Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC最新文献

{"title":"Access to Early Pregnancy Assessment Clinics and Guideline-Recommended Investigations for Recurrent Pregnancy Loss in Ontario.","authors":"Catherine Friedman, Susan Ellis, Modupe Tunde-Byass, Vanessa Bacal","doi":"10.1016/j.jogc.2026.103554","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103554","url":null,"abstract":"<p><p>Early pregnancy assessment clinics (EPACs) are key in managing early pregnancy complications, yet access across Ontario remains limited. Little is also known regarding EPACs' integration of recurrent pregnancy loss (RPL) care, impacting up to 5% of patients. We surveyed Ontario obstetrics and gynaecology chiefs (May-October 2025, 33 responses, 61% response rate), and found 50% had EPACs and 15% had RPL protocols. Access to RPL investigations varied: gynaecologic ultrasound (89%), antiphospholipid antibody testing (85%), products of conception testing (54%), parental karyotyping (39%), and 3D ultrasound/sonohysterography (31%). We advocate for greater EPACs access, and integrated RPL protocols to improve patient care.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103554"},"PeriodicalIF":0.0,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291472","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":"Weight and Risk Adjusted Perioperative (WRAP) Bundle for Prevention of Cesarean Delivery Surgical Site Infection: A Quality Improvement Initiative.","authors":"Sara C Scremin Souza, Heather Anne Walker, Alexa C Bowie, Caroline Champagne, Ruth Rennicks White, Mark Walker, Darine El-Chaâr, Megan Gomes","doi":"10.1016/j.jogc.2026.103553","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103553","url":null,"abstract":"<p><strong>Objective: </strong>Many individual interventions to reduce surgical site infection (SSI) risk after Cesarean delivery (CD) have been identified; however, their collective impact when used as a bundle is not well defined. This quality improvement initiative compared SSI rates before and after the implementation of a weight- and risk-adjusted perioperative (WRAP) bundle, developed to improve CD outcomes.</p><p><strong>Methods: </strong>The WRAP bundle was designed to standardize care by tailoring evidence-based interventions according to each patient's individual SSI risk category. Risk stratification was based on pre-gravid body mass index (BMI) and the presence of comorbidities associated with increased SSI risk. This quality improvement initiative adopted a before-and-after quasi-experimental design over two years. Post-CD telephone calls by clinical reviewers were made 30-42 days postpartum to identify CD-SSI incidence.</p><p><strong>Results: </strong>A total of 4014 CDs were performed between July 1, 2022, and March 1, 2024, with 1275 before WRAP bundle implementation and 2739 after. Maternal characteristics were comparable between pre- and post-WRAP bundle groups, except for hypertension in pregnancy, which was more prevalent in the post-implementation period (22.1% vs. 17.1%, P = 0.001). Across all BMI categories, a statistically significant reduction in overall CD-SSI incidence from 8.9% to 5.8% (P = 0.007) was observed. In the high-BMI group, the CD-SSI rate decreased from 13.9% to 6.9% (P = 0.03).</p><p><strong>Conclusion: </strong>Tailored bundled interventions, such as the WRAP bundle may be effective in reducing the incidence of CD-SSI, particularly among high-risk individuals. Continuous monitoring of post-CD SSI is vital for quality improvement efforts aimed at optimizing postpartum outcomes.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103553"},"PeriodicalIF":0.0,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291488","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":"Maternal and neonatal outcomes for pre-existing diabetes before and during the pandemic: A population-based study in Ontario, Canada.","authors":"Jamie L Benham, Baiju R Shah, Luis Palma, Howard Berger, Amy Metcalfe, Nikki Stephenson, Katherine Bernier, Sarah Sigurdson, Chelsea Ruth, Lois E Donovan, Denice S Feig, Jennifer M Yamamoto","doi":"10.1016/j.jogc.2026.103546","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103546","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103546"},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149757","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 Multicentre Assessment of Factors Associated With Worse Postpartum Recovery Using the STanford Obstetric Recovery checKlist (STORK).","authors":"Phillip Callihan, Moe Kaeley Takenoshita, Nan Guo, Brendan Carvalho, Danielle M Panelli, Pervez Sultan","doi":"10.1016/j.jogc.2026.103541","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103541","url":null,"abstract":"<p><strong>Objective: </strong>The STanford Obstetric Recovery checKlist (STORK) is a validated patient-reported outcome measure that assesses outpatient postpartum recovery across four domains. We aimed to identify factors associated with worse global recovery at 6 weeks postpartum, and across individual domains at 2 and 12 weeks using STORK.</p><p><strong>Methods: </strong>In this secondary analysis of the STORK validation study, English-speaking adults at three US academic centers completed STORK within 24±12 hours of delivery and at 2, 6 and 12 weeks postpartum. The primary outcome was worse global recovery at 6 weeks, defined as STORK scores in the lowest quartile. Secondary outcomes were worse individual domains at 6 weeks, and worse global recovery at 2 and 12 weeks. Variables with P < 0.2 in univariate analyses were entered into multivariable logistic regression models.