Journal of obstetrics and gynaecology Canada最新文献

{"title":"Systemic Inequities in Women’s Health for Providers and Patients: The Impact on Access to Care","authors":"Nicholas A. Leyland MD, MHCM, Marfy Abousifein BHSc","doi":"10.1016/j.jogc.2025.103080","DOIUrl":"10.1016/j.jogc.2025.103080","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103080"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985938","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":"Serum Biglycan and Decorin as Biomarkers for Preterm Birth: A Prospective Cohort Study","authors":"Sundas Akram Mphil,&nbsp;Kaleem Maqsood PhD,&nbsp;Javeria Malik PhD,&nbsp;Nabila Roohi PhD","doi":"10.1016/j.jogc.2025.103086","DOIUrl":"10.1016/j.jogc.2025.103086","url":null,"abstract":"<div><h3>Objectives</h3><div>Preterm birth (PTB) affects 10% of pregnancies worldwide, causing significant neonatal morbidity and mortality. Biglycan and decorin, essential proteoglycans in fetal membranes, are linked to spontaneous PTB pathophysiology. This study investigates their potential as biomarkers for spontaneous PTB.</div></div><div><h3>Methods</h3><div>This study included 500 pregnant women from various hospitals. Blood samples were collected, and participants were followed up until delivery. Pregnant women were categorized into groups based on gestational age at birth: moderate PTB, very PTB (vPTB), and term birth (control group). Serum levels of biglycan and decorin were measured using enzyme-linked immunosorbent assay kits. Statistical analysis included analysis of variance, logistic regression, and receiver operating characteristic curve evaluation using SPSS.</div></div><div><h3>Results</h3><div>Serum levels of biglycan were higher in the vPTB group in the second (82.49 ± 2.86 pg/mL, <em>P</em> = 0.0012) and third trimesters (81.17 ± 2.01 pg/mL, <em>P</em> = 0.0097). In both trimesters, decorin levels were lower in the vPTB group (second: 36.32 ± 0.90 ng/mL, <em>P</em> = 0.0013; third: 34.25 ± 1.86 ng/mL, <em>P</em> = 0.0023). Receiver operating characteristic curve analysis showed fair discriminatory power for decorin in the third trimester (area under the curve = 0.70, <em>P</em> = 0.0021). Multinomial logistic regression further confirmed that both biomarkers (biglycan: OR 1.034, <em>P</em> = 0.001; decorin: OR 0.914, <em>P</em> = 0.001) were significant predictors of PTB.</div></div><div><h3>Conclusions</h3><div>Reduced amount of decorin and increased concentration of biglycan during pregnancy were associated with enhanced risk of spontaneous PTB. These results support the potential of early gestation serum glycoprotein complex as a predictive model for spontaneous PTB.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103086"},"PeriodicalIF":2.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985924","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":"Association Between Elevated Maternal BMI, Cervical Length, and Spontaneous Preterm Birth in Persons at Increased Risk of Spontaneous Preterm Birth","authors":"Joan Crane MD, MSc ,&nbsp;Donnette O’Brien BN","doi":"10.1016/j.jogc.2025.103090","DOIUrl":"10.1016/j.jogc.2025.103090","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the association between maternal BMI, short cervical length (CL) ≤2.50 cm, and spontaneous preterm birth (SPTB) in persons with risk factors for SPTB, including those with a history of excisional cervical procedures or uterine anomalies.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included asymptomatic pregnant persons with singleton gestations and intact membranes, without a history of SPTB but at increased risk of SPTB (including those with a history of excisional cervical procedures or uterine anomalies), who underwent transvaginal ultrasound assessment of CL between 16⁰ and 23⁶ weeks gestation and had pre-pregnancy BMI (or height and weight) reported. The primary exposure was pre-pregnancy BMI, with the primary outcomes of interest being CL and SPTB. Univariate and multivariate logistic regression analyses were performed to assess the associations between BMI and CL and BMI and SPTB &lt;37 weeks gestation, adjusting for possible confounders.