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Studies show poor maternal and fetal outcomes associated with prenatal cannabis use. With the legalization of cannabis in Canada, it is of timely importance to increase awareness of the effects of its use in pregnancy. An anonymous, online questionnaire was used to assess the pregnant population's knowledge, beliefs, and risk perceptions concerning cannabis. Additionally, educational materials on the effects of prenatal cannabis use were evaluated. A potential knowledge gap was found among 9%-19% of participants, who reported that cannabis posed no risk of harm to the pregnant person or fetus. Moreover, minor changes could improve the effectiveness of educational resources.

Objectives To evaluate surgeon opioid prescribing patterns for patients undergoing hysterectomy for benign indication, as well as patient use of postoperative medications and satisfaction with postoperative pain management. Methods Patients undergoing hysterectomy for benign indications at [redacted] were invited to participate in a telephone survey 2 weeks post-surgery to review their analgesia use and pain management. Patient demographics, medical history, intraoperative surgical details, and postoperative prescriptions were gathered through patient record review. Opioid prescribing and utilization patterns were assessed, as was satisfaction with postoperative pain management. Results Of 124 eligible patients 110 (89%) completed the telephone survey, a mean 15.9 ± 2.3 days after surgery. The mean age of participants was 51.6 ± 11.9 years. Most surgeries (84.5%) were minimally invasive, and 45.5% of patients were discharged within 24 hours of surgery. An opioid prescription was given to 71.8% of participants, and 52.7% used at least 1 dose of opioid medication after discharge. Most participants described very good or adequate postoperative pain management (88.2%). Satisfaction with postoperative pain control was not associated with receipt of an opioid prescription (P = 0.89). A greater proportion of those who used 1 or more doses of opioids versus none indicated poor or inadequate pain management (19.0% vs. 4.1%; P = 0.035). Conclusion Many patients do not use postoperative opioid analgesia following hospital discharge after hysterectomy, without experiencing poor pain management. Surgeons should assess each individual and tailor the analgesia plan as necessary, optimizing non-opioid options.

To compare the efficacy of two methods of outpatient cervical ripening (CR): an intracervical Foley catheter and a prostaglandin EAll records of women receiving outpatient CR at a tertiary care hospital from January 2017 to June 2018 were retrospectively reviewed. We compared time from insertion of first CR agent until delivery between groups using a Cox proportional hazards (CPH) model. Exclusion criteria included age18 years, multiple gestation, or contraindication to either CR method. Secondary outcomes included time from removal of agent and time from admission until delivery, additional CR used, uterine tachysystole, labour and delivery complications, type of delivery, and adverse neonatal outcomes.A total of 153 patients were included (82 Foley; 71 PGEOur results suggest that outpatient Foley catheter and PGE

Objective Induced abortion is the second most common reproductive health procedure in Canada. Among all Canadian women, 31% will have at least one induced abortion in their life. Unfortunately, abortion services are disparate throughout the country. With the recent introduction of mifepristone in Canada, it is hoped that access to abortion will be improved. However, it is recognized that some women who are eligible for medical abortion with mifepristone will still choose surgical abortion. The purpose of this study was to understand the patient's motivation to choose surgical abortion instead of medical abortion. Methods A survey was given to a sample of women coming to the Women's Clinic at Kingston General Hospital in Kingston, Ontario, for surgical abortion who qualified for medical abortion at the time their appointment was made. The study was approved by the Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board before data collection (#6022783) (Canadian Task Force Classification II-2). Results This study was conducted between February 13, 2018 and June 1, 2018. In agreement with previous studies, the most common perceived advantages of surgical abortion were that it is faster and requires fewer visits. Therefore, one of the greatest perceived obstacles to medical abortion is the need for follow-up. Conclusion Being able to offer two highly effective options for induced abortion will hopefully improve equitable access to abortion. To increase women's acceptance of medical abortion as a feasible option, we need to consider making some changes to the follow-up plan in our clinic.

