Pub Date : 2025-11-29DOI: 10.1016/j.jogc.2025.103190
Camille Leclerc MD, Marianne Boutet MD, M. Sc. FRSCS, Laval University
{"title":"Suburethral Calcification Secondary to Erosion of a Transobturator Tape","authors":"Camille Leclerc MD, Marianne Boutet MD, M. Sc. FRSCS, Laval University","doi":"10.1016/j.jogc.2025.103190","DOIUrl":"10.1016/j.jogc.2025.103190","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103190"},"PeriodicalIF":2.2,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650684","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}
Pub Date : 2025-11-28DOI: 10.1016/j.jogc.2025.103188
Marfy Ezekiel Abousifein BHSc, Nicholas Leyland BASc, MD, MHCM
Endometriosis affects 1 in 10 Canadians; however, its financial toxicity remains poorly understood. While universal health care covers physician and hospital services, patients face substantial out-of-pocket costs for medications, complementary therapies, fertility treatments, travel, and childcare. These burdens delay care, limit treatment, and worsen disparities. International evidence underscores the magnitude of these costs, but Canada lacks patient-level data to guide interventions. This commentary highlights manifestations of financial strain and calls for quantitative assessment and policy reform, including pharmacare, universal fertility coverage, and complementary therapy access, to ensure timely, comprehensive care nationwide
{"title":"The Financial Toxicity of Endometriosis: Unseen Costs and Policy Gaps","authors":"Marfy Ezekiel Abousifein BHSc, Nicholas Leyland BASc, MD, MHCM","doi":"10.1016/j.jogc.2025.103188","DOIUrl":"10.1016/j.jogc.2025.103188","url":null,"abstract":"<div><div>Endometriosis affects 1 in 10 Canadians; however, its financial toxicity remains poorly understood. While universal health care covers physician and hospital services, patients face substantial out-of-pocket costs for medications, complementary therapies, fertility treatments, travel, and childcare. These burdens delay care, limit treatment, and worsen disparities. International evidence underscores the magnitude of these costs, but Canada lacks patient-level data to guide interventions. This commentary highlights manifestations of financial strain and calls for quantitative assessment and policy reform, including pharmacare, universal fertility coverage, and complementary therapy access, to ensure timely, comprehensive care nationwide</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103188"},"PeriodicalIF":2.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650724","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}
Pub Date : 2025-11-26DOI: 10.1016/j.jogc.2025.103186
Maria Giroux MD, Alison Carter Ramirez MD, Sinead Dufour PT, PhD, Dobrochna Globerman MD, Maryse Larouche MD, MPH, Dante Pascali MD, Abdul Sultan MD
<div><h3>Objective</h3><div>The purpose of this guideline is to provide recommendations regarding long-term management for women with obstetric anal sphincter injuries (OASIs) and to describe the role of dedicated clinics. This guideline also presents key components and new algorithms for counselling and shared decision-making regarding subsequent mode of delivery post-OASIs.</div></div><div><h3>Target Population</h3><div>Women who have had prior obstetric anal sphincter injuries (OASIs).</div></div><div><h3>Benefits, Harms, and Costs</h3><div>Timely access to appropriate care is essential to reducing the significant burden of stigma, emotional distress, and financial hardship associated with complications from obstetric anal sphincter injuries (OASIs). Dedicated follow-up clinics and access to pelvic health physiotherapy play a critical role in recovery and long-term outcomes. These services must be accessible to all women, regardless of geographic location.</div><div>Women should receive clear and comprehensive information about the potential benefits of referral to specialized centers, including the possibility of better long-term prognosis when managed in these settings. Such knowledge is vital for informed decision-making around future care, including mode of delivery after an OASI.</div><div>Given the current scarcity of specialized services in regional and remote areas, there is a pressing need to improve equitable access across all geographic settings. Innovative models of care, such as telehealth and local provider training, should be expanded to reduce disparities in outcomes; access to these essential referrals and services should not limited by economic barriers. As with any other medically indicated referral, the costs associated with travel, treatment, and follow-up should be covered to guarantee that all women, regardless of circumstance, can access the care they need.</div></div><div><h3>Evidence</h3><div>Published studies were retrieved by searching PubMed, Ovid, MEDLINE, Embase, SCOPUS, and Cochrane Library databases from September 1, 2014 to July 1, 2025 using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIs, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to adult females and English- or French-language materials.</div></div><div><h3>Validation Methods</h3><div>The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online <span><span>Appendix A</span></span> (<span><span>Tab