</div></div><div><h3>Results</h3><div>Of the 407 persons included, 198 (48.6%) had a BMI ≥25.0. BMI ≥25.0 and CL ≤2.50 cm were associated with SPTB &lt;37 weeks gestation (adjusted OR 2.65; 95% CI 1.09–6.43, <em>P</em> = 0.031 and adjusted OR 7.30; 95% CI 2.18–24.50, <em>P</em> = 0.001; respectively). BMI ≥25.0 was not associated with CL ≤2.50 cm in the univariate or multivariate regression analyses (<em>P</em> = 0.29 and <em>P</em> = 0.48, respectively).</div></div><div><h3>Conclusions</h3><div>In persons with a history of an excisional cervical procedure or uterine anomaly, BMI ≥25.0 is associated with SPTB &lt;37 weeks gestation but is not associated with CL ≤2.50 cm in the second trimester.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103090"},"PeriodicalIF":2.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985900","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":"Viral Load Testing Practices Among Pregnant People Living With HIV on Admission From Obstetrical Triage","authors":"Jessica Shu Nan Li MD, MPH ,&nbsp;Alysha Nensi MD, MSc ,&nbsp;Mark H. Yudin MD, MSc","doi":"10.1016/j.jogc.2025.103089","DOIUrl":"10.1016/j.jogc.2025.103089","url":null,"abstract":"<div><h3>Objectives</h3><div>Routine viral load (VL) testing is recommended for pregnant people living with HIV (PLWH) to confirm viral suppression antenatally. The exact timing of this varies in practice. To obtain an up-to-date VL immediately prior to delivery, our institution implemented a policy to test VLs for all pregnant PLWH on admission. Our objective was to characterize testing practices since implementation.</div></div><div><h3>Methods</h3><div>Retrospective chart review of all pregnant PLWH admitted through obstetrical triage at St. Michael’s Hospital in Toronto, Ontario from January 2013 to December 2022. Outcomes of interest included VL completion status, stratified by year and other competing admission tasks.</div></div><div><h3>Results</h3><div>This study identified 135 admissions. The majority had VLs ordered (61.5%) and drawn (85.9%) on admission. VL ordering improved over the latter half of the study period (44.6% vs. 82.0%, <em>P</em> &lt; 0.001). More VLs were ordered among Group B <em>Streptococcus</em>-negative patients (71.3%) compared to positive (41.4%) (<em>P</em> = 0.031) and among those who received an epidural (74.2% vs. 50.7%, <em>P</em> = 0.020). More VLs were drawn by nurses among patients who delivered during the admission (90.9% vs. 42.9%, <em>P</em> &lt; 0.001) and patients who received an epidural (93.5% vs. 79.5%, <em>P</em> = 0.019).</div></div><div><h3>Conclusions</h3><div>While the rate of ordering VLs improved over the course of the study, the rate of drawing VLs remained high throughout, indicating that nurses consistently drew the bloodwork irrespective of an actual order. VL testing improved with the introduction of pre-printed orders, and varied by Group B <em>Streptococcus</em> status, epidural usage, and delivery status. These findings offer opportunities to guide future clinical practices on antenatal VL testing.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103089"},"PeriodicalIF":2.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985960","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":"Perspectives and Motivational Factors Surrounding Decision-Making in Women With Cancer Considering Fertility Preservation","authors":"Trish Dinh MD, MSc ,&nbsp;Salina Kanji MD ,&nbsp;Nicola Farnell CRNP ,&nbsp;Ruth Ronn MD ,&nbsp;Graciella Pio MD ,&nbsp;Xin Xu MD ,&nbsp;Swati Dixit PhD ,&nbsp;Ellen M. Greenblatt MD","doi":"10.1016/j.jogc.2025.103074","DOIUrl":"10.1016/j.jogc.2025.103074","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess perspectives of patients referred for urgent oncofertility consultation influencing whether to proceed or decline fertility preservation (FP).</div></div><div><h3>Methods</h3><div>An online survey was conducted in newly diagnosed cancer patients from August 2021 to July 2023 after an oncofertility consultation. Post-pubertal people with ovaries, a recent cancer diagnosis, and those who were referred for urgent oncofertility preservation consultation were eligible. Primary outcomes were patients’ experiences and final treatment decisions; secondary outcomes included cycle outcomes.