Journal of obstetrics and gynaecology Canada最新文献_第3页

Impassable passages: a case of intrauterine adhesions at the time of first trimester abortion

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-22 DOI: 10.1016/j.jogc.2025.102769

Chelsie Warshafsky MD, MS , Julie Thorne MD, MPH , Mostafa Atri MBBS , Heather Millar MD, MIPH

引用次数: 0

The Development and Validation of a Patient Questionnaire Tool for the Assessment of Patient-Reported Experiences With Endometriosis Ultrasound 开发和验证的患者问卷工具，以评估患者报告的经验子宫内膜异位症超声。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-03 DOI: 10.1016/j.jogc.2024.102760

Jayesh Tigdi MD, MBA , Mahsa Gholiof MSc , Allyson Bontempo PhD , Hanan Alsalem MBBS , Aikansha Chawla MD , Shay Freger MPH , Mathew Leonardi MD, PhD

Objectives

Endometriosis ultrasound is an accurate, cost-effective, and non-invasive diagnostic tool that can help improve the diagnostic delay that patients with endometriosis experience. As an emerging diagnostic method, the perspectives of patients undergoing endometriosis ultrasound remain unexplored. Therefore, the objective of this study was to develop and validate an assessment tool that evaluates patient-reported experiences with endometriosis ultrasound as a decision-making tool.

Methods

This was a 2-part study with the first phase involving a modified Delphi consensus process including a panel of clinicians, sonologists, researchers, and a patient with lived experience of endometriosis. Pre- and post-ultrasound patient questionnaires were subsequently developed. The second phase included validating the questionnaires via a prospective cross-sectional survey study carried out at the Endometriosis Clinic at McMaster University Medical Centre in Hamilton, Canada. Data were analyzed using measures of central tendency, chi-square test, and Fisher exact test as appropriate. Statistical significance was determined by 2-sided P values less than 0.05.

Results

Pre- and post-ultrasound questionnaires were developed comprising 8 and 10 questions, respectively. Of 46 respondents, there was a similar representation of patients with an abnormal endometriosis ultrasound (58.7% of patients, n = 27) and those with a normal endometriosis ultrasound (41.3 %, n = 19). Moreover, endometriosis ultrasound results helped most participants (84.8%, n = 39) with treatment decision-making.

Conclusions

This study validates a survey tool that can be used clinically to assess patient-reported experiences with endometriosis ultrasound. It also demonstrates the highly informative nature of endometriosis ultrasound, with many patients choosing to defer more invasive diagnostic methods (i.e., surgery).

目的：子宫内膜异位症超声诊断是一种准确、经济、无创的诊断工具，可以帮助改善子宫内膜异位症患者的诊断延迟。超声作为一种新兴的诊断方法，对子宫内膜异位症患者的诊断前景仍未得到充分探讨。因此，本研究的目的是开发和验证一种评估工具，以评估患者报告的子宫内膜异位症超声作为决策工具。方法：这是一项两部分的研究，第一阶段涉及修改的德尔菲共识过程，包括一组临床医生、超声医师、研究人员和一位有子宫内膜异位症生活经验的患者。超声前后的患者问卷随后被开发。第二阶段包括通过在加拿大汉密尔顿麦克马斯特大学医学中心子宫内膜异位症诊所进行的前瞻性横断面调查研究来验证问卷。数据分析采用集中趋势、卡方检验和Fisher精确检验。以双侧P值< 0.05判定差异有统计学意义。结果：超声前和超声后调查分别包括8个和10个问题。在46个调查对象中，子宫内膜异位症超声检查异常的患者（58.7%,n = 27）和子宫内膜异位症超声检查正常的患者（41.3%,n = 19）的代表性相似。此外，子宫内膜异位症的超声结果对大多数参与者（84.8%,n = 39）的治疗决策有帮助。结论：本研究验证了一种可用于临床评估患者报告的子宫内膜异位症超声经历的调查工具。它也证明了子宫内膜异位症超声的高度信息性质，许多患者选择推迟更具侵入性的诊断方法（即手术）。