{"title":"Guideline No. 465: Obstetrical Anal Sphincter Injuries (OASIs) Part II: Long-Term Management and Counselling Regarding Subsequent Mode of Delivery","authors":"Maria Giroux MD, Alison Carter Ramirez MD, Sinead Dufour PT, PhD, Dobrochna Globerman MD, Maryse Larouche MD, MPH, Dante Pascali MD, Abdul Sultan MD","doi":"10.1016/j.jogc.2025.103186","DOIUrl":"10.1016/j.jogc.2025.103186","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this guideline is to provide recommendations regarding long-term management for women with obstetric anal sphincter injuries (OASIs) and to describe the role of dedicated clinics. This guideline also presents key components and new algorithms for counselling and shared decision-making regarding subsequent mode of delivery post-OASIs.</div></div><div><h3>Target Population</h3><div>Women who have had prior obstetric anal sphincter injuries (OASIs).</div></div><div><h3>Benefits, Harms, and Costs</h3><div>Timely access to appropriate care is essential to reducing the significant burden of stigma, emotional distress, and financial hardship associated with complications from obstetric anal sphincter injuries (OASIs). Dedicated follow-up clinics and access to pelvic health physiotherapy play a critical role in recovery and long-term outcomes. These services must be accessible to all women, regardless of geographic location.</div><div>Women should receive clear and comprehensive information about the potential benefits of referral to specialized centers, including the possibility of better long-term prognosis when managed in these settings. Such knowledge is vital for informed decision-making around future care, including mode of delivery after an OASI.</div><div>Given the current scarcity of specialized services in regional and remote areas, there is a pressing need to improve equitable access across all geographic settings. Innovative models of care, such as telehealth and local provider training, should be expanded to reduce disparities in outcomes; access to these essential referrals and services should not limited by economic barriers. As with any other medically indicated referral, the costs associated with travel, treatment, and follow-up should be covered to guarantee that all women, regardless of circumstance, can access the care they need.</div></div><div><h3>Evidence</h3><div>Published studies were retrieved by searching PubMed, Ovid, MEDLINE, Embase, SCOPUS, and Cochrane Library databases from September 1, 2014 to July 1, 2025 using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIs, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to adult females and English- or French-language materials.</div></div><div><h3>Validation Methods</h3><div>The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online <span><span>Appendix A</span></span> (<span><span>Tab","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103186"},"PeriodicalIF":2.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644262","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}
Pub Date : 2025-11-26DOI: 10.1016/j.jogc.2025.103187
Maria Giroux MD, Sinead Dufour PT, PhD, Alison Carter Ramirez MD, Dobrochna Globerman MD, Maryse Larouche MD, MPH, Dante Pascali MD, Abdul Sultan MD
<div><h3>Objectif</h3><div>L'objectif de cette ligne directrice est de fournir des recommandations concernant la prise en charge à long terme des femmes présentant des lésions obstétricales du sphincter anal (LOSA) et de décrire le rôle des cliniques spécialisées. Cette ligne directrice présente également les éléments clés et les nouveaux algorithmes pour le conseil et la prise de décision partagée concernant le mode d'accouchement ultérieur après une LOSA.</div></div><div><h3>Population cible</h3><div>Femmes ayant déjà subi des LOSA.</div></div><div><h3>Avantages, inconvénients et coûts</h3><div>Un accès rapide à des soins appropriés est essentiel pour réduire le fardeau considérable que représentent la stigmatisation, la détresse émotionnelle et les difficultés financières associées aux complications liées aux lésions obstétricales du sphincter anal (LOSA). Les cliniques de suivi spécialisées et l'accès à la physiothérapie pelvienne jouent un rôle essentiel dans le rétablissement et les résultats à long terme. Ces services doivent être accessibles à toutes les femmes, quelle que soit leur situation géographique.</div><div>Les femmes doivent recevoir des informations claires et complètes sur les avantages potentiels d'une orientation vers des centres spécialisés, notamment la possibilité d'un meilleur pronostic à long terme lorsqu'elles sont prises en charge dans ces établissements. Ces informations sont essentielles pour prendre des décisions éclairées concernant les soins futurs, y compris le mode d'accouchement après une LOSA.