Pub Date : 2025-10-23DOI: 10.1016/j.jogc.2025.103159
Maria P. Velez MD, PhD , Kensie Treacy BSc , Jonas Shellenberger MSc , Joel G. Ray MD, MSc
This population-based study evaluated the association between SARS-CoV-2 vaccination and disorders of menstruation among all women in Ontario aged 18–44 years. Study exposure was receipt of a first dose of any SARS-CoV-2 vaccine from December 2021 to December 2022, handled in a time-varying manner. The outcome was an incident diagnosis of a disorder of menstruation, defined as 2 medical encounters billed as International Classification of Diseases, Ninth Revision diagnosis code 626 up to December 2023. Included were 2 114 589 women, of whom 44.7% were vaccinated against SARS-CoV-2. Disorders of menstruation occurred at a rate of 15.9 per 1000 person-years among vaccinated women, in contrast to a rate of 26.4 per 1000 person-years among unvaccinated women (adjusted rate ratio 0.60; 95% CI 0.59–0.60), supporting a lack of association between SARS-CoV-2 vaccination and an increased risk of disorders of menstruation.
这项基于人群的研究评估了安大略省所有18-44岁女性接种SARS-CoV-2疫苗与月经紊乱之间的关系。研究暴露是指在2021年12月至2022年12月期间以随时间变化的方式接种任何SARS-CoV-2疫苗的第一剂。结果是对月经紊乱的意外诊断，定义为截至2023年12月的两次医疗就诊，编号为ICD9-626。包括2 114 589名妇女，其中44.7%接种了SARS-CoV-2疫苗。在接种疫苗的妇女中，月经紊乱的发生率为每1000人年15.9例，而未接种疫苗的妇女为每1000人年26.4例（aRR 0.60; 95% CI 0.59至0.60），支持SARS-CoV-2疫苗接种与月经紊乱风险增加之间缺乏关联。
{"title":"SARS-CoV-2 Vaccination and Disorders of Menstruation: A Population-Based Cohort Study","authors":"Maria P. Velez MD, PhD , Kensie Treacy BSc , Jonas Shellenberger MSc , Joel G. Ray MD, MSc","doi":"10.1016/j.jogc.2025.103159","DOIUrl":"10.1016/j.jogc.2025.103159","url":null,"abstract":"<div><div>This population-based study evaluated the association between SARS-CoV-2 vaccination and disorders of menstruation among all women in Ontario aged 18–44 years. Study exposure was receipt of a first dose of any SARS-CoV-2 vaccine from December 2021 to December 2022, handled in a time-varying manner. The outcome was an incident diagnosis of a disorder of menstruation, defined as 2 medical encounters billed as International Classification of Diseases, Ninth Revision diagnosis code 626 up to December 2023. Included were 2 114 589 women, of whom 44.7% were vaccinated against SARS-CoV-2. Disorders of menstruation occurred at a rate of 15.9 per 1000 person-years among vaccinated women, in contrast to a rate of 26.4 per 1000 person-years among unvaccinated women (adjusted rate ratio 0.60; 95% CI 0.59–0.60), supporting a lack of association between SARS-CoV-2 vaccination and an increased risk of disorders of menstruation.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103159"},"PeriodicalIF":2.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370582","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 : 2025-10-23DOI: 10.1016/j.jogc.2025.103156
Yanjun Ge MBBS , Xintao Wang MSc , Yuchen Zhang MSc , Luzan Ma MBBS , Wei Jin MBBS , Haiyan Zhu PhD , Dewen Yan MBBS
Objectives
This study aims to assess the efficacy of total hysterectomy versus radical hysterectomy in the treatment of gastric-type endocervical adenocarcinoma (GEA).
Methods
Patients diagnosed with GEA from 2001 to 2021 were derived from the Surveillance, Epidemiology, and End Results database. Clinicodemographic characteristics, tumour clinicopathological features, and survival outcomes (including vital status and duration of follow-up) of these patients were collected. Kaplan-Meier survival curves were generated to estimate survival probabilities, with between-group differences assessed using log-rank tests for statistical significance.