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引用次数: 0

An Insidious Dyad: Velamentous Cord Insertion and Intraamniotic Hemorrhage 一个阴险的对立：膜束插入和羊膜内出血。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102733

Ottavio Cassardo MD, Michele Orsi MD

引用次数: 0

Digital Health Tools for Miscarriage Support: A Survey of Canadian Women Facing Early Pregnancy Loss 流产支持的数字健康工具：加拿大妇女面临早孕损失的调查。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102722

Breanna Flynn MD , Megan Gomes MD, MSc , Genevieve Tam MD, MSc , Roopan Gill MD, MPH

Objectives

Early pregnancy loss (EPL) affects 1 in 4 recognised pregnancies, yet often lacks patient-centred supportive care. This study assesses the feasibility and acceptance of a digital health tool to support those affected by EPL. The objectives are to (1) understand the experiences of those who have miscarried, (2) explore their methods of accessing health information, and (3) determine their preferences regarding digital tool content and design.

Methods

This mixed-methods study included Canadian persons aged 18–45 years who self-reported to have experienced EPL up to 12⁶ weeks gestation in the preceding 2 years. Recruitment was via social media and hospital posters. Participants completed an online survey and optional follow-up interview between September 2021 and April 2022. Survey responses were analysed using descriptive statistics. Interview findings are presented in a separate paper. Local ethics approval was obtained.

Results

Of the 185 survey respondents, 28% revealed that they are somewhat or very dissatisfied with the overall health care they received for their miscarriage. Thirty-nine percent of survey respondents are somewhat or very dissatisfied with how their mental/emotional health was addressed. Notably, 82% supported the development of a digital health tool for EPL care. Ninety-one percent of survey respondents use the internet to access health information.

Conclusions

Many participants reported dissatisfaction with their care after EPL but showed strong interest in a user-friendly digital tool that provides general information and mental health support. These findings, along with qualitative interview data, will guide the development and testing of the desired digital health tool, aiming to enhance patient experience and support after miscarriage.

目的：早期妊娠丢失（EPL）影响1 / 4的已确认妊娠，但往往缺乏以患者为中心的支持性护理。本研究评估了数字健康工具的可行性和接受度，以支持那些受EPL影响的人。目标是：1)了解流产妇女的经历，2)探索她们获取健康信息的方法，以及3)确定她们对数字工具内容和设计的偏好。方法：这项混合方法研究包括年龄在18-45岁的加拿大人，他们自我报告在过去两年内经历了妊娠126周的EPL。招聘是通过社交媒体和医院海报进行的。参与者在2021年9月至2022年4月期间完成了在线调查和可选的后续访谈。调查结果采用描述性统计进行分析。访谈结果在另一篇论文中提出。获得当地伦理审批。结果：在185名调查对象中，28%的人表示，他们对流产所获得的总体保健服务有些或非常不满意。39%的人对他们的心理/情绪健康问题有些或非常不满意。值得注意的是，82%的人支持为EPL护理开发数字健康工具。91%的人使用互联网获取健康信息。结论：许多参与者报告对EPL后的护理不满意，但对提供一般信息和心理健康支持的用户友好的数字工具表现出强烈的兴趣。这些发现以及定性访谈数据将指导所需数字健康工具的开发和测试，旨在增强流产后患者的体验和支持。

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引用次数: 0

Index des directives cliniques de la SOGC – 2024

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102747

引用次数: 0

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study 创新三维成像在复发性卵巢癌二次清宫手术术前评估中的应用：一项试点研究。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102714

Michael Lavie MD , Jumana Joubran MD , Amit Benady MD , Phillip Berman MA , Nadav Michaan MD , Dan Grisaru MD , Ido Laskov MD

Objective

The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation.

Methods

A retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups.

Results

Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05.

