Journal of obstetrics and gynaecology Canada最新文献

英文中文

Quadruplet Pregnancy (Two Sets of Monochorionic Twins) from Elective Single Embryo Transfer in a Stimulated Cycle 刺激周期中选择性单胚胎移植的四胞胎妊娠（两组单绒毛膜双胎）。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-12 DOI: 10.1016/j.jogc.2024.102691

Justin White MD, BSc , Vladimir Varin BHSc (in-progress) , Marjorie Farley BSc RM, RDMS , Clara Qianqian Wu MD, MSc

引用次数: 0

Mortality Following Childbirth in Ontario: A 20-Year Analysis of Temporal Trends and Causes 安大略省分娩后的死亡率--二十年来的时间趋势和原因分析。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-12 DOI: 10.1016/j.jogc.2024.102689

Ann E. Sprague RN, PhD , Nicole F. Roberts MSc , Carolina Lavin Venegas BScN, MSc , Tatung Nath MSc , Prakesh S. Shah MD, MSc , Jon Barrett MBBch, MD, MRCOG , Jocelynn Cook PhD, MBA , Elizabeth K. Darling RM, MSc, PhD , Rohan D’Souza MD, PhD , Sharon Dore RN, PhD , Wesley Edwards MBBS, MPH , Naomi Kasman MSc , Susie Dzakpasu PhD , Joel Ray MD , Mark Walker MD, MSc, MSHCM

Objectives

Maternal death during or after pregnancy is often preventable and accurate surveillance is key to prevention. We examined the number and causes of maternal death in Ontario over 20 years.

Methods

Retrospective cohort study including all hospital livebirths and stillbirths from 2002–2022 in the Canadian Institute for Health Information Discharge Abstracts (for hospitalizations) and National Ambulatory Care System (for emergency department encounters) linked to the Better Outcomes and Registry and Network births. Death was ascertained from childbirth to 365 days thereafter; all deaths were reviewed by at least 3 clinicians.

Results

There were 485 deaths among 2 764 214 live and stillbirths over 20 years—a maternal mortality ratio (MMR) of 17.5 per 100 000 (95% CI 16.0–19.2). There were 222 (45.8%) early deaths within 42 days of birth (MMR of 8.0 per 100 000; 95% CI 7.0–9.2), and 263 (54.2%) late deaths from 43 to 365 days after birth (MMR 9.5 per 100 000; 95% CI 8.4–10.7). Death was pregnancy-related in 169/485 cases (34.8%). Early death causes were predominantly hemorrhage, infection, preeclampsia, and pulmonary embolism. The top causes of 263 late deaths were cancer, injury, and cardiac arrest, or unknown.

Conclusions

Most deaths within 1 year of childbirth are not related to obstetrical factors; however, pregnancy complications factor in early deaths. Causes of early and late deaths differ, but examining late deaths is equally important to identify factors not regularly examined in maternal mortality. As death in early pregnancy or outside hospitals is not reported, mortality is likely higher.

目的：孕产妇在怀孕期间或之后死亡通常是可以预防的，准确的监测是预防的关键。我们研究了安大略省 20 年来孕产妇死亡的数量和原因：回顾性队列研究包括加拿大健康信息研究所（CIHI）出院摘要（住院）和国家非住院护理系统（急诊科就诊）中 2002-2022 年所有住院活产和死产的情况，并与更好结果和登记（BORN）出生情况相联系。所有死亡病例均由至少 3 名临床医生审查：20 年间，2 764 214 例活产和死产中有 485 例死亡，孕产妇死亡率（MMR）为十万分之 17.5（95% CI 16.0-19.2）。有 222 例（45.8%）早期死亡发生在产后 42 天内（孕产妇死亡率为每 100 000 例中有 8.0 例；95% CI 为 7.0-9.2 例），263 例（54.2%）晚期死亡发生在产后 43 天至 365 天内（孕产妇死亡率为每 100 000 例中有 9.5 例；95% CI 为 8.4-10.7 例）。169/485例（34.8%）的死亡与妊娠有关。早期死亡原因主要是出血、感染、子痫前期和肺栓塞。263 例晚期死亡病例的主要死因是癌症、外伤、心脏骤停或原因不明：结论：大多数产后一年内的死亡与产科因素无关；然而，妊娠并发症是导致早期死亡的因素。早期死亡和晚期死亡的原因各不相同，但检查晚期死亡同样重要，因为这可以发现孕产妇死亡中未经常检查的因素。由于未报告孕早期死亡或医院外死亡，死亡率可能更高。

