Journal of obstetrics and gynaecology Canada最新文献_第6页

Evaluation of Cesarean Delivery Rates across Ontario from 2012 to 2019 Using the Modified Robson Classification System: A Population-Based Study 使用改进的Robson分类系统评估2012-2019年安大略省剖宫产率：一项基于人群的研究

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-19 DOI: 10.1016/j.jogc.2025.103131

Sandra I. Dunn RN, BNSc, MEd, MScN, PhD , Yanfang Guo MSc, MB, PhD , Sheryll Dimanlig-Cruz MSc , Malia S.Q. Murphy PhD , Sara Carolina Scremin Souza MSc , Ruth Rennicks White RN, BScN , Deshayne B. Fell MSc, PhD , Shi Wu Wen PhD , Jun Zhang PhD , Mark C. Walker MD, MSc, MSCHM , Darine El-Chaâr MD, MSc

Objectives

This study aimed to describe the trends in cesarean delivery (CD) rates in Ontario using the modified Robson classification system, and identify the most common indications for CD.

Methods

We conducted a population-based retrospective cross-sectional study using data from the Better Outcomes Registry & Network, a comprehensive maternal-child registry in Ontario. The analysis included all pregnant persons who delivered a live- or stillborn infant weighing ≥500 g at ≥20⁰ weeks gestation between April 1, 2012 and March 31, 2019.

Results

A total of 952 567 pregnant persons gave birth in Ontario, Canada, during the study period. Our findings demonstrated a slight increase in the overall CD rate over 7 fiscal years from 2012–2013 to 2018–2019. Robson group 5 (term, singleton, cephalic pregnancy with previous CD), groups 1 and 2 (nulliparous, term, singleton, cephalic pregnancy and no labour, induced labour, or spontaneous labour), and group 6 (nulliparous pregnancy with breech presentation) made the largest contributions to the overall CD rate over the study period. The top 5 primary indications for CD across all years included previous CD, atypical or abnormal fetal surveillance, malposition/malpresentation, non-progressive first stage of labour, and non-progressive second stage of labour.

Conclusions

The results enhance our understanding of the key drivers of CD rates. These findings will help to inform practice improvement, support policy change, and identify areas where future research is needed.

目的：本研究旨在利用改进的Robson分类系统描述安大略省剖宫产率的趋势，并确定剖宫产最常见的适应症。方法：我们进行了一项基于人群的回顾性横断面研究，研究数据来自安大略省的一个综合母婴登记处——更好的结局登记处和网络（BORN）。该分析包括2012年4月1日至2019年3月31日期间妊娠≥20周分娩体重≥500克活产或死产婴儿的所有孕妇。结果：在研究期间，加拿大安大略省共有952 567名孕妇分娩。我们的研究结果表明，从2012-2013年到2018-2019年的七个财政年度，总体CD率略有上升。Robson组5（足月单胎头位妊娠，既往有乳糜泻）、组1和组2（无产、足月、单胎、头位妊娠，无分娩、引产或自然分娩）和组6（无产妊娠，臀位分娩）在研究期间对总乳糜泻率贡献最大。在所有年份中，乳糜泻的前五大主要指征包括既往乳糜泻、非典型或异常胎儿监测、体位/表现不当、第一产程非进行性和第二产程非进行性。结论：研究结果加深了我们对慢性阻塞性肺病发病率的主要影响因素的认识。这些发现将有助于为实践改进提供信息，支持政策变化，并确定未来需要研究的领域。

{"title":"Evaluation of Cesarean Delivery Rates across Ontario from 2012 to 2019 Using the Modified Robson Classification System: A Population-Based Study","authors":"Sandra I. Dunn RN, BNSc, MEd, MScN, PhD , Yanfang Guo MSc, MB, PhD , Sheryll Dimanlig-Cruz MSc , Malia S.Q. Murphy PhD , Sara Carolina Scremin Souza MSc , Ruth Rennicks White RN, BScN , Deshayne B. Fell MSc, PhD , Shi Wu Wen PhD , Jun Zhang PhD , Mark C. Walker MD, MSc, MSCHM , Darine El-Chaâr MD, MSc","doi":"10.1016/j.jogc.2025.103131","DOIUrl":"10.1016/j.jogc.2025.103131","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe the trends in cesarean delivery (CD) rates in Ontario using the modified Robson classification system, and identify the most common indications for CD.</div></div><div><h3>Methods</h3><div>We conducted a population-based retrospective cross-sectional study using data from the Better Outcomes Registry & Network, a comprehensive maternal-child registry in Ontario. The analysis included all pregnant persons who delivered a live- or stillborn infant weighing ≥500 g at ≥20<sup>0</sup> weeks gestation between April 1, 2012 and March 31, 2019.</div></div><div><h3>Results</h3><div>A total of 952 567 pregnant persons gave birth in Ontario, Canada, during the study period. Our findings demonstrated a slight increase in the overall CD rate over 7 fiscal years from 2012–2013 to 2018–2019. Robson group 5 (term, singleton, cephalic pregnancy with previous CD), groups 1 and 2 (nulliparous, term, singleton, cephalic pregnancy and no labour, induced labour, or spontaneous labour), and group 6 (nulliparous pregnancy with breech presentation) made the largest contributions to the overall CD rate over the study period. The top 5 primary indications for CD across all years included previous CD, atypical or abnormal fetal surveillance, malposition/malpresentation, non-progressive first stage of labour, and non-progressive second stage of labour.</div></div><div><h3>Conclusions</h3><div>The results enhance our understanding of the key drivers of CD rates. These findings will help to inform practice improvement, support policy change, and identify areas where future research is needed.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103131"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115908","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

