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

{"title":"Designing for Dyads: A Multidisciplinary Panel on Inclusion of Pregnant and Lactating Persons and Their Infants in Clinical Trials.","authors":"Lauren E Kelly, Laurie Proulx, Ngawai Moss, Fabiana Bacchini, Isabelle Malhamé, Souvik Mitra, Karel Allegaert, Natalie Dayan","doi":"10.1016/j.jogc.2025.103111","DOIUrl":"10.1016/j.jogc.2025.103111","url":null,"abstract":"<p><p>There is international momentum to improve the representation of pregnant and lactating persons and neonates in clinical trials to generate equitable and robust data for these groups. Appropriate inclusion of these groups in clinical trials requires additional considerations owing to alterations in pharmacokinetics of medicines during pregnancy, evaluating newborn outcomes and exposures through lactation, ethical issues relating to the timing of and approach to informed consent, and a lack of regulatory incentives or frameworks to guide trial design. These factors, combined with low overall knowledge of clinical trials, make it challenging to engage health care providers and patients in discussions about clinical trials during pregnancy. A multidisciplinary approach is needed to develop guidance for researchers, clinicians, industry, and regulatory agencies to promote safe participation. We herein provide a summary of the discussion from a multidisciplinary panel entitled \"Designing for Dyads\" that was held at the 2024 Increasing capacity for Maternal and Paediatric Clinical Trials summit in Vancouver, BC, Canada and the action items suggested by the panel.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103111"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056583","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":"Mortality After Childbirth Among Black Persons in Ontario: A Call for Better Race-Based and Sociodemographic Data.","authors":"Carolina Lavin Venegas, Nicole F Roberts, Alicia St Hill, Modupe Tunde-Byass, Kasim E Abdulaziz, Mark Walker, Ann E Sprague","doi":"10.1016/j.jogc.2025.103110","DOIUrl":"10.1016/j.jogc.2025.103110","url":null,"abstract":"<p><p>Racial disparities in obstetric outcomes are well-documented internationally, with Black persons facing significantly higher risks of maternal mortality, but Canadian data remain limited. We investigated the causes of death among 20 Black birthing persons over a 10-year period in Ontario, Canada. Efforts to advance and monitor equity in perinatal health require improved collection, use, and governance of sociodemographic and social determinants of health data, including race data. This is essential for decision-making within and outside the health system to drive impactful change. The Better Outcomes Registry & Network (BORN) Ontario is involved in initiatives to raise awareness and advocate for advancing health equity and welcomes collaboration with communities, people with lived experience, clinicians, and organizations empowered for change.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103110"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056598","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":"Postoperative Outcomes and Practices in Vaginal Hysterectomy: A Retrospective Cohort Study and Comparison of General Gynecologists and Urogynecologists.","authors":"Caroline Leps, Justin W J Lim, Elizabeth Miazga, Lindsay Shirreff, Ally Murji","doi":"10.1016/j.jogc.2025.103117","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103117","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate differences in post operative complications and practice patterns amongst vaginal hysterectomy (VH) performed by fellowship-trained urogynecologists compared to general gynecologists.</p><p><strong>Methods: </strong>This was a retrospective chart review of patients who underwent VH for benign conditions across nine Canadian hospitals (six academic, three community) between July 2016 and November 2022. Post-operative complications and practice patterns were compared between fellowship-trained urogynaecologists compared to general gynaecologists.</p><p><strong>Results: </strong>A total of 1459 VHs were performed, 691 VH by 10 fellowship-trained urogynaecologist, and 768 VH by 33 general gynaecologists. After adjustment, the odds of post operative complication were not statistically significant between the groups (1.08, 95%CI 0.66 - 1.76). Compared to general gynaecologists, urogynaecologists had no difference in transfusion rates (OR 1.99, 95%CI 0.77-5.12), operative time (median 126min [IQR 77] vs 125 [IQR 98]), and no difference in odds of the composite outcome, any complication or readmission within 30 days of hysterectomy (OR 1.23, 95% CI 0.91 - 1.65). Urogynaecologists did not have a clinically significant increase in estimated blood loss (average 25cc per case). The rates of apical repair were low amongst urogynaecologists and general gynecologists, 57.3% and 28.5% respectively. Of the 33 general gynaecologists, 1 (3%) was new to practice (<5 years).</p><p><strong>Conclusion: </strong>Major postoperative complications are comparable between general gynecologists and urogynecologists, and general gynecologists should continue to have a robust VH practice to address growing demand. With few new generalists having a VH practice, tailored education is necessary.