Conclusion

CT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

导言：复发性卵巢癌二次细胞减灭术（SCS）的疗效仍存在争议，因此必须制定周密的术前计划。虽然三维成像技术已经改变了各学科的手术方法，但在妇科肿瘤学中的应用却刚刚起步。本研究介绍了一项在 SCS 准备过程中采用术前 3D 建模的新调查：在一所大学附属三级医疗中心进行了一项回顾性分析，研究对象为 2017 年至 2022 年期间因复发性卵巢癌接受 SCS 治疗的患者。患者被分为两组：术前CT三维成像组（A组）和无CT三维成像组（B组）。对两组患者的人口统计学特征、临床数据和手术结果进行了比较：结果：在 76 名确定的患者中，18 人被认为适合手术，其中 A 组中有 7 人进行了术前三维建模。虽然手术指标和合作努力在统计学上没有显著差异，但与 B 组（54%）相比，A 组（100%）达到无残留疾病（R0）的最佳清除率要高得多，显著性水平为 P = 0.05：基于 CT 的三维建模在卵巢癌二次细胞减灭术的术前阶段显示出加强手术规划的潜力。虽然这项开创性的研究强调了将三维成像整合到妇科肿瘤学中的潜在益处，但这项回顾性研究的局限性意味着这些发现主要是假设性的。有必要开展进一步的前瞻性研究来验证其影响。

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引用次数: 0

Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour 子宫破裂的风险和结果在妇女有和没有试产。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102718

Ohad Houri MD , Or Bercovich MD , Avital Wertheimer MD , Alexandra Berezowsky MD , Gil Zeevi MD , Shir Danieli-Gruber MD , Eran Hadar MD

Objectives

The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.

Methods

A population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.

Results

Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, P = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, P < 0.01). There was no neonatal or maternal death in any group.

Conclusions

Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.

目的：本研究旨在评估子宫破裂患者的产妇和新生儿结局，比较那些进行了分娩试验的患者和那些没有进行分娩试验的患者。方法：2008 - 2019年在某高等院校医学中心进行人群回顾性研究。该队列包括所有在剖宫产（CD）或剖腹手术中被诊断为子宫破裂的妇女。曾经有过一次乳糜泻并经历过分娩试验的患者（TOLAC组）与有乳糜泻病史但没有分娩试验的患者和/或没有乳糜泻但在分娩过程中或分娩后诊断出子宫破裂的患者（no-TOLAC组）进行比较。排除子宫瘢痕裂开患者。结果：在研究期间分娩的103 542名妇女中，10 325名有既往CD。95例发生子宫破裂：55例接受TOLAC(0.98%)， 40例（0.85%）未进行分娩试验。与TOLAC组相比，未尝试TOLAC的单一既往CD妇女亚组（n = 16）新生儿重症监护病房住院率更高（56.3%比21.7%,OR 4.15, 95% CI 1.3-13.3, P = 0.01）和不良综合产妇结局（输血、膀胱损伤和/或重症监护病房住院）（75%比30.9%,OR 6.7, 95% CI 1.8-23.8, P < 0.01）。所有组均无新生儿或产妇死亡。结论：尽管TOLAC患者子宫破裂的发生率较高，但如果子宫破裂发生在分娩试验之外且子宫未损伤，则预后较差。

{"title":"Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour","authors":"Ohad Houri MD , Or Bercovich MD , Avital Wertheimer MD , Alexandra Berezowsky MD , Gil Zeevi MD , Shir Danieli-Gruber MD , Eran Hadar MD","doi":"10.1016/j.jogc.2024.102718","DOIUrl":"10.1016/j.jogc.2024.102718","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.</div></div><div><h3>Methods</h3><div>A population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.</div></div><div><h3>Results</h3><div>Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, <em>P</em> = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, <em>P</em> < 0.01). There was no neonatal or maternal death in any group.</div></div><div><h3>Conclusions</h3><div>Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102718"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752768","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}

引用次数: 0

Fertility Preservation and Infertility Treatment in Female Surgical Trainees in Alberta: A Survey of Trainee Knowledge, Attitudes, and Needs 艾伯塔省女性外科培训生的生育能力保存和不孕症治疗：对培训生知识、态度和需求的调查。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102731

Sylvie Bowden MD, Selphee Tang BSc, Amy Metcalfe PhD, Shu Foong MD

Objectives

This study aimed to describe fertility knowledge and views on family planning and fertility preservation/treatment among female surgical trainees in Alberta.

