Journal of obstetrics and gynaecology Canada最新文献_第10页

Transvaginal Mesh Versus Native Tissue Repair for Anterior and Apical Pelvic Organ Prolapse 经阴道网片与原生组织修复术治疗前部和顶部盆腔器官脱垂。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-12 DOI: 10.1016/j.jogc.2024.102658

Eric R. Sokol MD, PhD , Le Mai Tu MD, PhD , Sherry L. Thomas MD , Ty B. Erickson MD , Jan-Paul W.R. Roovers

Objectives

This prospective comparative cohort study aims to evaluate the safety and efficacy of transvaginal mesh compared to native tissue repair (NTR) in the surgical correction of anterior and apical compartment pelvic organ prolapse (POP) over a 36-month follow-up period.

Methods

Prospective comparative cohort study to prove superiority for efficacy and non-inferiority for serious adverse events (SAEs). The setting was 49 sites across the United States, Canada, Europe, and Australia. Women with bothersome POP symptoms indicated for vaginal surgery with pelvic organ prolapse quantification (POP-Q) scores of Ba ≥0 and C ≥ -1/2 total vaginal length were included. Interventions included vaginal NTR or single-incision transvaginal mesh based on shared decision-making. POP recurrence, the primary efficacy endpoint, was defined as anatomical prolapse beyond the hymenal ring, subjective perception of protrusion or bulge, or retreatment in the target compartment. The primary safety endpoint consisted of the proportion of device and/or procedure-related SAEs in the target compartment. Secondary endpoints included surgical parameters, quality of life, postoperative pain, and sexual function.

Results

POP recurrence rate at 12 months was 13.1% in the Mesh-arm and 11.5% in the NTR-arm (P = 0.44). The primary safety endpoint was met, with the Mesh-arm demonstrating statistically non-inferior outcomes compared to the NTR-arm in the incidence of device and/or procedure-related SAEs in the target compartment through 12 months (P < 0.01). At 36 months, the surgical POP recurrence rate was 26.7% in the Mesh-arm and 27.0% in the NTR-arm.

Conclusions

At 12- and 36-month follow-up, transvaginal mesh was not superior, but non-inferior in terms of efficacy and safety when compared to NTR for patients with combined anterior and apical compartment prolapse.

研究目的这项前瞻性队列比较研究旨在评估经阴道网片与原生组织修复术（NTR）相比，在为期 36 个月的随访期内，在手术矫正前壁和顶壁盆腔器官脱垂（POP）方面的安全性和有效性：方法：前瞻性队列比较研究，以证明疗效的优越性和严重不良事件（SAE）的非劣性。研究地点位于美国、加拿大、欧洲和澳大利亚的 49 个地点。研究对象包括有POP症状且POP-Q评分Ba≥0、C≥-1/2 TVL、有阴道手术指征的妇女。根据共同决策，干预措施包括阴道NTR或单切口经阴道网片。POP复发是主要的疗效终点，定义为超过处女膜环的解剖学脱垂、主观感觉的突出或隆起，或目标区的再治疗。主要安全性终点包括目标腔室中发生器械和/或手术相关 SAE 的比例。次要终点包括手术参数、生活质量、术后疼痛和性功能：12个月时，Mesh-arm和NTR-arm的POP复发率分别为13.1%和11.5%（P = 0.44）。Mesh治疗组达到了主要安全性终点，与NTR治疗组相比，Mesh治疗组在12个月内靶区的器械和/或手术相关SAE发生率在统计学上不劣于NTR治疗组（P < 0.01）。36个月时，Mesh臂的手术POP复发率为26.7%，NTR臂为27.0%：结论：在12个月和36个月的随访中，经阴道网片在治疗合并前壁和顶端脱垂患者的疗效和安全性方面与原生组织修复术相比没有优势，但没有劣势。

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引用次数: 0

Deferred Cord Clamping in Twin Pregnancies Across Canada: A National Survey of Practices 加拿大双胎妊娠中的延迟脐带钳夹：全国做法调查。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-12 DOI: 10.1016/j.jogc.2024.102659

Naila Bouadi , Marc Beltempo MD, MSc , Guillaume Éthier MSc(A), NNP , Isabelle Boucoiran MD, MSc , Sarah D. McDonald BA, MD, FRCSC, MSc , Andréanne Villeneuve MD, MSc

Objective

Guidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada.

Methods

A web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units.

Results

The site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother’s thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother’s abdomen, 32% on the mother’s thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion.

Conclusions

DCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.

