Journal of obstetrics and gynaecology Canada最新文献

{"title":"Patients Presenting to the Emergency Department with Bleeding in Early Pregnancy: Comparing Different Models to Predict Pregnancy Success","authors":"Nana Owusu M. Essel MD, MSc, MPH ,&nbsp;Stephanie Couperthwaite BSc ,&nbsp;Esther H. Yang MEng ,&nbsp;Steven Fisher MD ,&nbsp;Brian H. Rowe MD, MSc","doi":"10.1016/j.jogc.2025.102789","DOIUrl":"10.1016/j.jogc.2025.102789","url":null,"abstract":"<div><h3>Objectives</h3><div>Bleeding in early pregnancy is a common obstetric presentation in the emergency department (ED), and the outcome is difficult to predict. We developed and compared random forest machine learning (Live Birth Risk Score [<em>LiBRisk</em>]) and nomogram models for predicting the likelihood of a live birth among women presenting at 3 Canadian EDs with bleeding in early pregnancy.</div></div><div><h3>Methods</h3><div>Data were prospectively collected on 200 patients with bleeding in early pregnancy using a structured questionnaire, medical record review, and administrative databases. We developed the nomogram with variables selected via multivariable logistic regression analysis. <em>LiBRisk</em> was built using the Shapley variable importance cloud (ShapleyVIC) to derive a simple point-based clinical risk scoring system.</div></div><div><h3>Results</h3><div>Overall, 115 (55%) patients experienced a miscarriage. We excluded duration of vaginal bleeding and pain score, which did not enhance model performance, and constructed <em>LiBRisk</em> with the 8 most important variables (β-human chorionic gonadotrophin level, age, gestational age, gravidity, parity, proportionality of uterine size to gestational age, abdominal cramping, and number of prior spontaneous abortions). All 10 variables were included in the nomogram. The area under the receiver operating characteristic curve of <em>LiBRisk</em> in the test and validation sets were 0.913 (95% CI 0.907−0.919) and 0.900 (95% CI 0.887−0.913), respectively. The <em>C</em>-index of the nomogram was 0.720 (95% CI 0.714−0.726) and 0.860 (95% CI 0.853−0.867) in the test and validation sets, respectively. <em>LiBRisk</em> outperformed the nomogram in all metrics.</div></div><div><h3>Conclusions</h3><div>We developed and compared <em>LiBRisk</em> and nomogram models for determining the probability of eventual pregnancy success/failure in women presenting to the ED with bleeding in early pregnancy. <em>LiBRisk</em> was more parsimonious, incorporating only 8 variables, and outperformed the nomogram in all metrics. Given these promising results, further testing seems warranted.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102789"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434826","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":"The Impact of the COVID-19 Pandemic on Prenatal Screening Modality for Singleton Pregnancies in Ontario","authors":"Marie Belcourt BSc, MD ,&nbsp;Andrea Guerin MD, MEd","doi":"10.1016/j.jogc.2025.102785","DOIUrl":"10.1016/j.jogc.2025.102785","url":null,"abstract":"<div><div>The COVID-19 pandemic has complicated access to timely prenatal screening. Using the Better Outcome Registry &amp; Network database, screening practices were compared across Ontario for the modality of screening and subdivided based on rurality for the first year of the pandemic.</div><div>There was little difference in the proportion of screening modalities across provinces in the first year of the pandemic. However, using a rurality index, there was a pattern of increased use of screening options that did not require ultrasound in rural areas compared to the pre-pandemic period, suggesting an ongoing equity issue for patients in rural Ontario regarding timely prenatal screening.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102785"},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257603","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":"Extremely Preterm Vaginal Delivery of Twins En Caul","authors":"Faisal Sugati MD ,&nbsp;Marisa De Souza MD ,&nbsp;Dina El Demellawy MD, PhD ,&nbsp;Mark Walker MD, BA, MSc, MHCM ,&nbsp;Sarah L. Lawrence MD","doi":"10.1016/j.jogc.2025.102786","DOIUrl":"10.1016/j.jogc.2025.102786","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 5","pages":"Article 102786"},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257602","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":"Hysteroscopic resection of a cervical ectopic pregnancy","authors":"Leah Rusnell MD, BSc,&nbsp;Katherine Lo MD, BSc,&nbsp;Shaleeza Kaderali MD, MSc, BSc","doi":"10.1016/j.jogc.2024.102756","DOIUrl":"10.1016/j.jogc.2024.102756","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102756"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916443","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":"Iniencephaly