Methods

A voluntary, anonymous online survey was sent to surgical program coordinators in Alberta to forward to their respective trainees. Participants included surgical trainees from cardiac surgery, general surgery, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedics, otolaryngology, plastic surgery, urology, and vascular surgery. Questions assessed demographics, fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment. The primary outcome were the needs of trainees regarding fertility preservation/treatment. Secondary outcomes included fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment.

Results

The survey had a 71.8% response rate, with 125 responses analyzed. The median score for fertility knowledge was 3 out of 6. Most trainees (84.8%) were childless, with 68.0% citing career impact as a significant factor in delaying child-bearing. Career aspirations, training duration, and long work hours were identified as top factors impacting family planning. Only 3.2% had undergone oocyte cryopreservation, while 48.0% had considered it. Awareness of oocyte cryopreservation options and insurance coverage was low. During their training, 57.6% of trainees had received no counselling about family planning.

Conclusions

Female surgical trainees in Alberta face significant fertility concerns, exacerbated by gaps in fertility knowledge and career demands delaying child-bearing. There is strong interest in fertility preservation, but barriers include lack of awareness, financial constraints, and inadequate counselling. Enhanced education, counselling, insurance coverage, and supportive policies are needed to support trainees’ reproductive and career goals.

目的：了解艾伯塔省女性外科实习生的生育知识和对计划生育和生育保护/治疗的看法。方法：将一份自愿的匿名在线调查发送给艾伯塔省的外科项目协调员，并将其转发给各自的学员。参加者包括来自心脏外科、普通外科、神经外科、妇产科、眼科、骨科、耳鼻喉科、整形外科、泌尿外科和血管外科的外科学员。问题评估了人口统计、生育知识、生育史、计划生育观点和对生育保护/治疗的态度。主要结果是受训者对保存/治疗生育能力的需要。次要结局包括生育知识、生育史、计划生育观点和对生育保存/治疗的态度。结果：调查回复率为71.8%，共分析125份问卷。生育知识得分中位数为3/6。大多数学员（84.8%）没有孩子，其中68.0%认为职业影响是推迟生育的重要因素。职业抱负、培训时间和长工作时间被认为是影响计划生育的主要因素。接受卵母细胞冷冻保存的患者仅占3.2%，考虑冷冻保存的患者占48.0%。对卵母细胞冷冻保存选择和保险覆盖率的认识较低。57.6%的学员在培训期间未接受计划生育咨询。结论：艾伯塔省女性外科培训生面临严重的生育问题，生育知识差距和职业要求推迟生育加剧了这一问题。人们对保留生育能力有浓厚的兴趣，但障碍包括缺乏意识、经济限制和咨询不足。需要加强教育、咨询、保险覆盖面和支持性政策，以支持受训者的生殖和职业目标。

{"title":"Fertility Preservation and Infertility Treatment in Female Surgical Trainees in Alberta: A Survey of Trainee Knowledge, Attitudes, and Needs","authors":"Sylvie Bowden MD, Selphee Tang BSc, Amy Metcalfe PhD, Shu Foong MD","doi":"10.1016/j.jogc.2024.102731","DOIUrl":"10.1016/j.jogc.2024.102731","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe fertility knowledge and views on family planning and fertility preservation/treatment among female surgical trainees in Alberta.</div></div><div><h3>Methods</h3><div>A voluntary, anonymous online survey was sent to surgical program coordinators in Alberta to forward to their respective trainees. Participants included surgical trainees from cardiac surgery, general surgery, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedics, otolaryngology, plastic surgery, urology, and vascular surgery. Questions assessed demographics, fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment. The primary outcome were the needs of trainees regarding fertility preservation/treatment. Secondary outcomes included fertility knowledge, reproductive history, family planning views, and attitudes towards fertility preservation/treatment.</div></div><div><h3>Results</h3><div>The survey had a 71.8% response rate, with 125 responses analyzed. The median score for fertility knowledge was 3 out of 6. Most trainees (84.8%) were childless, with 68.0% citing career impact as a significant factor in delaying child-bearing. Career aspirations, training duration, and long work hours were identified as top factors impacting family planning. Only 3.2% had undergone oocyte cryopreservation, while 48.0% had considered it. Awareness of oocyte cryopreservation options and insurance coverage was low. During their training, 57.6% of trainees had received no counselling about family planning.</div></div><div><h3>Conclusions</h3><div>Female surgical trainees in Alberta face significant fertility concerns, exacerbated by gaps in fertility knowledge and career demands delaying child-bearing. There is strong interest in fertility preservation, but barriers include lack of awareness, financial constraints, and inadequate counselling. Enhanced education, counselling, insurance coverage, and supportive policies are needed to support trainees’ reproductive and career goals.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102731"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776256","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

