Journal of obstetrics and gynaecology Canada最新文献

{"title":"Revisiting Routine: Reducing Unnecessary CBC Testing After Scheduled Cesarean Delivery","authors":"Yannay Khaikin MD , Wei Sheila Yu MD , Andrea E. Page MD, MScHQ","doi":"10.1016/j.jogc.2025.102818","DOIUrl":"10.1016/j.jogc.2025.102818","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102818"},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interesting Case: A Levonorgestrel-Releasing Intrauterine System (LNG-IUS) Embedded in a Fiber Mass","authors":"Meiqi Li MD , Chenyu Xiao MD , Qianru Li MD , Leilei Gao MD, PhD","doi":"10.1016/j.jogc.2025.102813","DOIUrl":"10.1016/j.jogc.2025.102813","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102813"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasa Previa: From Ultrasound to Reality","authors":"Mélissa Boucher MD, M Sc, Cindy Taillon MD","doi":"10.1016/j.jogc.2025.102810","DOIUrl":"10.1016/j.jogc.2025.102810","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102810"},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antepartum Fetal Demise: Toward Diagnostic and Therapeutic Efficacy of Management","authors":"Venu Jain MD, PhD","doi":"10.1016/j.jogc.2025.102799","DOIUrl":"10.1016/j.jogc.2025.102799","url":null,"abstract":"<div><div>Management of women presenting with intrauterine fetal demise is complex, with medical, psychological, emotional and social variables that need careful consideration when determining the best way forward. The need for diagnostic assessment needs to be balanced against the wishes of the grieving patient and family, to allow adequate data collection that can help with insight into the etiology of the stillbirth as well as planning for management of the recurrence risk in a future pregnancy. Multidisciplinary involvement can aid the formulation of a sensitive patient-centred workup plan that can also enhance the evolution of a therapeutic relationship between the patient and the caregivers.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102799"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus clinique no 459 : Oncofertilité - Réduire l’écart géographique en gynécologie pédiatrique et de l’adolescence au Canada","authors":"Sarah McQuillan MD,&nbsp;Nicole Todd MD","doi":"10.1016/j.jogc.2025.102808","DOIUrl":"10.1016/j.jogc.2025.102808","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectif&lt;/h3&gt;&lt;div&gt;Examiner les options de préservation de la fertilité au Canada pour les patients en gynécologie pédiatrique et de l’adolescence qui reçoivent un traitement fertotoxique&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Population cible&lt;/h3&gt;&lt;div&gt;Adolescentes et enfants avec des ovaires ayant un plan de traitement pouvant affecter les futures options de reproduction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Options&lt;/h3&gt;&lt;div&gt;En fonction du stade pubertaire de la personne et conformément aux directives éthiques, des méthodes appropriées de préservation de la fertilité, telles que la cryoconservation ovocytaire, la cryoconservation du tissu ovarien et la transposition ovarienne, doivent être envisagées parallèlement à leur traitement. La modification des protocoles de traitement peut également s'avérer nécessaire.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Résultats&lt;/h3&gt;&lt;div&gt;Le Canada manque actuellement d'initiatives provinciales et nationales pour offrir la préservation de la fertilité aux enfants et aux adolescents. De nombreux obstacles contribuent à cette situation, notamment les lacunes dans les connaissances des prestataires de soins, l'absence de processus d'assentiment et l'accès limité aux consultations urgentes et aux procédures spécialisées. De plus, les patients et les prestataires peuvent rencontrer des obstacles dans l'accès au financement&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Bénéfices, risques et coûts&lt;/h3&gt;&lt;div&gt;Les recommandations formulées dans cet avis du comité profiteront à la fois aux prestataires de soins et aux familles en leur fournissant des informations sur les options de traitement. Bien que les consultations avec des spécialistes et les interventions en milieu hospitalier soient couvertes, les patients doivent payer les médicaments, les interventions effectuées dans des centres chirurgicaux privés et la conservation des tissus, ce qui peut représenter une lourde charge financière pour les familles. Il peut y avoir des disparités interprovinciales et interhospitalières en ce qui concerne la couverture des traitements. En outre, le coût plus élevé de la cryoconservation des ovules par rapport à celle des spermatozoïdes entraîne une inégalité considérable entre les sexes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Données probantes&lt;/h3&gt;&lt;div&gt;Une analyse documentaire des revues systématiques et des recherches originales (incluant des études de cohortes et des séries de cas ont été incluses ; aucun essai contrôlé randomisé n'a été publié) a été effectuée dans PubMed de janvier 1990 à janvier 2025 à l'aide des termes de recherche MeSH suivants : fertility preservation, paediatric/pediatric, adolescent, and female (préservation de la fertilité, pédiatrie/pédiatrie, adolescents et femmes). Les articles ont