</p><p><strong>Results: </strong>Among 498 participants (mean age 33±5 years), American Society of Anesthesiologists class 3 (P = 0.006) and low inpatient STORK scores (P = 0.001) were independently associated with worse global recovery at 6 weeks. Low inpatient psychosocial domain scores were associated with worse physical (P = 0.001) and psychosocial recovery (P < 0.001), and low inpatient sleep and fatigue scores with worse sleep and fatigue (P = 0.03) at 6 weeks. Low inpatient global STORK scores were also associated with worse global scores at 2 and 12 weeks (P < 0.001).</p><p><strong>Conclusion: </strong>Poor inpatient recovery, particularly within psychosocial domains, is associated with worse outpatient recovery at 6 weeks. Inpatient STORK assessment may help identify patients at risk of worse recovery, though whether acting on scores improves recovery requires further study.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103541"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140177","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":"From Counselling to Cryopreservation: Delivering Affirming Fertility Care for Transgender and Gender Diverse Patients.","authors":"Jenna Gale, Bryden Magee","doi":"10.1016/j.jogc.2026.103543","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103543","url":null,"abstract":"<p><p>The number of transgender and gender diverse (TGD) individuals seeking medical care, including reproductive care, has increased substantially over the past decade. Over 1 million people living in Canada over the age of 15 identify as 2SLGBTQ+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer/questioning, and other identities) and of those, 8% identify as transgender or non-binary (1). Over half of adolescent and adult TGD individuals express a desire for parenthood, with a stronger preference for biological parenthood reported among adults (2). Gender-affirming hormone therapy (GAHT) and gender-affirming surgery have well-documented effects on gonadal function. Despite this, fertility preservation uptake remains disproportionately low due to multiple barriers. Obstetrician-gynecologists and reproductive medicine specialists are well positioned to help address these barriers. This narrative review aims to describe the effects of GAHT on fertility in TGD patients, outline evidence-based fertility preservation options, and provide practical recommendations for implementing inclusive clinical practices.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103543"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140188","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":"Presidential Installation Speech, Annual Clinical and Scientific Meeting, 2026.","authors":"Nicholas A Leyland","doi":"10.1016/j.jogc.2026.103545","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103545","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103545"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140166","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":"Leaving the country for care: A descriptive study of those seeking care for suspected or confirmed endometriosis outside of Canada.","authors":"Sukhbir Singh, Layli Tanara, Gurleen Chahal, Mathew Leonardi, Philippa Bridge-Cook, Olga Bougie, Teresa Flaxman","doi":"10.1016/j.jogc.2026.103539","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103539","url":null,"abstract":"<p><strong>Objective: </strong>Canadians with endometriosis experience significant delays in access to care within our national health care system. This study aims to discern the factors leading individuals with suspected and/or confirmed endometriosis to seek care outside of Canada.</p><p><strong>Methods: </strong>An anonymous electronic questionnaire was shared online through social media. Respondents were required to be at least 18 years of age, have suspected and/or confirmed endometriosis, Canadian citizens or permanent residents, and have considered/obtained care abroad for endometriosis.</p><p><strong>Results: </strong>There were 559 survey responses, of which 348 responses were included. Most respondents were aged 25-44 (83.6%, n = 291), identified as White (83.3%, n = 290), and had an education of bachelor's degrees or above (56.6%, n = 197). One-third of respondents (33.1%, n = 115) reported household incomes of ≥ $150,000 CAD. Most respondents (70.7%, n = 246) sought surgical endometriosis care abroad after being dissatisfied or very dissatisfied with their current care in Canada (80.5%, n = 280). Ninety-six respondents (27.6%) received surgical care abroad, mainly travelling to Romania (n = 34, 35.4%), and the USA (n = 32, 33.3%). Main reasons for seeking surgical care abroad included long wait times (n = 79, 82.3%) and belief that Canadian surgeons lack sufficient expertise (n = 67, 69.8%). Most respondents (89.6%, n = 86) were satisfied with their care abroad. Average direct and indirect costs for surgical care abroad were $24 395.55 CAD and $7211.11 CAD per respondent, respectively.</p><p><strong>Conclusions: </strong>Canadian patients are seeking care abroad, most often due to delays in care and a belief that there is a lack of available skills to appropriately manage this disease. Results can inform Canadian health policies to decrease barriers to treatment and improve access to care.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103539"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130059","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":"Evaluating the effectiveness of quadruple therapy for chronic histiocytic intervillositis.","authors":"Chelsea Kubinec, Sabina Freiman, Suzanne Chan, Roger Turnell, Winnie W Sia","doi":"10.1016/j.jogc.2026.103538","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103538","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of quadruple therapy (Aspirin, low molecular weight heparin, hydroxychloroquine and prednisone) on mitigation of chronic histiocytic intervillositis (CHI) in subsequent pregnancies.