Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC最新文献

Objective: This study aimed to evaluate whether abnormal uterine artery Doppler (UtAD) indices are associated with increased risk of preeclampsia with severe features in pregnancies complicated by late preterm fetal growth restriction (FGR), and to compare this association to that of abnormal umbilical artery Doppler (UAD) indices.

Methods: This retrospective cohort study included patients with singleton pregnancies complicated by FGR who underwent uterine and umbilical artery Doppler assessment between 34 0/7 and 36 6/7 weeks of gestation and delivered at hospitals within a large academic health system from 2018 to 2022. Abnormal UtAD was defined as a pulsatility index >95th percentile and/or the presence of notching; abnormal UAD was defined as a pulsatility index >95th percentile. The primary outcome was preeclampsia with severe features. Multivariable logistic regression using backward selection was performed to estimate adjusted odds ratios (aORs), controlling for maternal age and body mass index (BMI).

Results: Among 415 patients, 143 (34.5%) had abnormal UtAD and 28 (6.7%) had abnormal UAD. Severe preeclampsia occurred in 13.3% of patients with abnormal UtAD compared to 5.6% with normal indices (P = 0.01). In adjusted models, abnormal UtAD was significantly associated with severe preeclampsia (aOR 2.12; 95% CI, 1.03-4.36), whereas abnormal UAD was not (aOR 1.76; 95% CI, 0.72-4.29).

Conclusion: Abnormal uterine artery Doppler is independently associated with increased risk of preeclampsia with severe features in late preterm FGR pregnancies. UtAD may serve as a useful tool for risk stratification in this population.

IUDs are a popular and effective form of contraception. This study assessed the benefit of 2D US-guided Copper T IUD insertion. It involved 100 eligible clients in 2 groups, each of 50. The first group had IUDs insertion blindly, and the second had real-time 2D US-guided insertion. Perfect insertion showed a significant difference (P = 0.002) between the 2 groups. Misplacement showed a non-significant difference. Cervical displacement and reinsertion showed a difference (P = 0.056). Using 2D ultrasound during IUD insertion gives better outcomes and decreases the failure rate. Ultrasound improves client satisfaction, with a subsequent increased rate of use and contraceptive efficacy.

Objective: There is limited real word data regarding the utilization of gemcitabine as a single agent in ovarian cancer (OC). We aimed to study the outcomes of treating recurrent OC with single-agent gemcitabine.

Materials and methods: We conducted a retrospective study including patients with recurrent OC who were treated with single-agent gemcitabine. Patients who received gemcitabine in combination with other agents were excluded. Our primary outcome was the overall survival (OS) of patients treated with single-agent gemcitabine.

Results: Overall, eighteen patients were included. The median age of patients was 59 [interquartile range (IQR) 49-63]. The majority of patients (67%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 1. The median number of lines of treatments prior to gemcitabine was 4 [IQR3-5]. The median duration on gemcitabine was 2 months [IQR1-4], and the median OS was 4 months [95% confidence interval 1-6]. One patient had a reaction to treatment after the first infusion and treatment was discontinued. Four patients (22%) had at least one additional line of treatment following gemcitabine. During gemcitabine treatment, 67% of patients were admitted, and 61% of patients have passed away within 30 days of treatment.

Conclusions: Single-agent gemcitabine in heavily pretreated recurrent OC is associated with a median OS of four months, and some patients even benefit from further lines of treatment.

Objective: To systematically review the literature on endometrial osseous metaplasia, its clinical presentation, diagnostic approaches, and the efficacy of uterine-preserving treatments in restoring fertility and alleviating symptoms. This review was registered on PROSPERO (CRD42023387361).

Data sources: A comprehensive search of PubMed, OVID and EMBASE was conducted from inception to February 2025.

Study selection: Included studies reported on the diagnosis of endometrial osseous metaplasia, uterine-preserving treatments, and fertility or gynecology outcomes. The search yielded 1836 studies, narrowed to 153 articles, of which 37 were included (26 case reports, 8 case series, 2 retrospective and 1 prospective study).

Data extraction/synthesis: Across 37 studies, 128 patients were identified. The mean age was 34.4 years, with 64.1% having a history of abortion or miscarriage. Among 83 patients with infertility, 10.8% had primary and 57.8% had secondary infertility. All underwent hysteroscopic resection; 18.0% also had dilatation and curettage, and one received endometrial ablation. Of 60 patients pursuing fertility after treatment, 78.3% conceived: 59.6% spontaneously, 10.6% through assisted reproductive technology, and 4.2% with ovulation induction. The mean time to conception was 6.7 months (range 1-36). Symptom resolution occurred in 83.3% of patients, including improvements in abnormal bleeding, dysmenorrhea, and pelvic pain. Risk of bias varied (scores 2-7), with retrospective cohort studies demonstrating higher methodological quality.