背景：指南建议延迟脐带夹闭（DCC），即在分娩后至少延迟 30 秒钟夹闭脐带，这对单胎早产有显著益处。目的：本研究旨在评估加拿大三级医院目前报告的双胎妊娠 DCC 实践。方法：向与加拿大新生儿和早产儿网络（CNN/CPTBN）相关的新生儿科医生和产科医生调查人员发放了一份网络调查问卷，这些调查人员负责管理产科和新生儿科。结果：调查地点的回复率为 93%（28/30 个地点），其中新生儿科医生的回复率为 83%（25/30），产科医生的回复率为 56%（17/30）。大多数医疗中心都制定了针对双胎妊娠的本地方案（产科医生 13/17，新生儿科医生 21/25）。虽然所有中心都对二绒毛膜双胎进行了顺产，但对单绒毛膜双胎则有所不同，56%的新生儿科医生和 65% 的产科医生进行了顺产。在剖宫产过程中，大多数产科医生（76.5%）将头胎婴儿放在母亲的大腿上。新生儿科医生的做法各不相同，32%的医生将婴儿放在母亲的腹部，32%的医生将婴儿放在母亲的大腿上，28%的医生将婴儿抱在会阴部的高度。在禁忌症方面，包括产后出血风险和绒毛插入脐带的风险，观察到了不同的意见。结论：据报道，在 CNN/CPTBN 中心，大多数双胎分娩都采用了脐带绕颈术，但在实践中存在很大差异，尤其是在采用脐带绕颈术的双胎的特征方面。背景：指南建议延迟脐带钳夹（DCC），即在分娩后至少延迟 30 秒钳夹脐带，这对早产的单胎妊娠有显著的益处。目的：本研究旨在评估加拿大三级医院目前针对双胎妊娠的 CRC 实践。方法：向与加拿大新生儿和早产儿网络（CNN/CPTBN）有联系的新生儿科医生和产科研究人员发放了一份在线调查问卷，这些网络管理着新生儿和产科单位。结果：各中心的回复率为 93%（28/30 个中心）：新生儿科医师的回复率为 83%（25/30 个中心），产科医师的回复率为 56%（17/30 个中心）。大多数中心都有针对双胎妊娠的本地方案（产科医生 13/17，新生儿科医生 21/25）。虽然所有中心都对双胎妊娠实施了 CRC，但对单胎妊娠实施 CRC 的情况有所不同，56% 的新生儿科医生和 65% 的产科医生实施了 CRC。在剖腹产过程中，大多数产科医生（76.5%）会将头胎婴儿放在母亲的大腿上。新生儿科医生的做法各不相同：32%的医生将婴儿放在母亲的腹部，32%的医生将婴儿放在母亲的大腿上，28%的医生将婴儿抱在会阴部。对于禁忌症，尤其是产后出血的风险和脐带绒毛插入的禁忌症，医生们的意见不一。结论：在 CNN/CPTBN 中心，大多数双胎分娩都要进行 CRC。然而，在实践中存在很大差异，特别是与进行 CRC 的双胎的特征有关。未来的研究应重点关注双胞胎脐带钳夹的最佳管理，以规范操作并最大限度地提高效益。

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引用次数: 0

Diagnostic Laparoscopy: Unveiling Primary Fallopian Tube Carcinoma 诊断性腹腔镜手术：揭开原发性输卵管癌的神秘面纱

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-10 DOI: 10.1016/j.jogc.2024.102660

Satish Choudhury, Ayushi Sethi, Avantika Gupta

引用次数: 0

Enhanced Recovery After Surgery (ERAS) Practices in Minimally Invasive Gynaecologic Surgery: A National Survey 微创妇科手术中的术后强化恢复 (ERAS) 实践：全国调查。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-10 DOI: 10.1016/j.jogc.2024.102657

Azra Shivji MD, MSc , Elizabeth Miazga MD, LLM , Carmen McCaffrey MD, MSc , Sari Kives MD, MSc , Alysha Nensi MD, MSc

Objectives

Enhanced recovery after surgery (ERAS) pathways are evidence-based practices that minimize perioperative physiologic stress, reducing postoperative complications and recovery time. This study assessed the Canadian application of, and adherence to, ERAS recommendations during minimally invasive gynaecologic surgery, and identified barriers to ERAS uptake.

