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

{"title":"Reconsidering RhIg following threatened, spontaneous, or induced abortions in the first trimester.","authors":"Justin Wei-Jia Lim, Adam Suleman, Karen Fung-Kee-Fung, Julie Thorne, Gwen Clarke, Lani Lieberman","doi":"10.1016/j.jogc.2025.103039","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103039","url":null,"abstract":"<p><p>Routine Rh(D) immunoglobulin (RhIg) administration following first trimester threatened, spontaneous, or induced abortions is a long-standing practice, but emerging evidence suggests limited benefit. This editorial reviews the outdated data that has informed current guidelines and presents contemporary literature demonstrating a negligible risk of RhD alloimmunization at early gestational ages. Recent studies challenge the necessity of RhIg in the first trimester, and highlight the clinical, resource, and equity-related harms of routine use. In light of evolving evidence and the need to optimize healthcare delivery, we recommend against routine RhD testing and RhIg administration for first trimester threatened, spontaneous, or induced abortions.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103039"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629291","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":"Intrauterine Contraception Device Satisfaction and Continuation in an Urban Youth Clinic in British Columbia, Canada: A Longitudinal Survey Study.","authors":"M Dangerfield, B K Johnston, E Nethery, H Torry, P Sagert, M Ennis, M Ohtsuka, S Munro, L Schummers","doi":"10.1016/j.jogc.2025.103033","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103033","url":null,"abstract":"<p><strong>Objective: </strong>Intrauterine devices (IUDs) are highly effective forms of contraception but may be underutilized by Canadian youth. Youth's experiences with IUDs remain poorly understood. This study examined 6-month IUD continuation and satisfaction among youth (aged 12-24 years) attending a youth contraception clinic in Vancouver, British Columbia.</p><p><strong>Methods: </strong>Participants completed surveys at baseline (patient characteristics) and at 2-6-weeks, 3-months, and 6-months post-placement measuring IUD continuation, satisfaction, side-effects, and menstrual symptoms. We examined baseline characteristics, IUD discontinuation, planned continuation beyond 6-months for participants, and IUD type (levonorgestrel-releasing 'hormonal' or copper). We examined trajectories of reported satisfaction, side effects, and menstrual symptoms over 6-months post-placement.</p><p><strong>Results: </strong>Among 140 participants, 86% (n = 120) chose a hormonal IUD. Five percent of participants removed their IUDs and 5% had an expulsion. Most (86%) IUDs were in-place at 6-months. Nearly all (99%) participants with an IUD in-place at 6-months planned to continue use. IUD satisfaction was >90% at each follow-up for both IUD types. Cramping and spotting were the most frequently reported side effects; 49% of all respondents reported cramping at 2-6-weeks post-placement, this frequency decreased by 6-months for hormonal users. Copper IUD users experienced more bothersome heavy periods than hormonal users. Most (>70%) hormonal IUD users reported reduced menstrual pain, reduced duration, and reduced flow at 6-months post-placement.</p><p><strong>Conclusions: </strong>This study found low rates of IUD discontinuation, high satisfaction, and reduced menstrual side effects among youth over 6-months after IUD placement. This could inform youth-specific counseling for contraceptive method selection and IUD continuation decision-making soon after placement.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103033"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621683","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 HPV Vaccine on Preterm Birth in British Columbia.","authors":"Elisabeth McClymont, Arianne Albert, Sela Grays, Gal Av-Gay, Marette Lee, Gina Ogilvie, Deborah Money, Chelsea Elwood","doi":"10.1016/j.jogc.2025.103032","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103032","url":null,"abstract":"<p><strong>Objective: </strong>Recent evidence has suggested that HPV vaccination may reduce the risk of preterm birth. The objective of this study was to determine the feasibility of linking existing provincial databases to begin to understand if the risk of preterm birth is lower in HPV-vaccinated women in British Columbia.</p><p><strong>Methods: </strong>In this population-based retrospective cohort study of women delivering infants in BC, data on birth outcomes and HPV vaccination status from the BC Perinatal Data Registry and the Panorama Public Health Information System were linked. We compared the overall and spontaneous preterm birth rates between vaccinated and unvaccinated women using logistic regression.</p><p><strong>Results: </strong>Among women who were age eligible for HPV vaccination in school-based programs, there were 5447 deliveries from 5399 individuals between 2015-2018. Of these, 2925 (54.2%) women had been vaccinated in the school-based program. Overall and spontaneous preterm birth were significantly associated with previous preterm delivery and maternal substance use, but not found to be associated with HPV vaccination status.</p><p><strong>Conclusion: </strong>We were readily able to link provincial databases to assess the role of HPV vaccination in preterm birth risk. These pilot data did not show a significant association between HPV vaccination status and preterm birth. Subsequent larger studies are warranted to better assess for the presence of a relationship, which may promote vaccination and result in improved reproductive outcomes for women and their infants.