Results
Overall, 114 patients undergoing total hysterectomy, and 129 patients undergoing radical hysterectomy were included for survival analysis. No statistically significant differences in overall survival (OS) were observed between surgical approaches, either in the entire cohort (P = 0.0594) or the International Federation of Gynecology and Obstetrics stage I–IIA subcohort (P = 0.0777). Adjuvant therapy (radiotherapy and/or chemotherapy) was administered to 52.6% (60/114) of patients in the total hysterectomy group and 42.6% (55/129) in the radical hysterectomy group. However, there was no statistically significant difference in OS between the total hysterectomy and radical hysterectomy groups among patients who received adjuvant therapy, and similar results were also found in the subgroup of patients with International Federation of Gynecology and Obstetrics stage Ⅰ–ⅡA disease. Notably, adjuvant therapies failed to demonstrate significant OS benefits in either surgical group for stage I-IIA disease.
Conclusions
Total hysterectomy demonstrated comparable survival outcomes to radical hysterectomy in patients with GEA. These findings suggest that less extensive surgery may represent a viable treatment alternative for early-stage disease.
{"title":"Comparative Survival Outcomes of Total Hysterectomy Versus Radical Hysterectomy in Gastric-Type Endocervical Adenocarcinoma: A SEER Database Analysis","authors":"Yanjun Ge MBBS , Xintao Wang MSc , Yuchen Zhang MSc , Luzan Ma MBBS , Wei Jin MBBS , Haiyan Zhu PhD , Dewen Yan MBBS","doi":"10.1016/j.jogc.2025.103156","DOIUrl":"10.1016/j.jogc.2025.103156","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess the efficacy of total hysterectomy versus radical hysterectomy in the treatment of gastric-type endocervical adenocarcinoma (GEA).</div></div><div><h3>Methods</h3><div>Patients diagnosed with GEA from 2001 to 2021 were derived from the Surveillance, Epidemiology, and End Results database. Clinicodemographic characteristics, tumour clinicopathological features, and survival outcomes (including vital status and duration of follow-up) of these patients were collected. Kaplan-Meier survival curves were generated to estimate survival probabilities, with between-group differences assessed using log-rank tests for statistical significance.</div></div><div><h3>Results</h3><div>Overall, 114 patients undergoing total hysterectomy, and 129 patients undergoing radical hysterectomy were included for survival analysis. No statistically significant differences in overall survival (OS) were observed between surgical approaches, either in the entire cohort (<em>P</em> = 0.0594) or the International Federation of Gynecology and Obstetrics stage I–IIA subcohort (<em>P</em> = 0.0777). Adjuvant therapy (radiotherapy and/or chemotherapy) was administered to 52.6% (60/114) of patients in the total hysterectomy group and 42.6% (55/129) in the radical hysterectomy group. However, there was no statistically significant difference in OS between the total hysterectomy and radical hysterectomy groups among patients who received adjuvant therapy, and similar results were also found in the subgroup of patients with International Federation of Gynecology and Obstetrics stage Ⅰ–ⅡA disease. Notably, adjuvant therapies failed to demonstrate significant OS benefits in either surgical group for stage I-IIA disease.</div></div><div><h3>Conclusions</h3><div>Total hysterectomy demonstrated comparable survival outcomes to radical hysterectomy in patients with GEA. These findings suggest that less extensive surgery may represent a viable treatment alternative for early-stage disease.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 3","pages":"Article 103156"},"PeriodicalIF":2.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370560","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}
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally. Although endothelial dysfunction and vascular alterations in preeclampsia may increase PPH risk, this association lacks robust synthesis. We conducted a systematic review and meta-analysis to quantify the impact of preeclampsia on PPH.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed observational studies (case-control/cohort) assessing PPH as the primary outcome. Subgroup analyses examined delivery mode and geographic region. Risk of bias was evaluated using the Newcastle-Ottawa Scale (International Prospective Register of Systematic Reviews - PROSPERO: CRD42023441579).
