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

Objective: Early pregnancy loss (EPL) affects 1 in 4 recognized pregnancies, yet often lacks patient-centered supportive care. This study assesses the feasibility and acceptance of a digital health tool to support those affected by EPL. The objectives are: 1) understand the experiences of those who have miscarried, 2) explore their methods of accessing health information, and 3) determine their preferences regarding digital tool content and design.

Methods: This mixed-methods study included Canadian individuals aged 18-45 who self-reported to have experienced EPL up to 126 weeks gestation in the preceding two years. Recruitment was via social media and hospital posters. Participants completed an online survey and optional follow-up interview between September 2021 and April 2022. Survey responses were analyzed using descriptive statistics. Interview findings are presented in a separate paper. Local ethics approval was obtained.

Results: Of the 185 survey respondents, 28% revealed that they are somewhat or very dissatisfied with the overall health care they received for their miscarriage. 39% are somewhat or very dissatisfied with how their mental/emotional health was addressed. Notably, 82% supported the development of a digital health tool for EPL care. 91% use the internet to access health information.

Conclusion: Many participants reported dissatisfaction with their care following EPL but showed strong interest in a user-friendly digital tool that provides general information and mental health support. These findings, along with qualitative interview data, will guide the development and testing of the desired digital health tool, aiming to enhance patient experience and support following miscarriage.

Objectives: Anemia in pregnancy has negative impacts on maternal and neonatal morbidity and mortality and has been described as an issue of health equity. The primary aim of our study was to describe rates of anemia near delivery and assess whether this correlates with neighbourhood-level income status.

Methods: We conducted a retrospective cohort study of pregnant individuals delivering from January 2012 through December 2022 at two large academic centres. We used log binomial regression to estimate the association between neighbourhood-level income quintile and anemia near delivery, defined as a hemoglobin <110 g/L within 30 days of delivery, controlling for maternal age, parity, thalassemia trait, number of fetuses, blood group, and service provider type. Secondary maternal and fetal outcomes were analyzed descriptively.

Results: A total of 51 782 deliveries were included; the majority were singleton (97%) pregnancies delivered vaginally (61%). While 77% of patients had a complete blood count done within 30 days of delivery, only 13% had a ferritin value checked within 9 months of delivery. Approximately 30% of all patients were anemic near delivery with higher rates of anemia in lower income quintiles; patients in the lowest income quintile were 18% more likely to be anemic than those in the highest income quintile (RR 1.18; 95% CI: 1.12-1.25).

Conclusion: Even within a high resource, academic setting, anemia in pregnancy is common. Given high rates of anemia in our study, particularly amongst patients in lower income quintiles, widespread targeted educational and system interventions are required to ensure equitable patient care.

Objective: The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.

Methods: A population-based retrospective study was conducted in a tertiary university medical center from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with one previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occured and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.

Results: Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared to the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15, 95% CI 1.3-13.3, P = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7, 95% CI 1.8-23.8, P < 0.01). There was no neonatal or maternal death in any group.

Conclusion: Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favorable when rupture occurs outside the trial of labour and if the uterus is unscarred.

Objective: The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae.

Target population: All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury.

Outcomes: Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications.

Benefits, harms, and costs: Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts.

Evidence: Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no. 330.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).

Objective: Acute histological chorioamnionitis (HCA) is detected in over 50% of spontaneous preterm birth (PTB) and is associated with worse neonatal prognosis. We aim to investigate whether the presence of HCA impacts subsequent pregnancy outcomes.

Methods: This retrospective cohort study included deliveries at a tertiary center from 2014 to 2020. Participants were individuals with a history of spontaneous PTB or pregnancy loss >16 weeks and available placental pathology (index pregnancy) with a subsequent pregnancy followed at the same institution. Placentas were classified according to the presence of HCA, other placental lesions, or no lesions. Subsequent pregnancy outcomes were analyzed. Primary outcome was the rate of overall and spontaneous PTB (<37 weeks ) in the subsequent pregnancy.

Results: A total 292 individuals met study criteria, of which 133 had HCA, 61 had other placental lesions, and 98 had no lesions. Individuals with HCA in the index delivery had higher risk of PTB <28 weeks in the subsequent pregnancy, compared to the no-lesion group (10.4% vs 1.0%, P = 0.004). Rates of PTB >28 weeks did not significantly differ. The risk of neonatal adverse composite outcomes was higher in the HCA group (13.9% vs 4.2%, P < 0.01). In a sub-analysis of different placental lesions at the index PTB, only maternal vascular malperfusion was associated with recurrent PTB (aOR 2.57, P = 0.01).

Conclusion: PTB with HCA is associated with higher rates of extreme PTB and adverse neonatal outcomes in the subsequent pregnancy. The inclusion of placental pathology analysis may improve individualized risk assessment in future pregnancies.

Introduction: The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While 3D imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modeling in SCS preparation.

Methods: A retrospective analysis was undertaken at a university affiliated tertiary medical center, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into two cohorts: those with pre-operative CT-based 3D imaging (Group A) and those without (Group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups.

Results: Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in Group A undergoing preoperative 3D modeling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in Group B. Although operative metrics and collaborative endeavors exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in Group A (100%) compared to Group B (54%), with a significance level of P = 0.05.

Conclusion: CT-based 3D modeling in the preoperative phase of secondary cytoreductive surgery for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate impact.