September 17, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) advocates on behalf of women to receive quality of care throughout their sexual and reproductive life, including the right to have a safe and respectful birth experience.
There are more than 380,000 births in Canada each year. In the vast majority of cases, obstetricians, nurses, family physicians, midwives and doulas are extraordinarily caring professionals who are mindful of the particular vulnerability of women during and after labour, and are deeply sensitive and caring to the needs of the women in their care. There are, however, instances when women either were not properly listened to, or felt this to have been the case. In response to recent media reports, the SOGC feels it is timely to remind women of their rights related to labour and delivery and to remind health care providers of the importance of appropriate and caring behaviour during labour and delivery.
Respectful Maternity Care has been addressed by the World Health Organization (WHO). In a 2015 statement the WHO calls for “greater action, dialogue, research and advocacy on this important public health and human rights issue.” This report identifies seven types of abuse including: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care and poor rapport between women and providers.
The consequences of inappropriate care are long-lasting, and women who report disrespectful care are less likely to seek health care in future.
We are confident that all health care facilities strive to ensure that the basic rights of women in childbirth are assured. Standards for professional communication are available through most provincial and territorial licensing and regulatory bodies. Best practice in care is outlined in SOGC Clinical Practice Guidelines. Specific training in intrapartum communication is available through the MOREOB Program chapters and skills drills.
Care may be perceived differently depending upon the circumstances and context in care. Health care providers should be sensitive to those circumstances, and attempt to address any perceived shortcomings in care as promptly as possible. We also urge women who feel their basic human rights have been violated during these important life-events, to take action by talking to their health care provider, the hospital ombudsman, patient representative, or their local provincial or territorial college.
There is no moment more important, and none that is more indelibly inscribed than childbirth. Relationships of mutual trust and respect help to ensure the best possible outcomes.
September 11, 2018
Health Canada is informing Canadians that packages of certain lots of Marvelon 28 do not include day-of-the-week stickers. The stickers are meant to be applied on the blister pack containing the pills. The stickers indicate the first day of the week when the medication is started, and the weekdays that the pills should be taken. The stickers may be used by women to help them remember if they took their daily pill on a given day. Without these stickers, there may be an increased chance of missing a dose.
This issue does not impact the safety or effectiveness of the pills. Canadians should continue to take their medication as prescribed. It is important to keep track of when you take your pills to avoid missing any doses.
Merck Canada Inc. the importer of Marvelon 28, is currently working to correct this issue. Merck Canada will distribute day-of-the-week stickers to pharmacies, beginning the week of September 10. Customers who use Marvelon 28 will be able to pick up the day-of-the-week stickers at no additional cost.
August 31, 2018
The August issue of the Health Product InfoWatch published by Health Canada includes a Product Monograph Update on Tactupump and Tactupump Forte (adapalene and benzoyl peroxide) which is now contraindicated in pregnant women and in women planning a pregnancy.
For more information, and to consult the August 2018 issue, please visit: https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/health-product-infowatch/health-product-infowatch-august-2018.html
August 22, 2018
For a period of many months, patients who were being tested with either a 50 or 75 gram glucose challenge may have received only a fraction of the glucose ordered.
Your lab should have contacted you if these solutions were used; however, you may wish to contact your laboratory to learn if this impacted your patients, and take appropriate clinical steps.
Jamp Pharma Corporation has voluntarily recalled three (3) lots of Jamp-Glucose 50 and three (3) lots of Jamp-Glucose 75 because they contain significantly less D-glucose than what is declard on the label. When these affected products are used, they can give false negative results and lead to a failure to diagnose diabetes. Unidentified diabetes in pregnancy can have serious consequences for the mother and the growing fetus. A false negative result in people who are not pregnant may lead to the delayed diagnosis and treatment of diabetes.
August 15, 2018
Sepsis is the third most common direct cause of maternal mortality. Globally, it is estimated that sepsis causes up to 75,000 maternal deaths each year (WHO). In high income countries, maternal sepsis related deaths approach 1.8/100,000 pregnancies (BMJ Open 2016; 6: e012323) with an incidence of maternal morbidity due to sepsis of 0.1-0.6 / 1000 deliveries (PloS Med 2014; 11:e1001672). It is also highly preventable and deaths due to sepsis can be prevented if treated early.
Unfortunately, rates of maternal sepsis are on the rise, globally and in high income countries, although the reason is unclear. (Plos One 2013;8(7):e67175.) However, an increase in the number of infections associated with virulent organisms such as group A Streptococcus, highlights the urgency of the need for the early detection of sepsis, and rapid therapeutic response (Current Opinion in Obstetrics and Gynecology 2013 April;25(2): 109-16.) A recent Ontario Coroners report highlighted two cases of maternal death due to sepsis. Critical to their review was the finding that incomplete recognition of the signs and symptoms of sepsis led to delayed treatment, resulting in catastrophic outcomes.
Maternal sepsis has been defined by the World Health Organization as a life-threatening condition, whereby there is organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or the post-partum period. Criteria for the identification of maternal sepsis cases should be based on the presence of suspected or confirmed infection, plus signs of mild to moderate organ dysfunction including tachycardia, hypotension, tachypnea, altered mental status and/or reduced urinary output. (WHO reference number: WHO/RHR/17.02). Successful management of sepsis requires a high index of suspicion, rapid identification of at risk patients and appropriate treatment, including antibiotic or antiviral therapy, fluid resuscitation and intensive monitoring.