Endometrial Carcinoma Molecular Classification and Barriers to Implementation, Possible Solutions, and the Implications for Ongoing Clinical Trials 子宫内膜癌分子分类和实施的障碍，可能的解决方案和对正在进行的临床试验的影响。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-18 DOI: 10.1016/j.jogc.2025.103124

Anjelica Hodgson MD , Kathy Han MD, MSc , Stephen Welch MD , Wendy R. Parulekar MD , Jessica N. McAlpine MD , Mary Kinloch MD

Molecular classification of endometrial carcinoma provides important prognostic and predictive information and ongoing clinical trials are investigating different treatment paradigms and therapy de-escalation. Despite its benefits, there is variability in the application of molecular classification worldwide, including in Canada. A digital survey was distributed to gynaecologic pathologists in 13 Canadian academic pathology departments, and areas of homogeneity and variability in practice for endometrial carcinoma molecular classification were identified. Perceived barriers to universal application included resource restrictions and ambiguity of management implications. Focused research, knowledge translation, and guideline development will aid in more consistent implementation/application.

子宫内膜癌的分子分类提供了重要的预后和预测信息，正在进行的临床试验正在研究不同的治疗模式和治疗降级。尽管它的好处，有在世界各地的应用分子分类的变化，包括在加拿大。一项数字调查被分发给13个加拿大学术病理部门的妇科病理学家，并确定了子宫内膜癌分子分类在实践中的同质性和可变性。普遍应用的障碍包括资源限制和管理影响的模糊性。重点研究、知识转化和指南制定将有助于更一致的实施/应用。

引用次数: 0

Trans Peoples’ Interest in Reproduction and Fertility Preservation: A Cross-Sectional, Descriptive Study Into Barriers to Reproductive Care 跨性别人群对生殖和生育保护的兴趣：对生殖保健障碍的横断面描述性研究。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-18 DOI: 10.1016/j.jogc.2025.103125

Lara Des Roches MD, MSc, BScN, Bianca Ziegler MD, MSc, BHSc, Stacy Deniz MD

Objective

This study aimed to ascertain trans peoples’ interest in reproductive choices. Our secondary objective was to understand barriers to meeting their reproductive goals.

Methods

We conducted a descriptive cross-sectional study using a one-time anonymous survey. Analysis was conducted using descriptive statistics and a thematic analysis using inductive coding.

Results

Analysis of trans participants’ responses revealed 82% (N = 169) of participants are interested in pursuing reproductive options (biologically related children, donor gametes, gestational carriers, or fertility preservation). Sixty-eight percent (N = 172) of participants are taking gender-affirming hormone therapy or plan to start. Forty-nine percent (N = 124) have had or plan to have gender-affirming surgery that affects fertility. Trans folks experience many barriers when accessing fertility care; cost and trans-specific barriers were the most common and insurmountable barriers.

Conclusions

Our study highlights that trans folks are interested in reproductive options. However, many trans people experience significant barriers to meeting their reproductive goals and this significantly impacts their quality of life. With most of our survey population identifying as trans at an age during the window of peak fertility, we highlight the importance of early assessment and treatment to achieve fertility goals.

简介：变性人是一个不断增长的弱势群体。从历史上看，性别确认护理是失去生育选择的同义词。变性和生育保健一直在发展，因此，有必要对当前的生殖兴趣和生殖障碍进行调查。目的：了解跨性别人群对生育选择的兴趣。我们的第二个目标是了解阻碍她们实现生育目标的障碍。方法：采用一次性匿名调查进行描述性横断面研究。采用描述性统计和归纳编码的专题分析方法进行分析。结果：对跨性别参与者的反应分析显示，82% （N = 169）的参与者有兴趣追求生殖选择（生物学上相关的孩子、供体配子、妊娠载体或生育能力保存）。68% （N = 172）的参与者正在接受或计划接受性别确认激素治疗。49% （N = 124）的人已经或计划进行影响生育能力的性别确认手术。跨性别人士在获得生育护理时遇到许多障碍；成本和跨特定障碍是最常见和最难以克服的障碍。结论：我们的研究强调了变性人对生育选择的兴趣。然而，许多跨性别者在实现生育目标方面遇到了重大障碍，这对生活质量产生了重大影响。由于我们的大多数调查人口在生育高峰期的年龄确定为变性人，我们强调早期评估和治疗对实现生育目标的重要性。

{"title":"Trans Peoples’ Interest in Reproduction and Fertility Preservation: A Cross-Sectional, Descriptive Study Into Barriers to Reproductive Care","authors":"Lara Des Roches MD, MSc, BScN, Bianca Ziegler MD, MSc, BHSc, Stacy Deniz MD","doi":"10.1016/j.jogc.2025.103125","DOIUrl":"10.1016/j.jogc.2025.103125","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to ascertain trans peoples’ interest in reproductive choices. Our secondary objective was to understand barriers to meeting their reproductive goals.</div></div><div><h3>Methods</h3><div>We conducted a descriptive cross-sectional study using a one-time anonymous survey. Analysis was conducted using descriptive statistics and a thematic analysis using inductive coding.</div></div><div><h3>Results</h3><div>Analysis of trans participants’ responses revealed 82% (N = 169) of participants are interested in pursuing reproductive options (biologically related children, donor gametes, gestational carriers, or fertility preservation). Sixty-eight percent (N = 172) of participants are taking gender-affirming hormone therapy or plan to start. Forty-nine percent (N = 124) have had or plan to have gender-affirming surgery that affects fertility. Trans folks experience many barriers when accessing fertility care; cost and trans-specific barriers were the most common and insurmountable barriers.</div></div><div><h3>Conclusions</h3><div>Our study highlights that trans folks are interested in reproductive options. However, many trans people experience significant barriers to meeting their reproductive goals and this significantly impacts their quality of life. With most of our survey population identifying as trans at an age during the window of peak fertility, we highlight the importance of early assessment and treatment to achieve fertility goals.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103125"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103088","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

