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

Objective: Despite therapeutic advances improving 5-year survival in epithelial ovarian cancer (EOC), it remains unclear whether these treatments effectively promote long-term survival (currently exceeding 10 years). This study aimed to analyze 10-year survival trends and develop a nomogram to predict long-term survival.

Methods: Using the SEER database, we collected data from 30 924 EOC patients diagnosed between 2004 and 2015. Age-adjusted overall survival (OS) and cancer-specific survival (CSS) rates were calculated, and survival trends were analyzed using Joinpoint software. A nomogram was constructed based on clinicopathological and socioeconomic variables, then validated using the C-index, calibration curves, and decision curve analysis (DCA).

Results: While 5-year OS and CSS improved significantly, 10-year survival showed minimal improvement (OS: +0.59%/year; CSS: unchanged). Race, household income, stage, tumour size and chemotherapy were identified as independent predictors of OS, while age, marital status, grade, stage, lymph node positivity and chemotherapy were independent predictors of CSS. A nomogram was constructed and validated based on the above independent predictors. Compared with the traditional AJCC staging system, this novel nomogram showed superior prognostic discrimination with a C-index of 0.712 for OS and 0.738 for CSS.

Conclusion: The influence of factors such as family income, age, and marital status on the prognosis of ovarian cancer highlights the necessity of comprehensive and sustained management approaches. Additionally, for the first time, we present a multifactorial nomogram for predicting long-term survival in EOC with an accuracy superior to traditional staging methods, offering clinicians a more personalized approach to patient assessment. Résumé OBJECTIF: Malgré les avancées thérapeutiques qui améliorent le taux de survie à 5 ans des personnes atteintes d'un cancer épithélial de l'ovaire (CEO), on ne sait toujours pas avec certitude si ces traitements favorisent efficacement la survie à long terme (établie actuellement à plus de 10 ans). Cette étude avait pour objectif d'analyser les tendances du taux de survie à 10 ans et de concevoir un nomogramme pour prédire le taux de survie à long terme. MéTHODES: Nous avons recueilli des données de la base de données SEER sur 30 924 patientes ayant reçu un diagnostic de CEO dans la période entre 2004 et 2015. Le taux de survie globale (SG) ajusté selon l'âge et le taux de survie spécifique au cancer (SSC) ont été calculés et les tendances de survie ont été analysées au moyen du logiciel Joinpoint. Un nomogramme a été conçu selon des variables socioéconomiques et clinicopathologiques. Il a ensuite été validé au moyen de l'indice de concordance (indice C), des courbes de calibration et de l'analyse de la courbe de décision. RéSULTATS: Bien que les taux de SG et de SSC à 5 ans aient

Objective: This study aims to assess the efficacy of total hysterectomy versus radical hysterectomy in the treatment of gastric-type endocervical adenocarcinoma.

Methods: Patients diagnosed with gastric-type endocervical adenocarcinoma from 2001 to 2021 were derived from the Surveillance, Epidemiology, and End Results database (SEER). Clinicodemographic characteristics, tumor clinicopathological features, and survival outcomes (including vital status and duration of follow-up) of these patients were collected. Kaplan-Meier survival curves were generated to estimate survival probabilities, with between-group differences assessed using log-rank tests for statistical significance.

Results: One hundred and fourteen patients undergoing total hysterectomy, and 129 patients undergoing radical hysterectomy were included for survival analysis. No statistically significant differences in overall survival (OS) were observed between surgical approaches, either in the entire cohort (P = 0.0594) or the FIGO stage I-IIA subcohort (P = 0.0777). Adjuvant therapy (radiotherapy and/or chemotherapy) was administered to 52.6% (60/114) of patients in the total hysterectomy group and 42.6% (55/129) in the radical hysterectomy group. However, there was no statistically significant difference in OS between the total hysterectomy and radical hysterectomy groups among patients who received adjuvant therapy and similar results were also found in the subgroup of patients with FIGO stage Ⅰ-ⅡA disease. Notably, adjuvant therapies failed to demonstrate significant OS benefits in either surgical group for stage I-IIA disease.

Conclusion: Total hysterectomy demonstrated comparable survival outcomes to radical hysterectomy in gastric-type endocervical adenocarcinoma (GEA) patients. These findings suggest that less extensive surgery may represent a viable treatment alternative for early-stage disease.

Objective: To assess the pre-treatment severity of adenomyosis and compare the effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) with that of dienogest (DNG) over various follow-up periods.

