Counselling Patients for Trial of Labour after Cesarean (TOLAC) and Invasive Placentation: Are We Missing the Mark? The Importance of Local Data and Informed Choice.

Objective: Rates of cesarean delivery are increasing, and these procedures carry potential complications, like the risk of invasive placentation, which increases with each cesarean. A trial of labour after cesarean (TOLAC) is a viable option for patients; however, it has been associated with uterine rupture, a complication with maternal and fetal risks. To better counsel patients considering TOLAC, we aimed to determine local uterine rupture rates and maternal and neonatal outcomes with TOLAC and compare these with outcomes related to invasive placentation.

Graduating Obstetrics and Gynaecology Residents' Readiness for Practice: A Cross-Sectional Survey Study.

Objective: This study sought to evaluate the self-reported and program director-reported comfort of graduating Canadian obstetrics and gynaecology residents in independently performing various surgical skills.

Methods: A Web-based survey was distributed to four cohorts of graduating obstetrics and gynaecology residents across Canada (2014-2017). Residents were asked to indicate their comfort level with independently performing 34 core surgical procedures by using a five-point Likert-type scale.

N 366 - Prise en charge gynécologique du cancer du sein et de l'ovaire héréditaire.

Objectif: La présente opinion de comité énumère les recommandations pour la prise en charge gynécologique des femmes ayant reçu un diagnostic de syndrome du cancer du sein et de l'ovaire héréditaire (CSOH) en ce qui a trait au dépistage, à la contraception, à la chimioprophylaxie, aux facteurs à considérer pour la fertilité, à la chirurgie de réduction du risque et aux soins post-ovariectomie.

Utilisateurs Cibles: La présente opinion de comité s'adresse aux gynécologues oncologues, aux gynécologues généralistes, aux médecins de famille, aux conseillers en génétique, aux infirmières autorisées, infirmières praticiennes, aux résidents et aux autres fournisseurs de soins.

Population Cible: Les femmes adultes (18 ans et plus) présentant une mutation des gènes BRCA1 ou BRCA2 ou d'autres gènes associés au cancer de l'ovaire.

No. 366-Gynaecologic Management of Hereditary Breast and Ovarian Cancer.

Objective: This Committee Opinion outlines the gynaecologic management recommendations for women diagnosed with hereditary breast and ovarian cancer syndrome (HBOC) with respect to screening, contraception, chemoprophylaxis, fertility considerations, risk-reducing surgery, and post-oophorectomy care.

Intended Users: This Committee Opinion is designed for gynaecologic oncologists, general gynaecologists, family physicians, genetic counsellors, registered nurses, nurse practitioners, residents, and health care providers.

Target Population: Adult women (18 years and older) with a pathogenic germline variant in the BRCA1, BRCA2, and other ovarian cancer-associated genes.

Evaluation of Obstetrics & Gynecology Ultrasound Curriculum and Self-Reported Competency of Final-Year Canadian Residents.

Objective: Ultrasonography in obstetrics and gynaecology (OB/GYN) is a vital component of patient assessment, diagnosis, and management. Standards for Canadian obstetrician-gynecologists' ultrasound skills are limited and vague. The primary objective was to audit the current curriculum administered to Canadian OB/GYN residents.

Arteriovenous Malformation Following Conservative Management of Cervical Pregnancy.

Background: Medical management using potassium chloride feticide and methotrexate is often the first-line approach to cervical pregnancies.

Case: A 25-year-old woman presenting with a cervical ectopic pregnancy was unsuccessfully managed with conservative therapy, resulting in an arteriovenous malformation requiring a laparoscopic hysterectomy.

Conclusion: Conservative management of ectopic pregnancies is the treatment of choice for young women looking to preserve fertility.

Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy.

Objective: Previous studies have demonstrated that outpatient total laparoscopic hysterectomy (TLH) is both safe and feasible. Our objective was to decrease length of stay for patients undergoing TLH by implementing a same-day discharge protocol at two Canadian teaching hospitals.

Methods: We conducted a prospective cohort study assessing length of stay (primary outcome), perioperative complications, and readmission rates over a 12-month period following implementation of a same-day discharge protocol for TLH.

Surgical Management Algorithm for Caesarean Scar Pregnancy.

Objectives: To report our experience with the management of Caesarean scar pregnancy (CSP) in the first trimester and to develop a unique treatment algorithm allowing physicians to customize their management based on clinical patient characteristics.

Methods: A retrospective review of 12 patients diagnosed with CSP between December 2012 and June 2016 was conducted in a tertiary care hospital in Toronto. All patients were diagnosed with CSP by transvaginal ultrasound using radiologic criteria.

Selective progesterone receptor modulators (SPRMs) for uterine fibroids.

