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.
{"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}
Pub Date : 2025-09-10DOI: 10.1016/j.jogc.2025.103111
Lauren E. Kelly PhD , Laurie Proulx BA , Ngawai Moss BA , Fabiana Bacchini BA , Isabelle Malhamé MD, Msc , Souvik Mitra MD, MSc, PhD , Karel Allegaert MD, PhD , Natalie Dayan MD, MSc
There is international momentum to improve the representation of pregnant and lactating persons and neonates in clinical trials to generate equitable and robust data for these groups. Appropriate inclusion of these groups in clinical trials requires additional considerations owing to alterations in pharmacokinetics of medicines during pregnancy, evaluating newborn outcomes and exposures through lactation, ethical issues relating to the timing of and approach to informed consent, and a lack of regulatory incentives or frameworks to guide trial design. These factors, combined with low overall knowledge of clinical trials, make it challenging to engage health care providers and patients in discussions about clinical trials during pregnancy. A multidisciplinary approach is needed to develop guidance for researchers, clinicians, industry, and regulatory agencies to promote safe participation. We herein provide a summary of the discussion from a multidisciplinary panel entitled “Designing for Dyads” that was held at the 2024 Increasing capacity for Maternal and Paediatric Clinical Trials summit in Vancouver, BC, Canada and the action items suggested by the panel.
{"title":"Designing for Dyads: A Multidisciplinary Panel on Inclusion of Pregnant and Lactating Persons and Their Infants in Clinical Trials","authors":"Lauren E. Kelly PhD , Laurie Proulx BA , Ngawai Moss BA , Fabiana Bacchini BA , Isabelle Malhamé MD, Msc , Souvik Mitra MD, MSc, PhD , Karel Allegaert MD, PhD , Natalie Dayan MD, MSc","doi":"10.1016/j.jogc.2025.103111","DOIUrl":"10.1016/j.jogc.2025.103111","url":null,"abstract":"<div><div>There is international momentum to improve the representation of pregnant and lactating persons and neonates in clinical trials to generate equitable and robust data for these groups. Appropriate inclusion of these groups in clinical trials requires additional considerations owing to alterations in pharmacokinetics of medicines during pregnancy, evaluating newborn outcomes and exposures through lactation, ethical issues relating to the timing of and approach to informed consent, and a lack of regulatory incentives or frameworks to guide trial design. These factors, combined with low overall knowledge of clinical trials, make it challenging to engage health care providers and patients in discussions about clinical trials during pregnancy. A multidisciplinary approach is needed to develop guidance for researchers, clinicians, industry, and regulatory agencies to promote safe participation. We herein provide a summary of the discussion from a multidisciplinary panel entitled “Designing for Dyads” that was held at the 2024 Increasing capacity for Maternal and Paediatric Clinical Trials summit in Vancouver, BC, Canada and the action items suggested by the panel.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103111"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056583","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 : 2025-09-10DOI: 10.1016/j.jogc.2025.103121
Katy Dmowski MSc , Uyen Do MSc , Danielle Cutler BSc , Tahereh Najafi Ghezeljeh PhD , Elahe Khorasani PhD , Pepa Kaneva MSc , Agnihotram V. Ramanakumar PhD , Liane S. Feldman MD , Andrew Zakhari MD , Julio F. Fiore Jr. PhD
Objectives
This study aimed to assess the extent to which patient and care characteristics are associated with in-hospital opioid consumption and discharge prescribing following cesarean delivery (CD).
Methods
This retrospective cohort study included patients undergoing CD under neuraxial anesthesia at a university-affiliated hospital from December 2020 to December 2021. Patient demographics, care characteristics, in-hospital opioid consumption, and discharge prescription (in number of morphine 5 mg pills) were collected from medical records. Predictors were analyzed using negative binomial regression, with multiple imputations for missing data.
