Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC
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J Obstet Gynaecol Can · Jun 2019
Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review.
The number of Caesarean section (CS) procedures has increased dramatically both in developed and developing countries in recent decades. CS has been associated with chronic pain. A vicious impediment on quality of life may occur among women who experience chronic post-CS pain (CPCSP). ⋯ Moreover, the evidence demonstrates that severe acute postoperative pain after CS is an important contributing factor for the development of CPCSP. However, no strong evidence-based conclusions and recommendations may be drawn from the evidence. Future well-designed studies with a longer follow-up period are needed to identify the most important perioperative factors associated with chronic pain following Caesarean delivery.
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J Obstet Gynaecol Can · Jan 2019
Meta AnalysisInterventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses.
The most effective preterm birth (PTB) intervention is unknown for women who are at risk of PTB due to a history of conization. The objective of this systematic review was to determine whether PTB interventions, progesterone, cerclage, and pessary decrease the risk of PTB compared to no treatment in singleton-and separately in twin-pregnancies of women with history of conization. ⋯ In women with a previous conization and a current singleton gestation, the existing evidence, which is likely limited due to confounding by indication, does not support cerclage or other interventions used to try to decrease PTB.
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J Obstet Gynaecol Can · Jul 2018
Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review.
Ondansetron, not approved for use in pregnancy, is increasingly being prescribed for nausea and vomiting in pregnancy and hyperemesis gravidarum. A number of recent lawsuits have highlighted the possibility that ondansetron may cause congenital malformations. The aim of this study was to systematically review epidemiological evidence on the potential association of prenatal exposure to ondansetron and congenital malformations. ⋯ While further investigation of the literature is needed, our results highlight the paucity of evidence linking prenatal exposure to ondansetron to an increased risk of congenital malformations. There is a need for additional epidemiologic studies to confirm whether ondansetron represents a safe and effective alternative treatment for nausea and vomiting in pregnancy and hyperemesis gravidarum.
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Maternal mortality and severe maternal morbidity are devastating for women, their families, and care providers. International efforts have been made to develop and to implement data collection, management, and surveillance systems that capture pregnancy-related information that can be assessed and used to improve health and system outcomes. At present, Canada does not have a national enquiry process to review maternal deaths, severe morbidity, and near misses, and has not set targets for maternal mortality reduction. ⋯ Information about near misses as well as maternal morbidity is crucial to truly understand and to prevent maternal mortality. Canadian experts must work together with governments, provinces, and territories to determine key indicators, measurement, and meaningful data analysis strategies. These data and their comparisons will form the foundation of evidence to guide programs, policies, priorities, and interventions that will ultimately improve the health of mothers and their children.
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J Obstet Gynaecol Can · Jul 2017
ReviewCompetency-Based Medical Education and Assessment of Training: Review of Selected National Obstetrics and Gynaecology Curricula.
There are global variations in obstetrics and gynaecology (OBGYN) training curricula, both in length and in their structure and content. The ultimate goal for all residency programs is to ensure a skilled, competent physician, capable of independent practice by the end of his or her training. An online search was used for nationally recognized OBGYN training curricula. ⋯ Even though curricula reviewed have or will be integrating competency-based medical education into their residency program, there is a need to develop adequate assessment tools, including simulation, to train competent physicians capable of independent practice. Standardization of curricula leads to a decrease in the variability and an increase in the quality of training and allows for measurements and comparisons across centres. Ultimately, modifications to the curricula or even consensus for an international standard, including a standardized national simulation curriculum, may potentially increase the quality and efficiency of training, which could have a direct impact on patient safety and quality of care.