Journal of obstetrics and gynaecology Canada最新文献

{"title":"Nouvelle série de chroniques cliniques sur la mortalité et la morbidité maternelles au Canada","authors":"Rohan D’Souza MD, PhD, FRCOG , Graeme Smith MD, PhD, FRCSC, FCAHS","doi":"10.1016/j.jogc.2024.102729","DOIUrl":"10.1016/j.jogc.2024.102729","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 11","pages":"Article 102729"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759514","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":"Guideline No. 456: Prenatal Screening for Fetal Chromosomal Anomalies","authors":"Francois Audibert MD, MSc, Karen Wou MD, Nanette Okun MD, Isabelle De Bie MD, PhD, R. Douglas Wilson MD","doi":"10.1016/j.jogc.2024.102694","DOIUrl":"10.1016/j.jogc.2024.102694","url":null,"abstract":"<div><h3>Objective</h3><div>To review the available prenatal aneuploidy screening options and to provide updated clinical guidelines for reproductive care providers.</div></div><div><h3>Target Population</h3><div>All pregnant persons receiving counselling and providing informed consent for prenatal screening.</div></div><div><h3>Benefits, Harms, and Costs</h3><div>Implementation of the recommendations in this guideline should increase clinician competency to offer counselling for prenatal screening options and provide appropriate interventions. Given the variety of available options for prenatal screening with different performance, cost, and availability across Canada, appropriate counselling is of paramount importance to offer the best individual choice to Canadian pregnant persons. Prenatal screening may cause anxiety, and the decisions about prenatal diagnostic procedures are complex given the potential risk of fetal loss.</div></div><div><h3>Evidence</h3><div>Published literature was retrieved through searches of Medline, PubMed, and the Cochrane Library in and prior to July 2023, using an appropriate controlled vocabulary (prenatal diagnosis, amniocentesis, chorionic villi sampling, non-invasive prenatal screening) and key words (prenatal screening, prenatal genetic counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1995 to July 2023.</div></div><div><h3>Validation Methods</h3><div>The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online <span><span>Appendix A</span></span> (<span><span>Tables A1</span></span> for definitions and <span><span>A2</span></span> for interpretations).</div></div><div><h3>Intended Audience</h3><div>Health care providers involved in prenatal screening, including general practitioners, obstetricians, midwives, maternal–fetal medicine specialists, geneticists, and radiologists.</div></div><div><h3>Social Media Abstract</h3><div>Non-invasive prenatal screening is the most accurate method for detecting major aneuploidies. It is not universally available in the public health system and has some limitations.</div></div><div><h3>SUMMARY STATEMENTS</h3><div><ul><li><span>1.</span><span><div>First-trimester ultrasound (at 11–14 weeks gestation) offers many advantages for prenatal screening and pregnancy management, including accurate dating, determination of twin chorionicity, and early detection of some major structural abnormalities, regardless of the aneuploidy screening options <em>(high).</em></div></span></li><li><span>2.</span><span><div>The risk of fetal loss after prenatal invasive testing is lower than the rates currently cited and appears to be negligible when these interventions are compared with control groups of patients with the same risk profiles. Second","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 11","pages":"Article 102694"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468226","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":"An Ileal Mesenteric Leiomyoma: A Rare Extrauterine Site","authors":"Samidha Chouksey MBBS, MS , Ajeet Kumar Mourya MBBS, MS , Avantika Gupta MBBS, MS , Mangani Deepika MBBS, MS","doi":"10.1016/j.jogc.2024.102708","DOIUrl":"10.1016/j.jogc.2024.102708","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102708"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563511","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":"Recognizing Endometrial Cancer Risks in Perimenopausal and Postmenopausal Experiences: Insights From Community Qualitative Interviews and Workshop","authors":"Malak Ibrahim MSc,&nbsp;Karman Johal BSc,&nbsp;Madeline Dow BSc,&nbsp;Mohamed Bedaiwy MD, PhD,&nbsp;Andrea Neilson MD,&nbsp;Jerilynn C. Prior MD,&nbsp;Aline Talhouk PhD","doi":"10.1016/j.jogc.2024.102707","DOIUrl":"10.1016/j.jogc.2024.102707","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the experiences of perimenopausal and postmenopausal women in British Columbia, their perceptions of expected reproductive aging, and potential concerns about endometrial cancer (EC).