été retenus s'ils portaient sur des personnes assignées de sexe féminin à la naissance, s'ils étaient liés au domaine de l'oncofertilité, s'ils étaient accessibles via le système bibliothécaire de l'Université de Calgary et s'ils étaient rédigés en anglais&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Méthodes de validation&lt;/h3&gt;&lt;div&gt;Les aute","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102808"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143636670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Consensus Statement No. 459: Oncofertility – Bridging the Geographical Gap in Pediatric and Adolescent Gynaecology in Canada","authors":"Sarah McQuillan MD,&nbsp;Nicole Todd MD","doi":"10.1016/j.jogc.2025.102807","DOIUrl":"10.1016/j.jogc.2025.102807","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To review the options for fertility preservation in Canada for paediatric and adolescent gynaecology patients who are receiving fertotoxic therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Target Population&lt;/h3&gt;&lt;div&gt;Adolescent and pediatric individuals with ovaries and a treatment plan that affects future reproductive options.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Options&lt;/h3&gt;&lt;div&gt;Depending on the individual’s pubertal status and in accordance with ethical guidelines, appropriate fertility preservation methods such as oocyte preservation, ovarian tissue preservation, and ovarian transposition should be considered alongside their treatment. Modification of treatment protocols may also be necessary.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Canada currently lacks provincial and national initiatives to offer fertility preservation for pediatric and adolescent individuals. Many barriers contribute to this, including knowledge gaps among providers, lack of assent processes, and limited access to urgent consultation and specialized procedures. In addition to this, patients and providers may experience barriers in accessing funding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Benefits, Harms, and Costs&lt;/h3&gt;&lt;div&gt;The recommendations outlined in this committee opinion will benefit both providers and families by providing them with knowledge of treatment options. While consultations with specialist providers and in hospital procedures are covered, patients are responsible to pay for medications, procedures performed in private surgical centres, and tissue storage, which can put a large financial burden on families. There may be inter-province and inter-hospital differences in coverage for treatment. Additionally, there is considerable gender inequity in the higher cost of cryopreservation of eggs compared with sperm.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Evidence&lt;/h3&gt;&lt;div&gt;A literature review of systematic reviews and original research (cohort studies, case series/studies were included; there were no randomized Controlled trials published) was conducted in PubMed from January 1990 to January 2025 using the MeSH search terms fertility preservation, paediatric/pediatric, adolescent, and female. Articles were included if they focused on individuals assigned female at birth, were related to the field of oncofertility, were available through the University of Calgary’s library system, and were written in English.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Validation Methods&lt;/h3&gt;&lt;div&gt;The authors rated the quality of evidence and strength of recommendations using the &lt;span&gt;&lt;span&gt;Grading of Recommendations Assessment, Development and Evaluation&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; (GRADE) approach. See online &lt;span&gt;&lt;span&gt;Appendix A&lt;/span&gt;&lt;/span&gt; (&lt;span&gt;&lt;span&gt;Tables A1&lt;/span&gt;&lt;/span&gt; for definitions and &lt;span&gt;&lt;span&gt;A2&lt;/span&gt;&lt;/span&gt; for interpretations of strong and conditional [weak] recommendations).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intended Audience&lt;/h3&gt;&lt;div&gt;Family physicians and nurse practitioners providing primary care, obstetricians and Gynaecologists,","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102807"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143636669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis as a Risk Factor for Ischemic and Hemorrhagic Stroke: A Population-Based Cohort Study","authors":"Olga Bougie MD, MPH ,&nbsp;Jessica N. Blom MD, PhD ,&nbsp;Jonas Shellenberger MSc ,&nbsp;Jessica Pudwell MSC, MPH ,&nbsp;Susan B. Brogly PhD, MSc ,&nbsp;Maria P. Velez MD, PhD","doi":"10.1016/j.jogc.2025.102798","DOIUrl":"10.1016/j.jogc.2025.102798","url":null,"abstract":"<div><div>We completed a retrospective population-based cohort study using administrative data from Ontario female patients from 1993 to 2015 to examine the association between a diagnosis of endometriosis and stroke. We identified 166 853 female patients with a diagnosis of endometriosis and 333 706 unexposed female patients. Although the absolute risk of stroke was low, during the study period, 680 patients had ischemic stroke in the endometriosis group (28.2 cases per 100 000 person-years; 95% CI 26.1–30.4) and 1119 in the unexposed group (23.8 cases per 100 000 person-years; 95% CI 22.5–25.3)—adjusted hazard ratio 1.13 (95% CI 1.03–1.24). Confirmation of this association and consideration for clinical implications is warranted.