Effect of Olanzapine on Hyperemesis Gravidarum in Individuals With Mood Disorders: A Case Series 奥氮平对情绪障碍患者妊娠剧吐的影响：一个病例系列。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102751

Verinder Sharma MBBS , Katelyn N. Wood PhD

This case series examines the effect of olanzapine on symptoms of hyperemesis gravidarum in individuals with mood disorders. Patient charts from 2022 to 2024 were reviewed, focusing on those with hyperemesis gravidarum who were treated with olanzapine alone or with other psychotropic drugs for their mood disorder. Of 6 patients with hyperemesis gravidarum, 3 had bipolar II disorder, and the others had major depressive disorder. Olanzapine was used alone in 3 cases. A daily dose of 2.5–5 mg was well tolerated and effective in all patients who had failed trials of conventional antiemetics. Thus, olanzapine may be a viable treatment for hyperemesis gravidarum in mood disorder patients unresponsive to standard antiemetics.

本病例系列探讨奥氮平对情绪障碍患者妊娠剧吐症状的影响。回顾了2022年至2024年的患者图表，重点关注那些因情绪障碍而单独使用奥氮平或其他精神药物治疗的妊娠剧吐患者。6例妊娠剧吐患者中，3例合并双相情感障碍，其余为重度抑郁障碍。单独使用奥氮平3例。在所有常规止吐药试验失败的患者中，每日2.5- 5mg的剂量耐受性良好且有效。因此，奥氮平可能是治疗对标准止吐药无反应的心境障碍患者妊娠剧吐的可行方法。

引用次数: 0

Test or No-Test: Comparison of Medication Abortion Outcomes and Adverse Events When Forgoing Ultrasound, Laboratory Testing, and Physical Examination 检查或不检查：放弃超声、实验室检查和体格检查时药物流产结局和不良事件的比较。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-01-01 DOI: 10.1016/j.jogc.2024.102730

Caitlin Hunter MD, CCFP , Maya Burck BA , Colleen Chambers MSc , Farhana Shawon MD , M. Ruth Lavergne PhD , Amanda Whitten MA, MD, CCFP , Mei-ling Wiedmeyer MD, CCFP, MSc

Objectives

This study aimed to compare demographics and clinical outcomes between patients who did not undergo investigations and those who underwent investigations before receiving a prescription for medication abortion (MA) during the first 6 months of the COVID-19 pandemic. Outcomes include success rates, adverse events, pathways to completion, and loss to follow-up rates.

Methods

We conducted a retrospective medical record review of 1452 patients presenting for MA between 23 March 2020 and 30 September 2020. Descriptive statistics, 2 × 2 chi-square tests, and Fisher exact tests were used to compare characteristics and outcomes between groups.