</div><div>Compte tenu de la rareté actuelle des services spécialisés dans les zones régionales et éloignées, il est urgent d'améliorer l'accès équitable dans toutes les zones géographiques. Des modèles de soins innovants, tels que la télésanté et la formation des prestataires locaux, devraient être développés afin de réduire les disparités en matière de résultats ; l'accès à ces orientations et services essentiels ne devrait pas être limité par des obstacles économiques. Comme pour toute autre orientation médicalement indiquée, les frais liés au déplacement, au traitement et au suivi devraient être pris en charge afin de garantir que toutes les femmes, quelle que soit leur situation, puissent accéder aux soins dont elles ont besoin.</div></div><div><h3>Preuves</h3><div>Les études publiées ont été récupérées en effectuant des recherches dans les bases de données PubMed, Ovid, MEDLINE, Embase, SCOPUS et Cochrane Library entre le 1er septembre 2014 et le 1er juillet 2025 à l'aide des termes MeSH appropriés (accouchement, obstétrique, procédures chirurgicales obstétricales, complications obstétricales, canal anal, épisiotomie) et des mots clés (LOSA, lésion obstétricale du sphincter anal, lésion anale, sphincter anal, accouchement vaginal, suture, incontinence fécale, incontinence anale, réparation par chevauchement, réparation bout à bout, protocole vésical, analgésie). Les résultats ont été limités aux revues systématique
{"title":"Directive n° 465: Lésions obstétricales du sphincter anal (LOSA) Partie II : Prise en charge à long terme et conseils concernant le mode d'accouchement ultérieur","authors":"Maria Giroux MD, Sinead Dufour PT, PhD, Alison Carter Ramirez MD, Dobrochna Globerman MD, Maryse Larouche MD, MPH, Dante Pascali MD, Abdul Sultan MD","doi":"10.1016/j.jogc.2025.103187","DOIUrl":"10.1016/j.jogc.2025.103187","url":null,"abstract":"<div><h3>Objectif</h3><div>L'objectif de cette ligne directrice est de fournir des recommandations concernant la prise en charge à long terme des femmes présentant des lésions obstétricales du sphincter anal (LOSA) et de décrire le rôle des cliniques spécialisées. Cette ligne directrice présente également les éléments clés et les nouveaux algorithmes pour le conseil et la prise de décision partagée concernant le mode d'accouchement ultérieur après une LOSA.</div></div><div><h3>Population cible</h3><div>Femmes ayant déjà subi des LOSA.</div></div><div><h3>Avantages, inconvénients et coûts</h3><div>Un accès rapide à des soins appropriés est essentiel pour réduire le fardeau considérable que représentent la stigmatisation, la détresse émotionnelle et les difficultés financières associées aux complications liées aux lésions obstétricales du sphincter anal (LOSA). Les cliniques de suivi spécialisées et l'accès à la physiothérapie pelvienne jouent un rôle essentiel dans le rétablissement et les résultats à long terme. Ces services doivent être accessibles à toutes les femmes, quelle que soit leur situation géographique.</div><div>Les femmes doivent recevoir des informations claires et complètes sur les avantages potentiels d'une orientation vers des centres spécialisés, notamment la possibilité d'un meilleur pronostic à long terme lorsqu'elles sont prises en charge dans ces établissements. Ces informations sont essentielles pour prendre des décisions éclairées concernant les soins futurs, y compris le mode d'accouchement après une LOSA.</div><div>Compte tenu de la rareté actuelle des services spécialisés dans les zones régionales et éloignées, il est urgent d'améliorer l'accès équitable dans toutes les zones géographiques. Des modèles de soins innovants, tels que la télésanté et la formation des prestataires locaux, devraient être développés afin de réduire les disparités en matière de résultats ; l'accès à ces orientations et services essentiels ne devrait pas être limité par des obstacles économiques. Comme pour toute autre orientation médicalement indiquée, les frais liés au déplacement, au traitement et au suivi devraient être pris en charge afin de garantir que toutes les femmes, quelle que soit leur situation, puissent accéder aux soins dont elles ont besoin.</div></div><div><h3>Preuves</h3><div>Les études publiées ont été récupérées en effectuant des recherches dans les bases de données PubMed, Ovid, MEDLINE, Embase, SCOPUS et Cochrane Library entre le 1er septembre 2014 et le 1er juillet 2025 à l'aide des termes MeSH appropriés (accouchement, obstétrique, procédures chirurgicales obstétricales, complications obstétricales, canal anal, épisiotomie) et des mots clés (LOSA, lésion obstétricale du sphincter anal, lésion anale, sphincter anal, accouchement vaginal, suture, incontinence fécale, incontinence anale, réparation par chevauchement, réparation bout à bout, protocole vésical, analgésie). Les résultats ont été limités aux revues systématique","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103187"},"PeriodicalIF":2.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644219","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}
Pub Date : 2025-11-25DOI: 10.1016/j.jogc.2025.103175
Kaija Käärid MD , Erin Marshall MD , Richard Honor MSc , Rachel Sorensen MD , Phil Murphy MSc , Joan Crane MD , Erika Fowler MD
Objectives
This study aimed to evaluate the effects of elevated pre-pregnancy BMI on the outcomes of labour induction, especially for those in higher BMI categories.