Methods

A self-administered cross-sectional survey was distributed to obstetrics and gynaecology residents, fellows, and attendings through 3 national listservs from February 2021 to January 2022. The survey assessed 14 perioperative components per the American Association of Gynecologic Laparoscopists ERAS consensus guidelines. Two study groups were defined—participants with versus without an established ERAS program—and comparison analyses as well as inferential statistical tests were performed.

Results

Overall, 158 responses were analyzed. A total of 41.9% of respondents work in a centre with an ERAS program. Adherence to ERAS recommendations was high with engaging patients in the operative processes, changing equipment after a contaminated procedure, discontinuing urinary catheters, and initiating early postoperative mobilization. ERAS programming enhanced adherence to preoperative carbohydrate loading, intraoperative fluid management, normothermia, and bowel-regimen adjuncts (P < 0.05). Despite ERAS programming, adherence to some recommendations—preoperative fasting, and comorbidity optimization—remained low. Most respondents felt that ERAS is safe (98%) and improves outcomes (82%).

Conclusions

While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners across Canada engage in various ERAS components. ERAS program sites had higher adherence to some perioperative recommendations; however, some high-level evidence recommendations still have national adherence gaps. Targeted research around low-adherence components would help identify and address barriers to optimizing surgical care.

目的：加强术后恢复（ERAS）途径是基于证据的实践，可最大限度地减少围手术期的生理压力，减少术后并发症和恢复时间。本研究评估了加拿大在妇科微创手术中应用和遵守ERAS建议的情况，并确定了采用ERAS的障碍：方法：2021 年 2 月至 2022 年 1 月期间，通过三个全国性列表服务器向妇产科住院医师、研究员和主治医师发放了一份自填式横断面调查表。调查根据 AAGL（美国妇科腹腔镜医师协会）ERAS 共识指南评估了 14 项围手术期内容。定义了两个研究组--有ERAS计划的参与者和没有ERAS计划的参与者，并进行了比较分析和推理统计检验：分析了 158 份回复。41.9%的受访者在有ERAS计划的中心工作。在让患者参与手术过程、污染手术后更换设备、停用导尿管和术后早期活动方面，对ERAS建议的依从性很高。ERAS 计划提高了术前碳水化合物负荷、术中液体管理、正常体温和肠道辅助治疗的依从性（P < 0.05）。尽管对ERAS进行了编程，但一些建议（术前禁食、合并症优化）的依从性仍然很低。大多数受访者认为ERAS是安全的（98%），并能改善预后（82%）：虽然各省和各医院实施ERAS的正式途径不同，但加拿大各地的从业人员都参与了ERAS的各种内容。ERAS计划的实施地点对一些围手术期建议的依从性较高；但是，一些高水平的证据建议在全国范围内的依从性仍有差距。围绕依从性低的部分开展有针对性的研究将有助于识别和解决优化外科护理的障碍。

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引用次数: 0

Improving Influenza Vaccine Uptake During Pregnancy Through Vaccination at Point of Care: A Before-and-After Study 通过在医疗点接种疫苗提高孕期流感疫苗接种率：前后对比研究

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-10 DOI: 10.1016/j.jogc.2024.102656

Sofiya Manji MPH , Laura Idarraga Reyes MD , Sheila McDonald PhD , Megan Mungunzul Amarbayan MPP , Deshayne B. Fell PhD , Amy Metcalfe PhD , Eliana Castillo MD

Objectives

Vaccine administration where pregnant individuals receive prenatal care may increase vaccine coverage. Availability of influenza vaccine at prenatal care visits is not standard in Canada. Since the 2016–2017 influenza season, pregnant individuals can receive the influenza vaccine at the point of care (POC) in an urban clinic in Calgary, Alberta. The objective of this study was to descriptively examine vaccination rates across multiple influenza seasons for a POC vaccination in pregnancy (VIP) intervention and describe associations between influenza vaccine coverage and comorbidities and area-level socioeconomic status.

Methods

A before-and-after study design was used to examine vaccine coverage across 6 consecutive influenza seasons: 2 before (2014–2015 and 2015–2016) and 4 after POC-VIP implementation (2016–2017 to 2019–2020). We identified the birth cohort and measured influenza vaccine uptake using clinical and administrative databases. Influenza vaccination rates were computed and compared using the Fisher exact test with statistical significance at a P value of 0.05.

Results

A total of 4443 pregnancies were identified during the study period. The influenza vaccination rate increased in the intervention years at 40.1 per 1000 patient-weeks (P < 0.001), compared to the pre-intervention influenza seasons at 11.7 per 1000 patient-weeks. Vaccine coverage did not statistically differ between pregnancies with or without comorbidities across most seasons. Vaccine coverage decreased as material deprivation increased in pre-intervention years.

