Journal of obstetrics and gynaecology Canada最新文献

{"title":"Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study","authors":"Michael Lavie MD ,&nbsp;Jumana Joubran MD ,&nbsp;Amit Benady MD ,&nbsp;Phillip Berman MA ,&nbsp;Nadav Michaan MD ,&nbsp;Dan Grisaru MD ,&nbsp;Ido Laskov MD","doi":"10.1016/j.jogc.2024.102714","DOIUrl":"10.1016/j.jogc.2024.102714","url":null,"abstract":"<div><h3>Objective</h3><div>The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation.</div></div><div><h3>Methods</h3><div>A retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups.</div></div><div><h3>Results</h3><div>Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of <em>P</em> = 0.05.</div></div><div><h3>Conclusion</h3><div>CT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102714"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640412","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":"Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour","authors":"Ohad Houri MD ,&nbsp;Or Bercovich MD ,&nbsp;Avital Wertheimer MD ,&nbsp;Alexandra Berezowsky MD ,&nbsp;Gil Zeevi MD ,&nbsp;Shir Danieli-Gruber MD ,&nbsp;Eran Hadar MD","doi":"10.1016/j.jogc.2024.102718","DOIUrl":"10.1016/j.jogc.2024.102718","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.</div></div><div><h3>Methods</h3><div>A population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.</div></div><div><h3>Results</h3><div>Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, <em>P</em> = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, <em>P</em> &lt; 0.01). There was no neonatal or maternal death in any group.</div></div><div><h3>Conclusions</h3><div>Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102718"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752768","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":"Fertility Preservation and Infertility Treatment in Female Surgical Trainees in Alberta: A Survey of Trainee Knowledge, Attitudes, and Needs","authors":"Sylvie Bowden MD,&nbsp;Selphee Tang BSc,&nbsp;Amy Metcalfe PhD,&nbsp;Shu Foong MD","doi":"10.1016/j.jogc.2024.102731","DOIUrl":"10.1016/j.jogc.2024.102731","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe fertility knowledge and views on family planning and fertility preservation/treatment among female surgical trainees in Alberta.</div></div><div><h3>Methods</h3><div>A voluntary, anonymous online survey was sent to surgical program coordinators in Alberta to forward to their respective trainees. Participants included surgical trainees from cardiac surgery, general surgery, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedics, otolaryngology, plastic surgery, urology, and vascular surgery. Questions assessed demographics, fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment. The primary outcome were the needs of trainees regarding fertility preservation/treatment. Secondary outcomes included fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment.</div></div><div><h3>Results</h3><div>The survey had a 71.8% response rate, with 125 responses analyzed. The median score for fertility knowledge was 3 out of 6. Most trainees (84.8%) were childless, with 68.0% citing career impact as a significant factor in delaying child-bearing. Career aspirations, training duration, and long work hours were identified as top factors impacting family planning. Only 3.2% had undergone oocyte cryopreservation, while 48.0% had considered it. Awareness of oocyte cryopreservation options and insurance coverage was low. During their training, 57.6% of trainees had received no counselling about family planning.</div></div><div><h3>Conclusions</h3><div>Female surgical trainees in Alberta face significant fertility concerns, exacerbated by gaps in fertility knowledge and career demands delaying child-bearing. There is strong interest in fertility preservation, but barriers include lack of awareness, financial constraints, and inadequate counselling. Enhanced education, counselling, insurance coverage, and supportive policies are needed to support trainees’ reproductive and career goals.