Journal of obstetrics and gynaecology Canada最新文献

英文中文

National Consensus Statements for the Prevention of Maternal Rhesus D Alloimmunization and Management of Alloimmunized Pregnancies: A Modified Delphi Process 预防母恒河猴（RhD）同种异体免疫和管理同种异体免疫妊娠的全国共识声明：一个改进的德尔菲过程。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103113

Nancy Robitaille MD , Lani Lieberman MD , Gwen Clarke MD , Jon Barrett MD, MBBch , Barbra De Vrijer MD , Heather A. Hume MD , Edwin Massey MB, ChB , Nan Okun MD, MHsc , Catherine Taillefer MD , David Somerset BM, DM , Evangelia Vlachodimitropoulou MBBS, BSc, PhD , Karen Fung-Kee-Fung MD, MHPE

Objectives

National stakeholders developed guidance statements regarding controversial aspects of perinatal testing and management of pregnancies at risk of or affected by alloimmunization. The objective was to create national, standardized recommendations to guide testing practices, reduce unnecessary testing, optimize resources, and improve patient care.

Methods

A total of 46 multidisciplinary Canadian experts participated in an iterative Delphi process to reach consensus on 47 practices regarding all aspects of screening and management of pregnant persons at risk of alloimmunization. The panel rated their agreement on a 5-point Likert scale. After each round, panellists voted again on the statements until consensus was achieved, defined as a Cronbach α >0.95 in a maximum of 3 voting rounds. Fifteen of the 47 statements pertaining to high-risk obstetrical scenarios are presented.

Results

A total of 46 experts completed all rounds of voting. Consensus was achieved after 3 survey rounds (Cronbach α = 0.94) for all statements. The 15 statements reaching consensus addressed general issues pertinent to the evaluation of the high-risk patient, including testing for clinically significant antibodies (e.g., Kell), antibody titration frequency, paternal phenotyping, fetal genotyping, multidisciplinary care, and administration of RhIG following clinical situations such as ectopic or molar pregnancy and after invasive fetal testing or therapy.

Conclusions

The consensus document provides guidance regarding best practices for prevention and management of alloimmunization to RhD and clinically significant antibodies to optimize RhIG usage and support clinical units. To effect practice change, knowledge translation of this consensus will require a broad educational program involving clinical offices, hospital emergency departments, and birthing units.

目的：国家利益攸关方就围产期检测和有同种异体免疫风险或受同种异体免疫影响的妊娠管理的争议性方面制定了指导声明。其目标是制定全国性的标准化建议，以指导检测实践，减少不必要的检测，优化资源并改善患者护理。方法：46名加拿大多学科专家参与了反复德尔菲过程，就47种做法达成共识，这些做法涉及同种异体免疫风险孕妇的筛查和管理的各个方面。该小组以5分的李克特量表对他们的协议进行了评分。每轮投票结束后，小组成员对声明进行重新投票，直到达成共识，即Cronbach's alpha >.95或最多三轮投票。十五个四十七声明有关高危产科情况提出。结果：46位专家完成了各轮投票。在3轮调查后，所有陈述都达成了共识（Cronbach’s alpha = 0.94）。达成共识的15项声明涉及与高危患者评估相关的一般问题，包括临床重要抗体（如Kell）的抗体检测，抗体滴定频率，父亲表型，胎儿基因分型，多学科护理，以及临床情况下RhIG的管理：异位妊娠和磨牙妊娠以及随后的侵入性胎儿检测和治疗。结论：该共识文件为预防和管理RhD和临床重要抗体的同种免疫的最佳实践提供了指导，以优化RhD的使用并支持临床单位。为了实现实践变革，这种共识的知识转化将需要一个涉及临床办公室、医院急诊室和分娩单位的广泛教育计划。

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引用次数: 0

Letter to the Editor: Fertility Care in OBGYN Residency 致编辑的信：妇产科住院医师的生育护理

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103069

Ruth Habte MD , Nicole Thompson BScOT, MClSc, MD , Marguerite Heyns MD

引用次数: 0

Letter to the Editor: Supporting Non-Urban ObGyn Training 致编辑的信：支持非城市妇产科培训

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103084

Giuliana Guarna HBSc, MD, DRCPSC, Andrea Mosher MD, PhD, Sapna Sharma MD, Bryon DeFrance MSc, MD, Jon Barrett MBBch, MD, MRCOG

