Journal of obstetrics and gynaecology Canada最新文献

{"title":"Clinical Care Pathways for Second and Third Trimester Termination of Pregnancy for Medical Reasons in Canada","authors":"Elise Lavoie-Lebel MD, MSc ,&nbsp;Madeleine Ennis PhD ,&nbsp;Regina Renner MD, MPH ,&nbsp;Sarah Munro PhD ,&nbsp;Robin Leung RN ,&nbsp;Jennifer Chisholm PhD ,&nbsp;Brigid Dineley MD, MHSc ,&nbsp;Liv Knutzen MD ,&nbsp;Julie Robertson MD ,&nbsp;Jessica Liauw MD, MHSc","doi":"10.1016/j.jogc.2025.102770","DOIUrl":"10.1016/j.jogc.2025.102770","url":null,"abstract":"<div><h3>Objectives</h3><div>Termination of pregnancy in the second/third trimester for fetal or maternal complications (i.e., for medical reasons) is an essential health service. We aimed to describe the systems-level pathways for this care in Canada.</div></div><div><h3>Methods</h3><div>We conducted one-on-one semi-structured interviews with maternal–fetal medicine (MFM), medical genetics, and nursing/social work clinicians at the 10 academic MFM sites in Canada. We conducted qualitative content analysis to identify categories describing the clinical care pathway. We triangulated data from participants within sites and then compared data across sites to describe similarities and differences in care. We used NVivo14 software for coding.</div></div><div><h3>Results</h3><div>We recruited 28 participants representing all sites: 10 MFM specialists, 9 medical geneticists/genetic counsellors, and 9 nurses/social workers. We identified 4 main categories describing the clinical care pathway: (1) initial visit and clinic structure, (2) offering termination, (3) provision of procedural and medication termination, and (4) post-termination care. Across sites, although clinic structure and post-termination care were similar, there were differences in offering the option of termination (e.g., variable indications qualifying for approval) and variations in details regarding the provision of procedural and medical termination (e.g., upper gestational age limits for procedural vs. medical approaches).</div></div><div><h3>Conclusions</h3><div>Clinical care pathways for second/third trimester termination for medical reasons are variable across Canadian academic MFM centres, especially regarding circumstances under which termination is offered and details regarding the provision of procedural and medical termination. These differences provide opportunities to inform efforts to optimize equitable and comprehensive services in Canada.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102770"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044046","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":"Acceptability of Mifepristone and Misoprostol and Patients’ Experience With the Early Pregnancy Assessment Clinic at a Community Hospital in Canada","authors":"Salwa Farooqi MD, MSc ,&nbsp;Elyse Lackie MD ,&nbsp;Alice Pham MD ,&nbsp;Lynne Zolis MD ,&nbsp;Kalpana Sharma MD ,&nbsp;Karthika Devarajan MD ,&nbsp;Kirsten Smith MD ,&nbsp;Alexandra Nevin-Lam MD ,&nbsp;Sabrina Lee MD ,&nbsp;Heather Tempest RN ,&nbsp;Elad Mei-Dan MD ,&nbsp;Modupe Tunde-Byass MBBS","doi":"10.1016/j.jogc.2025.102771","DOIUrl":"10.1016/j.jogc.2025.102771","url":null,"abstract":"<div><h3>Objectives</h3><div>Early pregnancy loss (EPL) is a common complication of pregnancy. Research has demonstrated the efficacy of mifepristone pre-treatment followed by misoprostol for the induction of an EPL. North York General Hospital (NYGH) provides an all-in-one Early Pregnancy Assessment Clinic (EPAC) to streamline the care of women with an EPL.</div></div><div><h3>Methods</h3><div>We conducted a prospective single cohort qualitative survey to understand patients’ satisfaction with mifepristone and misoprostol and their experience with EPAC at NYGH. We recruited 191 patients with a confirmed EPL. They were given mifepristone and misoprostol. We administered the validated modified version of the Short Form-36 Health Survey Revised quality of life scales questionnaire to study the following outcomes: (1) acceptability of mifepristone and misoprostol: cramping, bleeding, duration of treatment, and recommendation to others; (2) effect on social activities; and (3) participants’ overall satisfaction with the EPAC at NYGH.</div></div><div><h3>Results</h3><div>We found that 96% of our participants responded completely to our questionnaire. For cramping, 24% reported definitely acceptable, whereas 8% definitely unacceptable. For bleeding, 26% reported definitely acceptable, whereas 4.8% definitely unacceptable. For duration of treatment, 27% reported definitely acceptable and 2.7% definitely unacceptable. Finally, for recommendation to others, 41% reported definitely acceptable and 2.1% definitely unacceptable. The rating for NYGH’s EPAC was high, with 68% of participants rating it as excellent.</div></div><div><h3>Conclusions</h3><div>We found that the acceptability of the medical management at our EPAC for an EPL is high with the mifepristone and misoprostol protocol. This study encourages this treatment and the establishment of similar centres.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 4","pages":"Article 102771"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044045","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":"Impassable passages: a case of intrauterine adhesions at the time of first trimester abortion","authors":"Chelsie Warshafsky MD, MS ,&nbsp;Julie Thorne MD, MPH ,&nbsp;Mostafa Atri MBBS ,&nbsp;Heather Millar MD, MIPH","doi":"10.1016/j.jogc.2025.102769","DOIUrl":"10.1016/j.jogc.2025.102769","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102769"},"PeriodicalIF":2.