Methods
This was a population-based retrospective cohort study using data from the Perinatal Program Newfoundland and Labrador database from 2002 to 2023. Mode of delivery was the primary outcome of interest. Composite secondary maternal and neonatal outcomes and a severity-weighted composite outcome were calculated. Outcomes were analyzed using logistic and Poisson regressions, adjusting for patient age, gestational age, parity, and smoking status. Adjusted risks or rates with associated 95% CIs were reported for each outcome. Outcome data were used to produce a clinical risk calculator.
Results
Analyses included 16 808 records. The risks of unplanned and emergency cesarean delivery (CD) increased with BMI in a dose-dependent manner. For example, the adjusted risks of unplanned and emergency CD at a BMI of 20.0 kg/m2 were 22.5% (95% CI 20.8–24.3) and 17.0% (95% CI 15.5–18.6), respectively. In comparison, these risks increased to 59.8% (95% CI 44.8–73.3) and 49.5% (95% CI 34.7–64.3), respectively, at a BMI of 65.0 kg/m2. The opposite trend was observed for spontaneous vaginal delivery. The severity-weighted composite outcome was lowest at a BMI of 19.0 kg/m2 (17.5; 95% CI 17.0–17.9) and increased to a maximum at a BMI of 48.0 kg/m2 (33.9; 95% CI 33.3–34.5).
Conclusions
Elevated BMI increases risks of unplanned and emergency CD among those who undergo induction of labour. Our risk calculator can provide additional information for patient assessment and counselling.
目的：探讨孕前体重指数（BMI）升高对引产效果的影响，尤其是对BMI较高的孕妇。方法：基于人群的回顾性队列研究，使用2002-2023年围产期计划纽芬兰和拉布拉多（PPNL）数据库的数据。分娩方式是主要关注的结果。计算产妇和新生儿二级综合结局，以及严重程度加权综合结局。采用logistic回归和泊松回归分析结果，调整患者年龄、胎龄、胎次和吸烟状况。报告每个结果的校正风险或相关95%置信区间（CI）。结果数据用于制作临床风险计算器。结果：共分析16 808例病例。意外和紧急剖宫产（CD）的风险随BMI呈剂量依赖性增加。例如，BMI为20.0kg/m2时，计划外和紧急CD的调整风险分别为22.5% （95% CI 20.8-24.3）和17.0% （95% CI 15.5-18.6）。相比之下，当BMI为65.0kg/m2时，这些风险分别增加到59.8% （95% CI 44.8-73.3）和49.5% （95% CI 34.7-64.3）。自然阴道分娩则有相反的趋势。严重加权复合结局在BMI为19.0kg/m2时最低（17.5,95% CI 17.0-17.9），在BMI为48.0kg/m2时最高（33.9,95% CI 33.3-34.5）。结论：BMI升高增加了人工晶状体植入术患者发生意外和突发CD的风险。我们的风险计算器可以为患者评估和咨询提供额外的信息。
{"title":"Association between Elevated Pre-pregnancy BMI and Outcomes of Labour Induction: A Population-Based Retrospective Cohort Study","authors":"Kaija Käärid MD , Erin Marshall MD , Richard Honor MSc , Rachel Sorensen MD , Phil Murphy MSc , Joan Crane MD , Erika Fowler MD","doi":"10.1016/j.jogc.2025.103175","DOIUrl":"10.1016/j.jogc.2025.103175","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the effects of elevated pre-pregnancy BMI on the outcomes of labour induction, especially for those in higher BMI categories.</div></div><div><h3>Methods</h3><div>This was a population-based retrospective cohort study using data from the Perinatal Program Newfoundland and Labrador database from 2002 to 2023. Mode of delivery was the primary outcome of interest. Composite secondary maternal and neonatal outcomes and a severity-weighted composite outcome were calculated. Outcomes were analyzed using logistic and Poisson regressions, adjusting for patient age, gestational age, parity, and smoking status. Adjusted risks or rates with associated 95% CIs were reported for each outcome. Outcome data were used to produce a clinical risk calculator.