Conclusions

The vaccination rate was higher in the intervention years compared to the pre-intervention period. In this study, we applied a systematic methodology to examine vaccine coverage in pregnancy and presented a descriptive examination of a POC-VIP intervention.

目的：在孕妇接受产前检查时接种疫苗可提高疫苗接种率。在加拿大，产前检查时接种流感疫苗并非标准做法。自 2016-2017 年流感季节起，孕妇可在阿尔伯塔省卡尔加里市一家城市诊所的护理点 (POC) 接种流感疫苗。本研究的目的是描述性地检查多个流感季节中POC-孕期疫苗接种（VIP）干预措施的疫苗接种率，并描述流感疫苗覆盖率与合并症和地区社会经济状况之间的关联：我们采用前后对比的研究设计，对连续六个流感季节的疫苗接种率进行了调查：其中两个季节是在实施 POC-VIP 之前（2014-2015 年和 2015-2016 年），四个季节是在实施 POC-VIP 之后（2016-2017 年至 2019-2020 年）。我们利用临床和行政数据库确定了出生队列并测量了流感疫苗的接种率。计算流感疫苗接种率，并使用费雪精确检验进行比较，统计学意义为 P 值 0.05 结果：研究期间共确定了 4443 例妊娠。与干预前流感季节每 1000 患者周 11.7 的接种率相比，干预年的流感疫苗接种率有所上升，达到每 1000 患者周 40.1（P < 0.001）。在大多数季节，有或没有合并症的孕妇之间的疫苗接种率没有统计学差异。疫苗接种率随着干预前几年物质匮乏程度的增加而下降：结论：与干预前相比，干预年的疫苗接种率更高。在这项研究中，我们采用了系统的方法来检查孕期疫苗接种率，并对 POC-VIP 干预措施进行了描述性检查。

{"title":"Improving Influenza Vaccine Uptake During Pregnancy Through Vaccination at Point of Care: A Before-and-After Study","authors":"Sofiya Manji MPH , Laura Idarraga Reyes MD , Sheila McDonald PhD , Megan Mungunzul Amarbayan MPP , Deshayne B. Fell PhD , Amy Metcalfe PhD , Eliana Castillo MD","doi":"10.1016/j.jogc.2024.102656","DOIUrl":"10.1016/j.jogc.2024.102656","url":null,"abstract":"<div><h3>Objectives</h3><div>Vaccine administration where pregnant individuals receive prenatal care may increase vaccine coverage. Availability of influenza vaccine at prenatal care visits is not standard in Canada. Since the 2016–2017 influenza season, pregnant individuals can receive the influenza vaccine at the point of care (POC) in an urban clinic in Calgary, Alberta. The objective of this study was to descriptively examine vaccination rates across multiple influenza seasons for a POC vaccination in pregnancy (VIP) intervention and describe associations between influenza vaccine coverage and comorbidities and area-level socioeconomic status.</div></div><div><h3>Methods</h3><div>A before-and-after study design was used to examine vaccine coverage across 6 consecutive influenza seasons: 2 before (2014–2015 and 2015–2016) and 4 after POC-VIP implementation (2016–2017 to 2019–2020). We identified the birth cohort and measured influenza vaccine uptake using clinical and administrative databases. Influenza vaccination rates were computed and compared using the Fisher exact test with statistical significance at a <em>P</em> value of 0.05.</div></div><div><h3>Results</h3><div>A total of 4443 pregnancies were identified during the study period. The influenza vaccination rate increased in the intervention years at 40.1 per 1000 patient-weeks (<em>P</em> < 0.001), compared to the pre-intervention influenza seasons at 11.7 per 1000 patient-weeks. Vaccine coverage did not statistically differ between pregnancies with or without comorbidities across most seasons. Vaccine coverage decreased as material deprivation increased in pre-intervention years.</div></div><div><h3>Conclusions</h3><div>The vaccination rate was higher in the intervention years compared to the pre-intervention period. In this study, we applied a systematic methodology to examine vaccine coverage in pregnancy and presented a descriptive examination of a POC-VIP intervention.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"46 11","pages":"Article 102656"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Directive clinique no 453 : Ablation de l’endomètre dans la prise en charge des saignements utérins anormaux 临床指南第 453 号：异常子宫出血治疗中的子宫内膜消融术。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-01 DOI: 10.1016/j.jogc.2024.102642

Nicholas Leyland M.D., MHCM, Philippe Laberge M.D., Devon Evans M.D., M. Sc. (santé publique), Émilie Gorak-Savard M.D., David Rittenberg M.D.