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103032"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621687","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":"Provider perspectives on Intrauterine device practices in adolescent patients.","authors":"Amber Sucharov, Kristina Arion, Sarah McQuillan","doi":"10.1016/j.jogc.2025.103031","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103031","url":null,"abstract":"<p><strong>Objective: </strong>Adolescent pregnancy is a worldwide public health concern, and the intrauterine device (IUD) is known to be a safe and effective method of long-acting reversible contraception in this group. Pediatric and gynecologic societies have recommended the IUD as a first line contraceptive for adolescents given their safety and efficacy. This study aims to understand current IUD practices, elucidate barriers to insertion.</p><p><strong>Methods: </strong>A survey was disseminated to NASPAG (North American Society for Pediatric and Adolescent Gynecologists) members via the listserv on two separate occasions. Consent was obtained prior to initiation of the survey. Results from the survey are anonymous. Results were tabulated with descriptive statistics. Ethics approval was obtained (REB22-0269).</p><p><strong>Results: </strong>There were 55 respondents, mostly in North America (93%). As per providers, adolescents most frequently seek out the IUD for contraception (45%) and abnormal uterine bleeding (24%). Providers felt the most common barrier was misconceptions (25%), and pain with insertion (24%). Although many physicians perform office insertions, many found that a Procedural Sedation Center optimized wait times (38%) or felt that such a center would be helpful (33%).</p><p><strong>Conclusion: </strong>This study demonstrated that misconceptions surrounding the IUD remain. Education on contraception, specifically LARCs, is pivotal in decreasing adolescent pregnancy, reducing barriers, and improving the attitude of adolescents toward the IUD. Pain with insertion is a limiting factor and procedural sedation may help in managing expectations and increasing acceptance.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103031"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621685","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":"Transfusion Testing During Routine Pregnancies: Consensus Recommendations from a Modified Delphi Process.","authors":"Heather VanderMeulen, Mira Shuman, Poh Nyuk Fam, Robyn Berman, Jeannie Callum, Gwen Clarke, Lani Lieberman, Catharine Walsh, Julie Thorne, Matthew Yan","doi":"10.1016/j.jogc.2025.103034","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103034","url":null,"abstract":"<p><strong>Objective: </strong>To standardize perinatal transfusion testing and Rh immunoglobulin (RhIG) administration in low-risk pregnancies through the creation of expert consensus statements.</p><p><strong>Methods: </strong>Modified Delphi consensus process involving iterative rounds of voting on statements by a national expert panel. After each round, responses were analyzed and resent to the panel for further ratings until consensus was achieved, defined as Cronbach alpha >0.95 or a maximum of 3 voting rounds. Once consensus was achieved, statements with a median score ≥4 out of 5 were included.</p><p><strong>Results: </strong>Forty-six expert panelists participated with representation across Canadian provinces and care providers including maternal fetal medicine, obstetrics, family practice, transfusion medicine, neonatology, midwifery, nursing and a patient representative. Twenty-one statements related to perinatal transfusion testing and RhIG administration met criteria for inclusion in the final set of statements. The two statements with the lowest proportion of \"strongly agree\" votes pertained to eliminating the 28-week group and screen in those with a negative first trimester screens and eliminating the need for RhIG before 12 weeks in threatened, spontaneous or therapeutic abortions.</p><p><strong>Conclusion: </strong>These 21 expert consensus statements aim to harmonize perinatal practice across Canada addressing conflicting guidelines and resource limitations, especially in rural settings. This is the first set of expert consensus statements that captures the Canadian context with coverage from first trimester to the birth of the neonate. These statements follow Choosing Wisely principles. Some are practice changing and will require efforts to ensure implementation into practice.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103034"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621689","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":"Replacing Iron and Preventing anemia in Pregnant patients of Limited Economic means (RIPPLE): Assessing the Impact of Funding Iron Supplementation in Pregnancy.","authors":"Suman Memon, Jeannie Callum, Chantal Armali, Elaine Herer, Amie Malkin, Anne McLeod, Harley Meirovich, Michelle Sholzberg, Yulia Lin, Heather VanderMeulen","doi":"10.1016/j.jogc.2025.103035","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103035","url":null,"abstract":"<p><strong>Objectives: </strong>Can funding iron supplementation for low-income pregnant patients reduce socioeconomic disparities in anemia rates at delivery?