Data sources: We used a comprehensive Population, Intervention, Comparison, and Outcomes (PICO) search strategy, including PubMed and Embase. The inclusion criteria were limited to randomized controlled trials or retrospective clinical trials, focusing on primary outcomes such as dysmenorrhea, uterine volume (UV), and menstrual blood loss.

Data extraction and synthesis: An initial screening of 235 publications yielded 8 studies that met the inclusion criteria, involving a total of 527 patients-277 receiving LNG-IUS and 250 undergoing DNG treatment. Baseline assessments showed severe dysmenorrhea (Visual Analog Scale [VAS] score: 6.826), increased UV (152.603 cm³), and significant menstrual blood loss (Pictorial Blood Loss Assessment Chart [PBAC] score: 108.705). Patients were divided into 3 groups following assessments after 3, 6, and 12 months. At the 3-month and 6-month follow-up, no significant differences were observed in dysmenorrhea, UV, or menstrual blood loss between the LNG-IUS and DNG groups. At the 12-month follow-up, 1 study reported that the LNG-IUS was associated with a significant reduction in UV, whereas DNG therapy led to a decrease in the severity of dysmenorrhea.

Conclusion: Both LNG-IUS and DNG are both useful for managing adenomyosis, though they exhibit different therapeutic effects. LNG-IUS helps in decreasing UV, whereas DNG more notably alleviates dysmenorrhea. Despite these findings, only 8 studies were included in this meta-analysis, calling for further large-scale, randomized controlled trials to compare these interventions' efficacy and to develop robust, evidence-based treatment protocols.

Background: While observational studies have established associations between pre-pregnancy obesity and hypertensive disorders of pregnancy, the causal nature of this relationship requires elucidation.

Objective: To investigate potential causal effects of pre-pregnancy obesity traits on hypertensive disorders of pregnancy-gestational hypertension, pre-eclampsia, and eclampsia-using genetic epidemiology approaches.

Methods: We performed a comprehensive two-sample Mendelian randomization (MR) analysis leveraging summary statistics from large-scale genome-wide association studies (GWAS). Eleven adiposity-related exposure traits were evaluated: body mass index (BMI), overweight status, obesity (subclassified into grades 1-3), childhood obesity, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), liver fat percentage, visceral adipose tissue volume, and abdominal subcutaneous adipose tissue volume. Primary causal estimates were derived via inverse-variance weighted (IVW) regression, supplemented by sensitivity analyses using MR-Egger and weighted median methods.

Results: Genetic predisposition to elevated BMI, overweight, obesity, obesity class 1, obesity class 2, childhood obesity, WHR, and abdominal subcutaneous adipose tissue volume were linked to increased risks of gestational hypertension and pre-eclampsia. Obesity class 3 also increased the risk of gestational hypertension. Additionally, obesity class 3 and childhood obesity increased the risk of eclampsia. Consistent results were observed using alternative MR methods in sensitivity analyses.

Conclusions: This genetic evidence substantiates causal effects of multidimensional pre-pregnancy adiposity on hypertensive pregnancy complications. Our findings highlight the importance of life-course weight management strategies beginning in childhood and extending through reproductive planning to mitigate risks of pregnancy-related vascular disorders.

Genitourinary syndrome of menopause (GSM) affects most postmenopausal women and gender diverse persons (GDP). Many will notice symptoms prior to the cessation of menstruation, related to declining hormone levels. Our aim was to assess GSM incidence among those referred to a specialized Canadian menopause clinic, and to identify potential gaps in care. Among 529 participants, 74% reported bothersome vaginal dryness, but only 10.9% had been prescribed a local vaginal hormone prior to referral. With long wait times for menopause clinics, our results highlight an important area for education for all providers caring for women and GDP in midlife and menopause.

Objective: To estimate the proportion of birth asphyxia cases associated with delay in delivery (DD) due to maternal heart rate artifact (MHRA).

Methods: Retrospective review of Canadian Medical Protective Association closed medico-legal cases of birth asphyxia from 2011-2020 in term labor, leading to hypoxic ischemic encephalopathy, cerebral palsy or stillbirth. The final two hours of electronic fetal monitoring (EFM) were analyzed in 10-minute time epochs by three independent experts using a template for evidence of MHRA judged to have resulted in DD. Records were also assessed for EFM classification, documentation of maternal pulse / MHRA and labor factors.