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103117"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056544","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 Primary Care Referrals for Heavy Menstrual Bleeding in Adolescents: A Retrospective Chart Review.","authors":"Raeesha Rajan, Valerie Bloomfield, Sari Kives, Lisa Allen","doi":"10.1016/j.jogc.2025.103118","DOIUrl":"https://doi.org/10.1016/j.jogc.2025.103118","url":null,"abstract":"<p><strong>Objective: </strong>Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with physical, social, emotional, or material quality of life. Several societies, including the Society of Obstetricians and Gynecologists of Canada (SOGC) and North American Society for Pediatric and Adolescent Gynecology (NASPAG), have created algorithms to guide investigations and management. We aim to evaluate the extent to which primary care providers (PCP) initiate first-tier guideline investigations and management prior to specialist referral.</p><p><strong>Methods: </strong>A retrospective review of adolescents referred to PAG for HMB over a 2-year period was conducted. Patient demographics, investigations and management initiated by the referring PCP were extracted. These investigations were compared to SOGC and NASPAG guidelines to assess completion of first-tier investigations. In addition, diagnosis, investigations, and management initiated by the PAG team at the first visit was captured.</p><p><strong>Results: </strong>In total, 242 patients were included for review. The minority of referrals included all first-tier investigations defined by SOGC or NASPAG (34.3% and 16.1%, respectively). Despite this, 80% of adolescents were started on a treatment modality by their PCP. Commonly prescribed treatments included oral combined hormonal contraceptives (44%) and non-steroidal anti-inflammatories (43%). After PAG consultation, the majority of adolescents completed first-tier investigations (SOGC 87% and NASPAG 67%).</p><p><strong>Conclusion: </strong>The study provides an understanding of how PCP are investigating, managing and referring adolescents with HMB, and the potential impact on decision making at first PAG consultation. This serves to inform collaboration between PCP and PAG providers, with the goal of promoting judicious use of healthcare resources and timely care.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103118"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056562","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":"Circulating Very Long-Chain Saturated Fatty Acids in Early Pregnancy: Association With Blood Pressure and Weight Gain.","authors":"Hana Arghavani, Line Berthiaume, Karine Greffard, Pierre Julien, François Audibert, William D Fraser, Iwona Rudkowska, Jean-François Bilodeau","doi":"10.1016/j.jogc.2025.103103","DOIUrl":"10.1016/j.jogc.2025.103103","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the associations of circulating very long-chain saturated fatty acids (VLSFAs) with maternal blood pressure (BP), weight gain, and incidence of gestational hypertension (GH)/preeclampsia (PE) in a retrospective longitudinal study.</p><p><strong>Methods: </strong>Blood samples from 92 pregnant women, including normotensive (n = 64) and hypertensive pregnancies (GH/PE, n = 28), from the International Trial of Antioxidants in the Prevention of PE (INTAPP; ISRCTN 85024310) were used at 8-14 weeks (visit 1) and 20-24 weeks (visit 2). Plasma Fatty acids (FA) profiles were measured by gas chromatography with flame ionization detection. Partial correlations and mixed models assessed BP and FA associations. Logistic regression models were used to assess GH/PE risks using FAs.</p><p><strong>Results: </strong>Weight gain adjusted for pre-pregnancy BMI was inversely correlated to arachidic acid at visit 1 (r = -0.364, P < 0.001). VLSFAs, arachidic acid, and tricosylic acid were negatively correlated with both systolic BP and diastolic BP (DBP) at visit 1 (r < -0.274, P < 0.03). Higher levels of VLSFAs were also associated with the lower quartile of DBP (P = 0.01). Integrating clinical parameters with FA profiles (palmitoleic acid and eicosapentaenoic acid) presented a promising predictive model for GH/PE.</p><p><strong>Conclusions: </strong>VLSFA levels in circulating phospholipids, especially arachidic acid, are associated with weight gain and BP, and with tricosylic acid, could be linked to a potentially protective role within FAs in a more complex lipid signature against hypertension in pregnancy.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103103"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056554","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":"In Practice: Maternal Heart Rate Artifact.","authors":"Daniel J Kiely, Sebastian Hobson, Katherine Tyndall, Lawrence Oppenheimer","doi":"10.1016/j.jogc.2025.103102","DOIUrl":"10.1016/j.jogc.2025.103102","url":null,"abstract":"<p><p>Maternal heart rate artifact occurs during fetal heart rate monitoring when the maternal heart rate is mistaken for the fetal heart rate. Unrecognized maternal heart rate artifact poses major patient safety risks due to errors of commission and omission when healthcare teams do not realise that the supposedly \"fetal\" heart rate tracing that they are observing is misleading. In 2022, a technical update was published by the Society of Obstetricians and Gynaecologists of Canada to mitigate this risk by describing the signs of possible maternal heart rate artifact and the steps to obtain an accurate fetal heart rate tracing. Despite this, concerns remain regarding implementation in clinical practice. Here, we present 2 illustrative fetal and maternal heart rate tracings to increase awareness and help with knowledge translation.