Objective To evaluate Canadian clinical practice regarding utilization of routine third-trimester ultrasound in low-risk pregnancies and assess provider expectations regarding components of such scans. Methods A cross-sectional online survey was distributed to Canadian antenatal providers through the Society of Obstetricians and Gynaecologists of Canada. Information regarding provider characteristics, years in practice and routine use of third-trimester ultrasound in low-risk pregnancies, preferred timing, and expectations regarding performance of biophysical profile (BPP) scoring and fetal Doppler was collected. Results A total of 765 responses were obtained, including 309 family physicians, 171 midwives, 272 obstetricians and gynecologists (OBG), and 13 OBG residents. Preference for routine third-trimester ultrasound assessment was reported by 41-63% of OBG, 50-62% of residents, 13-20% of family physicians and 2-15% of midwives. Most common timing was a single scan at 30-32 weeks or two scans at 32 and 36 weeks. Even in absence of fetal growth abnormality or other risk factor, BPP scoring was expected to be included in such scan by 27-67% of family physicians, 36-46% of midwives, 39-60% of OBG, and 25-75% of residents. Fetal Doppler was expected by 12-21% of family physicians, 6-14% of midwives, 5-17% of OBG, and around 25% of residents. Conclusion Substantial variation exists among Canadian antenatal care providers regarding routine use of third-trimester ultrasound in low-risk pregnancies. Differences are also evident in expectations regarding additional fetal surveillance measures. These findings highlight the need for greater awareness of current evidence and clinical guidelines to promote more standardized and evidence-based use of third trimester ultrasound.
OBJECTIVE:To describe the different menstrual suppression and contraceptive treatments provided to a cohort of transgender and gender diverse young people assigned female at birth receiving care at a gender diversity clinic. METHODS:This retrospective cohort study was conducted in a pediatric gender diversity clinic. Included participants were young people assigned female at birth aged between 11 - 18 years-old, consecutively seen for a first visit between November 1, 2016, and May 31, 2021, and followed until June 1, 2022. Gender identity, medical gender affirming treatments and outcome measures, including menstrual suppression, were obtained from medical records. Menstrual suppression treatment and contraception use in transgender males and non-binary or questioning participants were compared. RESULTS:In total, 112 young people were included in the study (median age at first consultation 15.2 years). The majority identified as transgender binary (n = 91, 81%) while other participants identified as non-binary or questioning (n = 21, 19%). Nearly half (44.6%) of participants received gonadotropin-releasing hormone agonists alone at least once during follow-up, with high rates of menstrual suppression. Hormonal contraceptive monotherapy was prescribed to 40.2% of the cohort, with similar proportion among transgender binary (38.5%) and non-binary or questioning (47.6%) participants. CONCLUSION:This study provides important data on the menstrual suppression and contraceptive treatments provided to young people assigned female at birth in pediatric gender diversity clinic.
Pregnant patients weigh many factors when deciding whether to continue a pregnancy with fetal anomaly, including their family context, access to resources, and barriers to healthcare. We explore the social factors and bioethical issues that affect decisions to continue a pregnancy with fetal anomaly, illustrated by our patient's experience of heteropagus twin pregnancy. The patient had to decide whether to undergo delivery and newborn surgery out-of-province, weighed against leaving her special needs child, and limited social supports. We analyze the relevant bioethical concepts: autonomy, justice, relational ethics, and relational autonomy. Physicians who consider these stressors and bioethical issues may better appreciate and support their pregnant patients' decision-making.
