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

{"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}

{"title":"Effectiveness of pelvic floor muscle strength training to prevent and treat Urinary Incontinence in Postpartum Primiparous Women: A systematic review.","authors":"Alfonso Javier Ibáñez-Vera, María Cano-Castilla, María Victoria Carazo-Carrasco, Esther Díaz-Mohedo","doi":"10.1016/j.jogc.2025.103023","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103023","url":null,"abstract":"<p><strong>Objectives: </strong>To analyse the effectiveness of active physiotherapy of the pelvic floor as a method of prevention and treatment in primiparous postpartum women.</p><p><strong>Methods: </strong>Pubmed (MEDLINE), SCOPUS, Web of Science (WOS), CINAHL Complete, and PEDro databases were searched to identify clinical trials that included primiparous postpartum women that compared the effects of physiotherapy active of the pelvic floor in the postpartum and also, that the degree of urinary incontinence be measured. Data extraction was carried out by two of the authors in a Microsoft Excel sheet, using a third author in case of discrepancy or doubt.</p><p><strong>Results: </strong>A total of 5 studies were selected including 444 primiparous postpartum women, 222 of whom received active physiotherapy of the pelvic floor. The results were very heterogeneous, two of the studies did not find significant differences between both groups, one study shows a clear improvement in the intervention group, and in the other studies, a significant intragroup improvement was found post-intervention. There is no significant difference in muscle resistance and strength (P < 0.05), but if it is applied combined with biofeedback there is a clear improvement (P = 0.001). With respect to urinary symptoms there is an improvement in the intervention group (P < 0.05).</p><p><strong>Conclusions: </strong>This systematic review indicates that pelvic floor muscle training (PFMT) is an effective intervention to prevent and treat urinary incontinence in postpartum women. PFMT in improving pelvic floor strength and reducing urinary incontinence symptoms.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103023"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565538","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":"Feasibility of Same-Day Discharge in Patients Undergoing Laparoscopic Gynecologic Oncology Surgery.","authors":"Mandy Litt, Jack Thorburn, Joannie Neveu","doi":"10.1016/j.jogc.2025.103025","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103025","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and feasibility of same-day discharge (SDD) of oncology patients undergoing complex laparoscopic gynecologic oncology surgery.</p><p><strong>Method: </strong>A retrospective review including patients from October 2019 to July 2023 undergoing surgical staging for endometrial, tubal, or cervical cancer, treatment for endometrial hyperplasia, or pelvic masses. Surgeries included a total laparoscopic hysterectomy. Patients accomplishing SDD were compared to those requiring admission. Data collection included clinical, demographical, and perioperative variables up to 6 weeks after surgery. Univariate and multivariate analyses were conducted.</p><p><strong>Results: </strong>152 patients were included. On multivariate analysis, variables that significantly predicted admission were an age ≥61 (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.102-0.642; P = 0.004), BMI ≥30-34.9 (OR, 0.291; 95% CI, 0.094-0.905), BMI ≥35 (OR, 0.207; 95% CI, 0.075-0.569; P = 0.002), operative time ≥181 minutes (OR, 0.143; 95% CI, 0.057-0.361; P < 0.001), and an operative start time after 2:00 PM or later (OR, .135; 95% CI 0.036-0.503; P = 0.003). A patient's location <1 hr. away from the center significantly increased the odds of SDD (OR, 2.50; 95% CI, 1.068-5.863; P = 0.035). Out of 51 patients who accomplished SDD, there was a <4% failure rate, with those who were discharged requiring admission >96 hours postoperatively. Of those admitted, the average length of stay was 1.09 days.</p><p><strong>Conclusion: </strong>SDD is safe and feasible for patients. There are few complications, re-admissions, or unscheduled patient contact postoperatively. Its success can be increased by refining patient selection using predictive variables.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103025"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565540","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":"Comparative Analysis of Venous Thromboembolism Prophylaxis Guidelines Following Cesarean Section.","authors":"M Alix Murphy, Lauren Clarfield, Laura Diamond, Elizabeth Miazga, Sari Kives","doi":"10.1016/j.jogc.2025.103022","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103022","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality in Canada. Expanding candidacy for VTE prophylaxis (VTEp) in the peripartum period has been associated with decreased maternal mortality, however there are inconsistencies in society recommendations for postpartum thromboprophylaxis and literature shows poor adherence to guidelines. This brief communication examines VTE prophylaxis prescribing in post-caesarean delivery (CD) patients at a tertiary hospital in Toronto, Ontario, and highlights high variance in risk stratification from national regulatory organizations. Ultimately, future work should be done to improve appropriate thromboprophylaxis prescribing practices to reduce the risk of adverse outcomes related to thromboembolism.