Unfortunately, the physiologic changes of pregnancy make the diagnosis of maternal sepsis challenging. However, its early recognition and rapid initiation of therapy is critical. If detected early, treatment of sepsis can prevent both maternal morbidity and mortality. Every health care facility should be aware of the signs and symptoms of sepsis and have systems in place to provide prompt and aggressive treatment. The SOGC encourages each health care facility to discuss their approach to the detection and management of sepsis. To assist with this, a task force is being struck by the SOGC to review the current literature available on bedside tools that assist in the identification of maternal sepsis, identification of at risk patients and appropriate treatment algorithms and pathways.
August 14, 2018
The SOGC is very saddened by the recall of Saudi trainees from our postgraduate and graduate programs across the country.
Over the past decades our programs have enjoyed the presence of the many men and women from Saudi Arabia. You have been good colleagues to Canadian trainees, opened doors of understanding between our countries, provided excellent care to Canadian patients, and remained esteemed colleagues upon your return home.
We regret the circumstances that have led to this abrupt departure, and hope that you will take with you our fervent wishes for every success in your careers, and our thanks for the many contributions that you and your predecessors have made while in Canada. We sincerely hope there will be an opportunity to collaborate again in the future.
August 13, 2018
A message from PHAC:
"The Public Health Agency of Canada (PHAC) was recently made aware of a new case of ceftriaxone-resistant gonorrhea in Alberta. This is the second reported case in Canada, following the one reported in Quebec in 2017. Detailed information on the Quebec case can be found here: https://wwwnc.cdc.gov/eid/article/24/2/17-1756_article. The 2017 case concerned a Canadian whose partner had travelled outside the country; the Alberta case had partners who were visiting from outside of the country. Testing has revealed that the strains from the two Canadian cases are highly related to each other as well as to those from cases previously reported in Japan and Australia.
The Canadian Guidelines on Sexually Transmitted Infections (CGSTI) recommend combination therapy to minimize the risk of development and spread of resistance. The current treatment recommendation for ceftriaxone-resistant gonorrhea consists of gentamicin IM or IV in combination with azithromycin PO.
PHAC would like to highlight the importance of:
using combination therapy;
using culture when possible to permit identification of emerging patterns of antimicrobial resistance, and;
performing a test of cure.
Cases of suspected treatment failure should be reported promptly to the local public health authority.
The CGSTI treatment recommendations for ceftriaxone-resistant gonorrhoea are available at the following link: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/gonorrhea-alternate-treatment.html
We encourage you to review these treatment recommendations and to share this notice with other colleagues who may benefit from this information."
July 13, 2018
The SOGC regrets the recent Ontario government announcement that it is cancelling the 2015 Sexual Education curriculum and intends to revert to teaching the curriculum from 1998.
The 1998 curriculum was developed before the legalization of same sex marriage in Canada and before the explosion of smartphones, social media, Google, cyber-bulling and sexting. We believe the more modern curriculum, which touches on these issues, better prepares students and parents for today’s world.
We urge the Ontario government to reconsider this decision and work with health care providers, educators and other experts as well as the public to ensure a more up-to-date sexual education plan is put in place as soon as possible.
SOGC members have already done a lot of work in this area through our public education website, SexandU.ca. SexandU.ca is an award-winning website dedicated to providing the most up-to-date, evidence-based, unbiased, relevant information on topics related to sexual health.
The website takes a real-life approach to the questions and issues around sex and sexuality that matter most to Canadians and is a helpful reference tool for health care providers, parents and students.
The site was first launched in 2001 and receives nearly 15,000 visitors per day from around the world.
We urge you to share details about this resource with your patients. You can order materials here: https://www.sexandu.ca/resources/order/
July 12, 2018
SOGC endorses Canadian Task Force on Preventive Health Care recommendation on screening for asymptomatic bacteriuria in pregnancy
The SOGC Board of Directors endorses the Canadian Task Force on Preventive Health Care recommendation on screening for asymptomatic bacteriuria in pregnancy clinical practice guideline. The guideline was released on July 9, 2018 in the Canadian Medical Association Journal (CMAJ).
The guideline recommends screening pregnant women for asymptomatic bacteriuria once during the first trimester with a urine culture. However, because of uncertainty regarding the benefits of screening as well as the various preferences of women regarding antibiotic treatment in pregnancy, physicians are urged to weigh the benefits and drawbacks of screening with their patients during their primary visit.
The full guideline can be accessed here: www.cmaj.ca/content/190/27/E823
June 29, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) welcomes a new President today while awarding the contributions of two of its members whose work continues excellence in the field of obstetrics and gynaecology in Canada.
Dr. Linda Stirk was sworn in today during the SOGC’s Annual Clinical and Scientific Conference as the 75th President of the Association and she will serve in this role from June 2018 - June 2019. Prior to becoming President, Dr. Stirk served as the Board’s Treasurer for three years after spending many years on the Finance Committee.
“This is a great honour for me,” says Dr. Linda Stirk. “The SOGC works tirelessly in its mission to advance the health of women in Canada, and around the world. And I am especially honoured that I have been appointed President as we celebrate our 75th anniversary as an association in the coming year.”