OBJECTIVE:We used Canadian medico-legal case data to examine patterns of oxytocin use in labour induction and augmentation and explore factors associated with adverse maternal-neonatal outcomes. METHODS:We conducted a qualitative descriptive study with thematic analysis of medico-legal events in Canada closed between 2020 and 2024. We identified 43 obstetric cases with the use of an oxytocic agent and with peer expert criticism specifically on oxytocin management. Two reviewers independently analyzed de-identified case summaries and expert reports with iterative discussion in a multidisciplinary team. RESULTS:Peer criticism clustered around four recurring patterns of oxytocin misuse: failure to reduce/discontinue oxytocin in the presence of atypical/abnormal fetal heart rate or uterine tachysystole, initiation despite clear contraindications, unsafe restart after fetal heart rate decelerations, and unjustified dose escalation. Insufficient maternal and fetal monitoring was a criticism across all cases. Three intersecting themes (health care provider issues, communication breakdowns, and system limitations) often co-occurred. Overall, 70% of cases involved low-risk pregnancies and maternal morbidity occurred in 16% of cases. Catastrophic adverse neonatal outcomes occurred in 93% of the cases and were commonly attributed by causation experts to prolonged intrapartum hypoxia exacerbated by oxytocin misuse. CONCLUSION:Medico-legal events involving oxytocin in Canada reveal recurring patterns of largely preventable oxytocin misuse embedded in cumulative breakdowns across the labour care environment rather than isolated errors. These findings support interventions such as robust oxytocin protocols, enhanced situational awareness and fetal surveillance skills, and reliable communication and escalation pathways to improve the safety of intrapartum use of oxytocin.
OBJECTIVES:Most refugees living in Canada have never had cervical cancer screening. The objective of this study was to compare the histologic grade of cervical dysplasia at the first colposcopy visit between refugees and Ontario residents. METHODS:Using a retrospective cohort design, we compared grades of dysplasia for individuals presenting to their initial colposcopy visit for abnormal pap cytology between those insured with coverage granted by the Federal government to refugees [the Interim Federal Health Program (IFHP)], and age-matched patients insured under the Ontario Health Insurance Plan (OHIP) at two tertiary care colposcopy clinics in Toronto, Canada between January 1, 2015 and February 1, 2020. The primary outcome was severity of cervical dysplasia on pathology results. RESULTS:41 IFHP patients and 82 age-matched OHIP patients met inclusion criteria. There was no significant difference in the cytology grade at referral. IFHP patients were significantly less likely to have received HPV vaccination (2.4% vs 26%, P=0.004), more likely to be living with the human immunodeficiency virus (HIV) (29% vs 0%, P < 0.001), and more likely to have high grade dysplasia or cancer on final biopsy (OR 1.4, (1.06-1.85), P = 0.023) compared with individuals with OHIP coverage. CONCLUSION:Refugees insured via IFHP are at greater risk of cervical cancer with lower HPV immunization rates and higher rates of HIV compared to Ontario residents. Furthermore, they are significantly more likely to have higher grade dysplasia on pathology. These findings signify the importance of advocating for primary and early secondary prevention for refugees.
OBJECTIVE:This study aimed to define surgical success in patients with endometriosis from a patient-centered perspective and determine the improvement in pain and quality of life that patients consider indicative of a successful surgical outcome. METHODS:This pilot study included a sample of 36 patients with symptomatic endometriosis and with scheduled surgery at Laval University Hospital Center (Québec, Canada), a tertiary referral center for endometriosis. Patients completed an online survey addressing their definitions of surgical success and surgical failure, as well as their baseline symptoms and the minimal improvement they would expect in various domains related to pain and quality of life. Mixed method combining qualitative and quantitative data was used. Absolute and relative differences between preoperative and expected postoperative scores for each domain were analyzed. RESULTS:Ninety-seven percent of patients (n = 35) identified improvement in quality of life as the main determinant of surgical success, while no consensus emerged regarding the definition of surgical failure. The mean minimal expected reduction in Endometriosis Health Profile (EHP-30) score was 34 points (95%CI 26.7-40.4; P < 0.001). Most patients (91.7%) expected a postoperative EHP-30 score below 40, regardless of their baseline score. Overall, patients expected a 52%-69% reduction in pain symptom scores. CONCLUSION:The most important patient-reported outcome defining surgical success was improvement in quality of life, with the majority of patients aiming for an EHP-30 score below 40 after surgery. The use of a defined threshold may help establish a standardized definition of surgical success in future clinical practice and research on endometriosis.