</div></div><div><h3>Results</h3><div>Overall, 67/126 (53.2%) completed the survey and met our study criteria. Median age was 28 years (IQR 29–36). Most referrals were from medical (47.8%; 32/67) and surgical (35.8%; 24/67) oncologists with a median interval of 3 days (IQR 2–6) from referral to consultation. Breast (64.2%; 43/67) and hematological (11.9%; 8/67) cancers were most common. Overall, 55/67 (82.1%) proceeded with cryopreservation, 38/55 (69.1%) oocyte cryopreservation, 12/55 (21.8%) embryo cryopreservation, and 5/55 (9.1%) both. Of those planning chemotherapy/radiation, 42/56 (75%) chose gonadotropin-releasing hormone agonist. Of those who declined cryopreservation, 3 (25%) chose gonadotropin-releasing hormone agonist treatment as the only form of FP; 9/67 (13.4%) chose no FP treatment. The most common reasons for not cryopreserving included: no time to complete FP before cancer treatment (41.7%; 5/12) and delaying cancer treatment (41.7%; 5/12). The most common motivating factors for pursuing FP were concern for future fertility (72.4%; 42/58) and health care provider advice (48.2%; 28/58).</div></div><div><h3>Conclusions</h3><div>Most patients who received urgent oncofertility counselling proceeded with treatment. Common reasons for declining were timing of FP and delaying oncological treatment.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103074"},"PeriodicalIF":2.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862771","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":"Placental Growth Factor Diagnostic Testing: An Opportunity to Transform Pregnancy Care for Patients With Suspected Preeclampsia in Canada","authors":"Kelsey McLaughlin PhD ,&nbsp;Melanie C. Audette MD, PhD ,&nbsp;Harrison Banner MD, MSc ,&nbsp;Jon Barrett MB, MD ,&nbsp;Emmanuel Bujold MD, MSc ,&nbsp;Honzer Chen MD ,&nbsp;Nicole Cohen MD ,&nbsp;Tina Delaney MD ,&nbsp;Ernesto A. Figueiro-Filho MD, PhD ,&nbsp;Rachel A. Gladstone MD, MSc ,&nbsp;Venu Jain MD, PhD ,&nbsp;Jessica Liauw MD, MSc ,&nbsp;Isabelle Malhamé MD, MSc ,&nbsp;Elad Mei-Dan MD ,&nbsp;Nir Melamed MD, MSc ,&nbsp;Kellie E. Murphy MD, MSc ,&nbsp;Christopher M. Nash MD ,&nbsp;Christy Pylypjuk MD, MSc ,&nbsp;Naila Ramji MD, MSc ,&nbsp;Anjana Ravi Chandran MSc ,&nbsp;John W. Snelgrove MD, MSc","doi":"10.1016/j.jogc.2025.103076","DOIUrl":"10.1016/j.jogc.2025.103076","url":null,"abstract":"<div><div>Preeclampsia is a leading cause of maternal morbidity and adverse perinatal outcomes in Canada. Growing evidence supports the novel blood-based biomarker placental growth factor (PlGF) as a diagnostic test to accelerate the timely diagnosis of preeclampsia, enhancing care for hypertensive pregnant patients. Despite national endorsement, challenges like regional disparities and test standardization hinder PlGF implementation. The Canadian PlGF Strategy &amp; Research Consortium convened with representation from clinicians, researchers, and patient partners to discuss the current state of PlGF testing. We universally agreed there is an urgent need to implement diagnostic PlGF testing to improve maternal and perinatal outcomes in Canada.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103076"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862772","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":"Patterns of Aspirin Non-Use by Preeclampsia Risk Factors in High-Risk Pregnancies: A Retrospective Cohort Study","authors":"Leonet B. Reid MD, MBA, MSc ,&nbsp;Kelsey McLaughlin PhD ,&nbsp;Hilary K. Brown PhD ,&nbsp;Valeria E. Rac MD, PhD ,&nbsp;John C. Kingdom MD ,&nbsp;John W. Snelgrove MD, MSc","doi":"10.1016/j.jogc.2025.103073","DOIUrl":"10.1016/j.jogc.2025.103073","url":null,"abstract":"<div><h3>Objectives</h3><div>Low-dose aspirin (acetylsalicylic acid [ASA]) prevents preterm preeclampsia, yet identifying who should initiate therapy remains challenging. We evaluated patterns of ASA non-use among high-risk pregnant patients with one or more preeclampsia risk factor(s) based on Canadian guidelines in a tertiary obstetrical centre in Ontario, Canada.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of pregnant patients at high risk of placenta-mediated disorders who gave birth at a single tertiary centre from March 1, 2017, to December 31, 2019. We evaluated ASA non-use for individual preeclampsia risk factors and for cumulative risk factors using descriptive analyses and logistic regression.