Conclusion: Hysteroscopic resection appears to be a promising fertility-sparing treatment for endometrial osseous metaplasia based on case reports and small case series. However, robust data on efficacy and long-term outcomes are lacking. Given its association with prior pregnancy loss and endometrial trauma, greater clinical awareness and early management may improve reproductive outcomes. Further prospective studies are needed to clarify long-term fertility and recurrence post-treatment.

Background: Despite substantial health expenditures and high national incomes, both Canada and the United States consistently underperform in international health system rankings, with particular implications for women's health equity and outcomes.

Methods: This scoping review examines systemic and policy-related drivers of health performance across five key domains: equity, access, administrative efficiency, care processes, and outcomes, with specific attention to gender disparities and women's health implications.

Findings: While both countries share more similarities than commonly recognized, they face persistent structural and political limitations that disproportionately impact women's health outcomes. Women face greater barriers to accessing care, significant pay disparities in healthcare professions, and inequitable treatment across multiple health domains. Both nations rank poorly in equity measures (Canada 7th/10, USA 9th/11), with women bearing a disproportionate burden of these inequities.

Conclusions: Critical areas requiring reform include ethical prioritization frameworks, enhanced investment in primary care infrastructure, integration of data systems, and specific attention to gender-responsive health policies. The generational shift toward more women entering healthcare professions presents opportunities for system transformation. Comprehensive health policy reform addressing women's health equity is urgently needed in North America.

Objective: To summarize the proceedings, key themes, and calls to action arising from the inaugural 2023 Summit on the Prevention of Maternal Mortality in Canada, convened by the Society of Obstetricians and Gynaecologists of Canada (SOGC) to advance a coordinated national approach to maternal mortality review and prevention.

Summit proceedings: The Summit brought together over 150 participants representing clinical providers, researchers, families with lived experience, policy makers, coroners and medical examiners, Indigenous and community leaders, health system administrators, and international experts. Through plenary sessions, panel presentations, and facilitated breakout discussions, participants examined gaps in current Canadian maternal mortality surveillance and identified priority actions across jurisdictions and professions.

Actions and recommendations: Participants emphasized the urgent need for a coordinated, National approach that includes standardized definitions, harmonized review processes, improved national data systems, and protected, learning-focused review mechanisms. Major themes included strengthening data quality and linkage; addressing inequities in maternal health outcomes; advancing national-provincial-territorial coordination; integrating the voices of affected families and communities; and translating evidence into clinical protocols, education, and quality improvement practices. The Summit produced clear recommendations for federal, provincial, territorial, and professional bodies, as well as for health care institutions and providers.

Conclusion: The 2023 Summit represents a foundational step toward establishing a unified, equity-driven maternal mortality review and prevention system in Canada. The calls to action generated at the meeting outline a national path forward-one that requires sustained collaboration, investment, and leadership to eliminate preventable maternal deaths and ensure that every woman in Canada receives safe, high-quality, and respectful care. The ripple effect will also improve outcomes from near-miss experiences and severe maternal morbidity.

Objective: To investigate the relationship between adverse obstetrical outcomes and cervical dysplasia treatments.

Methods: This study used linked health care databases through the Institute of Clinical Evaluative Sciences, in Ontario Canada, between 2005-2019. We conducted a population-based retrospective cohort study of pregnant women who had undergone previous colposcopy and subsequently had a pregnancy, comparing the no treatment cohort to patients who had a cervical excisional procedures (CEP) or cervical ablative procedures (CAP). The primary outcome was preterm birth (PTB). The secondary outcomes included preterm premature rupture of membranes, low birthweight, spontaneous abortion, stillbirth, and cervical incompetence. Cox proportional hazard models were used to calculate hazard ratios. We used unadjusted logistic regression to compare outcomes between those who underwent CEP vs CAP. Odds ratios with 95% confidence intervals were calculated.

Results: We included 515 726 pregnant patients. After exclusion criteria, 109 930 patients remained. There were 74 291 patients in the control group, 24 133 patients in the CEP group and 11 506 patients in the CAP group. In the control group 2620 patients (5.7%) had a PTB versus 1321 (7.6%) and 592 (6.5%) in the CEP and CAP groups, respectively (OR 1.18 95% CI 1.07-1.31, P<0.01). After controlling for age, there was a 32% increased risk of PTB with a CEP (HR 1.32, 95% CI 1.24-1.40, P<0.001). For a CAP, there was no increased risk in PTB (HR 1.01, 95% CI 0.94-1.09, P = 0.74.

Conclusion: In this large Ontario dataset of pregnant patients who underwent previous colposcopy, CEP was associated with PTB.