OBJECTIVE:In vitro fertilization (IVF) "add-ons" are supplementary interventions intended to improve IVF success, despite a lack of robust supporting evidence. Professional organizations advise caution or recommend against the routine use of several add-ons. Clinic websites are a common source of patient-facing information. As such, this study examined how Canadian IVF clinic websites describe add-ons, including pricing and references to benefits and harms. METHODS:This cross-sectional study systematically reviewed Canadian IVF clinic websites between November 2024 and March 2025. Recommendations from Choosing Wisely Canada and the European Society of Human Reproduction and Embryology were used to contextualize website-described add-ons. Two reviewers independently analyzed websites and appraised evidence quality using the Oxford Levels of Evidence scale. Descriptive analysis summarized the frequency, pricing, and reported benefits and harms of website-described add-ons. RESULTS:Forty-two Canadian IVF clinic websites were reviewed, and 17 distinct add-ons were identified. Overall, 97.6% described at least one add-on intervention. Reported costs ranged from CAD $200 to CAD $5234 per treatment cycle. Pre-implantation genetic testing for aneuploidy (85.4%) and sperm DNA fragmentation testing (53.7%) were the most commonly described. Potential benefits were referenced in 50.4% of descriptions, whereas harms were mentioned in 22.5%. Only 7.1% of websites cited supporting publications, all classified as low quality. CONCLUSION:Canadian IVF clinic websites frequently describe add-ons. Clearer communication about the evidence, risks, and the distinction between the standard of care and discretionary add-ons may support informed decision-making.
OBJECTIVE:(s): Laparoscopic radiofrequency ablation (Lap-RFA) is a minimally invasive procedure for reducing fibroid size; however, most published studies primarily focus on fibroids ≤7 cm. We describe the first Canadian case series of ultrasound-guided Lap-RFA for symptomatic fibroids, including treatment of fibroids up to 10 cm. METHODS:In this retrospective case series, an analysis was performed of consecutive ultrasound-guided Lap-RFA cases for the management of symptomatic fibroids from September 15, 2022 to May 13, 2024. The primary outcome was fibroid volume reduction at 3, 6 and 12 months postoperatively. Secondary outcomes included operative time, length of postoperative recovery stay (LOS), urgent care visits, reinterventions and subsequent pregnancies. RESULTS:60 cases were identified. Median age was 43 (IQR: 37.7-46.3) with the primary indication for Lap-RFA being bulk symptoms (83.3%). The median number of fibroids was 4 with 2 (IQR 1-8) ablations per fibroid. 17 patients had concurrent myomectomies. Median operative time was 105 minutes and median LOS was 173 minutes. Median fibroid volume was 81.7 cm3 preoperatively, 49.3 cm3 at 3 months, 49.9 cm3 at 6 months and 46.1 cm3 at 12 months, a difference of 39.7%, 38.9% and 43.6% respectively (P < 0.01). Two patients had postoperative urgent care visits and one underwent reintervention. Three patients (5%) conceived a median of 141 days (IQR 74-268) postoperatively, all delivered at term. CONCLUSION:(s): In this case series, we observed similar volume reductions as in the literature, even for fibroids 7-10 cm in size. Further studies incorporating validated patient-reported outcome measures are needed to better correlate objective outcomes with patient-reported improvement.
OBJECTIVES:To measure the association between treatment options and clinical outcomes in adolescent patients with acute uterine bleeding. METHOD:A cohort study was conducted using data collected on chart review of all patients under 19 years-old treated for acute uterine bleeding from 2012 until 2022 in our tertiary-care hospital center. The association between the treatment options (high-dose estrogens versus progestins) and two primary outcomes (delta of hemoglobin level from baseline to discharge and time to bleeding cessation) were measured using linear regressions with adjustment for potential confounding variables. As secondary outcomes, delta of hemoglobin from baseline to 1 and 4 months, side effects and adverse events were analyzed. RESULTS:We included 150 patients in our study, 116 exposed to high-dose estrogens and 34 to high-dose progestins. The median time to bleeding cessation was 36 hours overall (Q25,75: 17.5, 85.5) without statistically significant difference between treatment groups. The delta of hemoglobin at discharge and at 4 months, after adjustment, showed a tendency towards a better increase in hemoglobin levels for the progestin group, without statistical significance. The progestin group experienced less side effects compared to estrogen group (adjusted OR = 0.31 (95%CI: 0.10, 0.89 for a composite nausea outcome). Treatment failure occurred in 23.1% of cases, without significant difference across groups and no thromboembolic event were reported. CONCLUSION:This study suggests no statistically significant difference in the effectiveness between the two treatment protocols, but a better side effect profile for high-dose progestins.