Results
Twelve studies (7 case-control, 5 retrospective cohorts) comprising 2 102 987 pregnancies (61 139 preeclampsia cases) were included. Preeclampsia significantly increased PPH risk (OR 1.95; 95% CI 1.70–2.23). Geographic subgroup analyses revealed highest risk in Europe (OR 2.18; 95% CI 1.67–2.14), followed by America (OR 1.95; 95% CI 1.50–2.55) and Asia (OR 1.67; 95% CI 1.28–2.18). High heterogeneity (I2 = 67.5%) reflected methodologic variations. Evidence certainty was moderate (Grading of Recommendations Assessment, Development, and Evaluation); some studies indicated bias from unadjusted confounders.
Conclusions
Preeclampsia is associated with a near-doubling of PPH risk (moderate-certainty evidence). Clinical protocols should consider preeclampsia as a significant risk factor for PPH, warranting increased vigilance during delivery and the postpartum period.
目的：产后出血（PPH）仍然是全球孕产妇死亡的主要原因。虽然子痫前期的内皮功能障碍和血管改变可能增加PPH风险，但这种关联缺乏强有力的综合。我们进行了系统回顾和荟萃分析，以量化子痫前期对PPH的影响。方法：遵循PRISMA指南，我们分析观察性研究（病例对照/队列），评估PPH为主要结局。分组分析考察了交付方式和地理区域。偏倚风险采用纽卡斯尔-渥太华量表进行评估。(普洛斯彼罗:CRD42023441579)。结果：纳入12项研究（7个病例对照，5个回顾性队列），包括2102 987例妊娠（61 139例先兆子痫）。子痫前期显著增加PPH风险（OR 1.95; 95% CI 1.70-2.23）。地理亚组分析显示欧洲的风险最高（OR 2.18; 95% CI 1.67-2.14），其次是美洲（OR 1.95; 95% CI 1.50-2.55）和亚洲（OR 1.67; 95% CI 1.28-2.18）。高异质性（I2 = 67.5%）反映了方法的差异。证据确定性为中等（GRADE）；一些研究显示了未调整混杂因素的偏倚。结论：子痫前期与PPH风险增加近一倍相关（中等确定性证据）。临床方案应考虑先兆子痫作为PPH的一个重要危险因素，保证在分娩和产后期间提高警惕。
{"title":"Preeclampsia as a Risk Factor for Postpartum Hemorrhage: A Systematic Review and Meta-Analysis","authors":"Natalia Valeri Gallardo Cerna MD , Nayely Marisol Jara Huapaya MD , Wilfor Aguirre Quispe MSc, MD","doi":"10.1016/j.jogc.2025.103157","DOIUrl":"10.1016/j.jogc.2025.103157","url":null,"abstract":"<div><h3>Objectives</h3><div>Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally. Although endothelial dysfunction and vascular alterations in preeclampsia may increase PPH risk, this association lacks robust synthesis. We conducted a systematic review and meta-analysis to quantify the impact of preeclampsia on PPH.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed observational studies (case-control/cohort) assessing PPH as the primary outcome. Subgroup analyses examined delivery mode and geographic region. Risk of bias was evaluated using the Newcastle-Ottawa Scale (International Prospective Register of Systematic Reviews - PROSPERO: CRD42023441579).</div></div><div><h3>Results</h3><div>Twelve studies (7 case-control, 5 retrospective cohorts) comprising 2 102 987 pregnancies (61 139 preeclampsia cases) were included. Preeclampsia significantly increased PPH risk (OR 1.95; 95% CI 1.70–2.23). Geographic subgroup analyses revealed highest risk in Europe (OR 2.18; 95% CI 1.67–2.14), followed by America (OR 1.95; 95% CI 1.50–2.55) and Asia (OR 1.67; 95% CI 1.28–2.18). High heterogeneity (I<sup>2</sup> = 67.5%) reflected methodologic variations. Evidence certainty was moderate (Grading of Recommendations Assessment, Development, and Evaluation); some studies indicated bias from unadjusted confounders.</div></div><div><h3>Conclusions</h3><div>Preeclampsia is associated with a near-doubling of PPH risk (moderate-certainty evidence). Clinical protocols should consider preeclampsia as a significant risk factor for PPH, warranting increased vigilance during delivery and the postpartum period.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103157"},"PeriodicalIF":2.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370583","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 : 2025-10-23DOI: 10.1016/j.jogc.2025.103155
Nati Bor MD , Itay Hazan MD , Ronny Ram Biton MD , Ido Givon MD , Ran Matot MD , Lior Friedrich MD , Gil Zeevi MD , Haim Krissi MD
Objectives
This study aimed to compare the clinical course, management, and outcomes of women diagnosed with endometritis following delivery or abortion, with and without retained products of conception (RPOC).
