Journal of obstetrics and gynaecology Canada最新文献

Objective: To evaluate the experiences of perimenopausal and postmenopausal women in British Columbia, their perceptions of expected reproductive aging, and potential concerns about endometrial cancer (EC).

Methods: We interviewed 31 midlife community women of diverse backgrounds and hosted a workshop for more in-depth discussion. We summarized relayed experiences and beliefs through a thematic and descriptive analysis of participant stories and workshop feedback.

Results: Participants demonstrated a somewhat simplistic understanding of midlife changes, facing this phase of life with a "tough-it-out" attitude rather than seeking medical help for arising symptoms. Awareness of EC and EC-specific risk factors, such as obesity, was low. Confusion between cervical and endometrial cancer was common. Although abnormal bleeding was seen as potentially of concern, many opted to wait before seeking medical help. Workshop participants stressed the need to include awareness about EC in a broader conversation about perimenopause and menopause and suggested strategies for disseminating EC awareness.

Conclusion: Community women in British Columbia demonstrated low awareness about EC-associated symptoms and risk factors. There is little information to help distinguish when perimenopausal abnormal uterine bleeding is of concern and when to seek help. This highlights the need to enhance knowledge of EC and its risk factors in perimenopause among the public and among health care providers.

Myomectomy is a common procedure to remove uterine fibroids. Smoking impacts outcomes across various surgeries; however, may limit fibroid growth. We sought to determine if smoking impacts myomectomy for uterine fibroid removal outcomes. Patients with and without a history of tobacco smoking receiving a myomectomy for uterine fibroid removal were compared. Compared to patients with no history of tobacco smoking, tobacco smokers had a significantly increased risk of wound complications. No other variables analyzed demonstrated a clinically significant difference. Future research is needed to examine how different frequency of tobacco smoking impacts outcomes.

Objective: Childbirth evacuation, the transfer of patients from rural and remote communities to urban centers for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Quebec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, northern Quebec transferred to a southern tertiary care center.

Methods: A five-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care center between 2015 and 2019.

Results: The most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of 534 (78.9%) Inuit who gave birth at the tertiary center, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to neonatal intensive care unit. Some 3.4% (18/534) had complications within the postpartum period, the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%).

Conclusion: A relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.

Objective: To review the available prenatal aneuploidy screening options and to provide updated clinical guidelines for reproductive care providers.

Target population: All pregnant persons receiving counselling and providing informed consent for prenatal screening.

Benefits, harms, and costs: Implementation of the recommendations in this guideline should increase clinician competency to offer counselling for prenatal screening options and provide appropriate interventions. Given the variety of available options for prenatal screening with different performance, cost, and availability across Canada, appropriate counselling is of paramount importance to offer the best individual choice to Canadian pregnant persons. Prenatal screening may cause anxiety, and the decisions about prenatal diagnostic procedures are complex given the potential risk of fetal loss.

Evidence: Published literature was retrieved through searches of Medline, PubMed, and the Cochrane Library in and prior to July 2023, using an appropriate controlled vocabulary (prenatal diagnosis, amniocentesis, chorionic villi sampling, non-invasive prenatal screening) and key words (prenatal screening, prenatal genetic counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1995 to July 2023.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations).

Intended audience: Health care providers involved in prenatal screening, including general practitioners, obstetricians, midwives, maternal-fetal medicine specialists, geneticists, and radiologists.

Social media abstract: Non-invasive prenatal screening is the most accurate method for detecting major aneuploidies. It is not universally available in the public health system and has some limitations.

Summary statements: RECOMMENDATIONS.

Objectif: Examiner les possibilités de dépistage prénatal des aneuploïdies et fournir des lignes directrices cliniques actualisées aux prestataires de soins de la reproduction.

Population cible: Personnes enceintes qui reçoivent des conseils sur le dépistage prénatal et qui donnent leur consentement éclairé. BéNéFICES, RISQUES ET COûTS: La mise en application des recommandations de la présente directive devrait améliorer la compétence des cliniciens pour conseiller les patientes sur les options de dépistage prénatal et leur donner accès aux interventions indiquées. Compte tenu de la diversité des options disponibles pour le dépistage prénatal, dont la fiabilité, le coût et la disponibilité varient d'un bout à l'autre du Canada, il est primordial d'offrir des conseils appropriés pour permettre aux personnes enceintes canadiennes de faire un choix éclairé. Le dépistage prénatal peut être source d'anxiété, et les décisions relatives aux examens de diagnostic prénatal sont complexes compte tenu du risque de perte fœtale. DONNéES PROBANTES: La littérature publiée avant la fin de juillet 2023 a été colligée par des recherches dans les bases de données Medline, PubMed et Cochrane Library au moyen de termes (prenatal diagnosis, amniocentesis, chorionic villi sampling, non-invasive prenatal screening) et mots clés (prenatal screening, prenatal genetic counselling) pertinents et validés. Les seuls résultats retenus proviennent de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles publiés en anglais entre janvier 1995 et juillet 2023. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Professionnels de la santé impliqués dans le dépistage prénatal, y compris les omnipraticiens, les obstétriciens, les sages-femmes, les spécialistes en médecine fœto-maternelle, les généticiens et les radiologues. RéSUMé DES MéDIAS SOCIAUX: Le test génomique prénatal non invasif est la méthode la plus fiable pour détecter les aneuploïdies majeures. Il n'est pas universellement disponible dans le système de santé publique et comporte certaines limites.

Early pregnancy is a critical period often accompanied by complications like early pregnancy loss. Early Pregnancy Assessment Clinics (EPACs) provide specialized and compassionate care to those experiencing these complications. First introduced in the United Kingdom, EPACs have been found to improve quality of care, reduce wait times, and cut costs. In Canada, EPACs are primarily limited to large urban centres at hospital sites. Access in other parts of the country, especially in rural areas, remains limited. Low-volume units managed by specialist nurses and family doctors, with support from specialists, are the best way to bring EPACs to more Canadians in need.