</div></div><div><h3>Results</h3><div>Analyses included 16 808 records. The risks of unplanned and emergency cesarean delivery (CD) increased with BMI in a dose-dependent manner. For example, the adjusted risks of unplanned and emergency CD at a BMI of 20.0 kg/m<sup>2</sup> were 22.5% (95% CI 20.8–24.3) and 17.0% (95% CI 15.5–18.6), respectively. In comparison, these risks increased to 59.8% (95% CI 44.8–73.3) and 49.5% (95% CI 34.7–64.3), respectively, at a BMI of 65.0 kg/m<sup>2</sup>. The opposite trend was observed for spontaneous vaginal delivery. The severity-weighted composite outcome was lowest at a BMI of 19.0 kg/m<sup>2</sup> (17.5; 95% CI 17.0–17.9) and increased to a maximum at a BMI of 48.0 kg/m<sup>2</sup> (33.9; 95% CI 33.3–34.5).</div></div><div><h3>Conclusions</h3><div>Elevated BMI increases risks of unplanned and emergency CD among those who undergo induction of labour. Our risk calculator can provide additional information for patient assessment and counselling.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103175"},"PeriodicalIF":2.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644397","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}
Pub Date : 2025-11-20DOI: 10.1016/j.jogc.2025.103179
Kimia Sorouri MD, MPH , Edward R. Scheffer Cliff MBBS, MPH , Karen B. Glass MD , Jennia Michaeli MD
Gene therapies for sickle cell disease and beta-thalassemia offer potentially curative treatment for patients aged ≥12 years but require gonadotoxic myeloablative conditioning. Fertility preservation and hormone replacement are essential components of standard care for ex vivo gene therapies.
{"title":"Reproductive Considerations of Gene Therapies for Sickle Cell Disease and Beta-Thalassemia","authors":"Kimia Sorouri MD, MPH , Edward R. Scheffer Cliff MBBS, MPH , Karen B. Glass MD , Jennia Michaeli MD","doi":"10.1016/j.jogc.2025.103179","DOIUrl":"10.1016/j.jogc.2025.103179","url":null,"abstract":"<div><div>Gene therapies for sickle cell disease and beta-thalassemia offer potentially curative treatment for patients aged ≥12 years but require gonadotoxic myeloablative conditioning. Fertility preservation and hormone replacement are essential components of standard care for ex vivo gene therapies.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103179"},"PeriodicalIF":2.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582791","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}
Pub Date : 2025-11-12DOI: 10.1016/j.jogc.2025.103174
Hannah A. Hagy PhD , Amy M. Bohnert PhD , Rebecca L. Silton PhD , Kevin M. Hellman PhD , Frank F. Tu MD, MPH
Objectives
This study aimed to identify menstrual pain trajectories over 2 years in young women with moderate-to-severe intensity, and determine baseline factors, including modifiable variables, that differentiate these trajectories.
Methods
This secondary analysis of a prospective cohort study included 157 women aged 18–45 years, enriched for moderate-to-severe menstrual pain. Pain during periods (without/before analgesic use) was reported at 3 visits: baseline, Year 1 and Year 2. Baseline measures included non-menstrual pelvic pain (NMPP), anxiety, depression, pain catastrophizing, somatic sensitivity, and sleep disturbance. Hormonal contraceptive use, pregnancies, and menstrual suppression were tracked annually. We performed growth mixture modelling to identify pain trajectories.