Results
Overall, 904 patients were included (age 35 ± 5 years, gestational age 380 ± 26 weeks, multiple gestations 5.3%, previous CD 44.7%, emergency delivery 40.9%, and hospital stay 2.3 ± 1.1 days). In-hospital analgesia prescriptions included acetaminophen (100%), nonsteroidal anti-inflammatory drugs (91.2%), and opioids (100%). Median in-hospital opioid consumption was zero (IQR 0–2) morphine 5 mg pills. Opioid consumption was associated with opioid use during pregnancy (incidence rate ratio [IRR] 9.419; 95% CI 3.425–25.900), higher postoperative pain scores (IRR 1.599; 95% CI 1.524–1.678), higher post-anesthesia care unit opioid consumption (IRR 1.007; 95% CI 1.002–1.013), and nonsteroidal anti-inflammatory drugs consumption (IRR 0.613; 95% CI 0.460–0.818). At discharge, 89.2% of patients were prescribed opioids (median = 20 [IQR 20–20] morphine 5 mg pills). Decreased discharge prescribing was associated with receiving a preprinted discharge prescription with fewer morphine 5 mg pills (10 vs. 20; 0.548 [95% CI 0.389–0.770]).
Conclusions
In this study, in-hospital opioid consumption following CD was low and was associated with patient and care-related factors. At discharge, the only factor associated with prescription size was the use of preprinted prescriptions. These findings can inform strategies to mitigate opioid-related harms following CD.
{"title":"Predictors of In-Hospital Opioid Consumption and Discharge Prescribing Following Cesarean Delivery","authors":"Katy Dmowski MSc , Uyen Do MSc , Danielle Cutler BSc , Tahereh Najafi Ghezeljeh PhD , Elahe Khorasani PhD , Pepa Kaneva MSc , Agnihotram V. Ramanakumar PhD , Liane S. Feldman MD , Andrew Zakhari MD , Julio F. Fiore Jr. PhD","doi":"10.1016/j.jogc.2025.103121","DOIUrl":"10.1016/j.jogc.2025.103121","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess the extent to which patient and care characteristics are associated with in-hospital opioid consumption and discharge prescribing following cesarean delivery (CD).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients undergoing CD under neuraxial anesthesia at a university-affiliated hospital from December 2020 to December 2021. Patient demographics, care characteristics, in-hospital opioid consumption, and discharge prescription (in number of morphine 5 mg pills) were collected from medical records. Predictors were analyzed using negative binomial regression, with multiple imputations for missing data.</div></div><div><h3>Results</h3><div>Overall, 904 patients were included (age 35 ± 5 years, gestational age 38<sup>0</sup> ± 2<sup>6</sup> weeks, multiple gestations 5.3%, previous CD 44.7%, emergency delivery 40.9%, and hospital stay 2.3 ± 1.1 days). In-hospital analgesia prescriptions included acetaminophen (100%), nonsteroidal anti-inflammatory drugs (91.2%), and opioids (100%). Median in-hospital opioid consumption was zero (IQR 0–2) morphine 5 mg pills. Opioid consumption was associated with opioid use during pregnancy (incidence rate ratio [IRR] 9.419; 95% CI 3.425–25.900), higher postoperative pain scores (IRR 1.599; 95% CI 1.524–1.678), higher post-anesthesia care unit opioid consumption (IRR 1.007; 95% CI 1.002–1.013), and nonsteroidal anti-inflammatory drugs consumption (IRR 0.613; 95% CI 0.460–0.818). At discharge, 89.2% of patients were prescribed opioids (median = 20 [IQR 20–20] morphine 5 mg pills). Decreased discharge prescribing was associated with receiving a preprinted discharge prescription with fewer morphine 5 mg pills (10 vs. 20; 0.548 [95% CI 0.389–0.770]).</div></div><div><h3>Conclusions</h3><div>In this study, in-hospital opioid consumption following CD was low and was associated with patient and care-related factors. At discharge, the only factor associated with prescription size was the use of preprinted prescriptions. These findings can inform strategies to mitigate opioid-related harms following CD.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103121"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056526","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}
This cross-sectional study aimed to assess the desirability of a shared obstetrics-gynecology–midwifery care model for adolescents at an acute tertiary hospital in Canada. Validated questionnaires were given to adolescents and practitioners. Thirteen (86% response rate) respondents completed the antenatal survey and identified being given results of tests, feeling safe, and having a variety of health care professionals as important to them. Practitioners (n = 10, 100% response rate) identified having a good sense of their role but struggled with time efficiency amongst a large team. This quality improvement study shows promising results that shared care between obstetrician-gynecologists and midwives is desirable.
