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This guideline provides evidence-based guidance on the risk-based management of cervical dysplasia in the colposcopy setting in the context of primary HPV-based screening and HPV testing in colposcopy. Colposcopy management of special populations is also discussed. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC) and the Canadian Partnership Against Cancer (CPAC). The literature informing these guidelines was obtained through a systematic review of the relevant literature via a multi-step search process led by information specialists. The literature was reviewed up to June 2021 with manual searches of relevant national guidelines and more recent publications. Quality of the evidence and strength of recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include gynecologists, colposcopists, screening programs and healthcare facilities. Implementation of the recommendations is intended to promote equitable and standardized care for all people undergoing colposcopy in Canada. The risk-based approach aims to improve personalized care and reduce over-/under-treatment in colposcopy. [ABSTRACT FROM AUTHOR]

Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist. [ABSTRACT FROM AUTHOR]

Background: We performed a retrospective chart review in 2006 to review oncology patients' use of banked semen samples in fertility treatments at a tertiary care centre. Methods: From 2002 to 2005, 367 oncology patients banked semen. During the same period, 31 patients used banked samples in 48 treatment cycles. Samples were used for intrauterine insemination (lUl) in 28 cycles and for in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) in 20 cycles. Results: Pregnancy rates per cycle were 21% for lUl and 50% for IVF with or without ICSI. Overall, 16 of the 31 couples achieved a pregnancy with assisted reproductive technologies (52%). Conclusion: This data indicates high pregnancy success rates with the use of banked semen samples from men with cancer. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether opioid prescriptions at discharge after Cesarean delivery decreased following implementation of a quality improvement bundle., Methods: A quality improvement bundle was instituted at Mount Sinai Hospital in Toronto. Interventions included opioid prescribing instructions in resident orientation, nursing and patient education, and standard electronic prescriptions. We used an interrupted time series study design and included patients who had a Cesarean delivery six months pre intervention and six months post intervention. Primary outcome data (opioids prescribed at discharge in morphine milliequivalents [MME]), were aggregated (averaged) by calendar week and analyzed using interrupted time series. Secondary outcomes were assessed using bivariate methods and included opioid use for breakthrough pain in hospital, and amount of opioids prescribed by prescriber specialty and training level., Results: We included 2,578 women in our analysis. Based on the segmented regression analysis, prescribed opioids decreased from 97.6 MME in 2018 to 35.8 MME in 2019 (difference in means, - 61.7; 95% confidence interval [CI], - 72.2 to - 51.3; P < 0.001), and this decrease was sustained over the study period. Post intervention, there were no visits to our postnatal assessment clinic for inadequate pain control., Conclusion: A quality improvement bundle was associated with a marked and sustained decrease in discharge prescriptions of opioids post Cesarean delivery at a large Canadian tertiary academic hospital., (© 2021. The Author(s).)

Background: The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction., Method: Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations., Results: We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options., Interpretation: There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability., (© 2022. The Author(s).)