OBJECTIVE:To evaluate the clinical impact of incorporating patient specific 3-dimensional (3D) printed anatomical models into gynecological practice for improving surgical planning and patient outcomes in patients with deep endometriosis. METHODS:A pilot prospective randomized control study using a repeated measure, questionnaire-based design included patients consented for surgical excision of endometriosis. Patients were randomized to have a 3D printed model or not (control). 3D models were rendered from T2 weighted magnetic resonance images. Gynecologic surgeons completed questionnaires on surgical planning, surgical outcomes and surgeon experience before and after viewing the 3D printed models and post-operatively and comparisons were made using paired t tests. RESULTS:There were 5 patients included in the 3D printing group and 8 patients in the control group. In the 3D printing group, there was a change in 5/10(50%) surgeon responses for perception of surgical level of difficulty, 5/10(50%) surgeon responses for allotted surgical time, and 3/10(30%) surgeon responses for estimated blood loss after viewing the 3D model. Eight of 10(80%) of surgeon responses reported referencing the model intraoperatively. Allotted surgical time was significantly greater post viewing compared to pre-viewing the model (256.4±60.5 vs. 246.4±56.6 minutes; d = -0.19, P = 0.044) and estimated blood loss significantly lower post-viewing compared to pre-viewing the model (177.3±114.8 vs. 204.6±154.1 ml; d = 0.293, P = 0.003). Compared to control cases, mean surgical time was significantly lower in the 3D model cases (271.7±94.6 vs. 460±225.2mins; P = 0.006). CONCLUSIONS:3D printed models may help to optimize surgical planning and improve surgical performance, bettering the overall surgical outcomes in gynecologic surgery for deep endometriosis.
Objectif Formuler des recommandations fondées sur les données probantes concernant le dépistage, la prise en charge et le sevrage de la nicotine pendant la grossesse et la période post-partum. Population cible Les femmes enceintes ou qui envisagent de l’être, qui utilisent des produits contenant de la nicotine, notamment le tabac combustible, les cigarettes électroniques et le tabac sans fumée. Options Approches de dépistage, counseling comportemental, traitements pharmacologiques, stratégies de réduction des effets nocifs et interventions organisées par les systèmes de santé pour aider les personnes à cesser l’utilisation de la nicotine. Résultats Une amélioration des conséquences maternelles et néonatales, une réduction de l’exposition à la nicotine pendant la grossesse, une augmentation des taux de cessation de la consommation de produits contenant de la nicotine et la prévention des rechutes post-partum. Avantages, effets nocifs et coûts L’application de ces recommandations pourrait améliorer les taux de cessation tabagique pendant la grossesse et réduire les conséquences maternelles et néonatales défavorables. En revanche, ces effets pourraient entraîner une demande plus importante en temps clinique et en ressources pour les programmes de cessation. Données probantes Les données ont été extraites à partir de recherches dans la littérature scientifique portant sur des questions cliniques clés liées à l’exposition à la nicotine, au dépistage, aux interventions de cessation tabagique, aux cigarettes électroniques et à la prévention des rechutes post-partum. Méthodes de validation Les auteurs ont évalué la qualité des données probantes et la force des recommandations à l’aide de l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) [classement des recommandations, évaluation, développement et évaluation]. Voir l’annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l’interprétation des recommandations). Public visé Ces lignes directrices s’adressent aux professionnel(le)s de la santé offrant des soins aux femmes enceintes ou qui envisagent de l’être, notamment les obstétricien(ne)s, les médecins de famille, les sages-femmes, les infirmier(ère)s, les infirmier(ère)s praticien(ne)s et les autres professionnel(le)s de la santé assurant des soins prénataux et post-partum. Elles peuvent également s’adresser aux professionnel(le)s de la santé publique, les spécialistes en cessation tabagique, et les décideurs politiques œuvrant dans le domaine de la santé maternelle et infantile. Résumé sur les réseaux sociaux Bien qu’évitable, la consommation de nicotine pendant la grossesse demeure l’une des principales causes des conséquences maternelles et néonatales défavorable. Cette ligne directrice de la SOGC recommande un dépistage systématique, un counseling comportemental comme traitement de première intention, un recours prudent à la TRN ou à d’autres pharmacothérapies en cas de besoin, ainsi qu’un accompagnement