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

Objective: To compare maternal and neonatal outcomes before and after the implementation of a multidisciplinary management team for placenta accreta spectrum (PAS) disorders.

Methods: This retrospective cohort study reviewed pregnancies complicated by PAS disorders that culminated in delivery at the Regina General Hospital between January 2019 and December 2024. Patients were categorized by delivery date before or after the implementation of a multidisciplinary management team for PAS disorders. The primary outcome was the total units of transfused packed red blood cells (PRBCs). Secondary intraoperative and postoperative maternal and neonatal outcomes were also compared.

Results: Thirty-seven cases of PAS disorders were included (15 pre-implementation and 22 post-implementation). The post-implementation group received fewer units of transfused PRBCs (2 vs. 4, P = 0.175), had higher hemoglobin at discharge (89.14 g/dl vs. 87.93 g/dl, P = 0.839), fewer ICU admissions (2 vs. 4, P = 0.198), fewer postoperative infections (14% vs. 20%, P = 0.670) and a shorter hospital stay after surgery (median of 3 vs. 4 days, P = 0.094), but these differences did not reach statistical significance. General anesthesia was used more frequently post-implementation (59% vs. 27%, P = 0.061). After implementation, neonates had lower Apgar scores at 1 minute (4.68 vs. 6.40, P = 0.061), 5 minutes (6.73 vs. 8.27, P = 0.025) and 10 minutes (6.33 vs. 8.50, p = 0.045) but the neonatal cord arterial pH was similar (7.30 vs. 7.28, P = 0.413).

Conclusion: Our findings generally support the use of a multidisciplinary team for managing PAS disorders.

Objective: Studies addressing RhD alloimmunization following antenatal procedures and complications are limited, and practice of RhIG administration following these events is variable. Our objective was to assess evidence for RhIG efficacy for RhD negative pregnancies following selected antenatal events.

Data sources: Literature was sourced from databases including MEDLINE, EMBASE, Cochrane Evidence Based Medical (EBM) Reviews, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1946 to August 2024).

Study selection: Studies included those focused on RhIG effectiveness following antenatal procedures or complications.

Data extraction and synthesis: Thirty-one papers focused on alloimmunization risk and RhIG administration in the setting of antenatal procedures or events including chorionic villus sampling (CVS) (5), amniocentesis (ACS) (15), external cephalic version (ECV) (5), ectopic pregnancy (EP) (1), trauma (2), placenta previa (PP) and placental abruption (PA) (3). Most were retrospective or prospective observational trials conducted prior to 1995, and were variable in size, quality, methodology, and outcome parameters. Papers evaluated alloimmunization (11) or fetal maternal hemorrhage (FMH) (21) as a surrogate outcome and found that all interventions and/or complications increased risk of RhD alloimmunization.

Conclusion: The available literature supports RhIG prophylaxis for the listed procedures and complications. Data is limited by low methodologic quality, is frequently based on surrogate markers of alloimmunization, and reflects outcomes following antiquated procedures and techniques. With limited RhIG supply and a cautious approach to blood product administration, the general support for RhIG prophylaxis should be re-evaluated with high quality trials.

Introduction: Pelvic organ prolapse surgery with a vaginal approach is generally performed with an indwelling catheter and in a daycare unit. There is no international consensus regarding removal time of catheter after surgery. We hypothesized that reducing the length of postoperative catheterization from two hours to zero would not compromise the logistic and clinical feasibility of the daycare unit for prolapse surgery. Secondly, that this change would not lead to an increase in adverse postoperative events.

Material and methods: A historical cohort quality study comparing immediate removal of the indwelling catheter (Group 1, n = 182) with removal two hours postoperatively (Group 2, n = 209) after pelvic organ prolapse surgery. Demographic data, type of surgery, referral to the stationary unit, complications and contact after discharge were recorded. Follow-up time was three months. Statistics included Kruskal-Wallis test and chi-square test.

Results: Demographic data and type of surgery were comparable. Referrals to the stationary unit were infrequent in both groups and too limited to allow for statistical comparison. However, no negative impact on the feasibility of the daycare unit was detected. No change in adverse events was found. Postoperative contact with the hospital increased after the change with 19.3% in Group 1 and 11.0% in Group 2 (P = 0.02). Indications for contact were the same.

Conclusions: The reduction in catheter removal time did not affect the feasibility of the daycare unit. However, a subsequent increase in postoperative contacts was observed, which is likely to reflect concurrent structural changes within the department.

Cesarean delivery-associated surgical site infections (CD-SSI) significantly increase maternal morbidity but have not been systematically reported. Surveillance strategies have been inconsistent in assessing CD-SSI. This study aimed to compare different methods of assessing CD-SSI incidence. Two surveillance strategies have been evaluated: 1) electronic medical records (EMR) review and 2) postpartum phone call. The difference in the CD-SSI incidence assessed through EMR review (4.7%), and postpartum phone call (8.9%) was statistically significant (P < 0.001); this suggests that EMR review alone may underestimate the incidence of CD-SSI and that phone call surveillance is likely more effective for detecting cases of CD-SSI.

Objective: To examine the influence of the World Health Organization's social determinants of health (SDoH) as barriers or facilitators to Human Papillomavirus (HPV) vaccination among females under 18 years of age and their guardians in countries with publicly funded vaccination programs.

Methods: A systematic review was conducted using Ovid Medline, Embase, and CINAHL from inception to June 21, 2022. Eligible studies included females under 18 years or their guardians in jurisdictions offering HPV vaccination free of charge. Cohort, cross-sectional, qualitative, and mixed-methods designs were included. Two reviewers independently screened and appraised studies using Joanna Briggs Institute tools; those scoring below 75% were excluded. Data from 75 studies were synthesized according to five SDoH domains: economic stability, education access and quality, healthcare access and quality, neighbourhood and built environment, and social and community context.

Results: Key barriers included low socioeconomic status, unemployment, limited parental health literacy, lack of healthcare provider recommendation, and religious or cultural opposition. Lower vaccination rates were observed among marginalized, immigrant, and Indigenous populations. Facilitators included higher household income, parental or adolescent education, comprehensive vaccine information, and school-based vaccination programs that provided free and convenient access.

Conclusion: HPV vaccination uptake among adolescent girls is shaped by interrelated SDoH. Interventions that address socioeconomic disparities, strengthen health literacy and provider communication, and promote culturally sensitive outreach are critical to improving equitable vaccine coverage.

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.