Society Of Obstetricians And Gynaecologists Of Canada Research Articles

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines.

Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8-10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d' Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15-60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

Comparison of National Factor-based Models for Preeclampsia Screening.

This study aimed to compare the predictive values of the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the Society of Obstetricians and Gynecologists of Canada (SOGC) factor-based models for preeclampsia (PE) screening. We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE, and the SOGC models. Our primary outcomes were PE and preterm PE (PE combined with preterm birth) using the ACOG criteria. We calculated the detection rate (DR or sensitivity), the false positive rate (FPR or 1 - specificity), the positive (PPV) and negative (NPV) predictive values of each model for PE and for preterm PE using receiver operator characteristic (ROC) curves. We used 130,939 deliveries including 4,635 (3.5%) cases of PE and 823 (0.6%) cases of preterm PE. The ACOG model had a DR of 43.6% for PE and 50.3% for preterm PE with FPR of 15.6%; the NICE model had a DR of 36.2% for PE and 41.3% for preterm PE with FPR of 12.8%; and the SOGC model had a DR of 49.1% for PE and 51.6% for preterm PE with FPR of 22.2%. The PPV for PE of the ACOG (9.3%) and NICE (9.4%) models were both superior than the SOGC model (7.6%; p < 0.001), with a similar trend for the PPV for preterm PE (1.9 vs. 1.9 vs. 1.4%, respectively; p < 0.01). The area under the ROC curves suggested that the ACOG model is superior to the NICE for the prediction of PE and preterm PE and superior to the SOGC models for the prediction of preterm PE (all with p < 0.001). The current ACOG factor-based model for the prediction of PE and preterm PE, without considering race, is superior to the NICE and SOGC models. · Clinical factor-based model can predict PE in approximately 44% of the cases for a 16% false positive.. · The ACOG model is superior to the NICE and SOGC models to predict PE.. · Clinical factor-based models are better to predict PE in parous than in nulliparous..

The German guideline "Obesity in pregnancy": comparison with the international approach.

Obesity is an increasing problem, even in young women of reproductive age. Obesity has a negative impact on conception, the course of pregnancy, and neonatal outcomes. Caring for obese pregnant women has becoming an important aspect of standard prenatal care. The Guideline "Obesity and Pregnancy" of the German Society of Gynecology and Obstetrics aims to create evidence-based recommendations which can be used to improve the care of obese pregnant women. As obesity is a worldwide problem, many societies for obstetrics and gynecology have created national guidelines. We reviewed the following guidelines for obesity and pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2021, Royal College of Obstetrics and Gynecology (RCOG) 2018; AND Society of Obstetricians and Gynecologists of Canada (SOGC) 2019. These guidelines were compared to the German guideline. There are some variations between the guidelines, though no major contradictions exist. Disparities were found regarding the recommendations for substitution of high folic acid and Vitamin D. Furthermore, the recommended time for screening for gestational diabetes and the methods to control fetal growth differ between the guidelines. Regarding place of birth, RCOG allows delivery in midwifery-led units in the absence of other high-risk circumstances, while others request facility of care by neonatologists and medical staff trained in care of obese women. Induction of labor at term due to increased risk of intrauterine demise is mostly limited to women with a body mass index of 40 kg/m2. Only one guideline considers induction of all obese women. For intrapartum management, the majority allows tolerating of longer labor times to delivery if fetal monitoring is sufficient and fetal stress is excluded. Special encouragement of breastfeeding and healthy lifestyle is commonly recommended; only in the Canadian guideline, postpartum depression evaluation is requested due to the overall high prevalence of depression and anxiety in obese women. All guidelines consider pregnancies in obese women as high-risk pregnancies and emphasize the need for preconception counseling. There are special needs in pregnancy care and in the intrapartum and postpartum management to be observed.