Health Care System Burden During the COVID-19 Pandemic and Pregnancy Outcomes: A Population-Based Study COVID-19大流行期间的卫生保健系统负担和妊娠结局：一项基于人群的研究

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-18 DOI: 10.1016/j.jogc.2025.103127

Atar Ben Shmuel MD , Nikola Rasevic MSc , Howard Berger MD , Elad Mei-Dan MD , Jon Barrett MD , Nir Melamed MSc, MD , Amir Aviram MD

Objectives

We aimed to explore how the COVID-19 pandemic impacted the incidence of preterm birth (PTB) and other perinatal outcomes.

Methods

This is a population-based cohort study using provincial-level population data. The study population consisted of persons who gave birth in a setting of a single-payer insurer during the period from January 2020 to December 2020. The comparator group included persons who delivered in the same setting between January 2017 and December 2019. The main outcome measured was PTB before 37 weeks gestation. In addition, we analyzed several secondary outcomes, including PTB at different gestational ages, hypertensive disorders in pregnancy, and composite neonatal morbidity (5-minute Apgar score <5, respiratory distress syndrome, or need for mechanical ventilation).

Results

Between January 2020 and December 2020, 116 244 births were documented (study group) and were compared with 363 650 births that occurred between January 2017 and December 2019 (control group). There was no difference in the rate of PTB before 37 weeks (7.57% vs. 7.57%, adjusted relative risk [aRR] 1.00, 95% CI 0.98–1.02), nor were there differences in the rate of PTB before 34, 32, 28, or 26 weeks gestation. The risk for gestational diabetes was slightly higher (9.54% vs. 8.67%, aRR 1.07, 95% CI 1.05–1.10), as was the risk of composite neonatal morbidity (11.65% vs. 10.85%, aRR 1.06, 95% CI 1.04–1.08).

Conclusions

During the first year of the COVID-19 pandemic, the rate of PTB was not higher than in previous years. However, a higher risk of gestational diabetes and composite neonatal morbidity was noted.

目的：探讨新冠肺炎大流行对早产儿及其他围产期结局的影响。方法：采用基于人群的队列研究，使用省级人口数据。研究人群包括在2020年1月至2020年12月期间在单一付款人保险公司的环境中分娩的个人。比较组包括在2017年1月至2019年12月期间在相同环境中分娩的个体。测量的主要结果是妊娠37周前的早产（PTB）。此外，我们分析了几个次要结局，包括不同胎龄的PTB、妊娠期高血压疾病和新生儿综合发病率（5分钟Apgar评分）。结果：2020年1月至2020年12月，记录了116 244例新生儿（研究组），并与2017年1月至2019年12月（对照组）的363 650例新生儿进行了比较。37周之前的PTB发病率没有差异（7.57% vs. 7.57%, aRR 1.00, 95% CI 0.98-1.02），妊娠34、32、28或26周之前的PTB发病率也没有差异。妊娠期糖尿病的风险略高（9.54%对8.67%,aRR 1.07, 95% CI 1.05-1.10），新生儿复合发病率的风险也略高（11.65%对10.85%,aRR 1.06, 95% CI 1.04-1.08）。结论：2019冠状病毒病大流行第一年的早产率不高于前几年。但是，注意到妊娠期糖尿病和新生儿综合发病率的风险较高。

{"title":"Health Care System Burden During the COVID-19 Pandemic and Pregnancy Outcomes: A Population-Based Study","authors":"Atar Ben Shmuel MD , Nikola Rasevic MSc , Howard Berger MD , Elad Mei-Dan MD , Jon Barrett MD , Nir Melamed MSc, MD , Amir Aviram MD","doi":"10.1016/j.jogc.2025.103127","DOIUrl":"10.1016/j.jogc.2025.103127","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore how the COVID-19 pandemic impacted the incidence of preterm birth (PTB) and other perinatal outcomes.</div></div><div><h3>Methods</h3><div>This is a population-based cohort study using provincial-level population data. The study population consisted of persons who gave birth in a setting of a single-payer insurer during the period from January 2020 to December 2020. The comparator group included persons who delivered in the same setting between January 2017 and December 2019. The main outcome measured was PTB before 37 weeks gestation. In addition, we analyzed several secondary outcomes, including PTB at different gestational ages, hypertensive disorders in pregnancy, and composite neonatal morbidity (5-minute Apgar score <5, respiratory distress syndrome, or need for mechanical ventilation).</div></div><div><h3>Results</h3><div>Between January 2020 and December 2020, 116 244 births were documented (study group) and were compared with 363 650 births that occurred between January 2017 and December 2019 (control group). There was no difference in the rate of PTB before 37 weeks (7.57% vs. 7.57%, adjusted relative risk [aRR] 1.00, 95% CI 0.98–1.02), nor were there differences in the rate of PTB before 34, 32, 28, or 26 weeks gestation. The risk for gestational diabetes was slightly higher (9.54% vs. 8.67%, aRR 1.07, 95% CI 1.05–1.10), as was the risk of composite neonatal morbidity (11.65% vs. 10.85%, aRR 1.06, 95% CI 1.04–1.08).</div></div><div><h3>Conclusions</h3><div>During the first year of the COVID-19 pandemic, the rate of PTB was not higher than in previous years. However, a higher risk of gestational diabetes and composite neonatal morbidity was noted.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103127"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102880","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