Results
Four trajectories emerged: high-stable pain (63%), low-stable pain (15%), improving pain (11%), and worsening pain (11%). High-stable pain was characterized by higher baseline NMPP, somatic sensitivity, and sleep disturbance compared with low-stable pain. The improving group had greater hormonal contraceptive use at follow-up (primarily combined oral contraceptives; regimen patterns inconsistently reported) compared with the high-stable group. No predictors of the worsening trajectory group were identified. Very few pregnancies occurred over the follow-up period.
Conclusions
Most menstrual pain trajectories remained stable over 2 years. Because women in the high-stable group demonstrated a broader burden of symptoms—NMPP, somatic sensitivity, and sleep disturbance—future studies should focus on multidisciplinary approaches, such as sleep optimization, complementing traditional use of non-steroidal anti-inflammatories. Future work is also needed to understand how pregnancy and tolerance of hormonal therapy may influence adverse symptom trajectories.
{"title":"Psychosocial Predictors of Dysmenorrhea Stability and Change: A Two-Year Longitudinal Study","authors":"Hannah A. Hagy PhD , Amy M. Bohnert PhD , Rebecca L. Silton PhD , Kevin M. Hellman PhD , Frank F. Tu MD, MPH","doi":"10.1016/j.jogc.2025.103174","DOIUrl":"10.1016/j.jogc.2025.103174","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to identify menstrual pain trajectories over 2 years in young women with moderate-to-severe intensity, and determine baseline factors, including modifiable variables, that differentiate these trajectories.</div></div><div><h3>Methods</h3><div>This secondary analysis of a prospective cohort study included 157 women aged 18–45 years, enriched for moderate-to-severe menstrual pain. Pain during periods (without/before analgesic use) was reported at 3 visits: baseline, Year 1 and Year 2. Baseline measures included non-menstrual pelvic pain (NMPP), anxiety, depression, pain catastrophizing, somatic sensitivity, and sleep disturbance. Hormonal contraceptive use, pregnancies, and menstrual suppression were tracked annually. We performed growth mixture modelling to identify pain trajectories.</div></div><div><h3>Results</h3><div>Four trajectories emerged: high-stable pain (63%), low-stable pain (15%), improving pain (11%), and worsening pain (11%). High-stable pain was characterized by higher baseline NMPP, somatic sensitivity, and sleep disturbance compared with low-stable pain. The improving group had greater hormonal contraceptive use at follow-up (primarily combined oral contraceptives; regimen patterns inconsistently reported) compared with the high-stable group. No predictors of the worsening trajectory group were identified. Very few pregnancies occurred over the follow-up period.</div></div><div><h3>Conclusions</h3><div>Most menstrual pain trajectories remained stable over 2 years. Because women in the high-stable group demonstrated a broader burden of symptoms—NMPP, somatic sensitivity, and sleep disturbance—future studies should focus on multidisciplinary approaches, such as sleep optimization, complementing traditional use of non-steroidal anti-inflammatories. Future work is also needed to understand how pregnancy and tolerance of hormonal therapy may influence adverse symptom trajectories.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103174"},"PeriodicalIF":2.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524888","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}
Pub Date : 2025-11-12DOI: 10.1016/j.jogc.2025.103176
Justine Pleau MA , Lisiane F. Leal ScD , Odile Sheehy MSc , Anick Bérard PhD
Objectives
This study aimed to determine if the use of acetaminophen alone and in combination during the second and third trimesters of pregnancy is associated with the risk of attention-deficit/hyperactivity disorder (ADHD) in children, and to evaluate uncertainty from exposure and outcome misclassification.
Methods
We included all singleton live births from the Quebec Pregnancy Cohort between January 1, 1998, and December 31, 2013. Maternal acetaminophen use was identified through filled prescription data, and children were classified into 3 exposure groups: (1) unexposed, (2) exposed to acetaminophen alone, and (3) exposed to acetaminophen in combination with other medications during the second or third trimester of pregnancy. ADHD was assessed in children aged ≥2 years using a validated algorithm: 2 diagnostic codes, 2 filled prescriptions for ADHD medication, or 1 diagnostic code plus 1 filled prescription. To address potential non-differential exposure and outcome misclassification, we conducted a probabilistic bias analysis using individual-level data, which represents the central contribution of this study.