Dr. Stirk completed an undergraduate B.Sc. in genetics, a PhD in biochemical genetics and medical school at McGill University. She completed her residency in obstetrics and gynaecology at Dalhousie University and then worked at the Victoria General Hospital and Grace Maternity Hospital in Halifax, Nova Scotia from 1986 – 1993. Since moving to Toronto, Dr. Stirk has had a busy practice and is an active clinical teacher from 1993 to present. Currently, she holds an appointment at the University of Toronto and a hospital appointment at the North York General Hospital.
Dr. Stirk says she looks forward to carrying on the work of the SOGC Presidency as she succeeds Dr. Michael Bow, who served from 2017 - 2018. The work ahead of her includes warning pregnant women about the risks involved with cannabis use in pregnancy; advocating for the reduction of opioid usage in clinical practice; promoting uniform national standards of care; and strengthening the SOGC’s academic voice and education initiatives to improve health research, evidence-based care, and emergency response in medical practice.
June 28, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is launching an online tool to help Canadians of reproductive age choose the best contraception for them. The tool is being launched at a time when Canadians are searching the Internet more for information. It is designed to help women make informed decisions about contraception based on their own research, to be sure that they are basing decisions on information they can rely on.
The online quiz, called It’s a Plan, launches today and is available at ItsaPlan.ca. The quiz includes questions around age, comfort level with hormones or different types of contraception, health factors and previous contraceptive history, and personal preferences and values to make contraceptive recommendations based on the user's answers. The tool also gives evidence-based information about contraceptive methods available in Canada to support users in making informed choices about their preferred contraception.
“No two people are alike and no two contraceptive methods are alike,” said SOGC CEO, Dr. Jennifer Blake. “We developed this digital tool to give Canadians the facts about contraceptive methods in a way that is tailored to their personal needs and is also easy to use. The tool is accessible from any device and can be used to explore options and inform conversations around contraception with their health care providers."
June 27, 2018
Menopause is a stage and a fact of life. Hormones decline and fertility fades. Despite this, menopause is rarely talked about openly. The Society of Obstetricians and Gynaecologists of Canada (SOGC) hopes to change this.
Starting today, with the launch of its revamped website about menopause, www.MenopauseandU.ca, the society’s goal is to provide a resource for all women, including reach the 80 per cent of menopausal women who suffer in silence. The site has information for the 5-10% of women who lose ovarian function prior to age 45 and may not be aware that their situation is very different from typical menopause; which has different implications for their health that can be corrected with age-appropriate treatment.
“Despite being a fact of life, women don’t always discuss their symptoms openly and may not realize that their symptoms are treatable with safe, effective therapies” says SOGC CEO, Dr. Jennifer Blake. “Many women fear the unknown. Yet, as our bodies change, we can adapt our lifestyles to support and maintain our best health. Healthy diet, activity and social engagement are the essential foundation, but that may not be enough for disruptive symptoms. This is the conversation we want to start. We want women to reach out to each other and to their healthcare providers and have these talks supported by credible, evidence-backed advice.”
June 27, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Women’s Health Foundation (CFWH) are pleased to award two Canadian journalists for excellence in reporting on women’s health. The awards acknowledge journalists whose work has contributed a valuable public health service in both broadcasting and print media in Canada.
The winners of the 2018 SOGC/CFWH Journalism Awards for Excellence in Women’s Health Reporting are Rita Celli from CBC Radio One and Joanne Laucius from Post Media (Ottawa Citizen). The winners were unveiled today at the SOGC’s Annual Clinical and Scientific Conference in Victoria, British Columbia.
In the broadcasting category, Celli’s series on CBC’s Ontario Today called Daring to Ask about Abortion: Women and Men Talk created a public space for conversation about abortion from the perspective of people who have lived the experience.
In the print category, Joanne Laucius from Postmedia wrote about opioid addiction and pregnancy with a compelling perspective from a user who wanted the best for her baby.
June 26, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) says Canadian women who opt for a planned caesarean section (CS) without medical or obstetrical indication, need to be fully briefed by their physician on the pros and cons of the procedure prior to delivery. The SOGC's Clinical Practice Obstetrics and Guideline Management and Oversight Committees issued this Committee Opinion in light of the rising incidence of elective caesareans being performed to avoid vaginal birth.
“All maternal health care providers need to understand and hear the reasons why some women consider preplanned caesareans the best option for them. This includes understanding the person’s values, fears and concerns,” says Dr. Jennifer Blake, CEO, SOGC. “But any final decision should not be made until women are equipped with the most up-to-date and evidence-based information to help them make such an important decision about how their baby will be born.”
June 25, 2018
Legal Doesn’t Mean Safe. The SOGC Urges Canadians to Avoid Cannabis During Pregnancy and Breastfeeding.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) today launched a targeted public awareness campaign to inform women between the ages of 25-40 about the potential adverse effects associated with cannabis use during pregnancy and while breastfeeding.
“It is not abstract anymore. On October 17th, cannabis is going to be legal in Canada. And that means cannabis producers and distributors will be marketing cannabis to the Canadian public,” says Dr. Blake, CEO, SOGC. "But legal doesn’t mean safe and it is important that individuals be aware of the health risks, particularly for vulnerable populations such as pregnant women.”
Research suggests that 70% of pregnant and non-pregnant women believe there is a slight or no risk of harm from using cannabis once or twice a week during pregnancy. But the principal psychoactive component of cannabis, THC, crosses the placenta into fetal tissue and can also accumulate in breast milk. And the way cannabis is consumed—vaped, smoked, eaten, in pill or topical form, doesn’t matter.