{"title":"Obstetrician-Midwifery Shared Care for Adolescents: A Patient and Practitioner Perspective","authors":"Caroline Leps MSc, MD , Valerie Bloomfield MD , Anjali Aggarwal MD, MHSc , Rachel F. Spitzer MD, MPH","doi":"10.1016/j.jogc.2025.103104","DOIUrl":"10.1016/j.jogc.2025.103104","url":null,"abstract":"<div><div>This cross-sectional study aimed to assess the desirability of a shared obstetrics-gynecology–midwifery care model for adolescents at an acute tertiary hospital in Canada. Validated questionnaires were given to adolescents and practitioners. Thirteen (86% response rate) respondents completed the antenatal survey and identified being given results of tests, feeling safe, and having a variety of health care professionals as important to them. Practitioners (n = 10, 100% response rate) identified having a good sense of their role but struggled with time efficiency amongst a large team. This quality improvement study shows promising results that shared care between obstetrician-gynecologists and midwives is desirable.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103104"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056540","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 : 2025-09-10DOI: 10.1016/j.jogc.2025.103118
Raeesha Rajan BHSc, MSc , Valerie Bloomfield MAS, MD , Sari Kives MSc, MD , Lisa Allen MSc, MD
Objectives
Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with physical, social, emotional, or material quality of life. Several societies, including the Society of Obstetricians and Gynecologists of Canada (SOGC) and North American Society for Pediatric and Adolescent Gynecology (NASPAG), have created algorithms to guide investigations and management. We aim to evaluate the extent to which primary care providers (PCPs) initiate first-tier guideline investigations and management before specialist referral.
Methods
A retrospective review of adolescents referred to pediatric and adolescent gynaecology (PAG) for HMB over a 2-year period was conducted. Patient demographics, investigations, and management initiated by the referring PCPs were extracted. These investigations were compared with SOGC and NASPAG guidelines to assess completion of first-tier investigations. In addition, diagnosis, investigations, and management initiated by the PAG team at the first visit was captured.
Results
In total, 242 patients were included for review. The minority of referrals included all first-tier investigations defined by SOGC or NASPAG (34.3% and 16.1%, respectively). Despite this, 80% of adolescents were started on a treatment modality by their PCP. Commonly prescribed treatments included oral combined hormonal contraceptives (44%) and non-steroidal anti-inflammatories (43%). After PAG consultation, the majority of adolescents completed first-tier investigations (SOGC 87% and NASPAG 67%).
Conclusions
The study provides an understanding of how PCPs are investigating, managing, and referring adolescents with HMB and the potential impact on decision-making at first PAG consultation. This serves to inform collaboration between PCPs and PAG providers, with the goal of promoting judicious use of health care resources and timely care.