South Asian and East Asian Immigrant Pregnant women in Canada, United Kingdom, United States of America, Australia, and New Zealand: Prevalence of common mental health conditions and women’s lived experience with them

The goal of this review is to investigate the prevalence rates of common mental health conditions among pregnant East and South Asian immigrant women, as well as to understand their lived experiences with these conditions in 5 English-speaking countries: Canada, United Kingdom, United States of America, Australia, New Zealand. Pregnancy is a critical time in a woman's life marked by intricate physical, emotional, and psychological transitions. The mental health of pregnant women emerges as a paramount concern given its associations with poor pregnancy outcomes. This is crucial within the context of South Asian and East Asian immigrant women, who navigate unique cultural, social, and economic challenges in their host countries that may influence their emotional wellbeing. This review will investigate the prevalence rates of common mental health conditions. This review will also explore their encounters with mental health care services and interactions with perinatal mental health care providers and services. Quantitative and Qualitative studies in English language that examine East and/or South Asian immigrant women in the perinatal period will be considered for this review. Published abstracts and mixed methods studies will also be included. All languages and publication dates will be included. However, only studies with an English language translation will be considered. This review will exclude books/book chapters, editorials, commentaries, and reviews. CINAHL (EBSCO), MEDLINE ALL will be searched. Furthermore, a grey literature search will be included in the search using CINAHL and PsycINFO as well as websites such as Society of Obstetricians and Gynecologists of Canada (SOGC), Canadian Perinatal Surveillance System (CPSS), Canadian Perinatal Mental Health Collaborative (CPMHC), Centre for Addiction and Mental Health (CAMH) and the Canadian Pediatric Society. Screening, conflict resolution data extraction and aggregation will be done by two independent reviewers.

First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey

ObjectiveOur objective was to explore the workforce and clinical care of first and second-trimester surgical abortion (FTSA, STSA) providers following the publication of the updated Society of Obstetricians and Gynaecologists of Canada (SOGC) surgical abortion guidelines. MethodsWe conducted a national, cross-sectional, online, self-administered survey of physicians who provided abortion care in 2019. This anonymized survey collected participant demographics, types of abortion services, and characteristics of FTSA and STSA clinical care. Through healthcare organizations using a modified Dillman technique, we recruited from July to December 2020. Descriptive statistics were generated by R Statistical Software. ResultsWe present the data of 222 surgical abortion provider respondents, of whom 219 provided FTSA, 109 STSA, and 106 both. Respondents practiced in every Canadian province and territory. Most were obstetrician-gynaecologists (56.8%) and family physicians (36.0%). The majority of FTSA and STSA respondents were located in urban settings, 64.8% and 79.8%, respectively, and more than 80% practiced in hospitals. More than 1 in 4 respondents reported <5 years’ experience with surgical abortion care and 93.2% followed SOGC guidelines. Noted guideline deviations included that prophylactic antibiotic use was not universal, and more than half of respondents used sharp curettage in addition to suction. Fewer than 5% of STSA respondents used mifepristone for cervical preparation. ConclusionThe surgical abortion workforce is multidisciplinary and rejuvenating. Education, training, and practice support, including SOGC guideline implementation, are required to optimize care and to ensure equitable FTSA and STSA access in both rural and urban regions. Gestational Age Notationweeks, weeks’ gestation, gestational age (GA), e.g., 116 weeks.

Can Early First Trimester Ultrasounds Correctly Determine Gestational Age Compared to Ultrasounds Performed Between 7 to 14 Weeks Gestational Age?