June 1, 2018
NOTICE is hereby given that the Annual General Meeting of the Society of Obstetricians and Gynaecologists of Canada will be held:
Friday, June 29, 2018
07:00 - 08:00
Victoria Conference Centre (Salon A)
720 Douglas St., Victoria, BC V8W 3M7
May 18, 2018
The Society of Obstetricians and Gynaecologists (SOGC) is deeply concerned about the plight of tens of thousands of Rohingya women and girls who have suffered sexual violence at the hands of the Myanmar (Burmese) military. Not only were many of these innocent civilians victims of brutal rape and sexual torture, many have also become pregnant. The SOGC supports a woman’s sexual and reproductive health rights, including control over her body.
The use of a woman’s body as an instrument of war must be classified as among the most heinous of war crimes, and those crimes must be prosecuted. Secondly, women who have been impregnated as an act of war need access to women’s health where desired care, including safe termination of pregnancy, is available. Third, women who carry these pregnancies need access to safe, respectful and trauma-informed care, where ever they give birth, and specifically in the camps where they are being housed.
Without adequate water and food and the monsoon season looming, physicians are worried that many of these women will die. The babies who will be born are also at great risk of abandonment as the surviving women cope with Post-traumatic stress disorder (PTSD), sexually transmitted infections and depression in the aftermath of their attacks and traumatic births.
As obstetricians and gynaecologists we abhor these crimes against humanity and call on the Canadian government to immediately expedite international humanitarian relief measures to bring some relief to these refugees, as well as to provide the specific trauma-informed gynecological and obstetric care that is required. We also call on international courts to prosecute those responsible for this genocide.
Impregnating women as a weapon of war must be viewed by the world as a crime against humanity that will not be condoned or forgotten by civilized society anywhere.
April 20, 2018
The Society of Obstetricians and Gynaecologists (SOGC) today launched a public awareness campaign to inform those who are pregnant, breastfeeding, or of child-bearing age of the potential adverse effects associated with cannabis use during pregnancy and while breastfeeding.
“We know women are trying to do the best for their babies. Should cannabis become available for sale this summer, it is important that individuals be aware of the health risks, particularly for vulnerable populations such as pregnant women,” says Dr. Jennifer Blake, CEO SOGC.
Research suggests that 70% of pregnant and non-pregnant women believe there is a slight or no risk of harm from using cannabis once or twice a week during pregnancy. But the principal psychoactive component of cannabis, THC, crosses the placenta into fetal tissue and can also accumulate in breast milk. And the way cannabis is consumed—vaped, smoked, eaten, in pill or topical form, doesn’t matter.
March 27, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is hosting a national workshop in Toronto this week to improve deficiencies in tracking the incidence of maternal mortality and severe morbidity in Canada. The goal of the workshop is to develop a concrete strategy for the implementation of an identification, measurement, and national surveillance system. Experts from Canada and around the world will be in attendance, along with provincial and federal authorities.
While Canada has a comparatively low rate of maternal mortality, recent reports are showing a slight increase. Women are entering pregnancy older, and may have more underlying health issues. We are dealing with new and aggressive bacteria, mental health concerns, substance abuse and interpersonal violence. The working definition of maternal mortality and morbidity in Canada does not capture all of these kinds of cases and, in the absence of a national strategy, it is difficult to conduct standardized investigations and reduce preventable deaths.
As the causes of maternal death broaden, so must our thinking about when these cases occur. Women are not just at increased risk of death during pregnancy and in the first six weeks postpartum. Many jurisdictions and oversight bodies, including the World Health Organization (WHO), have extended their definition of maternal mortality and morbidity to include mental health, violence and accidents as examples of cases that have a negative impact on a woman’s well-being in the first year postpartum.
“Provincial and territorial maternal death review committees and their scope vary greatly across the country, and we are not routinely asking on death certificates if a woman of childbearing age had been pregnant during the preceding year,” says Dr. Jenifer Blake, CEO, SOGC. “But beyond the data reporting, we need a national standardized process to investigate maternal deaths that will help us take concrete actions to make pregnancy safer for women. We are lucky to have excellent maternal safety programs available across the country such as More OB and ALARM, but it is time now to put this next piece of the safety net into place.”
Canada falls behind other world leaders like the U.K., Australia and New Zealand, who have strong systems in place for monitoring, investigating and then acting on recommendations. The United States, who has also noted increasing rates of maternal deaths, has taken strong measures to improve the gaps and challenges in maternal mortality and morbidity data surveillance. Successful programs involve effective partnerships among government agencies, health care institutions, professional societies and leaders, health care professionals and pregnant women and their families.
“Gathering key Canadian decision-makers into the same room is an important first step towards our goal of providing the best care possible for every pregnant woman and her child in rural and urban communities across the country,” says Dr. Jocelynn Cook, Chief Scientific Officer, SOGC. “There is an urgent need for health care providers to understand the underlying cause of death and preventable cases of maternal death in Canada. Canada can do better.”
March 20, 2018
The SOGC congratulates our Western and Central Regional Award winners for 2018. The awards were presented on March 15th at the West/Central CME in Banff, Alberta.