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引用次数: 0

Fetal Goiter due to Fetal Thyroid Dyshormonogenesis 胎儿甲状腺发育异常导致的胎儿甲状腺肿。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-09 DOI: 10.1016/j.jogc.2024.102678

Edward Moreno MD , Yarelys Durán MD , Maria Nazareth Campo MD , Jorge Hernan Gutierrez MD , Jose Enrique Sanín MD , Raul García MD , Gustavo Giraldo MD , Diana Cuesta PhD

引用次数: 0

Racial Disparities in Parturient Urine Drug Screening at a Texas Level IV Maternal Care Centre: A Single-Centre Retrospective Study 德克萨斯州一家四级孕产妇护理中心的产妇尿液药物筛查中的种族差异：一项单中心回顾性研究。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-08 DOI: 10.1016/j.jogc.2024.102679

Ivie Izekor BS , Steven Lindheim MD , Jessica C. Ehrig MD , Robert S. White MD, MS , Michael P. Hofkamp MD

Objectives

We hypothesized that Black or African American (hereby referred to as Black) and Hispanic patients would have higher rates of urine drug screening (UDS) during pregnancy compared with White or Caucasian (herby referred to as White) patients at our hospital.

Methods

Patients who delivered at our hospital between 1 December 2020 and 31 May 2021 and between 1 December 2022 and 31 May 2023 and who were Black, Hispanic, or White were included in the final analysis. We performed separate bivariate analyses comparing White patients to either Black patients or Hispanic patients. We performed a multivariate logistic regression, including variables of interest designed to predict risk factors for UDS during pregnancy.

Results

A total of 457 Black, 813 Hispanic, and 1252 White patients were identified. During pregnancy, 187 (40.9%) Black patients had UDS compared with 265 (21.2%) White patients (P < 0.001). In addition, 258 (31.7%) Hispanic patients had UDS during pregnancy, which was statistically different compared with White patients (P < 0.001). A multivariate logistic regression found that identification as Black was independently associated with UDS during pregnancy (adjusted OR [aOR] 1.871; 95% CI 1.382–2.534, P < 0.001), identification as Hispanic was not independently associated (aOR 1.177; 95% CI 0.900–1.538, P = 0.234), and patients who delivered after the COVID-19 pandemic were less likely to receive UDS (aOR 0.783; 95% CI 0.621–0.987, P = 0.039).

Conclusion

Identification as Black and delivery during the COVID-19 pandemic were independently associated with increased adjusted odds of UDS during pregnancy at our hospital.