ObjectivesThe Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends the use of an ultrasound performed between 7 and 14 weeks gestation to accurately predict gestational age (GA). This study aimed to assess the accuracy of earlier ultrasounds (5 to 66 weeks gestation) by comparing the estimated delivery dates (EDD) in participants that had undergone both an earlier ultrasound and ultrasound completed during the standard of care timeframe. MethodsEDD based on crown-rump length were retrospectively reviewed for patients that had undergone an ultrasound between 5−66 weeks GA versus the recommended 7−14 weeks GA at the Montfort Hospital during 2018 and 2019. The charts of 981 patients that had an ultrasound prior to 7 weeks GA and at 7−14 weeks GA were reviewed; 54 were included. ResultsThere was no significant difference (P = 0.307) between the EDD of the early (5−66 weeks GA) and the second ultrasound (7−14 weeks GA). The first ultrasounds were then separated into very early (5−56 weeks GA) and early (6−66 weeks GA) and compared. No significant differences (P = 0.579) were found. Similarly, no difference was found between the EDD of the early (6−66 weeks GA) and standard of care timing (P = 0.324). ConclusionThese results show no significant difference in accurately determining the EDD between ultrasounds completed at the early and standard of care time points. This could result in cost-saving benefits by foregoing a repeat ultrasound; however, further research is required prior to applying these findings in clinical settings.

Editorial

Editorial

P-735 Exploring representation and inclusivity in fertility and reproductive health societies’ leadership

Abstract Study question How diverse is the board-level executive leadership of the leading fertility and reproductive health societies in Europe, Australia and North America? Summary answer There is good gender diversity among the reproductive health societies included in the study, with limited ethnic diversity. What is known already Reproductive health societies promote understanding and interest in reproductive biology and medicine. They are leading authorities, providing guidelines, opinions, and direction to practitioners, policy makers and the public. Membership on these societies’ board is a marker of influence and prestige. Many societies have clear Equality and Diversity Statement on their website, suggesting that they value representation of members from whom they obtain fees. This study presents a quantification of the executive leadership demographic diversity of major fertility and reproductive health societies in Europe, Australia and North America to evaluate diversity in governance. Study design, size, duration We conducted a review of the websites of ten leading fertility and reproductive health societies in the Europe, Australia and North America to quantity gender and ethnic diversity. Data analysis was conducted on the information obtained in January 2022. We included the executive leadership team /governing board members but excluded subgroup leaders or special interest group coordinators. Participants/materials, setting, methods Organisations reviewed include: American College of Obstetricians and Gynaecologists(ACOG), American Society for Reproductive Medicine(ASRM), British Fertility Society(BFS), Canadian Fertility and Andrology Society(CFAS), European Society of Human Reproduction and Embryology(ESHRE), The Fertility Society of Australia and New Zealand(FSA), International Federation of Obstetrics and Gynaecology(FIGO), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists(RANZCOG), Royal College of Obstetricians and Gynaecologists (RCOG), and The Society of Obstetricians and Gynaecologists of Canada(SOGC). Main results and the role of chance Proportion for each demographic group at the time of the study are summarised below; where n = total number of board members; Gender: W= women, M= Men; ethnicity: Wh = White, B = Black and A = Asian. In total, the number of board level/executive leadership members, responsible for governance in the societies reviewed were 112. Gender diversity was 41% Men, 59% Women, while ethnic diversity was 82% White, 3% Black and 15% Asian. It is encouraging to see the gender parity in the executive leadership of the organisations review, there remains an important need to improve ethnic diversity in order to better represent the membership and wider community they serve. This has implications for role-modelling, equity, minimising the negative impact of groupthink and reaching/giving underrepresented group a voice. Limitations, reasons for caution Results presented are based on a snapshot at the time of review. Organisations periodically change leadership. Additionally, gender identification is based on self-identification in individual’s profile biography. Wider implications of the findings As reproductive health organisations continue make extensive contributions to the field, it is important for their leadership to represent the diversity of members and wider population they serve. There remains a need to move beyond diversity and equality statement to actively deploy policies and processes to improve and monitor representation. Trial registration number not applicable

Provision of Surgical Abortion Care in Canada

In 2018 the Society of Obstetricians and Gynaecologists of Canada (SOGC) published an updated guideline on first and second trimester surgical abortion (FTSA, STSA). Our objective was to explore the workforce and clinical care of surgical abortion providers after these guideline changes.