{"title":"Evaluating Primary Care Referrals for Heavy Menstrual Bleeding in Adolescents: A Retrospective Medical Record Review","authors":"Raeesha Rajan BHSc, MSc , Valerie Bloomfield MAS, MD , Sari Kives MSc, MD , Lisa Allen MSc, MD","doi":"10.1016/j.jogc.2025.103118","DOIUrl":"10.1016/j.jogc.2025.103118","url":null,"abstract":"<div><h3>Objectives</h3><div>Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with physical, social, emotional, or material quality of life. Several societies, including the Society of Obstetricians and Gynecologists of Canada (SOGC) and North American Society for Pediatric and Adolescent Gynecology (NASPAG), have created algorithms to guide investigations and management. We aim to evaluate the extent to which primary care providers (PCPs) initiate first-tier guideline investigations and management before specialist referral.</div></div><div><h3>Methods</h3><div>A retrospective review of adolescents referred to pediatric and adolescent gynaecology (PAG) for HMB over a 2-year period was conducted. Patient demographics, investigations, and management initiated by the referring PCPs were extracted. These investigations were compared with SOGC and NASPAG guidelines to assess completion of first-tier investigations. In addition, diagnosis, investigations, and management initiated by the PAG team at the first visit was captured.</div></div><div><h3>Results</h3><div>In total, 242 patients were included for review. The minority of referrals included all first-tier investigations defined by SOGC or NASPAG (34.3% and 16.1%, respectively). Despite this, 80% of adolescents were started on a treatment modality by their PCP. Commonly prescribed treatments included oral combined hormonal contraceptives (44%) and non-steroidal anti-inflammatories (43%). After PAG consultation, the majority of adolescents completed first-tier investigations (SOGC 87% and NASPAG 67%).</div></div><div><h3>Conclusions</h3><div>The study provides an understanding of how PCPs are investigating, managing, and referring adolescents with HMB and the potential impact on decision-making at first PAG consultation. This serves to inform collaboration between PCPs and PAG providers, with the goal of promoting judicious use of health care resources and timely care.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103118"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056562","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}
To evaluate differences in postoperative complications and practice patterns amongst vaginal hysterectomy (VH) performed by fellowship-trained urogynaecologists compared with general gynaecologists.
Methods
This was a retrospective chart review of patients who underwent VH for benign conditions across 9 Canadian hospitals (6 academic, 3 community) between July 2016 and November 2022. Postoperative complications and practice patterns were compared between fellowship-trained urogynaecologists and general gynaecologists.
Results
A total of 1459 VHs were performed: 691 VH by 10 fellowship-trained urogynaecologist, and 768 VH by 33 general gynaecologists. After adjustment, the odds of postoperative complication were not statistically significant between the groups (1.08; 95% CI 0.66–1.76). Compared with general gynaecologists, urogynaecologists had no difference in transfusion rates (OR 1.99; 95% CI 0.77–5.12); operative time (median 126 minutes [IQR 77] vs 125 [IQR 98]); and in the odds of the composite outcome, any complication, or readmission within 30 days of hysterectomy (OR 1.23; 95% CI 0.91–1.65). Urogynaecologists did not have a clinically significant increase in estimated blood loss (average 25 cc per case). The rates of apical repair were low amongst urogynaecologists and general gynaecologists, 57.3% and 28.5%, respectively. Of the 33 general gynaecologists, 1 (3%) was new to practice (<5 years).
Conclusions
Major postoperative complications are comparable between general gynaecologists and urogynaecologists, and general gynaecologists should continue to have a robust VH practice to address growing demand. With few new generalists having a VH practice, tailored education is necessary.
{"title":"Postoperative Outcomes and Practices in Vaginal Hysterectomy: A Retrospective Cohort Study and Comparison of General Gynaecologists and Urogynaecologists","authors":"Caroline Leps MD, MSc , Justin W.J. Lim MD , Elizabeth Miazga MD, LLM , Lindsay Shirreff MD, MSc (HQ) , Ally Murji MD, MPH","doi":"10.1016/j.jogc.2025.103117","DOIUrl":"10.1016/j.jogc.2025.103117","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate differences in postoperative complications and practice patterns amongst vaginal hysterectomy (VH) performed by fellowship-trained urogynaecologists compared with general gynaecologists.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of patients who underwent VH for benign conditions across 9 Canadian hospitals (6 academic, 3 community) between July 2016 and November 2022. Postoperative complications and practice patterns were compared between fellowship-trained urogynaecologists and general gynaecologists.</div></div><div><h3>Results</h3><div>A total of 1459 VHs were performed: 691 VH by 10 fellowship-trained urogynaecologist, and 768 VH by 33 general gynaecologists. After adjustment, the odds of postoperative complication were not statistically significant between the groups (1.08; 95% CI 0.66–1.76). Compared with general gynaecologists, urogynaecologists had no difference in transfusion rates (OR 1.99; 95% CI 0.77–5.12); operative time (median 126 minutes [IQR 77] vs 125 [IQR 98]); and in the odds of the composite outcome, any complication, or readmission within 30 days of hysterectomy (OR 1.23; 95% CI 0.91–1.65). Urogynaecologists did not have a clinically significant increase in estimated blood loss (average 25 cc per case). The rates of apical repair were low amongst urogynaecologists and general gynaecologists, 57.3% and 28.5%, respectively. Of the 33 general gynaecologists, 1 (3%) was new to practice (<5 years).</div></div><div><h3>Conclusions</h3><div>Major postoperative complications are comparable between general gynaecologists and urogynaecologists, and general gynaecologists should continue to have a robust VH practice to address growing demand. With few new generalists having a VH practice, tailored education is necessary.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103117"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056544","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 : 2025-09-10DOI: 10.1016/j.jogc.2025.103103
Hana Arghavani MSc , Line Berthiaume BSc , Karine Greffard BSc , Pierre Julien PhD , François Audibert MD, MSc , William D. Fraser MD, MSc , Iwona Rudkowska PhD, RD , Jean-François Bilodeau PhD
Objectives
To examine the associations of circulating very long-chain saturated fatty acids (VLSFAs) with maternal blood pressure (BP), weight gain, and incidence of gestational hypertension (GH)/preeclampsia (PE) in a retrospective longitudinal study.