</div></div><div><h3>Results</h3><div>A total of 641 patients were included, 423 (66.0%) of whom did not use ASA. ASA non-use was prevalent among those with prior preeclampsia (33.6%), diabetes (47.1%), and chronic hypertension (45.0%). Risk factors with the highest non-use were nulliparity (76.0%), obesity (59.9%), and age &gt;40 (58.6%). Cumulative risk factors had decreasing odds of non-use compared to no risk factors, although this reduction plateaued with ≥2 risk factors (odds ratio 0.14; 95% CI 0.07–0.27). Among all patients with an ASA indication based on current Canadian guidelines, 55.3% were not using ASA during their pregnancy.</div></div><div><h3>Conclusions</h3><div>ASA non-use rates remain high among patients with significant risk factors for preeclampsia, including prior preeclampsia, diabetes, hypertension, obesity, and nulliparity. The presence of multiple risk factors is associated with minimal improvement in ASA use rates. Strategies are urgently needed to improve ASA use for preeclampsia prevention among high-risk pregnant patients.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103073"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862770","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":"Three-dimensional Microscopic Images of the Cervical Polyp by Microtomography","authors":"Ana Paula Pinho Matos MD ,&nbsp;Osvaldo Luiz Aranda MD ,&nbsp;Alessandra Silveira Machado PhD ,&nbsp;Heron Werner PhD ,&nbsp;Edward Araujo Júnior PhD ,&nbsp;Pedro Teixeira Castro PhD","doi":"10.1016/j.jogc.2025.103072","DOIUrl":"10.1016/j.jogc.2025.103072","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103072"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862774","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":"Primary Umbilical Endometriosis: A rare extra-pelvic presentation","authors":"Nitu Mishra MS (Obstetrics & Gynaecology), DNB (Obstetrics & Gynaecology) ,&nbsp;Avantika Gupta MS (Obstetrics & Gynaecology) ,&nbsp;Hemlata Panwar MD","doi":"10.1016/j.jogc.2025.103078","DOIUrl":"10.1016/j.jogc.2025.103078","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103078"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862773","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":"Attitudes Towards Pooled Surgical Waitlists and Group Referral in Urogynecology: Higher Contemporary Acceptance Among Patients","authors":"Hisham Khalil MD ,&nbsp;Sarah Kanji MD, MSc ,&nbsp;Taraneh Tabatabaei BSc ,&nbsp;Gurveen Cheema BSc ,&nbsp;Aisling Clancy MD, MSc, MPH","doi":"10.1016/j.jogc.2025.103077","DOIUrl":"10.1016/j.jogc.2025.103077","url":null,"abstract":"<div><h3>Objectives</h3><div>Consolidation of individual surgeon waitlists into a collective pool has been implemented in many public systems to optimize resource use and ensure equitable access to surgical care. Acceptance of such strategies was noted to be limited in urogynecology. We aimed to evaluate patient acceptance of pooled surgical waitlists in a contemporary population and compare results to a historical pre-COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>This cross-sectional study surveyed patients awaiting urogynecologic surgery after signing consent from 2022 to 2023. All responses were collected anonymously. Patient attitudes toward the potential for a pooled surgical waitlist were explored. We compared survey results to data from a historical cohort of published data from 2019 (N = 176) to evaluate whether there was a change in attitudes.</div></div><div><h3>Results</h3><div>Of the 101 patients awaiting surgery who completed the survey, 42% (42/101) reported that they would like to be offered the option of having surgery done by the next available skilled surgeon, rather than wait for their own surgeon, and this did not differ by patient symptom severity (<em>P</em> = 0.52). Overall, 53% (54/101) of patients reported feeling comfortable being referred to the first available urogynecologist for both consultation and follow-up visit. More respondents agreed with the pooled surgical waitlist option than in the historical cohort (42% vs. 19%, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>There appears to be greater acceptance of pooled surgical waitlists in a contemporary analysis, potentially supporting such a strategy in future urogynecology populations.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103077"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862768","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}