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103102"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056571","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":"Development of Quality Indicators for Pregnancy Care of People With Disabilities Using a RAND-Modified Delphi Method.","authors":"Kyara J Liu, Evelina Pituch, Kathryn Barrett, Anne Berndl, Lisa Graves, Yona Lunsky, Marina Vainder, Andi Camden, Meredith Evans, Lesley A Tarasoff, Hilary K Brown","doi":"10.1016/j.jogc.2025.103106","DOIUrl":"10.1016/j.jogc.2025.103106","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop quality indicators (QIs) for pregnancy care of people with disabilities.</p><p><strong>Methods: </strong>We used a RAND-modified Delphi method. We first conducted a scoping review of Medline, Embase, PsycInfo, and CINAHL (2004-2024) to identify candidate QIs related to the structures, clinical processes, and interpersonal processes of pregnancy care for people with disabilities. Draft QIs were then validated in a 3-round Delphi study from June 2023 to October 2024, with an expert panel of 17 pregnancy care providers and 10 birthing people with disabilities. In round 1, panellists rated draft QIs on importance and feasibility in a survey. New QIs and QIs requiring rephrasing were identified. In round 2, QIs were discussed and refined in focus groups. In round 3, panellists rated new and revised QIs on importance and feasibility. The final list of QIs was created on the basis of panel consensus on importance.</p><p><strong>Results: </strong>The review identified 98 studies, from which 44 candidate QIs were created for structures (n = 12), clinical processes (n = 22), and interpersonal processes of care (n = 10). In round 1 of the Delphi survey, consensus on importance was achieved for all QIs, 5 of which were identified as requiring rephrasing. Panellists suggested 10 new QIs. In round 2, the new and revised QIs were discussed in focus groups. In round 3, the new and revised QIs achieved consensus on importance, resulting in a final list of 54 QIs (n = 43 achieving consensus on feasibility).</p><p><strong>Conclusions: </strong>These QIs can assist health care providers, administrators, and policymakers in optimising the quality of pregnancy care for people with disabilities.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103106"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056595","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":"Melissa Dangerfield, Bronte Johnston, Elizabeth Nethery, Holly Torry, Pamela Sagert, Madeleine Ennis, Mika Ohtsuka, Sarah Munro, Laura Schummers","doi":"10.1016/j.jogc.2025.103033","DOIUrl":"10.1016/j.jogc.2025.103033","url":null,"abstract":"<p><strong>Objectives: </strong>Intrauterine devices (IUDs) are highly effective forms of contraception but may be underutilized by Canadian youth. Youth 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, 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, with this frequency decreasing 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 counselling 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":"2025-09-01","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":"An Extremely Rare Uterine Rhabdomyosarcoma.","authors":"Andrea A Mosher, Peter Yousef, Shangguo Tang, Mathew Leonardi","doi":"10.1016/j.jogc.2025.103048","DOIUrl":"10.1016/j.jogc.2025.103048","url":null,"abstract":"","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103048"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700856","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":"In Frozen Embryo Transfer, Is High-Dose Aspirin Better?","authors":"Hassan Hamze, Wadad Alameh, Robert Hemmings, Karen Kteily, Camille Sylvestre, Jacques Kadoch, Wael Jamal","doi":"10.1016/j.jogc.2025.103040","DOIUrl":"10.1016/j.jogc.2025.103040","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether high-dose aspirin during frozen embryo transfer (FET) improves pregnancy outcomes.</p><p><strong>Methods: </strong>This is a retrospective study of 1207 FET cycles performed in 2022, excluding patients older than 40 years, with recurrent implantation failure, or with recurrent pregnancy loss. Pregnancy outcomes, miscarriage rates, number of clinic visits, and obstetrical outcomes were compared between 2 groups: a group with 81 mg aspirin (January-June 2022) and the other group with 162 mg aspirin (June-December 2022). Aspirin was started on day 1 of the cycle and continued until delivery. Patients were divided into 2 endometrial preparation groups. The modified natural cycle group received ultrasound monitoring, trigger shot at 15 mm follicle size and 7 mm endometrial thickness. The artificial cycle group received estrogen supplementation until endometrial thickness reached ≥7 mm, followed by progesterone.</p><p><strong>Results: </strong>Pregnancy outcomes were similar in both endometrial preparation protocols. The subgroup analysis revealed a trend of lower clinical pregnancy rates and lower live birth rates in the 162 mg aspirin group for both preparation protocols. The only significant complication was hematoma formation, which was higher in the 162 mg group. Multiple regression analysis showed that a higher aspirin dosage and endometrial preparation method significantly increased miscarriage rates.</p><p><strong>Conclusion: </strong>High-dose aspirin during FET cycles may negatively impact pregnancy outcomes, increasing miscarriage risk. Lower-dose aspirin (81 mg) may be more beneficial.</p>","PeriodicalId":520287,"journal":{"name":"Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC","volume":" ","pages":"103040"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661693","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}