interest categories, the reviewer waiver standard, and the risk classification and management framework in Section 16.

• Authorship Policy: establishes the corresponding author's responsibility for conflict of interest declarations at submission; establishes conflict of interest disclosure obligations for industry authors and for medical writers; cross-references this Policy for definitions.

• Editorial Board Charter, Section 11: establishes the annual conflict of interest declaration obligation for editorial board members; cross-references this Policy as the master conflict of interest governance document. In the event of any inconsistency or conflict of interest, this Policy governs.

• Editorial Board Charter, Section 15: establishes the rules on simultaneous editorial board membership as a source of conflict of interest; cross-references this Policy.

• Artificial Intelligence Policy, Section 23: cross-references this Policy and the Editorial Board Charter for the management of conflicts of interest arising from editors' affiliations with AI companies; this Policy provides the operative provisions at Section 11.

• Complaints, Appeals and Whistleblowing Policy, Section 23: sets out the independence requirement for complaint and appeal proceedings; cross-references this Policy for conflict of interest definitions. This Policy governs the definitions; the Complaints, Appeals and Whistleblowing Policy governs the complaint and appeal procedures.

• Correction and Retraction Policy: governs the post-publication corrective measures applicable when an undisclosed conflict of interest is confirmed; the Correction, Expression of Concern, and Retraction procedures of the Correction and Retraction Policy apply in cases addressed by Sections 18 and 22 of this Policy.

• Special Issues and Guest Editors Policy: governs all operational procedures specific to Guest Editors in the context of special collections, including the specific instrument for conflict of interest declaration (Section 8), the management of manuscripts submitted by Guest Editors and the associated provenance statement (Section 11), and the oversight of peer review in special collections (Section 10). This Policy (conflict of interest) governs the definitions and general framework of conflict of interest; the Special Issues and Guest Editors Policy governs the operationalization of these provisions for Guest Editors of special collections.

26. NORMATIVE REFERENCES

This Policy has been developed in accordance with the following international standards and guidelines:

International Committee of Medical Journal Editors (ICMJE). Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. Updated January 2026. Available at: www.icmje.org.
International Committee of Medical Journal Editors (ICMJE). Disclosure Form for Disclosure of Interests. Current version (2021). Available at: www.icmje.org/disclosure-of-interest/.
Committee on Publication Ethics (COPE). Code of Conduct and Best Practice Guidelines for Journal Editors. Current version.
Committee on Publication Ethics (COPE). Guidance on Handling Conflicts of Interest. Current version. Available at: publicationethics.org.
Committee on Publication Ethics (COPE). Flowchart: What to do if you suspect an undisclosed conflict of interest in a submitted manuscript. Current version.
Committee on Publication Ethics (COPE). Flowchart: What to do if you suspect an undisclosed conflict of interest in a published article. Current version.
Committee on Publication Ethics (COPE). Guidance on Cooperation Between Journals and Research Institutions. Current version.
Committee on Publication Ethics (COPE). Ethical Guidelines for Peer Reviewers. Current version.
Directory of Open Access Journals (DOAJ). Principles of Transparency and Best Practice in Scholarly Publishing. Version 4.
World Association of Medical Editors (WAME). Policies on Conflicts of Interest. Current version.
Council of Science Editors (CSE). White Paper on Publication Ethics. Current edition.
PLOS. Competing Interests Policy. Current version. Available at: plos.org.
Elsevier. Competing Interests and Undisclosed Conflicts of Interest Policies. Current version. Available at: www.elsevier.com.
Wiley. Best Practice Guidelines on Publishing Ethics: Conflicts of Interest. Current version. Available at: authorservices.wiley.com.
Springer Nature. Journal Policies: Competing Interests. Current version. Available at: link.springer.com.
Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation - GDPR).
Italian Personal Data Protection Code (Legislative Decree 196/2003, as amended by Legislative Decree 101/2018).