Methods
A retrospective cohort study was conducted at a single tertiary medical centre between 2012 and 2023. Women admitted with a diagnosis of endometritis or pelvic inflammatory disease following delivery or abortion were identified and divided into 2 groups based on the presence or absence of RPOC. Clinical presentation, laboratory results, antibiotic treatment, need for surgical intervention, and severe complications were compared between groups.
Results
A total of 341 women were included, of whom 32 (9.4%) had RPOC. Baseline laboratory values did not differ significantly between groups. Most patients responded well to empiric antibiotic therapy, and modification of the antibiotic regimen was rare in both groups (0% in RPOC vs. 6.5% in non-RPOC, P = 0.2). Surgical interventions were significantly more frequent in the RPOC group (49% vs. 5.2%, P < 0.001), while severe complications such as intensive care unit admission, sepsis, and hysterectomy were rare in both groups.
Conclusions
Endometritis with RPOC does not necessarily follow a more severe course than endometritis alone. Most patients, regardless of RPOC status, improved with antibiotics alone. These findings support an individualized approach, wherein clinical stability may allow for conservative management of suspected infected RPOC.
目的：比较分娩或流产后诊断为子宫内膜炎的妇女的临床过程、处理和结局，有和没有保留妊娠产物（RPOC）。研究设计：2012年至2023年在单一三级医疗中心进行回顾性队列研究。分娩或流产后被诊断为子宫内膜炎或盆腔炎的妇女被确定并根据是否存在RPOC分为两组。比较两组患者的临床表现、实验室结果、抗生素治疗、手术干预需求和严重并发症。结果：共纳入341例妇女，其中32例（9.4%）有RPOC。试验室基线值在两组间无显著差异。大多数患者对经经性抗生素治疗反应良好，两组患者很少对抗生素方案进行修改（RPOC患者为0%，非RPOC患者为6.5%,P = 0.2）。RPOC组的手术干预明显更频繁（49% vs. 5.2%, P < 0.001），而重症监护病房入院、脓毒症或子宫切除术等严重并发症在两组中都很少见。结论：子宫内膜炎合并RPOC并不一定比单独的子宫内膜炎更严重。大多数患者，无论RPOC状态如何，单独使用抗生素均可改善。这些发现支持个体化治疗方法，其中临床稳定性可能允许对疑似感染的RPOC进行保守治疗。
{"title":"Endometritis Following Pregnancy: A Comparative Cohort Study of Cases With and Without RPOC","authors":"Nati Bor MD , Itay Hazan MD , Ronny Ram Biton MD , Ido Givon MD , Ran Matot MD , Lior Friedrich MD , Gil Zeevi MD , Haim Krissi MD","doi":"10.1016/j.jogc.2025.103155","DOIUrl":"10.1016/j.jogc.2025.103155","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare the clinical course, management, and outcomes of women diagnosed with endometritis following delivery or abortion, with and without retained products of conception (RPOC).</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at a single tertiary medical centre between 2012 and 2023. Women admitted with a diagnosis of endometritis or pelvic inflammatory disease following delivery or abortion were identified and divided into 2 groups based on the presence or absence of RPOC. Clinical presentation, laboratory results, antibiotic treatment, need for surgical intervention, and severe complications were compared between groups.</div></div><div><h3>Results</h3><div>A total of 341 women were included, of whom 32 (9.4%) had RPOC. Baseline laboratory values did not differ significantly between groups. Most patients responded well to empiric antibiotic therapy, and modification of the antibiotic regimen was rare in both groups (0% in RPOC vs. 6.5% in non-RPOC, <em>P</em> = 0.2). Surgical interventions were significantly more frequent in the RPOC group (49% vs. 5.2%, <em>P</em> < 0.001), while severe complications such as intensive care unit admission, sepsis, and hysterectomy were rare in both groups.