Investigation and management of stillbirth: a descriptive review of major guidelines.

Stillbirth is a common and devastating pregnancy complication. The aim of this study was to review and compare the recommendations of the most recently published guidelines on the investigation and management of this adverse outcome. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynecologists (RCOG), the Perinatal Society of Australia and New Zealand (PSANZ), the Society of Obstetricians and Gynecologists of Canada (SOGC) on stillbirth was carried out. Regarding investigation, there is consensus that medical history and postmortem examination are crucial and that determining the etiology may improve care in a subsequent pregnancy. All guidelines recommend histopathological examination of the placenta, genetic analysis and microbiology of fetal and placental tissues, offering less invasive techniques when autopsy is declined and a Kleihauer test to detect large feto-maternal hemorrhage, whereas they discourage routine screening for inherited thrombophilias. RCOG and SOGC also recommend a complete blood count, coagulopathies' testing, anti-Ro and anti-La antibodies' measurement in cases of hydrops and parental karyotyping. Discrepancies exist among the reviewed guidelines on the definition of stillbirth and the usefulness of thyroid function tests and maternal viral screening. Moreover, only ACOG and RCOG discuss the management of stillbirth. They agree that, in the absence of coagulopathies, expectant management should be considered and encourage vaginal birth, but they suggest different labor induction protocols and different management in subsequent pregnancies. It is important to develop consistent international practice protocols, in order to allow effective determination of the underlying causes and optimal management of stillbirths, while identifying the gaps in the current literature may highlight the need for future research.

The Get Active Questionnaire for Pregnancy: Reducing the Barriers to Physical Activity

The 2019 Canadian Guideline for Physical Activity Throughout Pregnancy revolutionized our view of prenatal exercise. Jointly published by the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Society for Exercise Physiology (CSEP), this was the first guideline to outline the risks of not being physically active during pregnancy, while reaffirming the safety of physical activity for the majority of pregnant patients.1

Development of a management guidewheel for vulvar cancer

Ismail’s Cancer Vulva Management Guidewheel is designed to enable physicians to refer to a quick and comprehensive reference to recommendations on the management of vulvar cancer at various stages. The wheel consists of patient characteristics, including the FIGO stage and the possible treatment modalities available along with alternatives. We compared guidelines on the management of vulvar cancer by international health organizations including the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynaecological Oncology (ESGO), the European Society of Urogenital Radiology (ESUR), the British Gynaecological Cancer Society (BGCS), the Royal College of Obstetricians and Gynaecologists (RCOG), the Japanese Society of Gynecologic Oncology (JSGO), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the International Federation of Gynecology and Obstetrics (FIGO). Their respective recommendations have been compared and carefully integrated on the guidewheel.

Changes in rate of preterm birth and adverse pregnancy outcomes attributed to preeclampsia after introduction of a refined definition of preeclampsia: A population-based study.

Since 2013, various guidelines for hypertension in pregnancy have been refined, no longer requiring proteinuria as a requisite criterion for preeclampsia. We aimed to evaluate the impact of the new definition on preterm birth (PTB) and adverse pregnancy outcomes. Women delivering in Ontario between April 2012 and November 2016 were included. Delivery <24+0/7weeks, major fetal anomalies or preexisting renal disease were excluded. The primary outcome was livebirth <37, <34 or <32weeks. Rates, adjusted rate ratios (aRR) and ratio of the rate ratio (RRR) were used to compare outcomes in the 2years after the new Society of Obstetricians and Gynaecologists of Canada (SOGC) guideline (December 2014-November 2016; period 2) vs the 2years before (April 2012-March 2014; period 1), among women with and without preeclampsia. In all, 268543 and 267964 births in periods 1 & 2, respectively, were included. Respective preeclampsia rates increased significantly from 3.9% to 4.4% (p<0.001), with no change in maternal morbidity rates. In preeclamptic women, respective rates of PTB <37weeks were 21.0% and 20.7% (aRR 1.01, 95% confidence interval [CI] 1.00-1.02), with significant aRR for PTB <34 (0.86, 95% CI 0.77-0.96) and <32weeks (0.79, 95% CI 0.67-0.94). A similar aRR was observed in women without preeclampsia. In preeclamptic women, composite severe neonatal morbidity decreased after guideline change (aRR 0.95, 95% CI 0.91-0.99), a finding not observed in women without preeclampsia (RRR 0.95, 95% CI 0.91-0.99). The new definition of preeclampsia was associated with increased disease rates, a modest reduction in adverse neonatal outcomes and no change in maternal outcomes.