Validation of a New Malnutrition Screening Tool for Hospitalized Pregnant Women 一种新的住院孕妇营养不良筛查工具的验证

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-18 DOI: 10.1016/j.jogc.2025.103126

Thi Thu Lieu Nguyen MD , Thu Huyen Doan BSc , Kieu Trang Ha BSc , Hien Anh Le BSc , Thi Tu Anh Tran BSc , Thi Thanh Xuan Le PhD , Thi Van Anh Nguyen MSc , Thi Huong Le PhD , Thi My Thuc Luu PhD

Objectives

The Screening for Obstetric Undernutrition in Pregnancy Detection (SOUND-P) is a questionnaire designed to assess the nutrition status of hospitalized pregnant women. The aim of this study was to evaluate the validity and reliability of the SOUND-P among inpatients.

Methods

A total of 200 pregnant women were admitted to the National Hospital of Obstetrics and Gynecology, Vietnam from November 2023 to January 2024. Nutritional risk screened by SOUND-P was compared with the International Federation of Gynecology and Obstetrics Nutrition Checklist, the obstetric nutritional risk screening, composite diagnostic criteria, and estimated fetal weight. We determined sensitivity, specificity, positive predictive values, negative predictive values, receiver operator characteristics curve, and the best cut-off scores. Inter-rater reliability was assessed using κ measurements.

Results

Using SOUND-P, the optimal cut-off score to identify malnourished pregnant women was 1, with 62.5% of patients at risk of malnutrition. The percentage agreement between dietitian and nurse was 98.0%, with a κ value of 0.96 (95% CI 0.94–1.00). SOUND-P demonstrated sensitivity ranging from 80.65% to 90.70%, specificity ranging from 40.11% to 45.22%, positive predictive values from 12.80% to 31.20%, and negative predictive values from 92.00% to 97.33%. The areas under the receiver operating characteristic curve for SOUND-P were above 0.6.

Conclusions

The SOUND-P is a valid and reliable nutrition screening tool for determining malnutrition risk in hospitalized pregnant women.

目的：妊娠检测中产科营养不良筛查（SOUND-P）是一份评估住院孕妇营养状况的问卷。本研究的目的是评估SOUND-P在住院病人中的效度和信度。方法：2023年11月至2024年1月在越南国立妇产科医院住院的200名孕妇。将SOUND-P筛查的营养风险与FIGO营养检查表、产科营养风险筛查、综合诊断标准和估计胎儿体重进行比较。我们确定了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、接受者操作者特征曲线和最佳截止分数。利用kappa测量法确定了各参数间的信度。结果：使用SOUND-P，识别营养不良孕妇的最佳临界值为1,62.5%的患者存在营养不良风险。营养师和护士之间的一致性百分比为98.0%，kappa值为0.96 （95% CI 0.94 - 1.00）。SOUND-P的敏感性为80.65% ~ 90.70%，特异性为40.11% ~ 45.22%，PPV为12.80% ~ 31.20%，NPV为92.00% ~ 97.33%。SOUND-P的ROC曲线下面积均在0.6以上。结论：SOUND-P是一种确定住院孕妇营养不良风险的有效、可靠的营养筛查工具。

{"title":"Validation of a New Malnutrition Screening Tool for Hospitalized Pregnant Women","authors":"Thi Thu Lieu Nguyen MD , Thu Huyen Doan BSc , Kieu Trang Ha BSc , Hien Anh Le BSc , Thi Tu Anh Tran BSc , Thi Thanh Xuan Le PhD , Thi Van Anh Nguyen MSc , Thi Huong Le PhD , Thi My Thuc Luu PhD","doi":"10.1016/j.jogc.2025.103126","DOIUrl":"10.1016/j.jogc.2025.103126","url":null,"abstract":"<div><h3>Objectives</h3><div>The Screening for Obstetric Undernutrition in Pregnancy Detection (SOUND-P) is a questionnaire designed to assess the nutrition status of hospitalized pregnant women. The aim of this study was to evaluate the validity and reliability of the SOUND-P among inpatients.</div></div><div><h3>Methods</h3><div>A total of 200 pregnant women were admitted to the National Hospital of Obstetrics and Gynecology, Vietnam from November 2023 to January 2024. Nutritional risk screened by SOUND-P was compared with the International Federation of Gynecology and Obstetrics Nutrition Checklist, the obstetric nutritional risk screening, composite diagnostic criteria, and estimated fetal weight. We determined sensitivity, specificity, positive predictive values, negative predictive values, receiver operator characteristics curve, and the best cut-off scores. Inter-rater reliability was assessed using κ measurements.</div></div><div><h3>Results</h3><div>Using SOUND-P, the optimal cut-off score to identify malnourished pregnant women was 1, with 62.5% of patients at risk of malnutrition. The percentage agreement between dietitian and nurse was 98.0%, with a κ value of 0.96 (95% CI 0.94–1.00). SOUND-P demonstrated sensitivity ranging from 80.65% to 90.70%, specificity ranging from 40.11% to 45.22%, positive predictive values from 12.80% to 31.20%, and negative predictive values from 92.00% to 97.33%. The areas under the receiver operating characteristic curve for SOUND-P were above 0.6.</div></div><div><h3>Conclusions</h3><div>The SOUND-P is a valid and reliable nutrition screening tool for determining malnutrition risk in hospitalized pregnant women.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103126"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103051","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