目的：我们假设，与本医院的白人或高加索人（以下简称白人）患者相比，黑人或非裔美国人（以下简称黑人）和西班牙裔患者在怀孕期间的尿液药物筛查（UDS）率会更高。方法：在 2020 年 12 月 1 日至 2021 年 5 月 31 日以及 2022 年 12 月 1 日至 2023 年 5 月 31 日期间在本医院分娩的黑人、西班牙裔或白人患者均纳入最终分析。我们分别对白人患者与黑人患者或西班牙裔患者进行了双变量分析。我们进行了多变量逻辑回归，其中包括旨在预测妊娠期 UDS 风险因素的相关变量。258名（31.7%）西班牙裔患者在怀孕期间患有 UDS，与白人患者相比也存在统计学差异（P < 0.001）。多变量逻辑回归发现，黑人身份与孕期 UDS 独立相关（调整赔率比 [aOR] 1.871；95% CI 1.382，2.534；P < 0.001）；识别为西班牙裔与此无关（aOR 1.177；95% CI 0.900，1.538；P = 0.234）；COVID-19 大流行后分娩的患者接受 UDS 的可能性较低（aOR 0.783；95% CI 0.621，0.987；P = 0.039）。目的：我们假设，在本医院，黑人或非裔美国人患者（以下简称黑人患者）和西班牙裔患者在妊娠期间接受尿液毒理学筛查（UDS）的比例将高于白人或高加索人患者（以下简称白人患者）。方法：将 2020 年 12 月 1 日至 2021 年 5 月 31 日或 2022 年 12 月 1 日至 2023 年 5 月 31 日期间在本医院分娩的黑人、西班牙裔或白人患者纳入最终分析。我们分别对白人患者和黑人或西班牙裔患者进行了双变量分析。我们使用多变量逻辑回归和相关变量来预测妊娠期尿毒症的风险因素。结果：我们分别发现了 457 名、813 名和 1252 名黑人、西班牙裔和白人患者。其中，187 名黑人患者和 265 名白人患者在怀孕期间出现过妊娠期尿崩症（40.9% p r vs 21.2%; P < 0.001）。至于西班牙裔患者，有 258 人在怀孕期间接受了 DTU，比例为 31.7%，与白人患者相比也有显著的统计学差异（P < 0.001）。多变量逻辑回归分析显示，黑人患者身份与孕期UTD有独立关联（调整后的几率比 [aOR]：1.871；95% CI ：1.382-2.534；P <0.001）；西班牙裔患者与UTD无关（aOR：1.177；95% CI：0.900-1.538；P =0.234）；COVID-19大流行后分娩的患者发生UTD的可能性较低（aOR：0.783；95% CI：0.621-0.987；P =0.039）。结论：在我们医院，黑人患者身份和在 COVID-19 大流行期间分娩与妊娠期UTD 调整后风险增加有独立关联。

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引用次数: 0

A Description of the THRIVE (The Study of Host-Bacterial Relationships and Immune Function in Different Vaginal Environments) Bacterial Vaginosis Observational Study 介绍 THRIVE（"不同阴道环境中宿主与细菌关系的研究"）细菌性阴道病观察研究。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-02 DOI: 10.1016/j.jogc.2024.102667

Alicia R. Berard PhD , Samantha Knodel BSc , Christina Farr Zuend PhD , Laura Noël-Romas MSc , Kenzie D. Birse MSc , Peter McQueen PhD , Marlon De Leon BSc , Kateryna Kratzer BSc , Oluwatobiloba A. Taylor BSc , Samantha Bailey BSc , Helen Pymar MD , Adam D. Burgener PhD , Vanessa Poliquin MD

Objectives

Bacterial vaginosis (BV) contributes to poor reproductive health and is characterized by a displacement of Lactobacillus in the vaginal microbiome. However, treatment for BV is limited to antibiotics and half of the women treated experience recurrence within a year. THRIVE (The Study of Host-Bacterial Relationships and Immune Function in Different Vaginal Environments) is a prospective study in Winnipeg, Manitoba, Canada, which is designed to capture the daily variation of the microbiome and host mucosal immunity during treatment. The objective of this study is to identify host and bacterial factors that associate with vaginal microbiome stability to better inform therapeutic interventions.

Methods

Women treated for BV, and controls, are followed for 6 months collecting daily vaginal swabs and monthly questionnaires. Comprehensive mucosal sampling, including swabs, cytobrushes, biopsies, and blood are collected at baseline, months 1 and 6 post-enrolment.