<div><h3>Objectif</h3><p>Fournir une mise à jour de la directive actuelle fondée sur des données probantes relativement aux techniques et technologies utilisées pour l’ablation de l’endomètre, une technique minimalement invasive pour la prise en charge des saignements utérins anormaux d’origine bénigne.</p></div><div><h3>Population cible</h3><p>Femmes en âge de procréer présentant des saignements utérins anormaux et une pathologie bénigne avec ou sans anomalies structurelles.</p></div><div><h3>Bénéfices, risques et coûts</h3><p>La mise en œuvre des recommandations de la directive améliorera la prestation de l’ablation de l’endomètre en tant que traitement efficace des saignements utérins anormaux. Le respect de ces recommandations permet de réaliser l’intervention chirurgicale de façon sécuritaire et de maximiser le succès du traitement pour les patientes.</p></div><div><h3>Données probantes</h3><p>La directive a été mise à jour à partir de la littérature publiée, telle que relevée par des recherches dans les bases de données Medline et Cochrane Library pour la période de janvier 2014 à avril 2023 en utilisant des termes et mots clés pertinents prédéterminés (<em>endometrial ablation, hysteroscopy, menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding, hysterectomy</em>). Seuls les résultats de revues systématiques, d’essais cliniques randomisés ou comparatifs et d’études observationnelles en anglais ont été retenus.</p><p>La littérature grise (non publiée) a été récupérée auprès de l’Association des obstétriciens et gynécologues du Québec (AOGQ) en 2023.</p></div><div><h3>Méthodes de validation</h3><p>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’<span><span>annexe A</span></span> (<span><span>tableau A1</span></span> pour les définitions et tableau <span><span>A2</span></span> pour l’interprétation des recommandations fortes et faibles).</p></div><div><h3>Professionnels concernés</h3><p>Obstétriciens, gynécologues et prestataires de soins primaires.</p></div><div><h3>Résumé des médias sociaux</h3><p>Cette directive est une version mise à jour de la directive de 2015 de la SOGC sur l’ablation de l’endomètre. Les auteurs abordent les considérations particulières, fournissent une mise à jour des données probantes et formulent de nouvelles recommandations concernant le déficit liquidien.</p></div><div><h3>DÉCLARATIONS SOMMAIRES</h3><p></p><ul><li><span>1.</span><span><p>L’ablation de l’endomètre est une intervention chirurgicale minimalement invasive sécuritaire et efficace qui est devenue une solution de rechange bien établie au traitement médical et à l’hystérectomie pour les saignements utérins anormaux dans certains cas (<em>élevée</em>).</p></span></li><li><span>2.</span><span><p>Il est possible de préparer médicalement l’endomètre pour l’amincir afin d’en faciliter l’abla

目标：对子宫内膜消融术（一种用于治疗良性异常子宫出血的微创技术）的现行指南进行循证更新。收益、风险和成本：实施指南建议将改善子宫内膜消融术作为异常子宫出血有效治疗方法的提供情况。遵守这些建议将使手术过程安全进行，并最大限度地提高患者的治疗成功率。资料来源：本指南是根据 2014 年 1 月至 2023 年 4 月期间在 Medline 和 Cochrane 图书馆数据库中使用预先确定的相关术语和关键词（子宫内膜消融术、宫腔镜检查、月经过多、月经过多出血、异常子宫出血、子宫切除术）搜索到的已发表文献更新而成。只有英文的系统综述、随机或对照临床试验以及观察性研究的结果才被纳入。2023 年从魁北克妇产科协会（AOGQ）检索了灰色（未发表）文献。验证方法：作者采用 GRADE（建议、评估、发展和评价分级）方法框架评估了证据的质量和建议的力度。参见附录 A（表 A1 为定义，表 A2 为强建议和弱建议的解释）。相关专业人员：产科医生、妇科医生和初级保健提供者。社会媒体摘要：本指南是 2015 年 SOGC 子宫内膜消融指南的更新版。作者阐述了特殊注意事项，提供了最新证据，并就液体不足提出了新建议。

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引用次数: 0

Guideline No. 453: Endometrial Ablation in the Management of Abnormal Uterine Bleeding 第 453 号指南：子宫内膜消融术治疗异常子宫出血。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-01 DOI: 10.1016/j.jogc.2024.102641