</div></div><div><h3>Conclusions</h3><div>Endometritis with RPOC does not necessarily follow a more severe course than endometritis alone. Most patients, regardless of RPOC status, improved with antibiotics alone. These findings support an individualized approach, wherein clinical stability may allow for conservative management of suspected infected RPOC.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103155"},"PeriodicalIF":2.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370589","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 : 2025-10-22DOI: 10.1016/j.jogc.2025.103148
Claire Ann Jones MD , Catherine Friedman MD, HBSc, BScN , Leslie Po MD, MSc , Karen Born MSc, PhD , Heather Shapiro MD , Geetha Mukerji MD, MSc
Obstetrics and Gynaecology residents were randomized into 1 of 2 novel resource stewardship curriculum workshops. Surveys elicited skill, comfort, and clinical behaviours around resource stewardship. Communication skills on resource use were evaluated in an Objective Structured Clinical Exam. The curriculum was favourably rated (4.2 of 5) and clinical behaviours around select resource use issues improved. Skill and comfort were not significantly changed, but there was a trend toward improved Objective Structured Clinical Exam scores in residents attending the communication workshop. Favourable ratings and improved behaviour support inclusion of resource stewardship curricula in Obstetrics and Gynaecology residency programs.
{"title":"Evaluation of a Novel Resource Stewardship Curriculum for Residents in Obstetrics and Gynaecology","authors":"Claire Ann Jones MD , Catherine Friedman MD, HBSc, BScN , Leslie Po MD, MSc , Karen Born MSc, PhD , Heather Shapiro MD , Geetha Mukerji MD, MSc","doi":"10.1016/j.jogc.2025.103148","DOIUrl":"10.1016/j.jogc.2025.103148","url":null,"abstract":"<div><div>Obstetrics and Gynaecology residents were randomized into 1 of 2 novel resource stewardship curriculum workshops. Surveys elicited skill, comfort, and clinical behaviours around resource stewardship. Communication skills on resource use were evaluated in an Objective Structured Clinical Exam. The curriculum was favourably rated (4.2 of 5) and clinical behaviours around select resource use issues improved. Skill and comfort were not significantly changed, but there was a trend toward improved Objective Structured Clinical Exam scores in residents attending the communication workshop. Favourable ratings and improved behaviour support inclusion of resource stewardship curricula in Obstetrics and Gynaecology residency programs.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103148"},"PeriodicalIF":2.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369370","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 : 2025-10-09DOI: 10.1016/j.jogc.2025.103145
Anat From MD , Manek Hirva MD , Gali Zaltsberg Shapira MD , Nick Barrowman PhD , Anne Tsampalieros MD, PhD , Nathalie Fleming MD , Tania Dumont MD
Objectives
To investigate the association between para-tubal cysts, adnexal torsion, and obesity in female adolescents. Para-tubal cysts, often misdiagnosed as ovarian cysts, may be androgen-sensitive and are of growing clinical concern in relation to obesity and adnexal torsion in adolescents. However, their associations remain underexplored.