Results

We performed analysis on the first 52 participants, (19 BV+, 33 BV–). Molecular profiling by 16s RNA sequencing showed 20 women with non-Lactobacillus-dominant microbiomes and 32 with Lactobacillus-dominant microbiomes, with increased microbial diversity in non-Lactobacillus-dominant microbiomes (P = 3.1E-05). A pilot analysis in 2 participants demonstrates that multi-omics profiling of self-collected daily swabs provides high-quality data identifying 73 bacterial species, 1773 mucosal proteins and 117 metabolites. Initial flow cytometry analysis showed an increased cluster of differentiation (CD)4+ T cells and neutrophil activation (CD11b+CD62L^neg/dim) in the positive participant at baseline, while after treatment these shifted and resembled the control participant.

Conclusions

This study provides a framework to comprehensively investigate the kinetics of vaginal mucosal microbiome alterations, providing further insight into host and molecular features predicting BV recurrence.

细菌性阴道病会导致生殖健康不良，其特点是阴道微生物群中的乳酸杆菌被取代。目的：THRIVE 是一项在 XXXXX 进行的前瞻性研究，旨在捕捉治疗期间微生物组和宿主粘膜免疫的每日变化。本研究的目的是确定与阴道微生物组稳定性相关的宿主和细菌因素，以便更好地为治疗干预措施提供依据。方法：对接受细菌性阴道病治疗的妇女和对照组进行为期 6 个月的跟踪调查，每天采集阴道拭子，每月进行问卷调查。在基线、入组后的第 1 个月和第 6 个月进行全面的粘膜采样，包括拭子、细胞刷、活检和血液。通过 16s RNA 测序进行的分子剖析显示，20 名女性的微生物组为非乳酸杆菌优势微生物组，32 名女性的微生物组为乳酸杆菌优势微生物组，非乳酸杆菌优势微生物组的微生物多样性有所增加（P = 3.1E-05）。对 2 名参与者进行的试点分析表明，对每天自取的拭子进行多组学分析可提供高质量的数据，确定 73 种细菌、1773 种粘膜蛋白质和 117 种代谢物。最初的流式细胞术分析表明，基线期阳性患者的 CD4+ T 细胞和中性粒细胞活化（CD11b+CD62Lneg/dim）增加，而治疗后这些细胞和中性粒细胞活化发生了变化，与对照组患者相似。摘要：细菌性阴道病导致生殖健康不良，其特点是阴道微生物群中乳酸杆菌被取代。目的：THRIVE 是一项在 XXXXX 进行的前瞻性研究，旨在测量治疗期间宿主微生物组和粘膜免疫的日常变化。该研究旨在确定与阴道微生物群稳定性相关的宿主和细菌因素，以便更好地指导治疗干预措施。方法：对接受细菌性阴道病治疗的妇女和对照组进行为期 6 个月的跟踪调查，每天采集阴道拭子，每月进行问卷调查。在招募时以及招募后的 1 个月和 6 个月，通过各种采样方法（包括拭子、细胞刷、活检和血液采样）进行详细的粘膜分析。结果：我们分析了首批 52 名参与者（19 名 VB+，33 名 VB-）。通过 16S RNA 测序进行的分子分析表明，20 名女性的微生物组以非乳酸杆菌为主，32 名女性的微生物组以乳酸杆菌为主，其中以非乳酸杆菌为主的微生物组的微生物多样性更高（P = 3.1E-05）。对 2 名参与者进行的试点分析表明，对每日自取的拭子进行多组学分析可提供高质量的数据，从而鉴定出 73 种细菌、1773 种粘膜蛋白质和 117 种代谢物。最初的流式细胞术分析显示，招募阳性患者的 CD4+ T 细胞和中性粒细胞活化（CD11b+CD62Lneg/低）升高，而治疗后这些细胞与对照组患者的细胞相似。结论：这项研究为全面研究阴道粘膜微生物组的变化动力学提供了一个框架，有助于更好地了解可预测细菌性阴道病复发的宿主和分子特征。

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引用次数: 0

Contraception Used by People Assigned Female at Birth With Spinal Cord Injury 脊髓损伤患者在出生时被指定为女性的情况下使用的避孕方法。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-02 DOI: 10.1016/j.jogc.2024.102673