with Craniospinal Rachischisis: A Rare Severe Neural Tube Defect","authors":"Avantika Gupta MD ,&nbsp;Chetan Khare DM ,&nbsp;Satish Choudhury MD ,&nbsp;Arun Kumar Dora MS","doi":"10.1016/j.jogc.2024.102752","DOIUrl":"10.1016/j.jogc.2024.102752","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102752"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901580","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":"Proposed Utilization of PlGF-Based Diagnostic Testing for Suspected Preeclampsia in Québec: Insights From an Expert Panel Discussion","authors":"Isabelle Malhamé MD, MSc ,&nbsp;Suzanne Demers MD ,&nbsp;Véronica Moramarco MD ,&nbsp;Noura Hassan MDCM, MPH ,&nbsp;Katherine Thériault MD ,&nbsp;François Audibert MD, MSc ,&nbsp;Nadine Sauvé MD ,&nbsp;Anne-Marie Côté MD ,&nbsp;Évelyne Rey MD, MSc ,&nbsp;Amichai Grunbaum MDCM","doi":"10.1016/j.jogc.2024.102759","DOIUrl":"10.1016/j.jogc.2024.102759","url":null,"abstract":"<div><div>Prompt diagnosis of preeclampsia is key to ensure appropriate management and reduce associated adverse outcomes. Placental growth factor (PlGF)-based biomarkers have been shown to be safe and effective diagnostic tools for preterm preeclampsia, and their use is recommended by most recent Canadian guidelines. The present report summarizes an expert panel discussion that led to the development of a proposed utilization algorithm for PlGF-based diagnostic testing for suspected preeclampsia in Québec. In addition to recommendations on who, why, when to test and how to interpret and respond to the test, considerations for optimizing clinical testing relevance were suggested.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102759"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924387","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":"Anemia Near Delivery Is Prevalent, Pernicious, and Associated With Lower Neighbourhood Income: An Analysis of Over 50 000 Pregnancies","authors":"Sumedha Arya MD, MSc ,&nbsp;Maryam Akbari-Moghaddam MSc ,&nbsp;Yang Liu PhD ,&nbsp;Elissa Press MSc ,&nbsp;Giulia M. Muraca PhD ,&nbsp;Heather VanderMeulen MD, MSc ,&nbsp;Jon Barrett MD ,&nbsp;Michelle P. Zeller MD, MSc ,&nbsp;Michele R. Hacker PhD ,&nbsp;Jeannie Callum MD","doi":"10.1016/j.jogc.2024.102721","DOIUrl":"10.1016/j.jogc.2024.102721","url":null,"abstract":"<div><h3>Objectives</h3><div>Anemia in pregnancy has negative impacts on maternal and neonatal morbidity and mortality and has been described as an issue of health equity. The primary aim of our study was to describe the rates of anemia near delivery and assess whether this correlates with neighbourhood-level income status.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of pregnant persons delivering from January 2012 through December 2022 at 2 large academic centres. We used log-binomial regression to estimate the association between neighbourhood-level income quintile and anemia near delivery, defined as a hemoglobin &lt;110 g/L within 30 days of delivery, controlling for maternal age, parity, thalassemia trait, number of fetuses, blood group, and service provider type. Secondary maternal and fetal outcomes were analyzed descriptively.</div></div><div><h3>Results</h3><div>A total of 51 782 deliveries were included; the majority were singleton (97%) pregnancies delivered vaginally (61%). Although 77% of patients had a complete blood count done within 30 days of delivery, only 13% had a ferritin value checked within 9 months of delivery. Approximately 30% of all patients were anemic near delivery, with higher rates of anemia in lower income quintiles; patients in the lowest income quintile were 18% more likely to be anemic than those in the highest income quintile (relative risk 1.18; 95% CI 1.12–1.25).</div></div><div><h3>Conclusions</h3><div>Even within a high-resource academic setting, anemia in pregnancy is common. Given the high rates of anemia in our study, particularly, amongst patients in lower income quintiles, widespread targeted educational and system interventions are required to ensure equitable patient care.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102721"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756017","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":"Clinical Consensus Statement No. 458: Hepatitis C Virus in Pregnancy","authors":"Andrea Atkinson MBBS,&nbsp;Natalie Bjurman MD,&nbsp;Mark Yudin MD,&nbsp;Chelsea Elwood MD","doi":"10.1016/j.jogc.2025.102780","DOIUrl":"10.1016/j.jogc.2025.102780","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Provide guidance for routine antenatal screening of hepatitis C virus in pregnancy to support best practice and optimize antenatal and infectious disease care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Target Population&lt;/h3&gt;&lt;div&gt;Pregnant women/pregnant individuals receiving antenatal care in Canada and consenting to routine infectious disease screening. Options include reviewing prior serology and avoiding repeat testing or providing information regarding the benefit of identifying hepatitis C virus infection for the mother/parent and the baby.