</p><p><strong>Methods: </strong>This is a case series using chart review of patients referred to Obstetric Medicine and Maternal Fetal Medicine clinics in our institution from January 2021 to April 2025 with a history of CHI. Data collected include demographics, pregnancy histories, delivery information, birthweights, relevant medical history, medications, the investigational quadruple therapies, and placental pathologies. Descriptive analyses were performed. Ethics board at the University of Alberta approved the study.</p><p><strong>Results: </strong>Twenty patients were referred for preconception counseling and/or pregnancy management given a history of CHI. Nine patients subsequently had 13 pregnancies while on the quadruple therapy protocol. Average age of the patients on treatment was 33 years old. Livebirth rate was 100% in the subsequent treated pregnancies (excluding first trimester losses). In the first subsequent treated pregnancy, the median gestational age at delivery was 37⁰ weeks (compared to 33⁶ weeks for the index pregnancy) and the median birthweight was 2710 g. A similar trend was observed in the second treated pregnancy compared to the index. More than two-thirds of the placentas from the treated pregnancies showed a reduction in the extent of inflammation from CHI compared to the respective index pregnancies.</p><p><strong>Conclusion: </strong>Patients with a history of CHI who were treated with the quadruple therapy in subsequent pregnancies had good livebirth rate, longer latency of gestation, and less inflammation on placental pathologies in the treated pregnancies.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103538"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130080","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":"Rates of HPV Vaccination among Women and People with a Cervix Living with HIV in Canada.","authors":"Sofia Nicolls, Emma Karlsen, Valérie Martel-Laferrière, Marie-Louise Vachon, Mark H Yudin, Deborah Money, Elisabeth McClymont","doi":"10.1016/j.jogc.2026.103542","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103542","url":null,"abstract":"<p><p>HPV vaccination is the primary method of preventing cervical cancer. Due to the high prevalence of HPV infection in women with HIV, we sought to determine the rates of HPV vaccination among women with HIV in Canada. The NOVA-HIV study assessing HPV vaccine dosing is currently recruiting women with HIV. As part of the screening protocol, the vaccination status of patients was evaluated to determine eligibility for study recruitment. Of the 505 women with HIV who have been screened across five study sites, 47.2% were vaccinated. More efforts are needed to increase HPV vaccine access and uptake among this population.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103542"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130052","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":"Temporal trends and recurrence risks of spontaneous and provider-initiated preterm birth in Canada - a population-based study.","authors":"Amy Metcalfe, Amelia Srajer, Amy Johnston, Padma Kaul, Nikki Stephenson, Tian Renton, Amity E Quinn, Kathleen H Chaput","doi":"10.1016/j.jogc.2026.103537","DOIUrl":"https://doi.org/10.1016/j.jogc.2026.103537","url":null,"abstract":"<p><strong>Background: </strong>Rates of preterm birth in Canada are increasing; however, national reports typically only include aggregate preterm birth rates and do not provide information on sub-types of preterm birth. This study aimed to describe temporal trends in preterm premature rupture of membranes (PPROM), spontaneous preterm labor, and provider-initiated preterm birth in Canada.</p><p><strong>Methods: </strong>Hospitalization data on livebirths in Canada (excluding Quebec) between 2004/05-2024/25 were obtained from the Canadian Institute of Health Information Discharge Abstract Database. Cochran-Armitage tests for trend were used to examine temporal trends in preterm birth (overall and by sub-type) per 100 live births. For primiparous females with ≥2 deliveries, a recurrence matrix was calculated to examine the probability of recurrent preterm birth.</p><p><strong>Results: </strong>Amongst 5 640 416 deliveries 7.4% were preterm, of which 39.8% were provider-initiated and 60.2% were spontaneous (34.0% PPROM, 60.3% spontaneous preterm labor, 5.7% unclassified). The preterm birth rate increased from 7.3% to 7.8%. Significant overall temporal increases masked increases in provider-initiated preterm birth and decreases in spontaneous preterm birth. The probability of recurrent preterm birth was 22.7% following a provider-initiated preterm birth, 25.7% following PPROM, 29.3% following spontaneous preterm labor, and 7.0% if the first delivery occurred at term.</p><p><strong>Conclusion: </strong>Preterm birth rates continue to increase in Canada, and a large proportion of this is attributed to increasing rates of provider-initiated preterm birth in the late preterm period. While previous preterm birth remains a risk factor for subsequent preterm birth, not all previous preterm births convey the same probability of recurrence in subsequent pregnancies.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103537"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130069","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}