Claire Mazzia MSc , Sarah Daisy Kosa PhD , Anne Harris PhD , Ashley Waddington MD, MPA , Anne Berndl MD, MSc

Objectives

There is limited data on contraception used by people assigned female at birth with spinal cord injury (SCI). Pregnancy in people with SCI can be medically complex, therefore access to contraception to prevent unplanned pregnancies is essential. This study aimed to assess the availability of contraception from health care providers (HCPs) to people with SCI and the contraception methods used.

Methods

An online international questionnaire was distributed. Demographic data and reproductive histories were recorded. Overall, 780 responses were received from participants in 33 different countries. Most participants lived in North America and self-identified as White. In total, 75% had a traumatic SCI. Most SCIs were at cervical and thoracic levels and American Spinal Injury Association-A and American Spinal Injury Association-B. Descriptive and χ² statistics were used.

Results

The recruitment rate was 85.4% and the completion rate was 73.8%. Overall, 93.6% of participants reported ever having been sexually active, while 60.7% reported sexual activity over the past year. Of people who were injured under the age of 50 years and who have been sexually active, 63.6% were offered birth control by an HCP. Condoms were used by 44.5% of participants, withdrawal by 20.1%, the combined oral contraceptive pill by 28.4% and intrauterine device by 20.1% of respondents.

Conclusions

This is the largest known study on SCI and contraception. Most people with SCI are sexually active. The withdrawal method and no contraception are used by many individuals, which may increase the risk of unplanned pregnancy. Increased use of highly effective contraception in this population may be achieved through HCP-initiated conversations about sexual health.

目标：有关脊髓损伤（SCI）患者在出生时被指定为女性的避孕数据非常有限。脊髓损伤患者怀孕在医学上可能很复杂，因此必须采取避孕措施以防止意外怀孕。本研究旨在评估医疗保健提供者（HCPs）向脊髓损伤患者提供避孕药具的情况以及所使用的避孕方法。共收到来自 33 个不同国家参与者的 780 份回复。大多数参与者居住在北美，自我认同为白人。大多数 SCI 发生在颈椎和胸部，以及 ASIA-A 和 ASIA-B。研究使用了描述性统计和卡方统计。结果：招募率为 85.4%，完成率为 73.8%。93.6%的参与者表示曾经有过性行为，60.7%的参与者表示在过去一年中有过性行为。在 50 岁以下有性生活的受伤者中，63.6% 的人接受过保健医生提供的节育服务。44.5%的参与者使用了避孕套，20.1%的参与者使用了体外射精，28.4%的参与者使用了口服避孕药，20.1%的受访者使用了宫内节育器。大多数 SCI 患者性生活活跃。许多人使用体外射精法或不采取任何避孕措施，这可能会增加意外怀孕的风险。目标：有关出生时即被分配患有脊髓损伤（SCI）的女性使用避孕措施的数据非常有限。在脊髓损伤的情况下处理怀孕问题可能很复杂，因此脊髓损伤患者必须采取避孕措施以避免意外怀孕。本研究旨在评估医疗机构提供的避孕服务以及 SCI 患者使用的避孕方法。方法：向世界各地的患者发放在线问卷。收集了人口统计学数据和生育史。共收到来自 33 个国家参与者的 780 份回复。大多数人居住在北美，自称是白人。在这些参与者中，有 75% 的人表示曾患有创伤性 SCI。SCI 一般为颈椎或胸部损伤，在 ASIA 量表中分为 A 级或 B 级。数据分析基于描述性统计和卡方检验。结果：招募率为 85.4%，完成率为 73.8%。在参与者中，93.6%的人表示他们有过性生活，60.7%的人表示他们在过去一年中有过性生活。在 50 岁前感染 SCI 的性活跃人群中，63.6% 的人曾获得医疗保健提供者提供的避孕措施。总体而言，44.5%的参与者使用避孕套；20.1%使用体外射精法；28.4%使用复合口服避孕药；20.1%使用宫内节育器。大多数 SCI 患者性生活活跃。他们中的许多人使用体外射精法或根本不采取任何避孕措施，这些因素可能会增加意外怀孕的风险。毫无疑问，通过由医疗保健提供者发起的有关性健康的对话，可以在这一人群中增加高效避孕方法的使用。