Methods
Retrospective cohort study of female patients aged 2–18 years who underwent surgery for suspected benign adnexal lesions at a tertiary-level paediatric hospital between 2018 and 2024. Data on demographics, BMI, cyst characteristics, surgical outcomes, and androgen profile were collected. Obesity was defined as a BMI or weight >95th percentile, using weight alone when BMI was unavailable.
Results
There were 124 patients included, median age 15 years, of whom 43 (34.7%) had para-tubal cysts. Thirty-seven patients (30%) had obesity. Obesity was significantly associated with para-tubal cysts (P = 0.002), with a relative risk of 2.2 (95% CI 1.4–3.5). In patients with a para-tubal cyst, a positive correlation was found between para-tubal cyst volume and BMI z-score (rho = 0.46, P = 0.007).
Para-tubal cysts were also associated with adnexal torsion (P < 0.001), with a relative risk of 2.4 (95% CI 1.6–3.6) compared to ovarian cysts, and this association remained significant even when restricting ovarian cysts to those of dermoid subtype, which are traditionally considered to be the primary cause of adnexal torsion in the paediatric literature.
Conclusions
Para-tubal cysts are more common in adolescents with obesity and are strongly associated with adnexal torsion. This highlights the need for heightened awareness and careful evaluation of para-tubal cysts in patients with obesity to prevent complications like adnexal torsion.
背景：输卵管旁囊肿常被误诊为卵巢囊肿，可能是雄激素敏感的，与青少年肥胖和附件扭转有关，越来越受到临床关注。然而，它们之间的联系仍未得到充分探讨。目的：探讨青春期女性输卵管旁囊肿、附件扭转与肥胖的关系。方法：回顾性队列研究2018 - 2024年在某三级儿科医院因疑似良性附件病变接受手术的2-18岁女性患者。收集了人口统计学、身体质量指数（BMI）、囊肿特征、手术结果和雄激素谱的数据。肥胖被定义为体重指数或体重bb0的第95个百分位数，在无法获得体重指数时仅使用体重。结果：纳入124例患者，中位年龄15岁，其中43例（34.7%）为输卵管旁囊肿。37例（30%）有肥胖。肥胖与输卵管旁囊肿显著相关（P = 0.002），相对危险度为2.2 （95% CI 1.4, 3.5）。输卵管旁囊肿患者的输卵管旁囊肿体积与BMI z-score呈正相关（rho = 0.46, P = 0.007）。输卵管旁囊肿也与附件扭转相关（P < 0.001），与卵巢囊肿相比，其相对风险为2.4 (95% CI 1.6, 3.6)，即使将卵巢囊肿限制为皮样亚型，这种相关性仍然显著，皮样亚型在儿科文献中被传统认为是附件扭转的主要原因。结论：输卵管旁囊肿在肥胖青少年中更为常见，且与附件扭转密切相关。这突出了肥胖患者需要提高对输卵管旁囊肿的认识和仔细评估，以防止附件扭转等并发症。
{"title":"Para-Tubal Cysts and Their Associations With Adnexal Torsion and Obesity","authors":"Anat From MD , Manek Hirva MD , Gali Zaltsberg Shapira MD , Nick Barrowman PhD , Anne Tsampalieros MD, PhD , Nathalie Fleming MD , Tania Dumont MD","doi":"10.1016/j.jogc.2025.103145","DOIUrl":"10.1016/j.jogc.2025.103145","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the association between para-tubal cysts, adnexal torsion, and obesity in female adolescents. Para-tubal cysts, often misdiagnosed as ovarian cysts, may be androgen-sensitive and are of growing clinical concern in relation to obesity and adnexal torsion in adolescents. However, their associations remain underexplored.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of female patients aged 2–18 years who underwent surgery for suspected benign adnexal lesions at a tertiary-level paediatric hospital between 2018 and 2024. Data on demographics, BMI, cyst characteristics, surgical outcomes, and androgen profile were collected. Obesity was defined as a BMI or weight >95th percentile, using weight alone when BMI was unavailable.</div></div><div><h3>Results</h3><div>There were 124 patients included, median age 15 years, of whom 43 (34.7%) had para-tubal cysts. Thirty-seven patients (30%) had obesity. Obesity was significantly associated with para-tubal cysts (<em>P</em> = 0.002), with a relative risk of 2.2 (95% CI 1.4–3.5). In patients with a para-tubal cyst, a positive correlation was found between para-tubal cyst volume and BMI z-score (rho = 0.46, <em>P</em> = 0.007).</div><div>Para-tubal cysts were also associated with adnexal torsion (<em>P</em> < 0.001), with a relative risk of 2.4 (95% CI 1.6–3.6) compared to ovarian cysts, and this association remained significant even when restricting ovarian cysts to those of dermoid subtype, which are traditionally considered to be the primary cause of adnexal torsion in the paediatric literature.