Results: Thirty-four cases of birth asphyxia were identified. Thirteen cases (38%) were found to have DD due to MHRA of which 9 (69%) were in the second stage of labor. The average estimated DD was 44.2 minutes +21.9. There was a lower proportion of time epochs with abnormal EFM in the 13 cases with DD versus 21 cases without DD [14.7% vs. 47.3%, (OR 0.19 (0.11-0.33) P < 0.002)]. Conversely, there was a higher proportion of MHRA [62.9% vs. 5.4%, (OR 29.8 (15.5-57.3) P = 0.002)]. The maternal pulse was documented in 34% vs. 30% respectively. Chart review revealed no recognition by the caregivers of the occurrence of MHRA.

Conclusion: Unrecognized MHRA resulting in a falsely reassuring fetal heart rate, mainly in the active second stage, led to DD in more than one third of birth asphyxia cases. These outcomes may be preventable by education and the routine use of technologies to detect MHRA.

Background: Despite efforts to protect, promote and support breastfeeding, breastfeeding duration and exclusivity rates remain inadequate within Canada and worldwide. A New Brunswick (Canada) hospital observed declining rates of exclusive breastfeeding 2014/2015 to 2020/2021 that were both the lowest in NB and below national averages. Thus, within the catchment area of this NB hospital, a targeted constructivist qualitative approach was used to shed light on these low levels of breastfeeding by examining both parents' and healthcare providers' (HCPs) perceptions of breastfeeding barriers and facilitators during the pre- and post-natal periods.

Methods: Semi-structured interviews were conducted with parents (N = 16) and HCPs working in family medicine or within maternal health (N = 13) in 2022 during the COVID-19 pandemic. Iterative reflexive thematic analysis was performed.

Results: Many themes discussing barriers and facilitators to breastfeeding were documented, with a particular focus on social and cultural influences. Both parent and HCP groups predominantly discussed the need for further education on breastfeeding; the parents focused on the education that they wanted for themselves, and HCPs felt that education was needed for both parents and HCPs.

Conclusions: Education on infant feeding is strongly needed for parents, HCPs, as well as the entire population in general. Education should be appropriately tailored to individuals' respective educational and cultural needs to move the needle forward on social and cultural acceptance and normalization of breastfeeding. Increased support throughout the breastfeeding journey, whereby a patient-centred approach is used, and available resources are made known, is also essential.

Racial disparities in obstetric outcomes are well-documented internationally, with Black persons facing significantly higher risks of maternal mortality, but Canadian data remain limited. We investigated the causes of death among 20 Black birthing persons over a 10-year period in Ontario, Canada. Efforts to advance and monitor equity in perinatal health require improved collection, use, and governance of sociodemographic and social determinants of health data, including race data. This is essential for decision-making within and outside the health system to drive impactful change. The Better Outcomes Registry & Network (BORN) Ontario is involved in initiatives to raise awareness and advocate for advancing health equity and welcomes collaboration with communities, people with lived experience, clinicians, and organizations empowered for change.

Objectives: Intrauterine devices (IUDs) are highly effective forms of contraception but may be underutilized by Canadian youth. Youth experiences with IUDs remain poorly understood. This study examined 6-month IUD continuation and satisfaction among youth (aged 12-24 years) attending a youth contraception clinic in Vancouver, British Columbia.

Methods: Participants completed surveys at baseline (patient characteristics) and at 2-6 weeks, 3 months, and 6 months post-placement, measuring IUD continuation, satisfaction, side-effects, and menstrual symptoms. We examined baseline characteristics, IUD discontinuation, planned continuation beyond 6 months, and IUD type (levonorgestrel-releasing 'hormonal' or copper). We examined trajectories of reported satisfaction, side effects, and menstrual symptoms over 6 months post-placement.

Results: Among 140 participants, 86% (n = 120) chose a hormonal IUD. Five percent of participants removed their IUDs, and 5% had an expulsion. Most (86%) IUDs were in place at 6 months. Nearly all (99%) participants with an IUD in place at 6 months planned to continue use. IUD satisfaction was >90% at each follow-up for both IUD types. Cramping and spotting were the most frequently reported side effects; 49% of all respondents reported cramping at 2-6 weeks post-placement, with this frequency decreasing by 6 months for hormonal users. Copper IUD users experienced more bothersome heavy periods than hormonal users. Most (>70%) hormonal IUD users reported reduced menstrual pain, reduced duration, and reduced flow at 6 months post-placement.

Conclusions: This study found low rates of IUD discontinuation, high satisfaction, and reduced menstrual side effects among youth over 6 months after IUD placement. This could inform youth-specific counselling for contraceptive method selection and IUD continuation decision-making soon after placement.