Results

Of the 1307 patients who received a prescription, 895 (68.5%) were in the no-test group and 412 (31.5%) were in the test group. The success rate was 95.2%, with no significant difference between groups (94.0% and 95.8%, P = 0.194). Rates of adverse events were low, with 28 patients presenting for emergency department visits (2.1%), 62 having clinically significant retained products of conception (4.7%), 5 with heavy bleeding requiring treatment (0.4%), 16 with ongoing pregnancy (1.2%), and 3 requiring ectopic pregnancy management (0.2%). Completion of abortion was verified in 1034 patients (80.5%), and the loss to follow-up rate was 22.6%, with no difference between the groups (82.1% vs. 79.8%, P = 0.341; and 21.4% vs. 23.1%, P = 0.477; respectively).

Conclusions

We found that clinical outcomes were consistent across the 2 groups, with high success rates and low adverse event rates. Our study contributes to the growing body of evidence that allows for individualized care implementing selective use of low- and no-test MA protocols.

目的：比较COVID-19大流行前6个月未接受调查的患者与接受药物流产（MA）处方前接受调查的患者的人口统计学和临床结果。结果包括成功率、不良事件、完成途径和失访率。方法：我们对2020年3月23日至2020年9月30日期间出现MA的1452例患者进行了回顾性图表回顾。描述性统计、2×2卡方检验和Fisher精确检验用于组间特征和结果的比较。结果：1307例处方患者中，未试验组895例（68.5%），试验组412例（31.5%）。成功率为95.2%，两组间差异无统计学意义（94.0%,95.8%,P = 0.194）。不良事件发生率较低，有28例患者就诊于急诊室（2.1%），62例有临床意义的妊娠残留（4.7%），5例需要治疗的大出血（0.4%），16例正在妊娠（1.2%），3例需要异位处理（0.2%）。流产完成1034例（80.5%），失访率为22.6%，两组间差异无统计学意义（82.1%∶79.8%,P = 0.341; 21.4%∶23.1%,P = 0.477）。结论：我们发现两组临床结果一致，成功率高，不良事件发生率低。我们的研究为个性化护理提供了越来越多的证据，这些证据可以选择性地使用低测试和无测试的MA协议。

{"title":"Test or No-Test: Comparison of Medication Abortion Outcomes and Adverse Events When Forgoing Ultrasound, Laboratory Testing, and Physical Examination","authors":"Caitlin Hunter MD, CCFP , Maya Burck BA , Colleen Chambers MSc , Farhana Shawon MD , M. Ruth Lavergne PhD , Amanda Whitten MA, MD, CCFP , Mei-ling Wiedmeyer MD, CCFP, MSc","doi":"10.1016/j.jogc.2024.102730","DOIUrl":"10.1016/j.jogc.2024.102730","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare demographics and clinical outcomes between patients who did not undergo investigations and those who underwent investigations before receiving a prescription for medication abortion (MA) during the first 6 months of the COVID-19 pandemic. Outcomes include success rates, adverse events, pathways to completion, and loss to follow-up rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective medical record review of 1452 patients presenting for MA between 23 March 2020 and 30 September 2020. Descriptive statistics, 2 × 2 chi-square tests, and Fisher exact tests were used to compare characteristics and outcomes between groups.</div></div><div><h3>Results</h3><div>Of the 1307 patients who received a prescription, 895 (68.5%) were in the no-test group and 412 (31.5%) were in the test group. The success rate was 95.2%, with no significant difference between groups (94.0% and 95.8%, <em>P</em> = 0.194). Rates of adverse events were low, with 28 patients presenting for emergency department visits (2.1%), 62 having clinically significant retained products of conception (4.7%), 5 with heavy bleeding requiring treatment (0.4%), 16 with ongoing pregnancy (1.2%), and 3 requiring ectopic pregnancy management (0.2%). Completion of abortion was verified in 1034 patients (80.5%), and the loss to follow-up rate was 22.6%, with no difference between the groups (82.1% vs. 79.8%, <em>P</em> = 0.341; and 21.4% vs. 23.1%, <em>P</em> = 0.477; respectively).</div></div><div><h3>Conclusions</h3><div>We found that clinical outcomes were consistent across the 2 groups, with high success rates and low adverse event rates. Our study contributes to the growing body of evidence that allows for individualized care implementing selective use of low- and no-test MA protocols.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 1","pages":"Article 102730"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776257","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