Hypertensive disorders of pregnancy (HDP) comprise an independent, sex-specific risk factor for cardiovascular disease (CVD) in women. This study examined the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) lipid guidelines to identify women requiring further screening or lipid treatment following HDP.Using data collected from the postpartum Maternal Health Clinic (MHC) at Kingston General Hospital in Kingston, Ontario and the Preeclampsia New Emerging Team (PE-NET) cohort study, the study investigators used the models recommended by the CCS guidelines and the cardiometabolic model of life expectancy in each cohort to estimate CVD risk in women after HDP. (Canadian Task Force Classification II-2).Using the 10-Year Modified Framingham Risk Score, all women were classified by the 2016 CCS Guidelines as low risk, requiring no follow-up. The 30-Year and Lifetime Risk Scores resulted in significant reclassification of women at risk in the PE-NET control and HDP groups (P 0.001 and P 0.0001, respectively); 49.2% of women with HDP were classified as high risk, requiring follow-up, compared with 14.3% of control subjects. Using the cardiometabolic model, median life expectancy was significantly lower and expected onset of CVD was earlier in the HDP group compared with the control group (P 0.0001).The 2016 CCS lipid guidelines' risk classification recommendations significantly underestimated lifelong CVD risk in the HDP group compared with the control group. Women with HDP also had a significant decrease in cardiometabolic life expectancy and an earlier predicted age at onset of CVD. Early primary prevention in this at-risk population may improve CVD outcomes and reduce the future burden on the health care system.

Objective At Kingston General Hospital, women who have pregnancy-related cardiovascular risk indicators (e.g., preeclampsia, gestational hypertension, gestational diabetes) are offered standardized six-month postpartum follow-up for cardiovascular disease risk screening and counselling. We sought to assess how patient characteristics predict attendance at follow-up. Methods We undertook a chart review of 650 patients who delivered between April 2011 and December 2014 and had preeclampsia, gestational hypertension, or gestational diabetes. Logistic regression was used to analyze the relationship between clinical and demographic variables and attendance at the follow-up clinic. Results Increasing age (in years) was significantly correlated with attendance at follow-up (adjusted OR [aOR] 1.08, 95% CI 1.04 to 1.12). Women who had preeclampsia were significantly more likely to attend than women who had gestational hypertension or gestational diabetes (aOR 1.54, 95% CI 1.05 to 2.26). Women who were known to be non-smokers or whose smoking status was not recorded were significantly more likely to attend follow-up (aOR 2.47, 95% CI 1.32 to 4.62). There was a trend towards lower follow-up for women from census tracts or subdivisions with a greater proportion of individuals without educational certificate, diploma, or degree, but this was not statistically significant (aOR 0.10, 95% CI 0.01 to 1.22). Conclusion There is significant selection bias among women who attend follow-up for postpartum cardiovascular disease risk screening and counselling after pregnancies complicated by preeclampsia, gestational hypertension, or gestational diabetes.

Objective To obtain information on women's attitudes and opinions about participation in vaccine and medication trials during pregnancy. Methods A quantitative, cross-sectional survey was administered to 110 consenting women over a four-week period in the waiting room of an ambulatory obstetrics and gynaecology clinic in Ontario. Results The final response rate was 74.8%, with the majority of participants agreeing with statements about the importance of obtaining safety data about products in pregnancy and the importance of a woman having the ability to choose whether to participate in such research. Of all participants, 16.3% indicated they would consider participating in vaccine research during pregnancy and 20.0% would consider participating in medication research during pregnancy. Factors relating to maternal or fetal/child health were the most frequently cited factors influencing willingness to participate, with lack of trust in researchers and pharmaceutical companies as factors that would discourage participation. Conclusion A minority of pregnant women were willing to consider participating in medication or vaccine research during pregnancy. Optimizing participation requires providing women (and if appropriate, their partners) with detailed, multidisciplinary education about the maternal and fetal benefits and risks of such trials. Education about the principles of research ethics, including the limits of involvement of pharmaceutical companies, would be beneficial.

Objectives To calculate the cardiovascular disease (CVD) risk estimates for women following a pregnancy with or without preeclampsia. Methods We calculated 10-year, 30-year, and lifetime CVD risk estimates at one year postpartum for women recruited into the Pre-Eclampsia New Emerging Team’s prospective cohort. Results Complete CVD risk screening data were obtained from 118 control women and 99 preeclamptic women. A total of 18.2% of preeclamptic women and 1.7% of control women had a high 10-year risk (OR 13.08; 95% CI 3.38 to 85.5), 31.3% of preeclamptic women and 5.1% of control women had a high 30-year risk (OR 8.43; 95% CI 3.48 to 23.23), and 41.4% of preeclamptic women and 17.8% of control women had a high lifetime risk for CVD (OR 3.25; 95% CI 1.76 to 6.11). Conclusion The association of preeclampsia with the future development of CVD makes pregnancy an early window of opportunity for the preservation of health and prevention of CVD.