post-partum continu afin de réduire les risques de rechute. Déclarations sommaires 1.La nicotine traverse le placenta et peut altérer la fonction placentaire, la croissance fœtale et le développement neurologique. (élevée)2.L’exposition prénatale à la nicotine est associée à un retard de croissance fœtale, à une naissance prématurée et à la mortalité périnatale. (élevée)3.L’exposition prénatale à la nicotine a été associée à des conséquences à long terme sur la santé de l’enfant, notamment des maladies respiratoires, des troubles du développement neurologique et des effets cardiométaboliques. (modérée)4.Les sources d’exposition à la nicotine pendant la grossesse sont multiples et comprennent notamment les produits du tabac combustible, les inhalateurs électroniques de nicotine, le tabac sans fumée, la thérapie de substitution de la nicotine, ainsi que l’exposition à la fumée secondaire ou aux aérosols. (élevée)5.La cessation tabagique pendant la grossesse est l’une des stratégies les plus efficaces pour améliorer la santé maternelle et néonatale (élevée).6.Les interventions comportementales augmentent les taux de cessation tabagique et améliorent les résultats à la naissance. (élevée)7.Le recours à la thérapie de remplacement de la nicotine peut augmenter les taux de cessation tabagique durant la grossesse par rapport aux interventions comportementales seules, bien que l’observance soit souvent faible et que le degré de certitude des données probantes reste limité. (faible)8.Les rechutes après l’accouchement sont fréquentes, en particulier au début de la période post-partum. (élevée) Recommandations 1.Les professionnel(le)s de la santé devraient informer les femmes en âge de procréer, y compris pendant la grossesse ou l’allaitement, qu’aucune exposition à la nicotine, quels que soit le seuil, le moment ou la forme, n’est exempte de risques. L’exposition à la nicotine est associée à des conséquences maternelles, fœtales et infantiles défavorables, y compris une augmentation du risque de naissance prématurée, de mortalité liée à la prématurité et de syndrome de mort subite du nourrisson; on estime que le tabagisme pendant la grossesse contribue à environ 11 % des naissances prématurées, 12 % des décès liés à la prématurité et jusqu’à 35 % des cas de syndrome de mort subite du nourrisson. Elle est également associée à des effets potentiels à long terme sur le neurodéveloppement, la santé mentale, la santé respiratoire et la santé cardiométabolique de l’enfant. (forte, élevée)2.Les professionnel(le)s de la santé devraient informer leurs patientes que l’exposition de la mère à la fumée secondaire et aux aérosols (provenant du vapotage) pendant la grossesse est également associée à des conséquences périnatales et infantiles défavorables. (forte, élevée)3.Les professionnel(le)s de la santé devraient intégrer un dépistage systématique de la consommation et de l’exposition à la nicotine dès la première consultation prénatale, puis lors de chaque suivi prénatal et en post-partum, dans le cadre des soins obstétricaux de routine. (forte, élevée)4.Les professionnel(le)s de la santé devraient s’appuyer sur des approches structurées, tels que le modèle des 3A Ask (demander) Advise (conseiller) Act (agir), pour guider le dépistage et les interventions liées à la consommation de nicotine pendant la grossesse. (conditionnelle, modérée)5.Les professionnel(le)s de la santé devraient encourager la cessation complète de la consommation du tabac et de tous les produits contenant de la nicotine, dès le début de la grossesse. Si l’abstinence s’avère irréalisable, la réduction de la consommation devrait être encouragée. Chaque unité de maternité ou de naissance devrait également avoir accès à des professionnel(le)s formé(e)s et dédié(e)s au soutien de la cessation du tabagisme pendant la grossesse et la période post-partum. (forte, élevée)6.Le counseling comportemental, allant des interventions brèves aux interventions multiples ou aux programmes d’accompagnement intensifs, devrait constituer le traitement de première intention pour le sevrage de la nicotine pendant la grossesse et la période post-partum. (forte, élevée)7.Les interventions d’accompagnement par les pairs devraient être proposées dans le cadre d’une stratégie globale de sevrage de la nicotine pour les personnes enceintes et en période post-partum, et se poursuivre pendant la période post-partum, en particulier au cours des 3 à 6 premiers mois, afin de soutenir le sevrage et de réduire le risque de rechute (conditionnelle, modérée)8.Des interventions pour le sevrage de la nicotine, numériques et à distance, devraient être offertes pendant la grossesse et la période post-partum afin d’améliorer l’accès à ces services et de soutenir le maintien de l’abstinence au début de la