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102731"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776256","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":"Effect of Olanzapine on Hyperemesis Gravidarum in Individuals With Mood Disorders: A Case Series","authors":"Verinder Sharma MBBS ,&nbsp;Katelyn N. Wood PhD","doi":"10.1016/j.jogc.2024.102751","DOIUrl":"10.1016/j.jogc.2024.102751","url":null,"abstract":"<div><div>This case series examines the effect of olanzapine on symptoms of hyperemesis gravidarum in individuals with mood disorders. Patient charts from 2022 to 2024 were reviewed, focusing on those with hyperemesis gravidarum who were treated with olanzapine alone or with other psychotropic drugs for their mood disorder. Of 6 patients with hyperemesis gravidarum, 3 had bipolar II disorder, and the others had major depressive disorder. Olanzapine was used alone in 3 cases. A daily dose of 2.5–5 mg was well tolerated and effective in all patients who had failed trials of conventional antiemetics. Thus, olanzapine may be a viable treatment for hyperemesis gravidarum in mood disorder patients unresponsive to standard antiemetics.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102751"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879567","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":"Test or No-Test: Comparison of Medication Abortion Outcomes and Adverse Events When Forgoing Ultrasound, Laboratory Testing, and Physical Examination","authors":"Caitlin Hunter MD, CCFP ,&nbsp;Maya Burck BA ,&nbsp;Colleen Chambers MSc ,&nbsp;Farhana Shawon MD ,&nbsp;M. Ruth Lavergne PhD ,&nbsp;Amanda Whitten MA, MD, CCFP ,&nbsp;Mei-ling Wiedmeyer MD, CCFP, MSc","doi":"10.1016/j.jogc.2024.102730","DOIUrl":"10.1016/j.jogc.2024.102730","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare demographics and clinical outcomes between patients who did not undergo investigations and those who underwent investigations before receiving a prescription for medication abortion (MA) during the first 6 months of the COVID-19 pandemic. Outcomes include success rates, adverse events, pathways to completion, and loss to follow-up rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective medical record review of 1452 patients presenting for MA between 23 March 2020 and 30 September 2020. Descriptive statistics, 2 × 2 chi-square tests, and Fisher exact tests were used to compare characteristics and outcomes between groups.</div></div><div><h3>Results</h3><div>Of the 1307 patients who received a prescription, 895 (68.5%) were in the no-test group and 412 (31.5%) were in the test group. The success rate was 95.2%, with no significant difference between groups (94.0% and 95.8%, <em>P</em> = 0.194). Rates of adverse events were low, with 28 patients presenting for emergency department visits (2.1%), 62 having clinically significant retained products of conception (4.7%), 5 with heavy bleeding requiring treatment (0.4%), 16 with ongoing pregnancy (1.2%), and 3 requiring ectopic pregnancy management (0.2%). Completion of abortion was verified in 1034 patients (80.5%), and the loss to follow-up rate was 22.6%, with no difference between the groups (82.1% vs. 79.8%, <em>P</em> = 0.341; and 21.4% vs. 23.1%, <em>P</em> = 0.477; respectively).</div></div><div><h3>Conclusions</h3><div>We found that clinical outcomes were consistent across the 2 groups, with high success rates and low adverse event rates. Our study contributes to the growing body of evidence that allows for individualized care implementing selective use of low- and no-test MA protocols.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102730"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776257","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":"Association of Acute Histological Chorioamnionitis and Other Placental Lesions With Subsequent Pregnancy Outcomes After Spontaneous Preterm Birth","authors":"Ludmila Porto MD, MSc ,&nbsp;Nir Melamed MD, MSc ,&nbsp;Jessica Liu MD ,&nbsp;John Kingdom MD ,&nbsp;John Snelgrove MD, MSc ,&nbsp;Elizabeth Aztalos MD, MSc ,&nbsp;Christopher Sherman MD ,&nbsp;Jon Barrett MD ,&nbsp;Stefania Ronzoni MD, PhD","doi":"10.1016/j.jogc.2024.102715","DOIUrl":"10.1016/j.jogc.2024.102715","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute histological chorioamnionitis (HCA) is detected in over 50% of spontaneous preterm birth (PTB) and is associated with worse neonatal prognosis. We aim to investigate whether the presence of HCA impacts subsequent pregnancy outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included deliveries at a tertiary centre from 2014 to 2020. Participants were individuals with a history of spontaneous PTB or pregnancy loss &gt;16⁰ weeks and available placental pathology (index pregnancy) with a subsequent pregnancy followed at the same institution. Placentas were classified according to the presence of HCA, other placental lesions, or no lesions. Subsequent pregnancy outcomes were analyzed. The primary outcome was the rate of overall and spontaneous PTB (&lt;37⁰ weeks) in the subsequent pregnancy.