</div></div><div><h3>Conclusions</h3><div>Para-tubal cysts are more common in adolescents with obesity and are strongly associated with adnexal torsion. This highlights the need for heightened awareness and careful evaluation of para-tubal cysts in patients with obesity to prevent complications like adnexal torsion.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103145"},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260467","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 : 2025-10-01DOI: 10.1016/j.jogc.2025.103143
Lacey Brennan MD, MBE, Emmanuel Bujold M.D., M.Sc., Sarah Maheux-Lacroix MD, PhD, Ari P. Sanders MD, MSc, Mohamed A. Bedaiwy MD, PhD, Ally Murji docteur en médecine, titulaire d'une maîtrise en santé publique
<div><h3>Objective</h3><div>This consensus statement aims to guide clinicians in the diagnosis, management and prevention of cesarean scar niche.</div></div><div><h3>Target Population</h3><div>Patients undergoing cesarean delivery or patients with cesarean scar disorder.</div></div><div><h3>Options</h3><div>Options for management include expectant, medical and surgical management. These will depend on symptoms, residual myometrial thickness, and future fertility plans.</div></div><div><h3>Outcomes</h3><div>Outcomes include resolution of symptoms, repair of defect and subsequent successful pregnancy.</div></div><div><h3>Benefits, Harms, and Costs</h3><div>This guideline aims to benefit patients undergoing cesarean delivery or those suffering from cesarean scar disorder and to offer healthcare providers an evidence-based approach to the prevention, diagnosis and management of cesarean scar defects.</div></div><div><h3>Evidence</h3><div>Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified between January 1<sup>st</sup>, 2005 and April 30<sup>th</sup>, 2025 using the search terms “cesarean scar niche”, “cesarean scar defect”, and “isthmocele”. Results were restricted to studies written in English.</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 <span><span>Appendix A</span></span>.</div></div><div><h3>Intended Audience</h3><div>All health care providers who perform cesarean delivery or who care for patients who have previously undergone a cesarean delivery and may be experiencing symptoms of cesarean scar disorder, including obstetrician gynaecologists, family physicians, registered nurses, nurse practitioners and radiologists.</div></div><div><h3>Tweetable Abstract</h3><div>Cesarean scar niche is a common consequence of cesarean delivery. Symptomatic patients suffering from cesarean scar disorder can be treated expectantly or with medical or surgical options. Asymptomatic patients do not require treatment.</div></div><div><h3>SUMMARY STATEMENTS</h3><div><ul><li><span>1.</span><span><div>Cesarean scar niches are common in patients who have had a cesarean delivery, with most being asymptomatic (<em>high</em>), but there are few studies that allow for a comprehensive understanding of the epidemiology of this common problem (<em>high</em>).</div></span></li><li><span>2.</span><span><div>Cesarean scar niche is defined as a myometrial indentation at the site of a previous cesarean hysterotomy, with a depth of at least 2 mm, as measured by transvaginal ultrasound at least 3 months following cesarean delivery (<em>moderate</em>).</div></span></li><li><span>3.</span><span><div>Abnormal uterine bleeding, specifically prolonged menstrual duration and early