引用次数: 0

Acetaminophen Use in Pregnancy and the Purported Link to Neurodevelopmental Disorders 妊娠期对乙酰氨基酚的使用及其与神经发育障碍的关联。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103140

Graeme N. Smith MD, PhD

引用次数: 0

First-Line Treatment Use and Survival Outcomes for Patients With Primary Advanced or Recurrent Endometrial Cancer in Alberta, Canada 加拿大艾伯塔省原发性晚期或复发子宫内膜癌患者的一线治疗使用和生存结果

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103107

Jacob McGee MD, MSC, FRPC , Dylan E. O’Sullivan PhD , Sophia Pin MD, MSc, FRCSC , Winson Y. Cheung MD, MPH, FRPC , Justin Riemer BSC, MBiotech , Patrick C. Turnbull PhD , Diana Martins BScH, MSc

Objective

To describe first-line treatment patterns and factors impacting survival for patients with primary advanced (stage III–IV) or recurrent (A/R) endometrial cancer (EC) in Canada.

Methods

This retrospective cohort study used health administrative data for patients with primary A/R EC (2010–2020) in Alberta, Canada. Characteristics by receipt of first-line systemic therapy were compared. Factors impacting overall survival (OS) after first-line chemotherapy were evaluated using a multivariable Cox proportional hazards model.

Results

Of 1185 patients included, 817 (68.9%) received first-line systemic therapy (advanced, n = 679 of 885; recurrent, n = 138 of 300). Patients in this cohort were generally younger, with fewer comorbidities than those who did not receive first-line systemic therapy. Patients with recurrent disease who received previous chemotherapy and who had a longer time to recurrence were more likely to receive first-line systemic therapy. The median OS was 53.5 months (95% CI 37.8–80.1); the OS was shorter with older age (≥75 vs. <65 years, adjusted hazard ratio [aHR] 1.62; 95% CI 1.18–2.23) and high-grade versus low-grade histology (aHR 1.99; 95% CI 1.59–3.67). The OS was longer in patients in stage III who had surgery (aHR 0.35; 95% CI 0.24–0.51).

Conclusion

Characteristics such as age and comorbidities impacted first-line systemic therapy use in primary A/R EC. Patients who were older, with high-grade histology, stage IV without surgery, and receiving platinum monotherapy had the shortest OS. Effective treatment options are needed to prolong survival for primary A/R EC.

目的：了解加拿大原发性晚期（III-IV期）或复发性（A/R）子宫内膜癌（EC）患者的一线治疗模式和影响生存的因素。方法：本回顾性队列研究使用了加拿大阿尔伯塔省2010-2020年原发性A/R EC患者的卫生管理数据。比较接受一线全身治疗的特点。采用多变量Cox比例风险模型评估一线化疗后影响总生存期（OS）的因素。结果：纳入的1185例患者中，817例（68.9%）接受了一线全身治疗（晚期，n = 679/885；复发，n = 138/300）。该队列中的患者通常比未接受一线全身治疗的患者更年轻，合并症更少。既往接受过化疗且复发时间较长的复发性疾病患者更有可能接受一线全身治疗。中位OS为53.5个月（95%可信区间[CI]: 37.8-80.1）；年龄越大，OS越短（≥75 vs）。结论：年龄和合并症等特征影响了原发性A/R EC一线全身治疗的使用。年龄较大，组织学分级高，未手术的IV期患者，接受铂单药治疗的总生存期最短。需要有效的治疗方案来延长原发性A/R EC的生存期。

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引用次数: 0

Letter to the Editor: Canada’s Perinatal Mental Health Landscape: Policy, Practice, and the Path Forward 致编辑的信：加拿大的围产期心理健康状况：政策、实践和前进的道路

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103101

Leo Zhao BHS student , Sandra Halliday MSc, MLIS , Michelle Carter RM, BSc, BSN, MSN , Josephine Etowa RN, RM, PhD , Canadian Academy of Nursing Fellows Expert Panel on Perinatal Mental Health and Guests, Shahirose Sadrudin Premji RN, BSc, MScN, PhD