Diagnosis and Management of Gestational Diabetes Mellitus: An Overview of National and International Guidelines.

Gestational diabetes mellitus (GDM) represents one of the most frequent complications of pregnancy and is associated with increased maternal and neonatal morbidity. Its incidence is rising, mostly due to an increase in maternal age and maternal obesity rate. The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of this condition. A descriptive review of guidelines from the National Institute for Health and Care Excellence (NICE), the International Federation of Gynecology and Obstetrics, the Australasian Diabetes in Pregnancy Society (ADIPS), the Society of Obstetricians and Gynecologists of Canada (SOGC), the American College of Obstetricians and Gynecologists (ACOG), the American Diabetes Association, and the Endocrine Society on gestational diabetes mellitus was carried out. The NICE guideline recommends targeted screening only for women with risk factors, whereas the International Federation of Gynecology and Obstetrics, ADIPS, SOGC, and the ACOG recommend screening for all pregnant women at 24 to 28 weeks of gestation in order to diagnose and effectively manage GDM; they also state that women with additional risk factors should be screened earlier (ie, in the first trimester) and retested at 24 to 28 weeks, if the initial test is negative. These guidelines describe similar risk factors for GDM and suggest the same thresholds for the diagnosis of GDM when using a 75-g 2-hour oral glucose tolerance test. Of note, the NICE only assesses the fasting and the 2-hour postprandial glucose levels for the diagnosis of GDM. Moreover, the SOGC and the ACOG do not recommend this test as the optimal screening method. The Endocrine Society alone, on the other hand, recommends the universal testing of all pregnant women for diabetes before 13 weeks of gestation or as soon as they attend the antenatal service and retesting at 24 to 28 weeks if the initial results are normal. In addition, there is a general consensus on the appropriate ultrasound surveillance of pregnancies complicated with GDM, and all the medical societies, except the ADIPS, recommend self-monitoring of capillary glucose to assess the glycemic control and set the same targets for fasting and postprandial glucose levels. There is also agreement that lifestyle modifications should be the first-line treatment; however, the reviewed guidelines disagree on the medical management of GDM. In addition, there are controversies regarding the timing of delivery, the utility of hemoglobin A1c measurement, and the postpartum and lifelong screening for persistent hyperglycemia and type 2 diabetes. However, all the guidelines state that all women in pregnancies complicated by GDM should undergo a glycemic test at around 6 to 12 weeks after delivery. Finally, there is a universal consensus on the importance of breastfeeding and preconception screening before future pregnancies. As GDM is an increasingly common complication of pregnancy, it is of paramount importance that inconsistencies between national and international guidelines should encourage research to resolve the issues of controversy and allow uniform international protocols for the diagnosis and management of GDM, in order to safely guide clinical practice and subsequently improve perinatal and maternal outcomes.

Canadian Enhanced Recovery After Surgery (ERAS) Cesarean Delivery Perioperative Management Survey

Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative that has spread across numerous surgical disciplines. The uptake of ERAS in cesarean delivery in Canada is presently unknown. This study surveyed the current practices of Society of Obstetricians and Gynaecologists of Canada (SOGC) members with regards to ERAS guidelines for preoperative, intraoperative, and postoperative cesarean delivery care. Survey responses highlight perioperative practice variations across Canada. Active implementation of ERAS cesarean delivery guidelines could potentially lessen variations in perioperative care, improve patient outcomes, and minimize health care costs.