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Benefits, Harms, and Costs&lt;/h3&gt;&lt;div&gt;Benefits may include identifying those eligible for treatment of hepatitis C virus infection, avoiding interventions that may increase the risk of transmission to the baby during labour and delivery, creating opportunities for appropriate screening of newborns, and reducing the burden of hepatitis C virus infection in line with World Health Organization recommendations. No direct harms are present given the possibility of testing for hepatitis C using the blood samples already included in antenatal screening. Psychological distress may occur with a new diagnosis of hepatitis C virus in pregnancy. The costs of identifying asymptomatic cases, with resulting treatment, outweigh the health care costs of this additional test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Evidence&lt;/h3&gt;&lt;div&gt;Published and unpublished literature was reviewed between 2017 and July 2023 (when the prior hepatitis C guideline: No. 96 The Reproductive care of Women Living with Hepatitis C infection, was last endorsed). OVID Medline, Embase, PubMed, and the Cochrane Library databases were searched for relevant publications available in English for each section of this statement. Unpublished literature, protocols, and international guidelines were identified by accessing the websites of health-related agencies, clinical practice guideline collections, and national and international medical specialty societies (i.e., American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, and Royal Australian and New Zealand College of Obstetricians and Gynaecologists).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Validation Methods&lt;/h3&gt;&lt;div&gt;The evidence was obtained and reviewed by the principal authors with recommendations reviewed by the Infectious Disease Committee of the SOGC (2022). The authors identified these recommendations using a consensus process and rated the quality of evidence and strength of recommendations according to the guidelines developed by the Canadian Task Force on Preventative Health Care (&lt;span&gt;&lt;span&gt;https://canadiantaskforce.ca/methods/&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;; see online &lt;span&gt;&lt;span&gt;Appendix A&lt;/span&gt;&lt;/span&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intended Audience&lt;/h3&gt;&lt;div&gt;Health care practitioners providing antenatal care, health care organizations, and provincial and federal governments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Social Media Abstract&lt;/h3&gt;&lt;div&gt;Universal screening for hepatitis ","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102780"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479109","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":"Enhanced Recovery Canada Clinical Pathway for Cesarean Delivery","authors":"Jackie Thomas ,&nbsp;Caitlin Anne Jago ,&nbsp;R. Douglas Wilson ,&nbsp;Gregg Nelson","doi":"10.1016/j.jogc.2024.102745","DOIUrl":"10.1016/j.jogc.2024.102745","url":null,"abstract":"<div><div>Enhanced recovery after surgery is a process to promote optimal recovery after a variety of operations utilized by many surgical specialties. This evidence-based series of interventions was developed to decrease the physiological stress and risks associated with surgery. In April of 2023, Enhanced Recovery Canada released its new Clinical Pathway for Cesarean Delivery. This has been endorsed by the Society of Obstetricians and Gynaecologists of Canada. This manuscript will introduce the Clinical Pathway, emphasize its unique features specific to cesarean delivery, and detail how to incorporate guidance into routine practice.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102745"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823048","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":"A Rare Finding of a Posterior Bladder Varicosity in Pregnancy: What Does the Literature Suggest?","authors":"Caroline Leps MD, MSc ,&nbsp;M. Alix Murphy MD, MA.SC ,&nbsp;Sebastian R. Hobson MD, MPH, PHD","doi":"10.1016/j.jogc.2024.102758","DOIUrl":"10.1016/j.jogc.2024.102758","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 2","pages":"Article 102758"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924381","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}