parentalité. (forte, modérée)9.Les professionnel(le)s de la santé, incluant les pharmacien(ne)s ayant les connaissances et les compétences requises, devraient proposer des pharmacothérapies pour le sevrage de la nicotine ou du tabac lorsque les interventions comportementales seules ne permettent pas de réduire la consommation de tabac ou d’y mettre fin. Les thérapies de remplacement de la nicotine devraient être considérées comme des traitements de première intention, suivis du bupropion et de la varénicline. Ces thérapies de remplacement devraient être accessibles sans frais durant la période préconceptionnelle, la grossesse et le postpartum, afin de favoriser le sevrage de la nicotine et optimiser les résultats de santé maternelle et infantile. (conditionnelle, modérée)10.Les interventions psychosociales et l’accompagnement par les pairs doivent être maintenus tout au long de la période post-partum, en accordant une attention particulière aux trois premiers mois, ainsi qu’au-delà du sixième mois, périodes durant lesquelles le risque de rechute est le plus élevé. (forte, modérée)
OBJECTIVE:This study examined the longitudinal association between bladder descent angle (BDA), measured by transperineal ultrasound (TPUS), and urinary incontinence (UI) subtypes during the perinatal period, focusing on stress urinary incontinence (SUI). METHODS:Women with singleton pregnancies at ≥36 weeks were recruited between June 2022 and June 2025. Of 100 participants, 87 completed follow-up and were analyzed. UI was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and participants were classified into UI and non-UI groups. BDA was measured using TPUS and compared between groups. Receiver operating characteristic (ROC) analysis and multivariate logistic regression were performed. RESULTS:UI prevalence was 67.0% in late pregnancy and 23.0% postpartum, with SUI as the most common subtype. BDA was higher in the UI group than in the non-UI group in late pregnancy (107.7° vs. 103.8°, P = 0.034) and postpartum (112.8° vs. 105.3°, P = 0.021). BDA showed a trend toward association with SUI, being higher in the SUI group in late pregnancy (P = 0.044), although significance was not maintained after correction for multiple comparisons. Similar trends were observed postpartum. The predictive ability of late pregnancy BDA for postpartum UI was limited (AUC = 0.552). CONCLUSIONS:BDA measured by TPUS was associated with perinatal UI and showed a subtype-specific tendency toward SUI-related symptoms. However, its predictive value for postpartum UI and SUI was limited. BDA may reflect structural vulnerability of the pelvic floor rather than serving as an independent predictive marker.
OBJECTIVE:To provide evidence-informed recommendations for the screening, management, and cessation of nicotine use during pregnancy and the postpartum period. TARGET POPULATION:Women who are pregnant or planning a pregnancy who use nicotine-containing products, including combustible tobacco, electronic cigarettes and smokeless tobacco. OPTIONS:Screening approaches, behavioural counselling interventions, pharmacologic therapies, harm-reduction strategies, and health system interventions for nicotine cessation. OUTCOMES:Improved maternal and neonatal outcomes, reduced nicotine exposure during pregnancy, improved cessation rates for nicotine-containing products, and prevention of postpartum relapse. BENEFITS, HARMS, AND COSTS:Implementation of these recommendations may improve smoking cessation rates during pregnancy and reduce adverse maternal and neonatal outcomes. Potential harms include increased clinical time requirements and resource utilization for cessation programs. EVIDENCE:Evidence was identified through comprehensive literature reviews addressing key clinical questions related to nicotine exposure, screening, cessation interventions, electronic cigarettes, and postpartum relapse prevention. 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 [weak] recommendations). INTENDED AUDIENCE:This guideline is intended for health care professionals involved in the care of pregnant individuals and those planning pregnancy, including obstetricians, family physicians, midwives, nurses, nurse practitioners, and other health professionals providing prenatal and postpartum care. It may also be relevant to public health practitioners, smoking cessation specialists, and policy makers involved in maternal and child health. SOCIAL MEDIA ABSTRACT:Nicotine use in pregnancy remains a major preventable cause of adverse maternal and neonatal outcomes. This SOGC guideline recommends routine screening, behavioural counselling as first-line therapy, cautious use of NRT or other pharmacotherapy when needed, and continued postpartum support to reduce relapse. SUMMARY STATEMENTS:RECOMMENDATIONS.