Objective: To assess an association of the discrepancy between gestational age (GA) estimated by the last menstrual period (LMP) and by ultrasound (US), with the effectiveness of misoprostol treatment for first-trimester early missed miscarriage METHODS: This retrospective study included women treated with vaginal misoprostol for first-trimester missed miscarriage during 2020-2024. Treatment failure was defined as the need for surgical evacuation. Multivariable logistic regression assessed whether the interval between GA-LMP and GA-US independently predicted failure.

Results: For women with failed (N = 74, 15.8%) compared to successful treatment (N = 394, 84.2%), the mean gravidity was higher (3 vs. 2, P = 0.007) and vaginal bleeding or abdominal pain at presentation was more frequent (18.9% vs. 31.6%, P = 0.037). A >4-week interval between LMP and US GA was more frequent in the failure group (21.6% vs. 10.9%, P = 0.014). Among women with an LMP-US interval >4 weeks, compared to <4 weeks, the failure rate was greater (27.1% vs. 14.1%), and a second dose of misoprostol was more frequent (39.0% vs. 27.5%, odds ratio [OR] 1.69, 95% CI 1.01-2.83, P = 0.05). In multivariable analysis, a >4-week interval was independently associated with failure (adjusted OR 2.03, 95% CI 1.01-4.09, P = 0.046), while bleeding or pain at presentation was associated with lower failure risk (adjusted OR 0.49, 95% CI 0.26-0.93, P = 0.029).

Conclusion: A longer LMP-US interval was associated with lower success of misoprostol treatment for early missed miscarriage. This simple measure may help identify women at increased risk of failure and support consideration of surgical intervention.

Objective: Outpatient postpartum recovery remains poorly understood. We aimed to characterize postpartum recovery and compare recovery by delivery mode and parity using with the newly validated STanford Obstetric Recovery checKlist (STORK).

Methods: Following institutional review board approval, English-speaking adults were recruited from three U.S. academic centers. Demographic and clinical data were collected. Participants completed STORK (47 items covering physical, mental/emotional health, motherhood experience/social support, sleep/fatigue domains), at two, six and 12 weeks postpartum. Chi-square, one-way ANOVA, and Kruskal-Wallis tests were used to compare categorical and continuous variables.

Results: A total of 498 participants were included (Asian 15%, Black 8%, White 51%), mean age 33±5years. Median gestational age was 39 weeks (IQR 2), and 46% were primiparous. Spontaneous/induced vaginal delivery (SVD), scheduled cesarean delivery (CD), non-scheduled CD, and operative vaginal delivery (OVD) represented 52%, 27%, 18% and 3% of participants, respectively. Total STORK, physical health, and sleep/fatigue scores improved from inpatient postpartum period to week 12 postpartum (P<0·001) for all delivery modes, with a 22% increase in median total scores. Mental health and motherhood experience scores improved until week six (P<0·001). Physical recovery scores differed significantly between delivery modes, with best scores after SVD and lowest after OVD up to week two. Overall recovery was better in multiparous compared to primiparous patients up to six weeks postpartum, though differences resolved by week 12.

Conclusion: Postpartum recovery continues through 12 weeks and varies by delivery mode and parity. Future studies are needed to determine clinically meaningful differences to inform thresholds for targeted interventions.

Objective: Pemphigoid gestationis (PG), a rare autoimmune condition characterized by pruritic urticarial plaques and blisters, typically develops in the second or third trimester of pregnancy. The objective of the study was to examine the associations between PG and adverse maternal and newborn outcomes.

Methods: Using the Healthcare Cost & Utilization Project-Nationwide Inpatient Sample from the United States, a retrospective cohort study was conducted consisting of pregnant patients admitted to the hospital for delivery between 2016 and 2021. The exposed group consisted of pregnant patients with PG (ICD-10 O26.4), while the unexposed group consisted of pregnant patients without PG. The associations between PG and maternal and newborn outcomes were examined using multivariable logistic regression models adjusted for baseline maternal characteristics.

Results: Of 4 337 612 births, 371 women developed PG, for an incidence of 8.6 per 100 000 deliveries. PG was more common among the following individuals: African-Americans, those belonging to lower income quartiles, having Medicare or Medicaid insurance, having thyroid disease, smokers, and morbidly obese. Furthermore, PG was associated with increased odds of gestational diabetes (OR 1.42, 95% CI 1.02-2.00), gestational hypertension (1.45, 1.01-2.08), preterm premature rupture of membranes (1.41, 1.02-1.95), caesarean delivery (1.65, 1.33-2.05), postpartum hemorrhage (1.78, 1.19-2.68), need for blood transfusion (2.38, 1.27-4.48), disseminated intravascular coagulation (9.78,1.37-69.77), and sepsis (2.73, 1.22-6.14). No statistically significant adverse events were found for newborns of women developing PG in pregnancy.

Conclusion: PG in pregnancy is associated with adverse obstetrical outcomes. Our results provide population-based information to patients and healthcare providers on this rare and understudied condition.