Umbilical Port Site Metastasis After Laparoscopic Radical Hysterectomy for Cervical Cancer 腹腔镜宫颈癌根治性子宫切除术后脐口部位转移。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-12 DOI: 10.1016/j.jogc.2025.103109

Zi-yun Liao MD, Yu Chen MD, Zhenbo OuYang MD

引用次数: 0

Fatal Obstetrical Hemorrhage: A 20-Year Analysis From Ontario 致死性产科出血：安大略省20年分析。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-12 DOI: 10.1016/j.jogc.2025.103112

Carolina Lavin Venegas BScN, MSc , Kasim E. Abdulaziz PhD , Joel G. Ray MD, MSc , Mark Walker MD, MSc, MSHCM , Janet Brownlee RN, MScN , Ann E. Sprague RN, PhD

Objectives

Obstetric hemorrhage is a leading cause of pregnancy-related death. This study examined the characteristics, subtypes, and timing of obstetrical hemorrhagic deaths within a universal health care system.

Methods

Secondary analysis of a retrospective cohort study of linked administrative data, in which 485 post-pregnancy deaths over a 20-year period were identified. Obstetric hemorrhage deaths within 365 days of birth were reviewed by at least 3 clinicians to determine the main cause and timing of death.

Results

Of 485 post-pregnancy deaths, 46 (9.5%) were attributed to obstetric hemorrhage, representing 27% of pregnancy-related deaths (46 of 169). All 46 obstetric hemorrhage deaths occurred within 12 days postpartum, with 26 deaths (56.5%) on the day of delivery. The top causes of fatal obstetrical hemorrhage were 9 (19.6%) amniotic fluid embolisms, 6 (13.0%) placental abruptions, and 5 (10.9%) uterine ruptures; but in 14 (30%) cases, the main cause was uncertain. Of all fatal hemorrhages, 3 (6.5%) began antepartum, 17 (37.0%) intrapartum, and 20 (43.5%) postpartum. Deaths were higher in more materially deprived neighbourhoods (39.1% in quintile 5 vs. 6.5% in quintile 1). Obstetric hemorrhage deaths were highest for Sunday deliveries (3.7 per 100 000 births, rate ratio 3.8; 95% CI 0.8–18.8), followed by Monday deliveries (2.7 per 100 000, rate ratio 2.7; 95% CI 0.5–13.9).

Conclusions

Obstetric hemorrhage remains a major contributor to pregnancy-related deaths, with most fatalities occurring very early postpartum. This study provides important insights into maternal post-pregnancy deaths due to obstetric hemorrhage in Ontario over a 20-year period.

目的：产科出血是妊娠相关死亡的主要原因。本研究探讨了产科出血性死亡的特点，亚型和时间在全民医疗保健系统。方法：对一项相关行政数据的回顾性队列研究进行二次分析，其中确定了20年间485例妊娠后死亡。至少有三名临床医生审查了出生365天内的产科出血死亡，以确定死亡的主要原因和时间。结果：在485例妊娠后死亡中，46例（9.5%）归因于产科出血，占妊娠相关死亡的27%（46/169）。所有46例产科出血死亡都发生在产后12天内，其中26例（56.5%）死亡发生在分娩当天。致死性产科出血的主要原因为羊水栓塞9例（19.6%），胎盘早早6例（13.0%），子宫破裂5例（10.9%），但有14例（30%）的主要原因不明。在所有致死性出血中，3例（6.5%）发生在产前，17例（37.0%）发生在产时，20例（43.5%）发生在产后。物质条件较差的社区的死亡率更高（第五分位数为39.1%，第一分位数为6.5%）。产科出血死亡率在周日分娩时最高（每10万例分娩中有3.7例死亡，比率比（RR）： 3.8, 95%可信区间（CI）： 0.8-18.8），其次是周一分娩（每10万例分娩中有2.7例死亡，RR: 2.7, 95%可信区间（CI）： 0.5-13.9）。结论：产科出血仍然是妊娠相关死亡的主要原因，大多数死亡发生在产后早期。这项研究为安大略省20年来产科出血导致的产妇妊娠后死亡提供了重要见解。