Our regional award for the Central Region goes to Dr. Hussam Azzam - a long time contributor to the SOGC. Dr. Azzam recently became the new medical director at Queen Elizabeth Hospital in Prince Edward Island after 20 years as a medical leader, educator, obstetrician and gynaecologist in northern Manitoba. He was previously the chief medical officer and executive director medical programs at St. Boniface Hospital.
Throughout his career, Dr. Azzam has remained committed to quality, patient- and family- centered care, teaching, and lifelong learning. He is recognized by his colleagues as a transformational leader who fosters a culture of clinical excellence through collaboration, leading by example and by promoting innovation.
Sam currently serves as co-chair of the SOGC’s Clinical Obstetrics Committee and provides guidance that has helped increasing productivity and quality.
March 20, 2018
Our award winner from the Western Region is Dr. Gerald Marquette. Dr. Marquette has dedicated his life to improving the health of women and their babies through clinical work, teaching, leadership and advocacy. He began his career in Montreal after graduating from the University of Montreal in 1975. He has continued his work in Vancouver for the past 16 years.
Since 2010, Dr. Marquette has been the Medical Director of Maternal Services at B.C. Women’s Hospital. Dr. Marquette has also been at the forefront of telehealth services in both Quebec and B.C. He has been medical lead of perinatal services in B.C. for many years. He also coordinated and trained the infant and maternal transport teams, worked on clinical care guidelines, and served as chair of the provincial maternal mortality committee.
As an administrative leader, Gerald has served as Department Head of Obstetrics at BCWH and St. Justine Hospital, and as Director of perinatal services in Montreal. Dr. Marquette has been a long time member of the MFM Committee of the SOGC and has co-authored a number of guidelines. He has also been an active member of numerous committees at the Association of Obstetricians and Gynaecologists of Quebec, as well as the Royal College of Physicians and Surgeons of Canada.
March 19, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has updated its Immunization in Pregnancy Clinical Practice Guideline and recommends pregnant women receive the seasonal inactivated influenza vaccine and the tetanus toxoid, diphtheria toxoid and acellular pertussis vaccine (Tdap) during their pregnancy.
“Women are at an increased risk of influenza-related hospitalization and serious complications, including death, during pregnancy,” says Dr. Jennifer Blake, CEO, SOGC. “And pertussis is a transmissible respiratory infection which kills about 300,000 infants worldwide every year—most under two months of age. The seasonal influenza and Tdap vaccinations are safe to administer during pregnancy and protect mothers and their fetus before the baby is born, and for the first few months of life, when infants are at the greatest risk of severe disease or death.”
The guideline also urges health care providers to undertake a thorough review of their patient’s overall immunization status to identity other potential risk areas during pregnancy. In some cases they should be offered the hepatitis B, hepatitis A, meningococcal, and/or pneumococcal vaccines for the wellbeing of the mother if they have specific risk factors or exposures.
The new recommendations also suggest women who have inadvertently received vaccination with a live or live-attenuated vaccine during pregnancy should no longer be counselled to terminate the pregnancy. In general, these vaccines are contraindicated in pregnancy. But, to date, there is no evidence to demonstrate harm, so mothers can be reassured that these vaccines will not harm their baby. The products are also safe and acceptable for breastfeeding mothers.
“We believe these additional measures, based on research and the development of new vaccines, should give pregnant women added comfort that they are doing the best they can to help their children avoid these common, yet serious childhood diseases,” adds Dr. Blake.
March 15, 2018
In post-marketing monitoring of ulipristal acetate (Fibristal [Esmya in Europe]), a small number of cases of hepatotoxicity have come to light. In four cases, this has resulted in liver failure and liver transplantation, and in one case, severe complications in surgery leading to fatality.
In response to this, the European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has undertaken a thorough review, results of which are anticipated within the next one to three months.
At this point in time, the PRAC has not determined if there is a causal relationship between ulipristal acetate and liver toxicity. There was no suggestion of liver harm in the earlier research trials, and there is no known mechanism for injury. In the meantime, the EMA has recommended some precautionary measures. The measures that they are recommending are temporary and precautionary until they have completed their assessment; the EMA consider that currently the benefit/risk to the use of this medication remains favourable. Health Canada is also reviewing the reports and will be providing guidance.
In Canada, there is an amendment to the product monograph to provide notification to patients and health care professionals of the possibility of liver damage - a rare, but serious, adverse reaction.
The SOGC suggests:
- The potential risk of liver injury should be discussed with patients on this medication.
- Liver function testing for patients on ulipristal acetate, where feasible, is a sensible precaution.
- The decision to initiate a new patient on therapy should follow an informed discussion between a patient and her provider.
The SOGC recognizes that ulipristal acetate has been an important non-surgical alternative for women suffering with fibroids, and that the surgical procedures that would otherwise be needed carry their own risks.
We are hopeful that putting measures in place to detect possible liver toxicity at an early stage will prevent the more serious risks. And we look forward to further guidance from Health Canada and the EMA.
March 8, 2018
UPDATE: Chipped pills in additional packages of Alysena 21 and 28 birth control pills: http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/66158a-eng.php
"Health Canada is advising Canadians that Apotex Inc. is voluntarily recalling one lot of Alysena 28 birth control pill (lot LF10133A) after complaints about chipped pink pills in sealed blister packages.
Alysena 28 is a prescription drug used to prevent pregnancy. It contains 21 “active” pink pills and 7 “inactive” white pills. Active pills that are chipped may contain less of the active drug ingredients, which may reduce Alysena’s effectiveness in preventing pregnancy."
