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Enhanced first trimester aneuploidy screening (eFTS) combines serum biomarkers and ultrasound. Abnormal biomarkers are associated with placental complications, such as fetal growth restriction (FGR). We aimed to evaluate whether a Midtrimester placental scan can provide reassurance regarding FGR in women with abnormal eFTS biomarkers.We conducted a retrospective cohort study of women who had eFTS and delivered at a single referral center. Women with abnormal biomarkers had a mid-trimester scan of the placenta (morphologic assessment, fetal biometry and uterine artery pulsatility index). We compared pregnancies with abnormal eFTS biomarkers and normal placental scans (study group) with those who had normal eFTS biomarkers (control group).A total of 6,514 women were included, of whom 343 (5.3%) comprised the study group. Women in the study group had an increased risk of hypertensive disorders of pregnancy [(aOR)1.96(95%CI 1.21-3.16)], and preterm birth37 weeks [aOR1.98(95%CI 1.33-2.95)] compared to the control group. Yet, their neonates were not at higher risk for FGR3A normal second trimester placental scan provided reassurance regarding the risk of FGR in women at high risk based on abnormal eFTS biomarkers.

Objective: To determine whether the incidence of pregnancy and live birth is similar in women of childbearing age undergoing abdominal myomectomy (AM) with the use of a pericervical tourniquet comp...

We retrospectively included women with abnormal FTS analytes and compared outcomes between those with elevated and normal UtA-PI. Out of 582 women with abnormal FTS analytes, 65 (11.2%) had elevated UtA-PI. Neonates of women in this group had higher rates of birth weight3rd, 5th, and 10th percentile. The area under the ROC curve for predicting FGR10th percentile by UtA-PI was 0.584, for FGR5th percentile 0.593, and for FGR3rd percentile 0.720. In women with abnormal FTS, elevated UtA-PI is associated with higher rates of FGR, but its predictability is moderate-to-poor.

Background It has been suggested that women admitted for delivery should have universal PCR testing for SARS‐CoV‐2. Yet, the considerable difference in the incidence of COVID‐19 between different geographic regions may affect screening strategies. Therefore, we aimed to compare questionnaire‐based testing versus universal PCR testing for SARS‐CoV‐2 in women admitted for delivery. Methods A prospective cohort study of women admitted for delivery at a single center during a four‐week period (April 22‐May 25, 2020). All women completed a questionnaire about COVID‐19 signs, symptoms, or risk factors, and a nasopharyngeal swab for PCR for SARS‐CoV‐2. Women who were flagged as suspected COVID‐19 by the questionnaire (questionnaire‐positive) were compared with women who were not flagged by the questionnaire (questionnaire‐negative). Results Overall, 446 women were eligible for analysis, of which 54 (12.1%) were questionnaire‐positive. PCR swab detected SARS‐CoV‐2 in four (0.9%) women: 3 of 392 (0.8%) in the questionnaire‐negative group, and 1 of 54 (1.9%) in the questionnaire‐positive group (P = .43), yielding a number needed to screen of 92 (95% CI 62‐177). In 96% of the cases, the PCR results were obtained only in the postpartum period. No positive PCR results were obtained from neonatal testing for SARS‐CoV‐2. The sensitivity of the questionnaire was 75.0%, and the negative predictive value was 99.7%. Conclusions Although the rate of positive PCR results was not significantly different between the groups, the number needed to screen is considerably high. The use of questionnaire‐based PCR testing in areas with low incidence of COVID‐19 allows for a reasonable allocation of resources and is easy to implement.

ObjectiveObesity is a major risk factor for low-grade endometrial cancer. The surgical management of patients with obesity is challenging, and they may face unique barriers to accessing care. We completed a qualitative study to understand the experiences of low-grade endometrial cancer patients with morbid obesity, from symptom onset to diagnosis to surgery.DesignSemi-structured interviews were performed with endometrial cancer patients with morbid obesity (body mass index (BMI)>40 kg/m2) referred for primary surgery. Transcribed interviews were coded line-by-line and analysed using an interpretive descriptive approach that drew on labelling theory to understand patients’ experiences. Thematic sufficiency was confirmed after 15 interviews.SettingTwo tertiary care centres in Toronto, Ontario, Canada.ParticipantsFifteen endometrial cancer patients with a median age of 61 years (range: 50–74) and a median BMI of 50 kg/m2(range: 44–70) were interviewed.ResultsThematic analysis identified that (1) both patients and providers lack knowledge on endometrial cancer and its presenting symptoms and risk factors; (2) patients with morbid obesity are subject to stigma and poor communication in the healthcare system and (3, 4) although clinical, administrative, financial, geographic and facility-related barriers exist, quality care for patients with morbid obesity is an achievable goal.ConclusionsImproved education on the prevention and identification of endometrial cancer is needed for both patients and providers. Delivery of cancer care to patients with morbid obesity may be improved through provider awareness of the impact of weight stigma and establishing streamlined care pathways at centres equipped to manage surgical complexity.