Nicholas Leyland MD, MHCM, Philippe Laberge MD, Devon Evans MD, MPH, Emilie Gorak Savard MD, David Rittenberg MD

<div><h3>Objective</h3><p>To provide an update of the current evidence-based guideline on the techniques and technologies used in endometrial ablation, a minimally invasive technique for the management of abnormal uterine bleeding of benign origin.</p></div><div><h3>Target Population</h3><p>Women of reproductive age with abnormal uterine bleeding and benign pathology with or without structural abnormalities.</p></div><div><h3>Benefits, Harms, and Costs</h3><p>Implementation of the guideline recommendations will improve the provision of endometrial ablation as an effective treatment for abnormal uterine bleeding. Following these recommendations would allow the surgical procedure to be performed safely and maximize success for patients.</p></div><div><h3>Evidence</h3><p>The guideline was updated with published literature retrieved through searches of Medline and the Cochrane Library from January 2014 to April 2023, using appropriate controlled vocabulary and keywords (endometrial ablation, hysteroscopy, menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding, hysterectomy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English.</p><p>Grey (unpublished) literature was retrieved from the Association of Obstetricians and Gynecologists of Quebec (AOGQ) in 2023.</p></div><div><h3>Validation Methods</h3><p>The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See <span><span>Appendix A</span></span> (<span><span>Tables A1</span></span> for definitions and <span><span>A2</span></span> for interpretations of strong and conditional [weak] recommendations).</p></div><div><h3>Intended Audience</h3><p>Obstetricians, gynaecologists, and primary care providers.</p></div><div><h3>Social Media Abstract</h3><p>This is an updated version of the 2015 SOGC Endometrial Ablation guideline. The authors discuss special considerations, update evidence, and make new fluid deficit recommendations.</p></div><div><h3>SUMMARY STATEMENTS</h3><p></p><ul><li><span>1.</span><span><p>Endometrial ablation is a safe and effective minimally invasive surgical procedure that has become a well-established alternative to medical treatment or hysterectomy for abnormal uterine bleeding in select cases (<em>high).</em></p></span></li><li><span>2.</span><span><p>Medical preparation to thin the endometrium can be used to facilitate resectoscopic endometrial ablation and can be considered for some non-resectoscopic techniques. For resectoscopic endometrial ablation, preoperative endometrial thinning results in higher short-term rates of amenorrhea, decreased distension media fluid absorption, and shorter operative time when compared with no treatment (<em>high</em>).</p></span></li><li><span>3.</span><span><p>Non-resectoscopic techniques are technically easier to perform than resectos

目的更新子宫内膜消融术（一种用于治疗良性异常子宫出血的微创技术）的现行循证指南：目标人群：异常子宫出血和良性病变（无论有无结构异常）的育龄女性：实施指南建议将改善子宫内膜消融术作为异常子宫出血有效治疗方法的提供情况。遵循这些建议将使手术过程安全进行，并最大限度地提高患者的成功率：通过检索 Medline 和 Cochrane 图书馆，使用适当的对照词汇和关键词（子宫内膜消融术、宫腔镜检查、月经过多、大量月经出血、异常子宫出血、子宫切除术），对 2014 年 1 月至 2023 年 4 月期间发表的文献进行了更新。研究结果仅限于用英语撰写的系统综述、随机对照试验/对照临床试验以及观察性研究。2023年从魁北克妇产科医师协会（AOGQ）检索到灰色（未发表）文献：作者采用建议评估、发展和评价分级法（GRADE）对证据质量和建议力度进行了评级。参见附录 A（表 A1：定义；表 A2：强推荐和有条件[弱]推荐的解释）：社交媒体摘要：这是 2015 年 SOGC 子宫内膜消融术指南的更新版。作者讨论了特别注意事项、更新了证据并提出了新的液体不足建议。

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引用次数: 0

Corrigendum to ‘Amniocentesis and Therapeutic Amnioreduction Prior to “Rescue Cerclage” (AARC Protocol): A Prospective Observational Study’ [Journal of Obstetrics and Gynaecology Canada (JOGC). Volume 46, Issue 5, May 2024, 102484] Rescue Cerclage"（AARC 协议）前的羊膜腔穿刺术和治疗性羊膜减少术》的更正：前瞻性观察研究》[《加拿大妇产科杂志》（JOGC）。第 46 卷，第 5 期，2024 年 5 月，102484] 。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-09-01 DOI: 10.1016/j.jogc.2024.102617

Avina De Simone