The full MedEffect Advisory can be viewed here:
February 28, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is voicing its support for Budget 2018 and its vision for women, science and research, indigenous peoples and potential changes to the pharmacare system in Canada. The SOGC is a leading authority on women’s reproductive health care, whose mission is to promote excellence in the practice of obstetrics and gynaecology through leadership, advocacy, collaboration, and education.
We were encouraged to read that Budget 2018 encompasses plans to advance gender equality world-wide that will include health programming including comprehensive sexual and reproductive health and rights; the empowerment of women and girls; supporting local women’s organizations to defend women’s rights and address barriers; increasing women’s economic participation and increasing help for vulnerable refugee women and girls.
Science and research is a major focus for the SOGC and for this reason we applaud the government’s decision to increase funding in this area to record amounts. Physical and life sciences, social science and health will all be advanced by this opportunity and researchers will have cutting edge equipment to forge forward. Big data will be one of those tools with funding for a Digital Research Infrastructure Strategy and equipment to enable researchers to discover new innovations. Investment in Canada’s Research Chairs will aim to increase the number of women nominated for the positions.
The SOGC strongly supports the government’s goals to improve the quality of life for indigenous populations. Health programs and services will be developed and delivered by First Nations, funds will be contributed to fight against high rates of tuberculosis and for the building of a new hospital in James Bay. Child care initiatives and access to skills development will ensure that indigenous women will have equal access to job opportunities; First Nations will be supported in the development of their own matrimonial real property laws and women and children living on reserve will have access to legal protection from family violence.
There are many additional important aspects to this budget, including plans to address the opioid crisis and public education on the risks of cannabis use.
We are pleased that discussions on a pharmacare program are beginning and encourage consultations to include health care organizations and physicians. Too many women are without sufficient health care coverage and a national pharmacare program may allow all women to access treatment more easily.
February 26, 2018
The risk of sexually transmitted infections (STIs) may be an awkward icebreaker on a first date or hook-up, but a new campaign advises that if you are sexually active, you should also be getting tested regularly.
"There is a misinformed stigma associated with STIs, even though they are very common and can be managed and treated," says Dr. Jennifer Blake, CEO, SOGC. "We've seen a 50-70% jump in the incidence of gonorrhea and chlamydia over the past 15 years - most common in young people under 25. These rates can be dramatically reduced."
The Canadian campaign follows on the success of the "Yes Means Test" campaign in the United States, sponsored by The American Sexual Health Association.
STIs are most often transmitted through unprotected vaginal, oral, and anal sex. Often an infected partner will not have any obvious signs or symptoms and may not be aware they are infected.
February 9, 2018
The Society of Obstetricians and Gynaecologists (SOGC) and the Association of Academic Professionals in Obstetrics and Gynaecology of Canada (APOG) are pleased to announce the integration of the two organizations, effective January 1, 2018. The alliance brings together about 4,000 health care professionals who are currently members of the SOGC and members of academic OB/GYN departments from medical schools across Canada.
"Together, we believe the united organization will provide a stronger voice to further common objectives and goals to improve the health of women and their families in Canada," says Dr. Michael Bow, President, SOGC. "With increased academic support, it will allow us to improve knowledge transfer from the genesis of ideas through to practical applications in clinical and social environments."
January 31, 2018
The Society of Obstetricians and Gynaecologists of Canada (SOGC) today released the Clinical Practice Guideline, Egg Freezing for Age-Related Fertility Decline, which provides a comprehensive review and evidence-based recommendations for Canadian fertility centres that offer social egg freezing.
Over the past 40 years, industrialized countries have seen an increase in child-bearing age. In Canada, half of all births now occur in women age 30 or older, and the average age at which women have their first child has increased from 23.7 in 1970 to 28.5 in 2011. “Although delay in the age of pregnancy is often portrayed as being a choice, for many women it is not a voluntary choice, it is a result of life circumstances over which they have little control”, says Dr. Jennifer Blake, CEO of the SOGC.
“But risk of infertility increases with age—at age 20-24 it is approximately 6%, 16% at age 30 to 34, and 64% at age 40 to 44. As a result, more and more women are seeking advice from fertility centres to manage age-related fertility decline or to improve their chances of conception at a later date.”
Options often include trying to conceive at a younger age, insemination with donor sperm, using donor egg/embryos, or social egg freezing (freezing one’s own eggs as a reproductive option to guard against natural age-related decline in fertility).
The number of Canadian women who have undergone social egg freezing is relatively small, and the number of women who have returned to use their frozen eggs is even smaller— only 10%, according to the largest social egg freezing studies published to date. It will take many years, potentially decades, for most clinics to have reliable, representative, and age-specific data.
In the meantime, the SOGC and the Canadian Fertility and Andrology Society (CFAS) have made a series of recommendations for Canadian fertility centres that offer social egg freezing.
January 24, 2018
The Society of Obstetricians and Gynaecologists (SOGC) today announced the launch of a new public education website that covers the cycle of menstruation from puberty to menopause. YourPeriod.ca was created by Canadian experts to explore many topics including a look at what is normal, to issues around heavy bleeding and symptoms to watch that could indicate endometriosis or fibroids.
“YourPeriod.ca encourages women to talk and ask questions about this normal, yet “taboo” bodily function. We believe the time has come to take our periods out of the closet, and recognize them as a normal part of a woman’s life,” says Dr. Jennifer Blake, CEO SOGC.