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103022"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565537","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":"Impact of COVID-19 public health restrictions on the home birth trends in Alberta: an observational retrospective cohort study.","authors":"Nikki Stephenson, Deborah A McNeil, Kassi Prisnie, Eliana Castillo, Verena Kuret, Kara Nerenberg, Radhmila Parmar, Gary F Teare, Kristin Klein, Amy Metcalfe","doi":"10.1016/j.jogc.2025.103021","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103021","url":null,"abstract":"<p><p>This study examined the association between public health restrictions and the point prevalence of home birth in Alberta between January 1, 2017- December 31, 2021 using administrative health data. Monthly home birth prevalences were examined over the pre-pandemic (n = 161 225), pandemic (n = 77 563), and pandemic wave periods via interrupted time series analysis. Logistic regression modelling estimated the association between home birth and monthly averaged Government Response Stringency Index (GSRI). During the pandemic, home birth prevalence increased (pre-pandemic: 24.82, P < 0.001; slope: -0.02, P = 0.332; pandemic: level change:7.51, P = 006; slope change: -0.40, P = 0.006. Only the first pandemic wave found an association between GSRI and the probability of home birth (OR:1.17; 95%CI:1.03-1.33).</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103021"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565541","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":"Directive n° 461 : La prise en charge des fibromes utérins.","authors":"Innie Chen, Sari Kives, Elizabeth Randle, Darrien Rattray, Ari Sanders, George Vilos","doi":"10.1016/j.jogc.2025.102971","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.102971","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectif: &lt;/strong&gt;Fournir aux cliniciens une compréhension de la signification clinique des fibromes pour les personnes ayant un utérus et fournir des conseils fondés sur des données probantes sur les options de traitement actuellement disponibles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population cible: &lt;/strong&gt;Ce guide de pratique clinique vise à améliorer la vie des personnes symptomatiques de leurs fibromes utérins via des saignements menstruels ou des symptômes de pression. Les considérations relatives à la fertilité ne sont pas abordées en détail, car elles sont décrites dans la directive clinique de la SOGC sur la prise en charge des fibromes utérins chez les femmes souffrant d'une infertilité autrement inattendue.&lt;sup&gt;1&lt;/sup&gt; OPTIONS: Cette ligne directrice passe en revue les options médicales et chirurgicales disponibles pour le traitement des symptômes liés aux fibromes. D'autres options procédurales, telles que l'embolisation de l'artère utérine et les options de traitement à base d'énergie, sont également examinées. RéSULTATS: Ce guide de pratique clinique est destiné à faciliter le processus de prise de décision entre les patientes et les prestataires de soins de santé concernant l'évaluation et la prise en charge des fibromes utérins symptomatiques. AVANTAGES, INCONVéNIENTS ET COûTS: La majorité des patientes présentant des fibromes sont asymptomatiques et ne nécessitent aucune intervention. Pour les patientes présentant des saignements utérins anormaux, une anémie ferriprive, des douleurs pelviennes ou des symptômes de pression, le traitement choisi doit prendre en compte les caractéristiques du fibrome et être orienté vers les symptômes de la patiente et ses objectifs de fertilité. Le coût de la thérapie des personnes atteintes de fibromes pour le système de santé doit être interprété dans le contexte du fardeau économique, de la perte de productivité et des impacts négatifs sur la qualité de vie qui peuvent être associés à une maladie non traitée. PREUVES à L'APPUI: Cette directive clinique est une mise à jour de la directive clinique n° 318 de la SOGC sur la prise en charge des léiomyomes utérins.&lt;sup&gt;4&lt;/sup&gt; À l'aide de titres MeSH et de mots clés pertinents, la littérature publiée a été recherchée par le biais de recherches dans PubMed et Cochrane Systematic Reviews, la date de la dernière recherche étant comprise entre février 2013 et janvier 2025. La littérature grise a été identifiée en consultant les sites web des agences d'évaluation des technologies de la santé et des agences liées aux technologies de la santé, les collections de lignes directrices pour la pratique clinique et les sociétés nationales et internationales de spécialité médicale. MéTHODES DE VALIDATION: Un panel national de patientes partenaires a été réuni pour fournir des commentaires et des perspectives sur les recommandations et les énoncés sommaires de cette directive. Les patientes partenaires ont été délibérément sélectionnées pour assurer la représentation de la","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"102971"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500206","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}