{"title":"Clinical Consensus No. 463: Diagnosis and Management of Cesarean Scar Niche","authors":"Lacey Brennan MD, MBE, Emmanuel Bujold M.D., M.Sc., Sarah Maheux-Lacroix MD, PhD, Ari P. Sanders MD, MSc, Mohamed A. Bedaiwy MD, PhD, Ally Murji docteur en médecine, titulaire d'une maîtrise en santé publique","doi":"10.1016/j.jogc.2025.103143","DOIUrl":"10.1016/j.jogc.2025.103143","url":null,"abstract":"<div><h3>Objective</h3><div>This consensus statement aims to guide clinicians in the diagnosis, management and prevention of cesarean scar niche.</div></div><div><h3>Target Population</h3><div>Patients undergoing cesarean delivery or patients with cesarean scar disorder.</div></div><div><h3>Options</h3><div>Options for management include expectant, medical and surgical management. These will depend on symptoms, residual myometrial thickness, and future fertility plans.</div></div><div><h3>Outcomes</h3><div>Outcomes include resolution of symptoms, repair of defect and subsequent successful pregnancy.</div></div><div><h3>Benefits, Harms, and Costs</h3><div>This guideline aims to benefit patients undergoing cesarean delivery or those suffering from cesarean scar disorder and to offer healthcare providers an evidence-based approach to the prevention, diagnosis and management of cesarean scar defects.</div></div><div><h3>Evidence</h3><div>Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified between January 1<sup>st</sup>, 2005 and April 30<sup>th</sup>, 2025 using the search terms “cesarean scar niche”, “cesarean scar defect”, and “isthmocele”. Results were restricted to studies written in English.</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 <span><span>Appendix A</span></span>.</div></div><div><h3>Intended Audience</h3><div>All health care providers who perform cesarean delivery or who care for patients who have previously undergone a cesarean delivery and may be experiencing symptoms of cesarean scar disorder, including obstetrician gynaecologists, family physicians, registered nurses, nurse practitioners and radiologists.</div></div><div><h3>Tweetable Abstract</h3><div>Cesarean scar niche is a common consequence of cesarean delivery. Symptomatic patients suffering from cesarean scar disorder can be treated expectantly or with medical or surgical options. Asymptomatic patients do not require treatment.</div></div><div><h3>SUMMARY STATEMENTS</h3><div><ul><li><span>1.</span><span><div>Cesarean scar niches are common in patients who have had a cesarean delivery, with most being asymptomatic (<em>high</em>), but there are few studies that allow for a comprehensive understanding of the epidemiology of this common problem (<em>high</em>).</div></span></li><li><span>2.</span><span><div>Cesarean scar niche is defined as a myometrial indentation at the site of a previous cesarean hysterotomy, with a depth of at least 2 mm, as measured by transvaginal ultrasound at least 3 months following cesarean delivery (<em>moderate</em>).</div></span></li><li><span>3.</span><span><div>Abnormal uterine bleeding, specifically prolonged menstrual duration and early","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103143"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215518","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 : 2025-10-01DOI: 10.1016/j.jogc.2025.103079
Lani Lieberman MD , Gwen Clarke MD
{"title":"Canadian Consensus for Prenatal, Postnatal, and Neonatal Immunohematology Testing: A Need for Improved Guidance","authors":"Lani Lieberman MD , Gwen Clarke MD","doi":"10.1016/j.jogc.2025.103079","DOIUrl":"10.1016/j.jogc.2025.103079","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103079"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415868","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 : 2025-10-01DOI: 10.1016/j.jogc.2025.103030
Sylvie Bowden MD
{"title":"Fertility Care for Trainees: The Need for National Policy and Transparent Institutional Support","authors":"Sylvie Bowden MD","doi":"10.1016/j.jogc.2025.103030","DOIUrl":"10.1016/j.jogc.2025.103030","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 10","pages":"Article 103030"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602695","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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