{"title":"Fatal Obstetrical Hemorrhage: A 20-Year Analysis From Ontario","authors":"Carolina Lavin Venegas BScN, MSc , Kasim E. Abdulaziz PhD , Joel G. Ray MD, MSc , Mark Walker MD, MSc, MSHCM , Janet Brownlee RN, MScN , Ann E. Sprague RN, PhD","doi":"10.1016/j.jogc.2025.103112","DOIUrl":"10.1016/j.jogc.2025.103112","url":null,"abstract":"<div><h3>Objectives</h3><div>Obstetric hemorrhage is a leading cause of pregnancy-related death. This study examined the characteristics, subtypes, and timing of obstetrical hemorrhagic deaths within a universal health care system.</div></div><div><h3>Methods</h3><div>Secondary analysis of a retrospective cohort study of linked administrative data, in which 485 post-pregnancy deaths over a 20-year period were identified. Obstetric hemorrhage deaths within 365 days of birth were reviewed by at least 3 clinicians to determine the main cause and timing of death.</div></div><div><h3>Results</h3><div>Of 485 post-pregnancy deaths, 46 (9.5%) were attributed to obstetric hemorrhage, representing 27% of pregnancy-related deaths (46 of 169). All 46 obstetric hemorrhage deaths occurred within 12 days postpartum, with 26 deaths (56.5%) on the day of delivery. The top causes of fatal obstetrical hemorrhage were 9 (19.6%) amniotic fluid embolisms, 6 (13.0%) placental abruptions, and 5 (10.9%) uterine ruptures; but in 14 (30%) cases, the main cause was uncertain. Of all fatal hemorrhages, 3 (6.5%) began antepartum, 17 (37.0%) intrapartum, and 20 (43.5%) postpartum. Deaths were higher in more materially deprived neighbourhoods (39.1% in quintile 5 vs. 6.5% in quintile 1). Obstetric hemorrhage deaths were highest for Sunday deliveries (3.7 per 100 000 births, rate ratio 3.8; 95% CI 0.8–18.8), followed by Monday deliveries (2.7 per 100 000, rate ratio 2.7; 95% CI 0.5–13.9).</div></div><div><h3>Conclusions</h3><div>Obstetric hemorrhage remains a major contributor to pregnancy-related deaths, with most fatalities occurring very early postpartum. This study provides important insights into maternal post-pregnancy deaths due to obstetric hemorrhage in Ontario over a 20-year period.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103112"},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067473","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

Implementation of Placental Growth Factor in a Tertiary Western Canadian Centre: Association with Ultrasound Findings and Perinatal Outcomes 胎盘生长因子（PlGF）在加拿大西部三级中心的实施：与超声结果和围产期结局的关系。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-11 DOI: 10.1016/j.jogc.2025.103120

Ernesto A. Figueiro-Filho MD, PhD, Genevieve Dietrich HBSc, MEng, Adrielle P. Souza Lira BSN, RN, Eman Ramadan MD, Adewumi Adanlawo MD, John Matelski MSc, Joshua D. Buse PhD

Objectives

This study aimed to evaluate the association between placental growth factor (PlGF) levels, ultrasound findings, and perinatal outcomes in a high-risk pregnant population at a tertiary referral centre in Western Canada, and to assess the predictive performance of the PlGF test.

Methods

We conducted a retrospective cohort study of 389 high-risk pregnant individuals who underwent PlGF testing between 12⁰ and 36⁰ weeks gestation. Participants were stratified by PlGF level: normal (≥10th centile), inconclusive (5th–9th centile), and low (≤5th centile). Clinical, biochemical, ultrasound, and perinatal outcomes were compared across groups. Odds ratios, sensitivity, specificity, and predictive values were calculated.

Results

Low PlGF levels were observed in 33.9% of pregnancies, with testing performed at a median gestational age of 27⁶ weeks. Low PlGF levels were significantly associated with higher maternal BMI, elevated blood pressure, and increased creatinine, uric acid, and proteinuria levels. Ultrasound findings in the low PlGF group revealed higher rates of fetal growth restriction, abnormal Doppler studies, and abnormal placental morphology. These pregnancies had increased incidence of preterm birth <34⁰ weeks (52/132; 39.3%), preeclampsia (69/132; 52.3%), neonatal intensive care unit admission (54/132; 40.9%), and small-for-gestational-age neonates (15/132; 11.4%). Most negative predictive values exceeded 90%.

Conclusions

Low maternal PlGF levels are strongly associated with ultrasound and biochemical indicators of placental dysfunction and adverse perinatal outcomes. PlGF testing may serve as an effective risk stratification tool in high-risk pregnancies, particularly in rural and underserved populations.

目的：评估加拿大西部三级转诊中心高危妊娠人群中胎盘生长因子（PlGF）水平、超声表现和围产期结局之间的关系，并评估PlGF检测的预测性能。方法：我们对389例妊娠12+0 ~ 36+0周间接受PlGF检测的高危孕妇进行了回顾性队列研究。参与者按PlGF水平分层：正常（≥10百分位）、不确定（5 -9百分位）和低（≤5百分位）。比较各组临床、生化、超声和围产期结局。计算比值比、敏感性、特异性和预测值。结果：低PlGF水平在33.9%的妊娠中被观察到，在中位胎龄为27.7周时进行检测。低PlGF水平与母亲较高的BMI、血压升高、肌酐、尿酸和蛋白尿水平升高显著相关。低PlGF组的超声检查结果显示胎儿生长受限率较高，多普勒检查异常，胎盘形态异常。结论：低PlGF水平与超声及胎盘功能障碍生化指标及不良围产期结局密切相关。PlGF检测可作为高危妊娠的有效风险分层工具，特别是在农村和服务不足的人群中。