Objective: To evaluate the knowledge, attitudes, and beliefs of women during pregnancy and the postpartum period related to placentophagy., Design: Mixed methods study (cross-sectional survey and online discussions)., Setting: We used social media to advertise the study to mother/parenting groups. Online discussion groups were conducted through Google Groups., Participants: Women during pregnancy and in the postpartum period and placenta encapsulation specialists with Internet access., Methods: We summarized descriptive data and analyzed subgroups with the use of chi-square tests. We conducted a binary logistic regression to compare placentophagy with demographic variables and used constant comparative analysis to analyze online discussion group themes., Results: Overall, 271 of 1,088 (24.9%) respondents consumed their placentas. Canadian respondents and those who experienced pregnancy/birth-related complications were significantly (p < .05) less likely to consume their placentas than respondents from the United States (odds ratio = 0.48, 95% confidence interval [0.28, 0.82]) and those who had no complications (odds ratio = 0.56, 95% confidence interval [0.37, 0.85]). Increased iron stores (521/1,030, 50.6%), prevention of postpartum depression (519/1,030, 50.4%), and increased energy/decreased fatigue (460/1,030, 44.7%) were the most commonly listed perceived benefits. Infection and improper handling/preparation of the placenta were important concerns, and hospital policy was noted as a barrier to placentophagy., Conclusion: Respondents who engaged in placentophagy were primarily motivated by unproven benefits, such as the prevention of postpartum depression and anemia, for which there are other management alternatives. Although placentophagy is gaining popularity, it remains unregulated, and safety and efficacy data are limited. A safe, standardized preparation process is needed to minimize potential harm before further efficacy studies can be done. Targeted educational material surrounding placentophagy is needed to improve woman-centered care., (Copyright © 2019 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: This study sought to identify and understand the barriers and supports associated with taking parental leave during obstetrics and gynaecology residency training in Canada, with the aim of helping to direct parental leave policies., Methods: Participants were recruited by social media, program directors, and through the SOGC. The study included a short demographic questionnaire and a semistructured qualitative interview in person, by either telephone or videoconference. The interviews were recorded, transcribed, and anonymized. Descriptive thematic analysis using the constant comparative method of grounded theory was performed on each transcript by two independent investigators. Codes were applied to each sentence of the transcript to identify the main idea in the text segment. Once coding was complete the investigators looked for relationships among codes to define themes. Data collection continued until a saturation of themes was reached., Results: Fifteen participants from across Canada completed the study. The most significant challenges surrounding parental leave during residency included breastfeeding, difficulty on return to work (skill loss, time management, examination preparation), and work-life balance. The major supports noted included family, colleagues and mentors, adequate childcare, and program flexibility surrounding the leave. Participants' suggestions for alleviating the stressors included a gradual return to work and careful planning surrounding returning rotation., Conclusion: Trainees identified formal program supports, non-surgical or core initial rotation back, and a gradual return to work as important areas to address in policies surrounding resident parental leave during Canadian obstetrics and gynaecology training., (Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.)

This study's objective was to assess the knowledge of prenatal screening for Trisomy 21 in pregnant women in one institution in Canada. A cross-sectional survey measuring demographics, knowledge of screening, and health literacy, was administered to pregnant women. Of the 135 women who completed the survey, 74% had adequate knowledge of Trisomy 21 and associated screening procedures. Twenty-eight point one percent of women did not receive any counseling. Overall, 29.5% of women did not know that the screening test was optional and 10.2% of women underwent screening prior to having been counseled. Multigravidity (p < 0.05) and prior counseling (p < 0.001) were positively correlated with knowledge while first language other than English (p < 0.001) was negatively correlated with knowledge. Given these findings, an effort needs to be made on the part of health care providers to increase counseling rates to 100%, stressing the optional nature of the test to attain true informed consent.

Objective: We evaluated the inter-rater reliability (IRR) of assessing the quality of evidence (QoE) using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach., Study Design and Setting: On completing two training exercises, participants worked independently as individual raters to assess the QoE of 16 outcomes. After recording their initial impression using a global rating, raters graded the QoE following the GRADE approach. Subsequently, randomly paired raters submitted a consensus rating., Results: The IRR without using the GRADE approach for two individual raters was 0.31 (95% confidence interval [95% CI] = 0.21-0.42) among Health Research Methodology students (n = 10) and 0.27 (95% CI = 0.19-0.37) among the GRADE working group members (n = 15). The corresponding IRR of the GRADE approach in assessing the QoE was significantly higher, that is, 0.66 (95% CI = 0.56-0.75) and 0.72 (95% CI = 0.61-0.79), respectively. The IRR further increased for three (0.80 [95% CI = 0.73-0.86] and 0.74 [95% CI = 0.65-0.81]) or four raters (0.84 [95% CI = 0.78-0.89] and 0.79 [95% CI = 0.71-0.85]). The IRR did not improve when QoE was assessed through a consensus rating., Conclusion: Our findings suggest that trained individuals using the GRADE approach improves reliability in comparison to intuitive judgments about the QoE and that two individual raters can reliably assess the QoE using the GRADE system., (Copyright © 2013 Elsevier Inc. All rights reserved.)