The SOGC is also launching a public awareness campaign on social media that highlights the cheeky #SorryNotSorry hashtag. Women should no longer feel like they must hide their tampons when they head to the checkout line at the supermarket, they shouldn’t cower when they see a male cashier, and if they aren’t in the mood for sex when they have their period, they should say #SorryNotSorry.
“We have designed this website to assist physicians, school teachers, parents, and females of all ages,” adds Dr. Blake.
January 19, 2018
The SOGC is aware of the recent debate arising from a recent publication by Dr. Nav Persaud, regarding the effectiveness of Diclectin. Our Clinical Committee has been asked to review the recent study, but much of the concern raised relate to data that we do not have access to. We hope that Health Canada or the U.S. Food and Drug Administration (FDA) will respond.
For now, we are reassured that after extensive reviews by both Health Canada and Dr. Persaud, no safety concerns have been raised. The SOGC has not changed its recommendations for management of nausea and vomiting in pregnancy.
December 20, 2017
The SOGC has become aware that there are questions around how to prescribe the TSEC (tissue selective estrogen complex) of conjugated estrogens and bazedoxifine Duavive. Bazedoxifine provides endometrial protection. The TSEC does not require a progestin for endometrial protection; neither a progestin nor progesterone should be prescribed to a woman receiving Duavive.
December 13, 2017
The SOGC is delighted to announce Dr. Elaine Jolly as this year’s regional award winner for the Ontario region, for her many years of service and volunteerism. The award was presented at the Ontario CME earlier this month.
Dr. Jolly is a Professor at the University of Ottawa. She obtained her medical degree from Queen's University in Kingston, Ontario and completed postgraduate training in Denver, Ottawa, and Halifax. She developed the first Reproductive Endocrinology and Infertility Treatment Program in Ottawa, opening the door of advanced science to childless couples in eastern Ontario.
She has been a leader in the community and a dedicated advocate of women's health - developing the first clinical service in Pediatric and Adolescent Gynecology at The Children's Hospital of Eastern Ontario and introducing Contraception and Family Planning Services at the Ottawa General Hospital. She was also an integral part of eastern Ontario's first Perinatal and High Risk Pregnancy Program. In 1986, she developed the first Mature Women's Health Initiative in Ontario and made available essential comprehensive services to menopausal women in a multi-disciplinary fashion.
Dr. Jolly is a well-known educator and opinion leader in her field - often quoted and interviewed by the media. As an educator, she has been recognized by the University of Ottawa, received the Faculty Award of Excellence, and has given over 450 scholarly presentations to her peers and physicians at all levels.
She has an active clinical research program focusing on menopause issues, hormonal therapies, osteoporosis, uterine bleeding and fibroids. She is also a strong advocate for the vital nursing role in patient care and strongly supports nursing research in women's health.
An exemplary physician, a recognized Canadian authority in mature women's health issues, and an advocate for medical education at all levels, Dr. Jolly is committed to Canadian women and their physicians in the promotion of health and prevention of disease.
Dr. Jolly was invested as an Officer in the Order of Canada in 1999, in recognition of her achievements in women's health. In 2000, she received the Reproductive Health Award from the Federation of Medical Women of Canada.
In 2001, she founded the Ottawa Women's Health Council - a group of women leaders in the community, who were instrumental in raising awareness, performing intensive lobbying and fundraising for women's health. The end result of this effort was a combined project with the Ontario Ministry of Health and Long Term Care to create a Women's Health Centre at the Riverside Campus of The Ottawa Hospital.
In 2003, Dr. Jolly was awarded the Consumer Healthcare Education Award of Excellence by the North American Menopause Society, acknowledging her significant contribution towards improving the quality of life of menopausal women. In January, 2005, The Shirley E. Greenberg Women's Health Centre at the Riverside site of The Ottawa Hospital was officially opened. Dr. Jolly is the founder and Medical Director of this unique, integrated Women's Health Centre.
Dr. Jolly represents the best and the most devoted of our profession.
December 7, 2017
The SOGC recently wrote to Health Canada to voice our concern about the recent approval of a generic “Diclectin” (doxylamine-pyridoxine).
In response to our letter, Health Canada has reassured us that they stand by the safety of the generic product. Health Canada also reassured us that they will continue to monitor the safety of mannitol and the safety of all health products, including those indicated for use by pregnant women.
As an organization that advocates for patient safety and evidence-based research, we believe pregnancy-specific test is best practice. However, we have accepted the reassurance of Health Canada.
December 1, 2017
Health Canada issued a MedEffect Safety Notice on December 1 2017, alerting consumers about a manufacturing defect of some broken oral contraceptive tablets of Alesse 21 and 28 mg.
The SOGC strongly recommends that women who use pills inspect their oral contraceptive tablets and return any defective products to their pharmacy.
If you suspect that you have taken one broken oral contraceptive tablet, there is low probability of the product failing, leading to an unintended pregnancy. However, if you suspect that you have taken two or more broken tablets consecutively, we advise that you use extra precaution with an alternative birth control measure, such as a condom, until your next menstrual period, or inquire with your pharmacist for emergency contraception also know as the morning after pill.
The full MedEffect Safety Notice can be viewed here:
Further information to assist health care professionals in advising their patients who use Alesse:
For additional questions or concerns, please speak with a health care provider.