Trends in National Canadian Guideline Recommendations for the Screening and Diagnosis of Gestational Diabetes Mellitus over the Years: A Scoping Review.

Canada’s largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.

Sonographic confirmation of fetal position before operative vaginal delivery should be recommended in clinical guidelines

Sonographic confirmation of fetal position before operative vaginal delivery should be recommended in clinical guidelines

Postpartum Analgesia in New Mothers (PAIN) Study: A Survey of Canadian Obstetricians' Post-Delivery Opioid-Prescribing Practices.

We aimed to describe opioid prescribing practices after obstetric delivery and to evaluate how these practices compare with national opioid prescribing guidelines. A closed survey was developed, evaluated for validity and reliability, and distributed by email to obstetrician members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) in December 2018. Descriptive statistics were used to summarize respondent demographics, pharmaceutical pain management strategies, and opioid prescribing practices. Logistic regression was used to measure associations between respondent characteristics and high-risk opioid prescribing practices (e.g., prescribing >50 mg morphine equivalent dose per day, prescribing >5 days, not screening for substance/opioid use disorder before prescribing). Our survey had high content validity (content validity index 0.89; 95% CI 0.78-1.00) and adequate reliability (Kappa 0.70; 95% CI 0.63-0.84 and intraclass correlation coefficient 0.70; 95% CI 0.67-0.81). Of the 1019 SOGC members reached, 243 initiated the survey (response rate, 24%). Among respondents, 235 (92%) completed the survey. Among opioid prescribers, 47% reported at least 1 high-risk opioid prescribing practice, the most frequent being a lack of substance/opioid use disorder screening. In the adjusted logistic regression model, being in practice more than 20 years (adjusted odds ratio [aOR] 0.53; 95% CI 0.29-0.93) and practising in a non-central area of Canada (aOR 0.49; 95% CI 0.28-0.84) reduced the odds of high-risk prescribing. Further research on barriers to screening are needed to support and enhance safer opioid prescribing practices among Canadian obstetricians.

Readability, Quality & Adherence of Online Education Material for the Medical, Surgical & Interventional Radiology Options for Leiomyoma

Study Objective To assess the readability, quality, and adherence of online patient education materials (PEMs) for leiomyoma treatment. Design Cross-sectional analysis was performed. Search queries included keywords targeting medical and surgical treatments, including minimally invasive and laparotomy approaches. The top 20 websites per search query were retrieved from “Google” and evaluated for readability using the “Flesch Reading Ease Score” (FRES), “Flesch Kincaid Grade Level” (FKGL) and “Gunning Fog Index” (GFI) formulas. Quality was ascertained using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health on the Net Foundation Code of Conduct (HONcode) certification by three reviewers. “Adherence” to Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines was assessed using a 5-point Likert scale by two reviewers. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results Of the 151 websites evaluated, 84 (55.6%), 49 (32.4%), 18 (11.9%) involved medical, surgical and interventional radiology modalities, respectively. The mean FRES, FKGL and GFI scores were 43.58 (95% CI 40.7, 45.40), 11.78 (95% CI 11.30, 12.20), and 14.39 (95% CI 13.90, 14.90), respectively. The mean DISCERN, JAMA, and adherence scores were 57%, 34%, and 59%, respectively. 39 (25.8%) of PEMs were HONcode accredited. 53 (35%) of PEMs were rated as either “good” or “excellent” by DISCERN. Majority of PEMs (79%) were not adherent to SOGC guidelines. Similarly, the majority of PEMs had JAMA scores Conclusion Online PEMs for leiomyoma treatment do not meet national reading recommendations, and may be difficult for patients to comprehend. Furthermore, the majority of PEMs do not meet minimum quality standards, potentially contributing to poor health literacy and adverse clinical outcomes.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.