</div></div><div><h3>Methods</h3><div>We interviewed 31 midlife community women of diverse backgrounds and hosted a workshop for more in-depth discussion. We summarized relayed experiences and beliefs through a thematic and descriptive analysis of participant stories and workshop feedback.</div></div><div><h3>Results</h3><div>Participants demonstrated a somewhat simplistic understanding of midlife changes, facing this phase of life with a “tough-it-out” attitude rather than seeking medical help for arising symptoms. Awareness of EC and EC-specific risk factors, such as obesity, was low. Confusion between cervical and EC was common. Although abnormal bleeding was seen as potentially of concern, many opted to wait before seeking medical help. Workshop participants stressed the need to include awareness about EC in a broader conversation about perimenopause and menopause and suggested strategies for disseminating EC awareness.</div></div><div><h3>Conclusions</h3><div>Community women in British Columbia demonstrated low awareness of EC-associated symptoms and risk factors. There is little information to help distinguish when perimenopausal abnormal uterine bleeding is of concern and when to seek help. This highlights the need to enhance knowledge of EC and its risk factors in perimenopause among the public and among health care providers.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102707"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563663","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":"Higher Risk of Wound Complications but No Clinically Significant Increase in Operative Time for Smokers Receiving Myomectomy for Uterine Fibroids","authors":"William Rienas BA ,&nbsp;Renxi Li BS ,&nbsp;Lianne Ryan BA ,&nbsp;SeungEun Lee BS ,&nbsp;Rubin Frenkel MD","doi":"10.1016/j.jogc.2024.102706","DOIUrl":"10.1016/j.jogc.2024.102706","url":null,"abstract":"<div><div>Myomectomy is a common procedure to remove uterine fibroids. Smoking impacts outcomes across various surgeries; however, may limit fibroid growth. We sought to determine if smoking impacts myomectomy for uterine fibroid removal outcomes. Patients with and without a history of tobacco smoking receiving a myomectomy for uterine fibroid removal were compared. Compared to patients with no history of tobacco smoking, tobacco smokers had a significantly increased risk of wound complications. No other variables analyzed demonstrated a clinically significant difference. Future research is needed to examine how different frequency of tobacco smoking impacts outcomes.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102706"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563608","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":"Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Centre for Childbirth in Québec, Canada: A Chart Review 2015–2019","authors":"Hilah Silver RN, BScN, PhD ,&nbsp;Christina Antinora MD ,&nbsp;Marianne Plourde MD ,&nbsp;Ariane Bergeron MD ,&nbsp;Lydia Mychaltchouk MD ,&nbsp;Karen Wou MD ,&nbsp;Neil Andersson MD, PhD","doi":"10.1016/j.jogc.2024.102709","DOIUrl":"10.1016/j.jogc.2024.102709","url":null,"abstract":"<div><h3>Objectives</h3><div>Childbirth evacuation, the transfer of patients from rural and remote communities to urban centres for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Québec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, Northern Québec transferred to a southern tertiary care centre.</div></div><div><h3>Methods</h3><div>A 5-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care centre between 2015 and 2019.</div></div><div><h3>Results</h3><div>The most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of the 534 (78.9%) Inuit who gave birth at the tertiary centre, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to the neonatal intensive care unit. Approximately 3.4% (18/534) had complications within the postpartum period, with the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%).</div></div><div><h3>Conclusions</h3><div>A relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102709"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563620","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":"Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database","authors":"Geoffrey W. Cundiff MD ,&nbsp;Paramdeep Kaur PhD ,&nbsp;Gillian E. Hanley PhD ,&nbsp;Patti Janssen PhD","doi":"10.1016/j.jogc.2024.102693","DOIUrl":"10.1016/j.jogc.2024.102693","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates.</div></div><div><h3>Results</h3><div>We report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate.</div></div><div><h3>Conclusions</h3><div>Quality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102693"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468230","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":"Complete Uterine Torsion Secondary to a Massive Uterine Fibroid","authors":"Sylvie Bowden MD,&nbsp;Chandrew Rajakumar MD","doi":"10.1016/j.jogc.2024.102692","DOIUrl":"10.1016/j.jogc.2024.102692","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102692"},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468221","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":"Fetal Surveillance in High-Risk Fetal Cardiac Disease: Frequency, Results and Relationship with Survival","authors":"Rosh Samuel MBBS, DCh ,&nbsp;Thotsapon Trakulmungkichkarn MD ,&nbsp;Lisa K. Hornberger MD ,&nbsp;Trina Stryker MD ,&nbsp;Luke Eckersley MBBS, PhD ,&nbsp;Angela McBrien MB, BCh, MD","doi":"10.1016/j.jogc.2024.102690","DOIUrl":"10.1016/j.jogc.2024.102690","url":null,"abstract":"<div><h3>Objectives</h3><div>We hypothesized that pregnancies with high-risk fetal heart disease (FHD) would benefit from frequent prenatal surveillance, abnormal fetal surveillance results would be associated with worse outcomes, and cardiovascular profile scoring (CVPS) could identify FHD cases at the highest risk of death.</div></div><div><h3>Methods</h3><div>A retrospective single-centre study of all actively treated pregnancies with high-risk FHD from 2006–2020. Frequency and results of fetal surveillance, survival, and mode of delivery were collected. Frequent fetal surveillance was defined as ≥ once weekly fetal well-being testing commencing by 28⁰–32⁰ weeks of gestation, or from later diagnosis, until delivery. Where possible, the CVPS was calculated.</div></div><div><h3>Results</h3><div>Fetal surveillance results were available in 92% (56/61) of pregnancies with high-risk FHD and were abnormal in 18% (10/56). A final CVPS of ≤7 carried a higher mortality (11/21, 52%) than ≥8 (6/31, 19% (<em>P</em> = 0.01)). There was a trend towards worse survival at the last follow-up when fetal surveillance was abnormal versus normal (40%, 4/10 vs. 72%, 33/46, <em>P =</em> 0.07). Survival did not differ between frequent versus infrequent surveillance (13%, 4/30 vs. 3%, 1/31, <em>P</em> = 0.20); nor when comparing abnormal versus normal surveillance results (20%, 2/10 vs. 7%, 3/46, <em>P</em> = 0.21). Where fetal surveillance was abnormal, emergency cesarean delivery was more common (70%, 7/10 vs. 4%, 2/46, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Abnormal fetal surveillance results and/or a CVPS ≤7 may identify compromised fetuses with high-risk FHD who could benefit from altered management or expedited delivery. Given the high rates of abnormal fetal surveillance in high-risk FHD, frequent fetal surveillance in the third trimester should be considered.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102690"},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468224","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":"Time to Make Early Pregnancy Care a Priority in Canada.","authors":"Vrati M Mehra, Selena Meng, Lynn Murphy-Kaulbeck, Modupe Tunde-Byass","doi":"10.1016/j.jogc.2024.102688","DOIUrl":"10.1016/j.jogc.2024.102688","url":null,"abstract":"<p><p>Early pregnancy is a critical period often accompanied by complications like early pregnancy loss. Early Pregnancy Assessment Clinics (EPACs) provide specialized and compassionate care to those experiencing these complications. First introduced in the United Kingdom, EPACs have been found to improve quality of care, reduce wait times, and cut costs. In Canada, EPACs are primarily limited to large urban centres at hospital sites. Access in other parts of the country, especially in rural areas, remains limited. Low-volume units managed by specialist nurses and family doctors, with support from specialists, are the best way to bring EPACs to more Canadians in need.</p>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":" ","pages":"102688"},"PeriodicalIF":2.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468229","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}