Methods
Blood samples from 92 pregnant women, including normotensive (n = 64) and hypertensive pregnancies (GH/PE, n = 28), from the International Trial of Antioxidants in the Prevention of PE (INTAPP; ISRCTN 85024310) were used at 8–14 weeks (visit 1) and 20–24 weeks (visit 2). Plasma Fatty acids (FA) profiles were measured by gas chromatography with flame ionization detection. Partial correlations and mixed models assessed BP and FA associations. Logistic regression models were used to assess GH/PE risks using FAs.
Results
Weight gain adjusted for pre-pregnancy BMI was inversely correlated to arachidic acid at visit 1 (r = –0.364, P < 0.001). VLSFAs, arachidic acid, and tricosylic acid were negatively correlated with both systolic BP and diastolic BP (DBP) at visit 1 (r < –0.274, P < 0.03). Higher levels of VLSFAs were also associated with the lower quartile of DBP (P = 0.01). Integrating clinical parameters with FA profiles (palmitoleic acid and eicosapentaenoic acid) presented a promising predictive model for GH/PE.
Conclusions
VLSFA levels in circulating phospholipids, especially arachidic acid, are associated with weight gain and BP, and with tricosylic acid, could be linked to a potentially protective role within FAs in a more complex lipid signature against hypertension in pregnancy.
目的：通过一项回顾性纵向研究，探讨循环甚长链饱和脂肪酸（VLSFAs）与孕妇血压（BP）、体重增加和妊娠高血压(GH)/子痫前期（PE）发生率的关系。方法：使用来自国际抗氧化剂预防先兆子痫试验（INTAPP; ISRCTN 85024310）的92名孕妇的血液样本，包括血压正常的孕妇（n = 64）和高血压孕妇（GH/PE, n = 28），于8-14周（访问1）和20-24周（访问2）使用。采用气相色谱火焰电离检测法测定血浆脂肪酸（FA）谱。部分相关和混合模型评估了BP和FA的关联。Logistic回归模型用于FAs评估GH/PE风险。结果：妊娠前体重指数调整后的体重增加与就诊1时花生四烯酸呈负相关（r = -0.364, P < 0.001）。vlsfa、花生四酸、三叶草酸与就诊1时收缩压、舒张压均呈负相关（r < -0.274, P < 0.03）。高水平的vlsfa也与DBP低四分位数相关（P = 0.01）。将临床参数与FAs谱（棕榈油酸和二十碳五烯酸）相结合，提出了一种很有前景的GH/PE预测模型。结论：循环磷脂中的vlsfa水平，特别是花生四烯酸，与体重增加和血压有关，而三叶草酸可能与FAs中潜在的保护作用有关，在更复杂的脂质特征中对抗妊娠期高血压。
{"title":"Circulating Very Long-Chain Saturated Fatty Acids in Early Pregnancy: Association With Blood Pressure and Weight Gain","authors":"Hana Arghavani MSc , Line Berthiaume BSc , Karine Greffard BSc , Pierre Julien PhD , François Audibert MD, MSc , William D. Fraser MD, MSc , Iwona Rudkowska PhD, RD , Jean-François Bilodeau PhD","doi":"10.1016/j.jogc.2025.103103","DOIUrl":"10.1016/j.jogc.2025.103103","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the associations of circulating very long-chain saturated fatty acids (VLSFAs) with maternal blood pressure (BP), weight gain, and incidence of gestational hypertension (GH)/preeclampsia (PE) in a retrospective longitudinal study.</div></div><div><h3>Methods</h3><div>Blood samples from 92 pregnant women, including normotensive (n = 64) and hypertensive pregnancies (GH/PE, n = 28), from the International Trial of Antioxidants in the Prevention of PE (INTAPP; ISRCTN 85024310) were used at 8–14 weeks (visit 1) and 20–24 weeks (visit 2). Plasma Fatty acids (FA) profiles were measured by gas chromatography with flame ionization detection. Partial correlations and mixed models assessed BP and FA associations. Logistic regression models were used to assess GH/PE risks using FAs.