引用次数: 0

Episiotomy as a Strategy to Minimise Obstetrical Anal Sphincter Injuries Risk 会阴切开术作为降低OASIS风险的策略。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.102931

Chelsea Harris MD , Jocelyn Stairs MD

引用次数: 0

Comment on “Letter to the Editor: Supporting Non-Urban OBGYN Training” 《给编辑的信：支持非城市妇产科培训》评论

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-10-01 DOI: 10.1016/j.jogc.2025.103083

Jena Hall MD, MEd, CIP, Erin Brennand MD, MSc

引用次数: 0

Consensus clinique n° 463 : Diagnostic et prise en charge de la niche cicatricielle césarienne 临床共识n°463：剖腹产疤痕龛的诊断和管理。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-30 DOI: 10.1016/j.jogc.2025.103144

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>Objectif</h3><div>Cette déclaration consensuelle vise à guider les cliniciens dans le diagnostic, la prise en charge et la prévention de la niche cicatricielle césarienne.</div></div><div><h3>Population cible</h3><div>Les patientes subissant un accouchement par césarienne ou les patientes présentant un trouble de la cicatrice de césarienne.</div></div><div><h3>Options</h3><div>Les options de prise en charge comprennent la prise en charge expectative, médicale et chirurgicale. Celles-ci dépendront des symptômes, de l'épaisseur résiduelle du myomètre et des projets de fertilité futurs.</div></div><div><h3>Résultats</h3><div>Les résultats comprennent la résolution des symptômes, la réparation du défaut et la réussite de la grossesse ultérieure.</div></div><div><h3>Avantages, inconvénients et coûts</h3><div>Cette directive vise à bénéficier aux patientes subissant une césarienne ou souffrant d'un trouble lié à la cicatrice de césarienne et à offrir aux professionnels de santé une approche fondée sur des preuves pour la prévention, le diagnostic et la prise en charge des défauts de la cicatrice de césarienne.</div></div><div><h3>Preuves</h3><div>Les essais cliniques publiés, les essais contrôlés randomisés, les études observationnelles, les études de population et les articles de revue systématique indexés dans PubMed et la base de données Cochrane ont été identifiés entre le 1er janvier 2005 et le 30 avril 2025 à l'aide des termes de recherche « cesarean scar niche », « cesarean scar defect » et « isthmocele ». Les résultats ont été limités aux études rédigées en anglais.</div></div><div><h3>Méthodes de validation</h3><div>Les auteurs ont évalué la qualité des donnees probantes et la force des recommandations en utilisant l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (<span><span>tableaux A1</span></span> pour les définitions et <span><span>A2</span></span> pour les interprétations des recommandations fortes et conditionnelles [faibles]).</div></div><div><h3>Public visé</h3><div>Tous les professionnels de santé qui pratiquent des césariennes ou qui s'occupent de patientes ayant déjà subi une césarienne et pouvant présenter des symptômes de troubles liés à la cicatrice de césarienne, y compris les gynécologues-obstétriciens, les médecins de famille, les infirmières diplômées, les infirmières praticiennes et les radiologues.</div></div><div><h3>Résumé tweetable</h3><div>La niche cicatricielle de césarienne est une conséquence courante de l'accouchement par césarienne. Les patientes symptomatiques souffrant d'un trouble de la cicatrice de césarienne peuvent être traitées de manière expectative ou par des options médicales ou chirurgicales. Les patientes asymptomatiques ne nécessitent pas de traitement.</div></div><div><h3>RÉSUMÉ</h3><div><ul><li><span>1)</span><span><div>Les niches cicatricielles de césariennes sont fréquentes chez les patientes ayant accouché par césarienne, la p