</p><p><strong>Methods: </strong>This single-center cohort study reviewed hematologic parameters and iron supplementation patterns in three groups: patients from low-income neighbourhoods, non-low-income neighbourhoods, and low-income patients enrolled in the RIPPLE program. RIPPLE provided access to intravenous iron to patients with an annual household income ≤$50 000 CAD and moderate-to-severe iron deficiency anemia, symptomatic iron deficiency with intolerance/inadequate response to oral iron, or iron deficiency anemia with less than 4 weeks to delivery. Patients were referred by their obstetrical provider, hematologist or pharmacist. The primary outcome was anemia (hemoglobin <110 g/L) at delivery.</p><p><strong>Results: </strong>Among 1206 patients (577 low-income, 603 non-low-income, 26 RIPPLE), anemia at delivery was more frequent in RIPPLE (54%) versus low-income (10%) and non-low-income (7%) groups (P < 0.0001). RIPPLE participants exhibited lower nadir hemoglobin (98.8 ± 9.9 g/L) and ferritin (9.6 ± 6.4 μg/L) compared to low-income (hemoglobin 114.2 ± 10.1 g/L; P < 0.0001; ferritin 30.0 ± 24.0 μg/L; P < 0.0001) and non-low-income groups (hemoglobin 115.9 ± 8.1 g/L, P < 0.0001; ferritin 40.9 ± 44.1 μg/L; P < 0.0001), and received infusions later in pregnancy (≤3 weeks pre-delivery: 42% vs. 27% vs. 9%). The RIPPLE cohort included more racial and ethnic minoritized individuals (73% vs. 58% vs. 33%).</p><p><strong>Conclusion: </strong>While funding for iron supplementation addressed cost barriers, disparities in care persisted. Our findings underscore the need for universal access to early screening and timely escalation of oral to intravenous iron to reduce social, racial and ethnic disparities in care.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103035"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621686","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":"Asymptomatic uterine rupture after prophylactic abdominal cerclage.","authors":"Valérie Boulet, Simon Benoit-Dubé, Dina Zaki","doi":"10.1016/j.jogc.2025.103036","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103036","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103036"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621682","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":"Mayer-Rokitansky-Kuster-Hauser syndrome associated with genital inguinal hernia.","authors":"Huarui Zhang, Yuan Wang, Yingli Wang, Hongliang Li, Qingyu Ji","doi":"10.1016/j.jogc.2025.103038","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103038","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103038"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621684","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 role of simulation in knowledge dissemination and improving clinical outcomes for the management of impacted fetal head at cesarean delivery.","authors":"Christopher M Nash, Elizabeth Randle, Allyson Cruickshank, Jocelyn Stairs","doi":"10.1016/j.jogc.2025.103037","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103037","url":null,"abstract":"<p><strong>Objective: </strong>Impacted fetal head (IFH) is an obstetrical emergency with associated maternal and fetal morbidity. The aim of this study was to assess the role for a simulation session about the management of IFH at cesarean delivery as a method of disseminating guideline recommendations to obstetricians. The secondary aim was to assess the clinical impact of this initiative.</p><p><strong>Methods: </strong>An IFH simulation session based on recent guidelines was developed using the PROMPT FLEX enhanced cesarean section model to review pull, push, and Patwardhan techniques. All faculty and obstetrical trainees were invited to participate. Participants completed baseline and post-session surveys. Survey scores were compared using paired t-test and ANOVA. To assess clinical impact, a 6 month pre/post cohort of all patients who underwent second stage cesarean delivery was assembled. Multivariable robust Poisson regression models were used to estimate relative risk of a composite maternal/neonatal morbidity outcome pre/post implementation.</p><p><strong>Results: </strong>34 clinicians participated (21 trainee,13 faculty). Trainees demonstrated significant, sustained improvement in knowledge following participation (P < 0.001). Trainees reported sustained comfort level with push and pull techniques but comfort with Patwardhan waned (P = 0.03). Faculty comfort was unchanged for push and pull techniques but significantly improved for Patwardhan (P = 0.01). The adjusted relative risk of composite maternal/neonatal morbidity following implementation was unchanged (RR 1.03, 95% CI 0.75-1.42). However, NICU admissions were reduced (P = 0.01).</p><p><strong>Conclusion: </strong>An IFH simulation session was associated with improvement in trainee knowledge and faculty and trainee comfort with the Patwardhan technique. Simulation may be an effective tool to improve obstetrician comfort with novel recommendations.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103037"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621688","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 Care for Trainees: The Need for National Policy and Transparent Institutional Support.","authors":"Sylvie Bowden","doi":"10.1016/j.jogc.2025.103030","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103030","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103030"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602695","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}