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102798"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triploidy in first trimester growth delay","authors":"Avantika Gupta MS OBGY ,&nbsp;Minal Dhanvij MS OBGY ,&nbsp;Neha Gangane MD OBGY ,&nbsp;Medha Davile MD OBGY ,&nbsp;Vasudha Vani Lanka MS OBGY","doi":"10.1016/j.jogc.2025.102793","DOIUrl":"10.1016/j.jogc.2025.102793","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102793"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amniocentesis and Therapeutic Amnioreduction Before Rescue Cerclage: Improving Patient Selection for Rescue Cerclage based on Amniotic Fluid Screening","authors":"Ana Werlang MD, MSc ,&nbsp;Avina De Simone MD ,&nbsp;Griffith Jones MD","doi":"10.1016/j.jogc.2025.102790","DOIUrl":"10.1016/j.jogc.2025.102790","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe our protocol that recommends amniocentesis for intra-amniotic infection and/or inflammation (IAI) screening to guide rescue cerclage decision-making.</div></div><div><h3>Methods</h3><div>We implemented a novel protocol at our centre in 2021, which recommends performing amniocentesis when exam-indicated cerclage is recommended (singleton or multiple pregnancies between 14 and 23⁶ weeks gestational age (GA), with cervical dilation &lt;4 cm and exposed membranes at or beyond the external cervical os). Amniotic fluid is tested for interleukin (IL)-6, glucose, white count, Gram-stain, and amniotic fluid cultures. We retrospectively reviewed records and reported outcomes such as interval from amniocentesis to delivery (ADI), GA at delivery, and perinatal survival for patients with low versus high IL-6 levels.</div></div><div><h3>Results</h3><div>From 25 patients included, 12 had low IL-6 (&lt;3000 pg/mL) (11 received rescue cerclage), while 13 had high IL-6 (≥3000 pg/mL) and were managed with antibiotics and progesterone. The low IL-6 group showed a significantly longer mean ADI (85⁵ ± 43² days vs. 21⁶ ± 14⁵ days, <em>P</em> = 0.0003) and higher mean GA at delivery (33² ± 6² weeks vs. 23⁶ ± 2⁶ weeks, <em>P</em> = 0.0003). 91.7% of patients with low IL-6 survived to discharge, compared to 46.2% in the high IL-6 group (<em>P</em> = 0.03). Most high IL-6 patients delivered within 3 to 5 weeks despite treatment.</div></div><div><h3>Conclusion</h3><div>Amniocentesis before cerclage, particularly IL-6 screening, is a valuable tool in guiding the decision to perform rescue cerclage in selected patients. IL-6 is a strong predictor of both the likelihood of successful cerclage and perinatal outcomes. More studies are needed to optimize management for patients with a high risk of IAI.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102790"},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twin Birth and Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome: A Population-Based Study","authors":"Sofia Nicolls MSc (cand) ,&nbsp;Li Qing Wang PhD ,&nbsp;Johanna Koegl MD ,&nbsp;Janet Lyons MD, MPH ,&nbsp;Julie Van Schalkwyk MD, MSc ,&nbsp;K.S. Joseph MD, PhD ,&nbsp;Sarka Lisonkova MD, PhD","doi":"10.1016/j.jogc.2025.102792","DOIUrl":"10.1016/j.jogc.2025.102792","url":null,"abstract":"<div><h3>Objectives</h3><div>Although twin pregnancies are known to have higher rates of preeclampsia, the association between twin pregnancy and Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) syndrome has not been adequately studied. We assessed the association between twin pregnancy and HELLP syndrome, and also examined gestational age–specific rates of HELLP syndrome in twin and singleton pregnancies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of women with singleton or twin live births or stillbirths between 20⁰ and 43⁶ weeks gestation in British Columbia, Canada, from 2008/09 to 2019/20. Data on the demographic and clinical characteristics were obtained from the British Columbia Perinatal Database Registry. Logistic regression was used to estimate adjusted odds ratios and 95% CIs, adjusted for maternal age, body mass index, smoking, and other potential confounders.</div></div><div><h3>Results</h3><div>Among 524 236 women (515 953 singleton and 8283 twin pregnancies), 1510 were diagnosed with HELLP syndrome (2.9 per 1000 women). HELLP syndrome occurred in 181 twin pregnancies (21.9 per 1000 women), while 1329 cases occurred in singleton pregnancies (2.6 per 1000 women) (rate ratio 8.5 [95% CI 7.3–9.9]). The adjusted odds ratio for the associations between HELLP syndrome and twin versus singleton pregnancies was 7.1 (CI 6.0–8.5). In twin pregnancies, the incidence of HELLP syndrome increased markedly from 26⁰ to 28⁶ weeks gestation until 37⁰ to 39⁶ weeks. In contrast, the incidence of HELLP syndrome increased more gradually from 23⁰ to 40⁶ weeks gestation in singleton pregnancies.</div></div><div><h3>Conclusions</h3><div>Twin pregnancy is strongly associated with HELLP syndrome. HELLP syndrome risk in twin pregnancies increases markedly from 26⁰ weeks gestation onwards.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102792"},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}