目的：本共识声明旨在指导临床医生诊断、管理和预防剖腹产疤痕。目标人群：剖腹产患者或有剖腹产疤痕障碍的患者。选择：护理选择包括预期、医疗和外科护理。这将取决于症状、子宫内膜的剩余厚度和未来的生育计划。结果：结果包括症状的解决，缺陷的修复和成功的后续怀孕。、优缺点及费用:这个指令旨在惠及患者经历剖腹产或患有相关疾病的剖腹产疤痕和保健专业人员提供基于证据的办法来预防、诊断和接管的剖腹产疤痕瑕疵。发表的临床试验的证据:随机对照试验的观测、研究、人口研究和系统性的综述文章Cochrane索引和PubMed数据库中确定了2005年1月1日至4月30日,2025年借助搜索词的«产后刀疤利基»,«产后刀疤»和«因为您isthmocele»。结果仅限于用英语写的研究。验证方法：验证方法：作者使用GRADE（建议分级评估、发展和评估）方法评估了证据的质量和建议的强度。在线见附录A（表A1为定义，表A2为强建议和条件[弱]的解释）。受众:剖腹产的所有保健专业人员从事或已经过剖腹产和照顾病人的症状可能失调在内的剖腹产疤痕的妇产科医生、家庭医生、护士、医师和护士从业人员。剖腹产疤痕凹痕是剖腹产的常见后果。有剖腹产疤痕障碍症状的患者可以在等待的基础上进行治疗，也可以通过医疗或手术选择进行治疗。无症状患者不需要治疗。MOTS- CLES：剖腹产疤痕凹痕，剖腹产疤痕缺陷，血栓形成，剖腹产疤痕障碍。

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引用次数: 0

Prolonged Exposure to Childhood Adversity and Birth Outcomes in a Bi-Generational Longitudinal Cohort Study 在一项两代纵向队列研究中，长期暴露于童年逆境和出生结果。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-22 DOI: 10.1016/j.jogc.2025.103123

Mary-Gray Southern MD , Cara Girardi MD , Dmitry Tumin PhD , James L. Whiteside MD, MA, MHA

Objectives

A higher number of exposures to different adverse childhood experiences (ACEs) has been associated with worse birth outcomes; however, the duration of ACE exposure could also negatively impact pregnancy outcomes. We sought to use a bi-generational longitudinal cohort survey to test if duration of exposure to specific types of childhood adversity exhibited a graded association with adverse birth outcomes.

Methods

The Bureau of Labor Statistics’ National Longitudinal Surveys of Youth 1979 cohort was used to create bi-generational cohorts capturing the number and duration of ACE events (reported by the oldest cohort and experienced by the middle cohort) and linking these with birth outcomes (low birth weight, preterm birth, route of delivery, and infant length of stay) documented in the youngest cohort. ACEs examined were maternal incarceration, divorce/separation, maternal binge drinking, and poverty.

Results

Demographic, birth outcome, and ACE exposures were determined from 1693 cases. Neither the count of ACEs nor the duration of exposure to ACEs was a statistically significant predictor of examined birth outcomes, except for greater ACE numbers and prolonged infant length of stay.

Conclusions

No association was identified between worsened birth outcomes and cumulative number or duration of ACE exposures, contradicting prior studies. This discrepancy may be explained by the mediating role of stressors encountered in adulthood, interactions between ACE exposure and adult-onset conditions, missing data on paternal ACE exposure, or differences in recall and reporting bias when collecting interview data from participants versus directly from the grandparent generation.

目的：不同童年不良经历（ace）的暴露次数越多，出生结局越差；然而，ACE暴露的持续时间也可能对妊娠结局产生负面影响。我们试图使用一项两代纵向队列调查来测试暴露于特定类型的童年逆境的持续时间是否与不良出生结局表现出分级关联。方法：采用美国劳工统计局1979年全国青年纵向调查（National Longitudinal Surveys of Youth）的队列数据创建两代人队列，收集年龄最大的队列报告的ACE事件的数量和持续时间，中间队列经历的ACE事件，并将这些事件与年龄最小队列记录的出生结果（低出生体重、早产、分娩方式和婴儿住院时间）联系起来。调查的ace包括母亲入狱、离婚/分居、母亲酗酒和贫困。结果：从1693例病例中确定了人口统计学、出生结局和ACE暴露。ACE的数量和暴露于ACE的持续时间都不是所检查的出生结果的统计显著预测因子，除了ACE的数量和延长的婴儿停留时间（LOS）。结论：与先前的研究相反，没有发现出生结果恶化与ACE暴露的累积次数或持续时间之间存在关联。这种差异可能是由于成年期遇到的压力源的中介作用，ACE暴露与成年发病条件之间的相互作用，父亲ACE暴露的数据缺失，或者从参与者那里收集访谈数据与直接从祖父母辈收集访谈数据时回忆和报告偏差的差异。

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