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引用次数: 0

Consensus clinique N^o 455 : Déterminer et révéler le sexe fœtal. 临床共识第 455 号：确定和揭示胎儿性别。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-01 DOI: 10.1016/j.jogc.2024.102676

Michiel C Van den Hof, Venu Jain, Ori Nevo

引用次数: 0

Excerpts From the World Medical Literature: Gynaecology 世界医学文献摘录：妇科

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-01 DOI: 10.1016/j.jogc.2024.102640

Paul J. Yong MD, PhD

引用次数: 0

SOGC Guideline Retirement Notice No. 9 SOGC 第 9 号指导原则退休通知 / Avis d'archivage des directives de la SOGC n° 9.

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-01 DOI: 10.1016/j.jogc.2024.102674

These documents have been archived because they contain outdated information. They should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Endometrial Ablation in the Management of Abnormal Uterine Bleeding [J Obstet Gynaecol Can 37 (2014) 362-376]

Authors

Philippe Laberge, MD, Quebec QC

Nicholas Leyland, MD, Ancaster ON

Ally Murji, MD, Toronto ON

Claude Fortin, MD, Montreal QC

Paul Martyn, MD, Sydney, Australia

George Vilos, MD, London ON

Avis d’archivage des directives de la SOGC n° 9

Ces documents ont étés archivés, car ils contiennent des informations périmées. Ils ne devraient pas êtres consultés pour un usage clinique, mais uniquement pour des recherches historiques. Veuillez consulter le site web du journal pour les directives les plus récentes.

Ablation de l’endomètre dans la prise en charge des saignements utérins anormaux [J Obstet Gynaecol Can 37 (2014) 377-379]

Auteurs

Philippe Laberge, MD, Quebec QC

Nicholas Leyland, MD, Ancaster ON

Ally Murji, MD, Toronto ON

Claude Fortin, MD, Montreal QC

Paul Martyn, MD, Sydney, Australia

George Vilos, MD, London ON

这些文件已经存档，因为它们包含过时的信息。临床使用时不应参考这些文件，而只能用于历史研究。请访问期刊网站获取最新指南。子宫内膜消融术在异常子宫出血治疗中的应用 [J Obstet Gynaecol Can 37 (2014) 362-376] 作者 Philippe Laberge，医学博士，魁北克省 Nicholas Leyland，医学博士，安大略省安卡斯特 Ally Murji，医学博士，多伦多安大略省 Claude Fortin，医学博士，蒙特利尔魁北克省 Paul Martyn，医学博士，澳大利亚悉尼 George Vilos，医学博士，安大略省伦敦。

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引用次数: 0

Corrigendum to Reconsidering Routine Repeat Group and Screens During Pregnancy-Personalizing Pregnancy Care, Journal of Obstetrics and Gynaecology Canada, Volume 46, Issue 5, May 2024, 102351 重新考虑孕期常规复查和筛查--个性化孕期护理》（Corrigendum to Reconsidering Routine Repeat Group and Screens During Pregnancy-Personalizing Pregnancy Care），《加拿大妇产科杂志》（Journal of Obstetrics and Gynaecology Canada），第 46 卷第 5 期，2024 年 5 月，102351 页。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2024-10-01 DOI: 10.1016/j.jogc.2024.102653

Ann Tran MD , Gwen Clarke MD , Jeannie L. Callum MD , Graeme Smith MD, PhD , David Somerset MD , Julie Thorne MD, MPH , Lani Lieberman MD

引用次数: 0

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