Results
Among the 182 775 children included, 1.0% were exposed to acetaminophen alone and 2.2% to acetaminophen in combination with other medications. In Cox proportional hazard models, acetaminophen use in combination was associated with increased risk of ADHD (adjusted hazard ratio 1.17; 95% CI 1.06–1.29), while acetaminophen alone showed a weaker association (adjusted hazard ratio 1.09; 95% CI 0.94–1.27). Probabilistic bias analysis demonstrated that these estimates might be biased away from the null.
Conclusions
Our findings suggest that the observed relationship might be partly explained by exposure and outcome misclassification.
目的：目的是确定在妊娠中期和晚期单独使用和联合使用对乙酰氨基酚是否与儿童注意力缺陷/多动障碍（ADHD）的风险相关，并评估暴露和结果错误分类的不确定性。方法：我们纳入了1998年1月1日至2013年12月31日期间魁北克妊娠队列的所有单胎活产。通过填写处方数据确定产妇对乙酰氨基酚的使用情况，并将儿童分为三个暴露组：(1)未暴露，(2)单独暴露于对乙酰氨基酚，(3)在妊娠中期或晚期暴露于对乙酰氨基酚与其他药物联合使用。对至少2岁的儿童进行ADHD评估，使用一种经过验证的算法：两个诊断代码，两个ADHD药物处方，或一个诊断代码加一个处方。为了解决潜在的非差异暴露和结果错误分类，我们使用个人水平的数据进行了概率偏差分析（PBA），这代表了本研究的核心贡献。结果：在纳入的182 775名儿童中，1.0%的儿童单独暴露于对乙酰氨基酚，2.2%的儿童暴露于对乙酰氨基酚联合其他药物。在Cox比例风险模型中，对乙酰氨基酚联合使用与ADHD风险增加相关（aHR = 1.17, 95% CI = 1.06-1.29），而单独使用对乙酰氨基酚的相关性较弱（aHR = 1.09, 95% CI = 0.94-1.27）。PBA证明这些估计可能偏离零值。结论：我们的研究结果表明，观察到的关系可能部分地被暴露和结果错误分类所解释。
{"title":"The Debate on Acetaminophen Use in Pregnancy and Neurodevelopmental Disorders: Facts or Fiction?","authors":"Justine Pleau MA , Lisiane F. Leal ScD , Odile Sheehy MSc , Anick Bérard PhD","doi":"10.1016/j.jogc.2025.103176","DOIUrl":"10.1016/j.jogc.2025.103176","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to determine if the use of acetaminophen alone and in combination during the second and third trimesters of pregnancy is associated with the risk of attention-deficit/hyperactivity disorder (ADHD) in children, and to evaluate uncertainty from exposure and outcome misclassification.</div></div><div><h3>Methods</h3><div>We included all singleton live births from the Quebec Pregnancy Cohort between January 1, 1998, and December 31, 2013. Maternal acetaminophen use was identified through filled prescription data, and children were classified into 3 exposure groups: (1) unexposed, (2) exposed to acetaminophen alone, and (3) exposed to acetaminophen in combination with other medications during the second or third trimester of pregnancy. ADHD was assessed in children aged ≥2 years using a validated algorithm: 2 diagnostic codes, 2 filled prescriptions for ADHD medication, or 1 diagnostic code plus 1 filled prescription. To address potential non-differential exposure and outcome misclassification, we conducted a probabilistic bias analysis using individual-level data, which represents the central contribution of this study.</div></div><div><h3>Results</h3><div>Among the 182 775 children included, 1.0% were exposed to acetaminophen alone and 2.2% to acetaminophen in combination with other medications. In Cox proportional hazard models, acetaminophen use in combination was associated with increased risk of ADHD (adjusted hazard ratio 1.17; 95% CI 1.06–1.29), while acetaminophen alone showed a weaker association (adjusted hazard ratio 1.09; 95% CI 0.94–1.27). Probabilistic bias analysis demonstrated that these estimates might be biased away from the null.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that the observed relationship might be partly explained by exposure and outcome misclassification.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103176"},"PeriodicalIF":2.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524901","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}
Pub Date : 2025-11-12DOI: 10.1016/j.jogc.2025.103173
Nicole N. Ofosu MSc, PhD , Jordan Tate BSc , Charlotte Hruczkowski MSN, BScN , Charlene Feuffel CHIM , Laurel Collier BSc, BA , Nonsikelelo Mathe PhD , Marcia Bruce BComm, PaCER , Denise Campbell-Scherer MD, PhD, CCFP , Eliana Castillo MD, MHSc
Objectives
Suboptimal antimicrobial prophylaxis in labour and delivery increases the risk of poor health outcomes. We examined Alberta’s obstetrical antimicrobial prophylaxis practices to identify gaps and opportunities for clinical improvement.