</div></div><div><h3>Results</h3><div>Weight gain adjusted for pre-pregnancy BMI was inversely correlated to arachidic acid at visit 1 (<em>r</em> = –0.364, <em>P</em> < 0.001). VLSFAs, arachidic acid, and tricosylic acid were negatively correlated with both systolic BP and diastolic BP (DBP) at visit 1 (<em>r <</em> –0.274, <em>P <</em> 0.03). Higher levels of VLSFAs were also associated with the lower quartile of DBP (<em>P =</em> 0.01). Integrating clinical parameters with FA profiles (palmitoleic acid and eicosapentaenoic acid) presented a promising predictive model for GH/PE.</div></div><div><h3>Conclusions</h3><div>VLSFA levels in circulating phospholipids, especially arachidic acid, are associated with weight gain and BP, and with tricosylic acid, could be linked to a potentially protective role within FAs in a more complex lipid signature against hypertension in pregnancy.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103103"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056554","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 : 2025-09-10DOI: 10.1016/j.jogc.2025.103106
Kyara J. Liu MPH , Evelina Pituch OT, PhD , Kathryn Barrett MLIS , Anne Berndl MD, MSc , Lisa Graves MD , Yona Lunsky PhD, CPsych , Marina Vainder MD , Andi Camden PhD , Meredith Evans PhD , Lesley A. Tarasoff PhD , Hilary K. Brown PhD
Objectives
This study aimed to develop quality indicators (QIs) for pregnancy care of people with disabilities.
Methods
We used a RAND-modified Delphi method. We first conducted a scoping review of Medline, Embase, PsycInfo, and CINAHL (2004–2024) to identify candidate QIs related to the structures, clinical processes, and interpersonal processes of pregnancy care for people with disabilities. Draft QIs were then validated in a 3-round Delphi study from June 2023 to October 2024, with an expert panel of 17 pregnancy care providers and 10 birthing people with disabilities. In round 1, panellists rated draft QIs on importance and feasibility in a survey. New QIs and QIs requiring rephrasing were identified. In round 2, QIs were discussed and refined in focus groups. In round 3, panellists rated new and revised QIs on importance and feasibility. The final list of QIs was created on the basis of panel consensus on importance.
Results
The review identified 98 studies, from which 44 candidate QIs were created for structures (n = 12), clinical processes (n = 22), and interpersonal processes of care (n = 10). In round 1 of the Delphi survey, consensus on importance was achieved for all QIs, 5 of which were identified as requiring rephrasing. Panellists suggested 10 new QIs. In round 2, the new and revised QIs were discussed in focus groups. In round 3, the new and revised QIs achieved consensus on importance, resulting in a final list of 54 QIs (n = 43 achieving consensus on feasibility).
Conclusions
These QIs can assist health care providers, administrators, and policymakers in optimising the quality of pregnancy care for people with disabilities.