Background: Uterine fibroids are smooth muscle tumours arising from the uterus. These tumours, although benign, are commonly associated with abnormal uterine bleeding, bulk symptoms and reproductive dysfunction. The importance of progesterone in fibroid pathogenesis supports selective progesterone receptor modulators (SPRMs) as effective treatment.

Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.

Background: Answering telephone calls and pagers is common distraction in the operating room. We sought to evaluate the impact of distractions on patient care by (1) assessing the accuracy and safety of responses to clinical questions posed to a surgeon while operating and (2) determining whether pager distractions affect simulation-based surgical performance.

Methods: We conducted a randomized crossover study of obstetrics and gynecology residents.

Angiogenic response of placental villi to heparin.

Objective: To estimate the angiogenic effect of heparin on human umbilical vein endothelial cells cultured in conditioned media from normal and severely pre-eclamptic human placental villi.

Methods: Normal first- and second-trimester floating placental villi were explanted in control conditions and increasing concentrations of heparin (unfractionated and low molecular weight heparin) across the clinical prophylactic and therapeutic range (0.025-25 units/mL).

Pregnancy outcomes in women with elevated levels of fetal hemoglobin.

Objective: Elevated maternal levels of fetal hemoglobin (HbF) present a unique situation where both mother and fetus produce hemoglobin with equivalent oxygen affinities. We aimed to determine pregnancy outcomes in women with persistently elevated HbF.

Methods: In this retrospective cohort study, women with HbF levels exceeding 10% were identified by searching a provincial database.

Propylthiouracil-induced agranulocytosis in the third trimester of pregnancy.

Background: Thionamide-induced agranulocytosis in pregnancy is a rare event that poses unique therapeutic challenges.

Case: A 37-year-old woman developed agranulocytosis while taking propylthiouracil in the third trimester. After she took broad-spectrum antibiotics and discontinued propylthiouracil, her neutrophil counts recovered.

Antibiotic inducibility of the MexXY multidrug efflux system of Pseudomonas aeruginosa: involvement of the antibiotic-inducible PA5471 gene product.

The MexXY components of the MexXY-OprM multidrug efflux system of Pseudomonas aeruginosa are encoded by a MexZ repressor-regulated operon that is inducible by antibiotics that target the ribosome. Mutant strains disrupted in a gene, PA5471, were shown to be compromised for drug-inducible mexXY expression and, therefore, MexXY-OprM-mediated antimicrobial resistance. The PA5471 gene was inducible by the same ribosome-targeting agents that induce mexXY expression.

Induction of the MexXY efflux pump in Pseudomonas aeruginosa is dependent on drug-ribosome interaction.

MexXY is an inducible efflux system that contributes to the natural resistance of Pseudomonas aeruginosa to antibiotics. Experiments involving real-time PCR after reverse transcription in reference strain PAO1 showed concentration-dependent induction of gene mexY by various ribosome inhibitors (e.g.

Mutations in PA3574 (nalD) lead to increased MexAB-OprM expression and multidrug resistance in laboratory and clinical isolates of Pseudomonas aeruginosa.

Mutations in genes mexR and nalC have previously been shown to drive overexpression of the MexAB-OprM multidrug efflux system in Pseudomonas aeruginosa. A transposon insertion multidrug-resistant mutant of P. aeruginosa overproducing MexAB-OprM was disrupted in yet a third gene, PA3574, encoding a probable repressor of the TetR/AcrR family that we have dubbed NalD.

Mutations in PA2491 (mexS) promote MexT-dependent mexEF-oprN expression and multidrug resistance in a clinical strain of Pseudomonas aeruginosa.

Disruption of the PA2491 gene in a mini-Tn5-tet insertion mutant of a clinical isolate of Pseudomonas aeruginosa increased expression of the mexEF-oprN multidrug efflux genes and decreased production of outer membrane protein OprD, concomitant with enhanced resistance to chloramphenicol, quinolones, and imipenem, which was reminiscent of previously described nfxC mutants. PA2491 encodes a probable oxidoreductase previously shown to be positively regulated by the MexT positive regulator of mexEF-oprN expression (T. Kohler, S.

Contribution of the MexXY multidrug transporter to aminoglycoside resistance in Pseudomonas aeruginosa clinical isolates.

MexXY is an aminoglycoside-inducible multidrug transporter shown to contribute to intrinsic and acquired aminoglycoside resistance in laboratory isolates of Pseudomonas aeruginosa. To assess its contribution to aminoglycoside resistance in 14 clinical isolates demonstrating a panaminoglycoside resistance phenotype unlikely to be explained solely by aminoglycoside modification, expression of mexXY by these isolates was examined by reverse transcription-PCR. Elevated levels of mexXY expression were evident for most strains compared with those detected for an aminoglycoside-susceptible control strain, although there was no correlation between mexXY levels and the aminoglycoside MICs for the resistant strains, indicating that if MexXY was playing a role, other factors were also contributing.