OBJECTIVE:Outpatient hysteroscopy offers a potential solution to improve access to gynecological surgical care; however, its widespread adoption remains limited in Canada. This quality improvement study aims to assess safety and efficiency outcomes of a dedicated high-volume OR-based transitional hysteroscopy program. METHODS:A retrospective observational study of patients who underwent elective hysteroscopy at a single tertiary care centre in Toronto, Canada, between April 3, 2023 and May 9, 2024 was performed. The pre-implementation group (n = 251) comprised patients who underwent hysteroscopy in the 6 months prior to the introduction of a monthly high-volume OR-based hysteroscopy program. The post-implementation group (n = 70) included those who underwent surgery in the 9 months following the program's introduction. RESULTS:Compared to the pre-implementation group, the post-implementation group demonstrated significant reductions in median total OR time (52 [42 - 65] vs. 36 [31 - 39.75] minutes, P < 0.01), procedure length (19 [14 - 29] vs. 14 [10.25 - 18.75] minutes, P < 0.01), and recovery time (136 [112.5 - 172.5] vs. 114 [99.25 - 137.75] minutes, P < 0.01). Surgical wait times did not differ significantly between groups (95 [50 - 182.5] vs. 92 [54.25 - 124.75] days, P = 0.30). There was no statistically significant difference in complication rates. CONCLUSION:Implementation of a high-volume, OR-based hysteroscopy program improved procedural efficiency without increasing complication or readmission rates. This model represents a feasible transitional approach for institutions aiming to expand toward a fully outpatient hysteroscopy service while maintaining patient safety and optimizing existing OR resources.
OBJECTIVE:Iron deficiency anemia (IDA) is a common cause of perioperative morbidity among women and individuals with a uterus undergoing gynecologic surgery, particularly those with abnormal uterine bleeding (AUB). Although intravenous (IV) iron is a safe and effective alternative to red blood cell (RBC) transfusion, IDA often remains underrecognized and undertreated. The Impact of Iron Supplementation on Transfusion in Women Undergoing Gynecologic Procedures (STRONG) pilot study evaluated the feasibility of implementing a multidisciplinary IV iron pathway for patients with IDA awaiting gynecologic surgery. METHODS:This prospective, single-centre cohort study was conducted between June 2022 and March 2025. Eligible patients were adults with laboratory-confirmed IDA (ferritin <30 μg/L or transferrin saturation <20%; and hemoglobin <120 g/L) scheduled for elective gynecologic surgery at least 4 weeks after diagnosis who had failed or were intolerant of oral iron. A multidisciplinary pathway integrating patient blood management (PBM) principles was developed for identifying and managing preoperative IDA. Primary outcomes were recruitment feasibility and pathway implementation feasibility, assessed by protocol adherence and IV iron delivery. Exploratory clinical measures included patient demographics, laboratory values, surgical details, transfusion rates, and perioperative outcomes. RESULTS:Twenty patients consented to study participation. Protocol adherence and IV iron delivery were 100%. Median hemoglobin increased from 93 g/L to 121 g/L preoperatively. Six patients (30%) required perioperative transfusion. CONCLUSION:Implementation of a multidisciplinary IV iron pathway for the detection and management of preoperative IDA in gynecologic surgery was feasible, supporting the integration of PBM strategies into routine perioperative care.