Methods
We used human-centred design (mapping out patients’ journey to delivery) and health care administrative data to establish a baseline of current antimicrobial prophylaxis practices for early-onset neonatal group B Streptococcus (GBS) disease and surgical site infection (SSI) prevention during labour and delivery.
Results
Seven obstetrical health care providers participated in the journey mapping process, which highlighted the need for improved allergy documentation. Specifically, the findings emphasized better penicillin allergy risk stratification, accurate electronic record-keeping, and identification of opportunities to de-label patients incorrectly identified as allergic. The analysis of 13 818 patients who delivered in Alberta hospital sites between November 1, 2022 and May 31, 2023 showed that most received appropriate antimicrobial prophylaxis for GBS and SSI prevention. Among the 140 GBS-positive patients with beta-lactam allergy who delivered vaginally, cefazolin (62%) was the most prescribed antibiotic, followed by clindamycin (26%) and penicillin (13%). Of the 58 patients with beta-lactam allergy needing SSI prophylaxis, most also received cefazolin. However, some cases still showed suboptimal use of second-line antibiotics.
Conclusions
The journey map highlights the prenatal period and hospital admission as key phases for ensuring allergy documentation accuracy. Considering that inappropriate penicillin allergy labelling and administration of suboptimal antimicrobial prophylaxis persist, there is room for quality improvement initiatives to promote validation of allergy status and address the use of suboptimal antibiotics for penicillin allergy.
{"title":"Antimicrobial Prophylaxis Practices for Obstetrical Infection Prevention in Alberta: A Multi-Method Study","authors":"Nicole N. Ofosu MSc, PhD , Jordan Tate BSc , Charlotte Hruczkowski MSN, BScN , Charlene Feuffel CHIM , Laurel Collier BSc, BA , Nonsikelelo Mathe PhD , Marcia Bruce BComm, PaCER , Denise Campbell-Scherer MD, PhD, CCFP , Eliana Castillo MD, MHSc","doi":"10.1016/j.jogc.2025.103173","DOIUrl":"10.1016/j.jogc.2025.103173","url":null,"abstract":"<div><h3>Objectives</h3><div>Suboptimal antimicrobial prophylaxis in labour and delivery increases the risk of poor health outcomes. We examined Alberta’s obstetrical antimicrobial prophylaxis practices to identify gaps and opportunities for clinical improvement.</div></div><div><h3>Methods</h3><div>We used human-centred design (mapping out patients’ journey to delivery) and health care administrative data to establish a baseline of current antimicrobial prophylaxis practices for early-onset neonatal group B <em>Streptococcus</em> (GBS) disease and surgical site infection (SSI) prevention during labour and delivery.</div></div><div><h3>Results</h3><div>Seven obstetrical health care providers participated in the journey mapping process, which highlighted the need for improved allergy documentation. Specifically, the findings emphasized better penicillin allergy risk stratification, accurate electronic record-keeping, and identification of opportunities to de-label patients incorrectly identified as allergic. The analysis of 13 818 patients who delivered in Alberta hospital sites between November 1, 2022 and May 31, 2023 showed that most received appropriate antimicrobial prophylaxis for GBS and SSI prevention. Among the 140 GBS-positive patients with beta-lactam allergy who delivered vaginally, cefazolin (62%) was the most prescribed antibiotic, followed by clindamycin (26%) and penicillin (13%). Of the 58 patients with beta-lactam allergy needing SSI prophylaxis, most also received cefazolin. However, some cases still showed suboptimal use of second-line antibiotics.</div></div><div><h3>Conclusions</h3><div>The journey map highlights the prenatal period and hospital admission as key phases for ensuring allergy documentation accuracy. Considering that inappropriate penicillin allergy labelling and administration of suboptimal antimicrobial prophylaxis persist, there is room for quality improvement initiatives to promote validation of allergy status and address the use of suboptimal antibiotics for penicillin allergy.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 1","pages":"Article 103173"},"PeriodicalIF":2.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524947","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}
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