{"title":"Implementation of Placental Growth Factor in a Tertiary Western Canadian Centre: Association with Ultrasound Findings and Perinatal Outcomes","authors":"Ernesto A. Figueiro-Filho MD, PhD, Genevieve Dietrich HBSc, MEng, Adrielle P. Souza Lira BSN, RN, Eman Ramadan MD, Adewumi Adanlawo MD, John Matelski MSc, Joshua D. Buse PhD","doi":"10.1016/j.jogc.2025.103120","DOIUrl":"10.1016/j.jogc.2025.103120","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the association between placental growth factor (PlGF) levels, ultrasound findings, and perinatal outcomes in a high-risk pregnant population at a tertiary referral centre in Western Canada, and to assess the predictive performance of the PlGF test.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 389 high-risk pregnant individuals who underwent PlGF testing between 12<sup>0</sup> and 36<sup>0</sup> weeks gestation. Participants were stratified by PlGF level: normal (≥10th centile), inconclusive (5th–9th centile), and low (≤5th centile). Clinical, biochemical, ultrasound, and perinatal outcomes were compared across groups. Odds ratios, sensitivity, specificity, and predictive values were calculated.</div></div><div><h3>Results</h3><div>Low PlGF levels were observed in 33.9% of pregnancies, with testing performed at a median gestational age of 27<sup>6</sup> weeks. Low PlGF levels were significantly associated with higher maternal BMI, elevated blood pressure, and increased creatinine, uric acid, and proteinuria levels. Ultrasound findings in the low PlGF group revealed higher rates of fetal growth restriction, abnormal Doppler studies, and abnormal placental morphology. These pregnancies had increased incidence of preterm birth <34<sup>0</sup> weeks (52/132; 39.3%), preeclampsia (69/132; 52.3%), neonatal intensive care unit admission (54/132; 40.9%), and small-for-gestational-age neonates (15/132; 11.4%). Most negative predictive values exceeded 90%.</div></div><div><h3>Conclusions</h3><div>Low maternal PlGF levels are strongly associated with ultrasound and biochemical indicators of placental dysfunction and adverse perinatal outcomes. PlGF testing may serve as an effective risk stratification tool in high-risk pregnancies, particularly in rural and underserved populations.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103120"},"PeriodicalIF":2.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056538","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

Predictors of Supportive Care in Young Adults Diagnosed With a Gynaecologic Malignancy 诊断为妇科恶性肿瘤的年轻成人支持治疗的预测因素。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-11 DOI: 10.1016/j.jogc.2025.103115

Catriona J. Buick RN, PhD, CON(C) , Akinkunle Oye-Somefun MSc, PhD , Charlotte Lee RN, OCN, CON(C), PhD , Allyson Nowell RN, MSc, CON(C) , Meagan Kennedy RN, MScN, PHC-NP , Parmis Mirzadeh MSc , Danielle Vicus MD, MSc

Objective

In Canada, gynaecologic cancers significantly impact adults aged 18–40 years, who may undergo multiple treatment modalities impacting their overall well-being. The objective of this study was to understand the individual characteristics, supportive care, and informational needs of these persons.

Methods

A cross-sectional survey of N = 50 adults (aged ≤40 years) receiving treatment (chemotherapy, surgery, and/or radiation) or under surveillance for gynaecologic cancer at a tertiary cancer centre in Toronto, Canada.

Results

Unmet supportive care needs were commonly reported, with more than half of the participants indicating unmet needs in all but 1 of the 5 domains (psychological [78%], health system and information [68%], physical and daily living [54%], sexuality [50%], and patient care and support [46%]). Unmet supportive care needs were associated with a host of psychosocial, demographic, and clinical factors. Notably, for psychosocial factors, low resilience was associated with a higher likelihood of unmet supportive care needs (health system and information [OR 2.97, 95% CI 1.06–8.35], physical and daily living [4.95, 1.69–22.66], and patient care and support [5.91, 1.77–40.50] domains and low perceived information and satisfaction [3.11, 1.30–11.60]). Various other socio-demographic (e.g., non-European cultural origins and other ethnicity, further distance to cancer centre) and clinical factors (e.g., number of treatment modalities) were also related to unmet needs.

Conclusion

Future studies must examine how to best meet the needs of younger adults affected by gynaecologic cancers to improve client-centred, supportive care through early intervention and adequate resources.

目的：在加拿大，妇科癌症对18-40岁的成年人影响很大，他们可能接受多种治疗方式，影响他们的整体健康。本研究的目的是了解这些个体的个体特征、支持性护理和信息需求。方法：在加拿大多伦多三级癌症中心对n = 50名（≤40岁）接受治疗（化疗、手术和/或放疗）或接受妇科癌症监测的成年人进行横断面调查。结果：未满足的支持性护理需求是普遍报告的，超过一半的参与者表示，除了五个领域中的一个之外，所有领域都有未满足的需求[心理（78%）；卫生系统和信息（68%）；身体和日常生活（54%）；性(50%);病人护理和支持（46%）。未满足的支持性护理需求与许多社会心理、人口统计学和临床因素有关。值得注意的是，对于社会心理因素，低弹性与未满足的支持性护理需求（卫生系统和信息（OR: 2.97, 95% CI: 1.06 - 8.35）、身体和日常生活（4.95,1.69 - 22.66）以及患者护理和支持（5.91,1.77 - 40.50）领域）的可能性较高相关；感知信息和满意度较低（3.11,1.30 - 11.60）。其他各种社会人口因素（如非欧洲文化起源和其他种族、距离癌症中心较远）和临床因素（如治疗方式的数量）也与未满足的需求有关。结论：未来的研究必须研究如何通过早期干预和充足的资源来最好地满足受妇科癌症影响的年轻成年人的需求，以改善以客户为中心的支持性护理。