</div></div><div><h3>Results</h3><div>A total of 292 individuals met the study criteria, of which 133 had HCA, 61 had other placental lesions, and 98 had no lesions. Individuals with HCA in the index delivery had a higher risk of PTB &lt;28⁰ weeks in the subsequent pregnancy, compared to the no-lesion group (10.4% vs. 1.0%, <em>P</em> = 0.004). Rates of PTB &gt;28⁰ weeks did not significantly differ. The risk of neonatal adverse composite outcomes was higher in the HCA group (13.9% vs. 4.2%, <em>P</em> &lt; 0.01). In a subanalysis of different placental lesions at the index PTB, only maternal vascular malperfusion was associated with recurrent PTB (adjusted odds ratio 2.57, <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>PTB with HCA is associated with higher rates of extreme PTB and adverse neonatal outcomes in the subsequent pregnancy. The inclusion of placental pathology analysis may improve individualized risk assessment in future pregnancies.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102715"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696281","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":"2024 Index of SOGC Clinical Practice Guidelines","authors":"","doi":"10.1016/j.jogc.2024.102748","DOIUrl":"10.1016/j.jogc.2024.102748","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102748"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158840","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":"Bilateral Salpingitis Isthmica Nodosa: A Laparoscopic Clue Supporting its Infectious Etiology","authors":"Konstantinos Koukoumpanis MD, MSc,&nbsp;Michail Panagiotopoulos MD, MSc,&nbsp;Athanasios Douligeris MD, MSc,&nbsp;Konstantinos Kypriotis MD, MSc,&nbsp;Nikolaos Kathopoulis MD, MSc, PhD,&nbsp;Athanasios Protopapas MD, PhD","doi":"10.1016/j.jogc.2024.102717","DOIUrl":"10.1016/j.jogc.2024.102717","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102717"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696282","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":"Placenta Accreta Spectrum Disorders: A Canadian Tertiary Care Centre’s Experience Over 10 years","authors":"Catherine Lu MD ,&nbsp;Carol Schneider MD ,&nbsp;Caroline Corbett MD ,&nbsp;Anet Maksymowicz MD ,&nbsp;Devon Evans MD","doi":"10.1016/j.jogc.2024.102757","DOIUrl":"10.1016/j.jogc.2024.102757","url":null,"abstract":"<div><h3>Objectives</h3><div>The placenta accreta spectrum disorders (PASD) are associated with significant maternal and neonatal morbidity and mortality worldwide. As cesarean delivery rates increase, so does the rate of PASD. PASD antepartum diagnosis and perioperative management are evolving, and we primarily aimed to share our tertiary care centre’s institutional approach and outcomes over a decade.</div></div><div><h3>Methods</h3><div>A retrospective medical record review of cesarean hysterectomy for suspected or confirmed PASD was conducted at a single tertiary centre in Canada from 2010 to 2021.</div></div><div><h3>Results</h3><div>A total of 46 records remained after applying the exclusion criteria, with a diagnosis of PASD in 94% of cases, and 20% consistent with accreta, 48% with increta, and 26% with percreta. Cesarean hysterectomies were conducted on an unscheduled emergency basis in 41% of cases. All cases had antenatal ultrasound imaging, and 57% received an antenatal MRI. Prophylactic ureteric stenting occurred in 37% of cases. Mean total operative time was 97 minutes, and 50% of cases received an intraoperative blood transfusion. Ureteric injury occurred in 2% of cases, and admission to the intensive care unit in 13% of cases.</div></div><div><h3>Conclusions</h3><div>PASD is a complex and highly morbid condition. We have shared our institutional experience and explored some variations in practice, including the use of prophylactic ureteric stenting. Additional research is needed to further explore the optimal methods to diagnose and manage this complex disorder.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102757"},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924384","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":"SOGC Guideline Retirement Notice No. 10","authors":"","doi":"10.1016/j.jogc.2024.102737","DOIUrl":"10.1016/j.jogc.2024.102737","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 12","pages":"Article 102737"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866961","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}