Study Objective To determine whether the pregnancy rate and live birth rate is similar in women of childbearing age undergoing abdominal myomectomy (AM) in two major Canadian urban centers with the use of a peri-cervical tourniquet compared to women undergoing AM without the use of a tourniquet. Design A multi-center retrospective cohort study was conducted, consisting of a retrospective chart review and a self-administered study questionnaire on reproductive outcomes. Setting Sunnybrook Health Sciences Center and St. Michael's Hospital, two tertiary care centers affiliated with the University of Toronto. Patients or Participants Women of childbearing age (18-45 years old) who underwent AM between June 2002 and 2012 were consecutively sampled. 1099 patients met inclusion criteria and 144 returned the study questionnaire. After excluding patients who did not attempt to conceive post-operatively, 82 patients were included in the final statistical analysis. Interventions Use of a peri-cervical tourniquet during AM. Measurements and Main Results Unadjusted and multivariable regression analysis was used to compare the groups of patients. Mean age of patients at time of surgery was 36 years. 28% of surgeries involved use of peri-cervical tourniquet. There was no significant association between the use of tourniquet and live birth rate (p=0.35). Similarly, there was no significant difference between the use of tourniquet and length of time attempting conception after surgery (p=0.91). Data analysis is ongoing and further results will be presented. Conclusion Our study suggests no significant association between use of tourniquet and live birth outcomes. Concerns about the tourniquet's impact on fertility may therefore be unfounded, and a more widespread uptake of peri-cervical tourniquet during AM may contribute to limiting surgical blood loss. Further prospective research is warranted with a larger sample size.

Background Uterine rupture in the non-laboring uterus is a rare occurrence, which can lead to significant morbidity and mortality for the mother and fetus. Management of this presentation is complex at pre-viable gestations. Case presentation A 35 year old primigravid woman with multiple previous myomectomies presented with spontaneous complete thickness uterine rupture at 21 weeks gestation. A 10 cm myometrial defect and iatrogenic amniotomy were surgically corrected with fetal preservation. This led to pregnancy continuation to 32 weeks gestation when elective cesarean delivery resulted in excellent neonatal outcome. Conclusions Early surgical diagnosis, multidisciplinary team approach, iatrogenic amniotomy and continuous two-layer myometrial closure were factors that contributed to pregnancy prolongation in this large myometrial rupture.

Objective Data Robotic assistance may facilitate completion of minimally invasive hysterectomy, which is the standard of care for the treatment of early-stage endometrial cancer, in patients for whom conventional laparoscopy is challenging. The aim of this systematic review was to assess conversion to laparotomy and perioperative complications after laparoscopic and robotic hysterectomy in patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2). Study We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1, 2000, to July 18, 2018) for studies of patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2) who underwent primary hysterectomy. Study Appraisal and Synthesis Methods We determined the pooled proportions of conversion, organ/vessel injury, venous thromboembolism, and blood transfusion. We assessed risk of bias with the Institute of Health Economics Quality Appraisal Checklist for single-arm studies, and Newcastle-Ottawa Quality Scale for double-arm studies. Results We identified 51 observational studies that reported on 10,800 patients with endometrial cancer and obesity (study-level body mass index, 31.0–56.3 kg/m2). The pooled proportions of conversion from laparoscopic and robotic hysterectomy were 6.5% (95% confidence interval, 4.3–9.9) and 5.5% (95% confidence interval, 3.3–9.1), respectively, among patients with a body mass index of ≥30 kg/m2, and 7.0% (95% confidence interval, 3.2–14.5) and 3.8% (95% confidence interval, 1.4–9.9) among patients with body mass index of ≥40 kg/m2. Inadequate exposure because of adhesions/visceral adiposity was the most common reason for conversion for both laparoscopic (32%) and robotic hysterectomy (61%); however, intolerance of the Trendelenburg position caused 31% of laparoscopic conversions and 6% of robotic hysterectomy conversions. The pooled proportions of organ/vessel injury (laparoscopic, 3.5% [95% confidence interval, 2.2–5.5]; robotic hysterectomy, 1.2% [95% confidence interval, 0.4–3.4]), venous thromboembolism (laparoscopic, 0.5% [95% confidence interval, 0.2–1.2]; robotic hysterectomy, 0.5% [95% confidence interval, 0.1–2.0]), and blood transfusion (laparoscopic, 2.8% [95% confidence interval, 1.5–5.1]; robotic hysterectomy, 2.1% [95% confidence interval, 1.6–3.8]) were low and not appreciably different between arms. Conclusion Robotic and laparoscopic hysterectomy have similar rates perioperative complications in patients with endometrial cancer and obesity, but robotic hysterectomy may reduce conversions because of positional intolerance in patients with morbid obesity. Existing literature is limited by selection and confounding bias, and randomized trials are needed to inform practice standards in this population.