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044047","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 Development and Validation of a Patient Questionnaire Tool for the Assessment of Patient-Reported Experiences With Endometriosis Ultrasound","authors":"Jayesh Tigdi MD, MBA ,&nbsp;Mahsa Gholiof MSc ,&nbsp;Allyson Bontempo PhD ,&nbsp;Hanan Alsalem MBBS ,&nbsp;Aikansha Chawla MD ,&nbsp;Shay Freger MPH ,&nbsp;Mathew Leonardi MD, PhD","doi":"10.1016/j.jogc.2024.102760","DOIUrl":"10.1016/j.jogc.2024.102760","url":null,"abstract":"<div><h3>Objectives</h3><div>Endometriosis ultrasound is an accurate, cost-effective, and non-invasive diagnostic tool that can help improve the diagnostic delay that patients with endometriosis experience. As an emerging diagnostic method, the perspectives of patients undergoing endometriosis ultrasound remain unexplored. Therefore, the objective of this study was to develop and validate an assessment tool that evaluates patient-reported experiences with endometriosis ultrasound as a decision-making tool.</div></div><div><h3>Methods</h3><div>This was a 2-part study with the first phase involving a modified Delphi consensus process including a panel of clinicians, sonologists, researchers, and a patient with lived experience of endometriosis. Pre- and post-ultrasound patient questionnaires were subsequently developed. The second phase included validating the questionnaires via a prospective cross-sectional survey study carried out at the Endometriosis Clinic at McMaster University Medical Centre in Hamilton, Canada. Data were analyzed using measures of central tendency, chi-square test, and Fisher exact test as appropriate. Statistical significance was determined by 2-sided <em>P</em> values less than 0.05.</div></div><div><h3>Results</h3><div>Pre- and post-ultrasound questionnaires were developed comprising 8 and 10 questions, respectively. Of 46 respondents, there was a similar representation of patients with an abnormal endometriosis ultrasound (58.7% of patients, n = 27) and those with a normal endometriosis ultrasound (41.3 %, n = 19). Moreover, endometriosis ultrasound results helped most participants (84.8%, n = 39) with treatment decision-making.</div></div><div><h3>Conclusions</h3><div>This study validates a survey tool that can be used clinically to assess patient-reported experiences with endometriosis ultrasound. It also demonstrates the highly informative nature of endometriosis ultrasound, with many patients choosing to defer more invasive diagnostic methods (i.e., surgery).</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 3","pages":"Article 102760"},"PeriodicalIF":2.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934409","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 Insidious Dyad: Velamentous Cord Insertion and Intraamniotic Hemorrhage","authors":"Ottavio Cassardo MD,&nbsp;Michele Orsi MD","doi":"10.1016/j.jogc.2024.102733","DOIUrl":"10.1016/j.jogc.2024.102733","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102733"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782269","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":"Digital Health Tools for Miscarriage Support: A Survey of Canadian Women Facing Early Pregnancy Loss","authors":"Breanna Flynn MD ,&nbsp;Megan Gomes MD, MSc ,&nbsp;Genevieve Tam MD, MSc ,&nbsp;Roopan Gill MD, MPH","doi":"10.1016/j.jogc.2024.102722","DOIUrl":"10.1016/j.jogc.2024.102722","url":null,"abstract":"<div><h3>Objectives</h3><div>Early pregnancy loss (EPL) affects 1 in 4 recognised pregnancies, yet often lacks patient-centred supportive care. This study assesses the feasibility and acceptance of a digital health tool to support those affected by EPL. The objectives are to (1) understand the experiences of those who have miscarried, (2) explore their methods of accessing health information, and (3) determine their preferences regarding digital tool content and design.</div></div><div><h3>Methods</h3><div>This mixed-methods study included Canadian persons aged 18–45 years who self-reported to have experienced EPL up to 12⁶ weeks gestation in the preceding 2 years. Recruitment was via social media and hospital posters. Participants completed an online survey and optional follow-up interview between September 2021 and April 2022. Survey responses were analysed using descriptive statistics. Interview findings are presented in a separate paper. Local ethics approval was obtained.</div></div><div><h3>Results</h3><div>Of the 185 survey respondents, 28% revealed that they are somewhat or very dissatisfied with the overall health care they received for their miscarriage. Thirty-nine percent of survey respondents are somewhat or very dissatisfied with how their mental/emotional health was addressed. Notably, 82% supported the development of a digital health tool for EPL care. Ninety-one percent of survey respondents use the internet to access health information.</div></div><div><h3>Conclusions</h3><div>Many participants reported dissatisfaction with their care after EPL but showed strong interest in a user-friendly digital tool that provides general information and mental health support. These findings, along with qualitative interview data, will guide the development and testing of the desired digital health tool, aiming to enhance patient experience and support after miscarriage.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102722"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756018","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":"Index des directives cliniques de la SOGC – 2024","authors":"","doi":"10.1016/j.jogc.2024.102747","DOIUrl":"10.1016/j.jogc.2024.102747","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102747"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158839","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":"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}