{"title":"Predictors of Supportive Care in Young Adults Diagnosed With a Gynaecologic Malignancy","authors":"Catriona J. Buick RN, PhD, CON(C) , Akinkunle Oye-Somefun MSc, PhD , Charlotte Lee RN, OCN, CON(C), PhD , Allyson Nowell RN, MSc, CON(C) , Meagan Kennedy RN, MScN, PHC-NP , Parmis Mirzadeh MSc , Danielle Vicus MD, MSc","doi":"10.1016/j.jogc.2025.103115","DOIUrl":"10.1016/j.jogc.2025.103115","url":null,"abstract":"<div><h3>Objective</h3><div>In Canada, gynaecologic cancers significantly impact adults aged 18–40 years, who may undergo multiple treatment modalities impacting their overall well-being. The objective of this study was to understand the individual characteristics, supportive care, and informational needs of these persons.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of N = 50 adults (aged ≤40 years) receiving treatment (chemotherapy, surgery, and/or radiation) or under surveillance for gynaecologic cancer at a tertiary cancer centre in Toronto, Canada.</div></div><div><h3>Results</h3><div>Unmet supportive care needs were commonly reported, with more than half of the participants indicating unmet needs in all but 1 of the 5 domains (psychological [78%], health system and information [68%], physical and daily living [54%], sexuality [50%], and patient care and support [46%]). Unmet supportive care needs were associated with a host of psychosocial, demographic, and clinical factors. Notably, for psychosocial factors, low resilience was associated with a higher likelihood of unmet supportive care needs (health system and information [OR 2.97, 95% CI 1.06–8.35], physical and daily living [4.95, 1.69–22.66], and patient care and support [5.91, 1.77–40.50] domains and low perceived information and satisfaction [3.11, 1.30–11.60]). Various other socio-demographic (e.g., non-European cultural origins and other ethnicity, further distance to cancer centre) and clinical factors (e.g., number of treatment modalities) were also related to unmet needs.</div></div><div><h3>Conclusion</h3><div>Future studies must examine how to best meet the needs of younger adults affected by gynaecologic cancers to improve client-centred, supportive care through early intervention and adequate resources.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103115"},"PeriodicalIF":2.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058880","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

Evaluation of an Obstetric Medicine Curriculum for Obstetrics and Gynecology Trainees: A Quality Improvement Study 妇产科培训生产科医学课程评价：质量改进研究。

IF 2.2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada

Pub Date : 2025-09-10 DOI: 10.1016/j.jogc.2025.103116

Kelsey MacEachern BMSc, MD , Katherine Steckham MD , Michelle Morais BSc, MD, DRCPSC , Serena Gundy MD , Amanda Huynh MD, MSc QIPS

Objectives

Medical disorders in pregnancy are increasing. This highlights the need for obstetrics trainees to develop a strong foundation in managing medical conditions in pregnancy.

Methods

To address this, the internal medicine curriculum at our institution was redesigned for first year obstetrics residents to include an obstetric medicine (OBM) rotation.

Results

Before implementation, only 19% of residents felt at least moderately comfortable with OBM topics outlined by the Canadian Consensus for a Curriculum in Obstetric Medicine. This increased to 66% after the introduction of the redesigned curriculum. Using quality improvement methodology, we aimed to increase this to 80% via iterative plan-do-study-act cycles. Post-intervention, 81% of trainees reported feeling at least moderately comfortable in 14 of 17 Canadian Consensus for a Curriculum in Obstetric Medicine topics.

Conclusions

This quality improvement–driven curriculum enhancement was well-received and further highlights the value of early OBM integration in obstetrics training.

目的：妊娠期医学障碍日益增多。这突出表明，产科培训生需要在管理妊娠医疗条件方面打下坚实的基础。方法：为了解决这个问题，我们机构重新设计了第一年产科住院医师的内科课程，包括产科医学（OBM）轮转。结果：在实施之前，只有19%的居民对加拿大产科医学课程共识（CanCOM）概述的产科医学主题感到至少适度舒适。引入重新设计的课程后，这一比例增加到66%。使用质量改进（QI）方法，我们的目标是通过迭代的计划-执行-研究-行动循环将这一比例提高到80%。干预后，81%的受训者报告在17个CanCOM主题中的14个中至少感到适度舒适。结论：以qi为导向的课程改进效果良好，进一步凸显了早期产科医学整合在产科培训中的价值。

{"title":"Evaluation of an Obstetric Medicine Curriculum for Obstetrics and Gynecology Trainees: A Quality Improvement Study","authors":"Kelsey MacEachern BMSc, MD , Katherine Steckham MD , Michelle Morais BSc, MD, DRCPSC , Serena Gundy MD , Amanda Huynh MD, MSc QIPS","doi":"10.1016/j.jogc.2025.103116","DOIUrl":"10.1016/j.jogc.2025.103116","url":null,"abstract":"<div><h3>Objectives</h3><div>Medical disorders in pregnancy are increasing. This highlights the need for obstetrics trainees to develop a strong foundation in managing medical conditions in pregnancy.</div></div><div><h3>Methods</h3><div>To address this, the internal medicine curriculum at our institution was redesigned for first year obstetrics residents to include an obstetric medicine (OBM) rotation.</div></div><div><h3>Results</h3><div>Before implementation, only 19% of residents felt at least moderately comfortable with OBM topics outlined by the Canadian Consensus for a Curriculum in Obstetric Medicine. This increased to 66% after the introduction of the redesigned curriculum. Using quality improvement methodology, we aimed to increase this to 80% via iterative plan-do-study-act cycles. Post-intervention, 81% of trainees reported feeling at least moderately comfortable in 14 of 17 Canadian Consensus for a Curriculum in Obstetric Medicine topics.</div></div><div><h3>Conclusions</h3><div>This quality improvement–driven curriculum enhancement was well-received and further highlights the value of early OBM integration in obstetrics training.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 12","pages":"Article 103116"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056534","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