{"title":"Development of Quality Indicators for Pregnancy Care of People With Disabilities Using a RAND-Modified Delphi Method","authors":"Kyara J. Liu MPH , Evelina Pituch OT, PhD , Kathryn Barrett MLIS , Anne Berndl MD, MSc , Lisa Graves MD , Yona Lunsky PhD, CPsych , Marina Vainder MD , Andi Camden PhD , Meredith Evans PhD , Lesley A. Tarasoff PhD , Hilary K. Brown PhD","doi":"10.1016/j.jogc.2025.103106","DOIUrl":"10.1016/j.jogc.2025.103106","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to develop quality indicators (QIs) for pregnancy care of people with disabilities.</div></div><div><h3>Methods</h3><div>We used a RAND-modified Delphi method. We first conducted a scoping review of Medline, Embase, PsycInfo, and CINAHL (2004–2024) to identify candidate QIs related to the structures, clinical processes, and interpersonal processes of pregnancy care for people with disabilities. Draft QIs were then validated in a 3-round Delphi study from June 2023 to October 2024, with an expert panel of 17 pregnancy care providers and 10 birthing people with disabilities. In round 1, panellists rated draft QIs on importance and feasibility in a survey. New QIs and QIs requiring rephrasing were identified. In round 2, QIs were discussed and refined in focus groups. In round 3, panellists rated new and revised QIs on importance and feasibility. The final list of QIs was created on the basis of panel consensus on importance.</div></div><div><h3>Results</h3><div>The review identified 98 studies, from which 44 candidate QIs were created for structures (n = 12), clinical processes (n = 22), and interpersonal processes of care (n = 10). In round 1 of the Delphi survey, consensus on importance was achieved for all QIs, 5 of which were identified as requiring rephrasing. Panellists suggested 10 new QIs. In round 2, the new and revised QIs were discussed in focus groups. In round 3, the new and revised QIs achieved consensus on importance, resulting in a final list of 54 QIs (n = 43 achieving consensus on feasibility).</div></div><div><h3>Conclusions</h3><div>These QIs can assist health care providers, administrators, and policymakers in optimising the quality of pregnancy care for people with disabilities.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103106"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056595","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 : 2025-09-10DOI: 10.1016/j.jogc.2025.103102
Daniel J. Kiely MDCM, MSc , Sebastian Hobson MD, MPH, PhD , Katherine Tyndall RN, BScN, PNC , Lawrence Oppenheimer MD
Maternal heart rate artifact occurs during fetal heart rate monitoring when the maternal heart rate is mistaken for the fetal heart rate. Unrecognized maternal heart rate artifact poses major patient safety risks due to errors of commission and omission when healthcare teams do not realise that the supposedly “fetal” heart rate tracing that they are observing is misleading. In 2022, a technical update was published by the Society of Obstetricians and Gynaecologists of Canada to mitigate this risk by describing the signs of possible maternal heart rate artifact and the steps to obtain an accurate fetal heart rate tracing. Despite this, concerns remain regarding implementation in clinical practice. Here, we present 2 illustrative fetal and maternal heart rate tracings to increase awareness and help with knowledge translation.
{"title":"In Practice: Maternal Heart Rate Artifact","authors":"Daniel J. Kiely MDCM, MSc , Sebastian Hobson MD, MPH, PhD , Katherine Tyndall RN, BScN, PNC , Lawrence Oppenheimer MD","doi":"10.1016/j.jogc.2025.103102","DOIUrl":"10.1016/j.jogc.2025.103102","url":null,"abstract":"<div><div>Maternal heart rate artifact occurs during fetal heart rate monitoring when the maternal heart rate is mistaken for the fetal heart rate. Unrecognized maternal heart rate artifact poses major patient safety risks due to errors of commission and omission when healthcare teams do not realise that the supposedly “fetal” heart rate tracing that they are observing is misleading. In 2022, a technical update was published by the Society of Obstetricians and Gynaecologists of Canada to mitigate this risk by describing the signs of possible maternal heart rate artifact and the steps to obtain an accurate fetal heart rate tracing. Despite this, concerns remain regarding implementation in clinical practice. Here, we present 2 illustrative fetal and maternal heart rate tracings to increase awareness and help with knowledge translation.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 11","pages":"Article 103102"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056571","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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