The SOGC maintains confidence in Alesse, and other oral contraceptives, as an effective form of birth control.
November 8, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is calling for a national surveillance system to accurately track the incidence of maternal mortality and severe morbidity in Canada. A review article, appearing in this month’s Journal of Obstetrics and Gynaecology Canada (JOGC), says miscalculated or underreported data collection makes it difficult to set targets and develop programs, policies, priorities and interventions that could save lives.
“Although Canada has the lowest maternal mortality rate among North American countries, we know the data is not capturing many non-obstetric causes, and near misses,” says Dr. Jocelynn Cook, Chief Scientific Officer, SOGC. “We also believe the WHO definitions of maternal mortality and morbidity need to be extended to 42 days following childbirth, and include other causes due to mental health, substance use, violence and accidents.”
November 7, 2017
The SOCG welcomes today’s notice from Health Canada which clarifies the regulations around the prescription and distribution of the abortion pill Mifegymiso. The “Updates to Product Monograph and Risk Management Plan” can be viewed here.
Mifegymiso was approved for use in Canada in January 2017. It is a combination of two drugs, mifepristone and misoprostol, and is used for the safe medical termination of early pregnancy. The Mifegymiso pill provides an important alternative to a surgical procedure for women, particularly for those who are unable to access abortion services in their area. We believe today’s announcement will improve access to the drug to women across the country.
We urge all SOGC members to review the important changes and to consider becoming prescribers. Although Health Canada no longer requires health care providers to take the SOGC online course before prescribing or dispensing, we strongly recommend the course as it provides a valuable overview of our Clinical Practice Guideline (http://www.jogc.com/article/S1701-2163(16)00043-8/abstract) for safe use of the drug.Some of the other changes include:
- MIFEGYMISO is now indicated for medical termination of a developing intra-uterine pregnancy with a gestational age up to nine weeks (63 days) as measured from the first day of the last menstrual period. The previous indication was for use up to seven weeks (49 days) as measured from the first day of the last menstrual period.
- Registration of health professionals with Celopharma is no longer required in order to prescribe or dispense MIFEGYMISO.
- The MIFEGYMISO education program is not mandatory. However, MIFEGYMISO should be prescribed by health professionals with prior adequate knowledge of medical abortion and use of MIFEGYMISO or who have completed a MIFEGYMISO education program.
- The Education Program is available to all health professionals.
- MIFEGYMISO can now be dispensed directly to patients by a pharmacist or a prescribing health professional. As was always the case, patients should take the medication as directed by their health professional, either at a health facility or at home.
- Health professionals are required to do the following prior to prescribing MIFEGYMISO:
- Ensure you have adequate knowledge of the use of these medications to prescribe Mifegymiso;
- Discuss informed consent with the patient and provide the patient with the current Patient Medication Information and a completed Patient Information Card;
- Exclude ectopic pregnancy and confirm gestational age by ultrasound;
- Counsel patients on the effects and risks of Mifegymiso, including bleeding, infection, and incomplete abortion;
- Ensure that patients have access to emergency medical care in the 14 days following administration of mifepristone; and,
- Schedule a follow-up 7 to 14 days after patients take mifepristone to confirm complete pregnancy termination and monitor for side effects.
Mifepristone has been approved for use in over 60 countries around the world, including Canada, and has proven to be a safe and effective means of terminating unplanned pregnancies.
November 1, 2017
The Society of Obstetricians and Gynaecologists (SOGC) has released the clinical practice guideline, Transvaginal Mesh Procedures for Pelvic Organ Prolapse, which reviews the risks and benefits of these repairs and updates recommendations first made in 2011.
The new guideline says transvaginal mesh still has an important use in urogynaecology in select cases because it can improve anatomical outcomes, especially for women with recurrent prolapse and for those with risk factors for failure after native tissue repairs. But, because it can also be associated with an increased risk of reoperation, mesh exposure, and pain, clinicians must also thoroughly weigh the pros and cons of using it and provide thorough preoperative counselling to their patients.
Pelvic organ prolapse is a common disorder that affects up to 50% of women of all ages. It occurs when a pelvic organ, like the bladder, drops (or prolapses) from its normal position and pushes against the wall of the vagina. The muscles holding these organs weaken or stretch, usually because of childbirth, a vaginal trauma or family history. Many women with mild symptoms can improve the condition by avoiding heavy lifting, or doing Kegel exercises, for example. Others may require some kind of surgery.
October 31, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has today released its latest clinical practice guideline, Hirsutism: Evaluation and Treatment, published in the Journal of Obstetrics and Gynaecology of Canada.
Hirsutism is the growth of excess hair on the female body in areas usually attributed to male hair patterns. It is an endocrine disorder affecting 5% - 10% of women of child-bearing age. Often, the condition can occur for no known reason, however, the condition is also found in women suffering from polycystic ovary syndrome (PCOS). Consuming steroids or certain medications and, more rarely, the presence of androgen-secreting tumour can also be causes.
“Hirsutism can be devastating for a woman’s morale. We are pleased that updated information on this condition has been compiled to help clinicians diagnose and treat the disorder and help patients avoid potential long term discomfort,” said Dr. Jennifer Blake, CEO of the SOGC.
October 18, 2017
The SOGC is delighted to announce Dr. Suzanne Roberge as this year’s regional award winner for Quebec for her many years of service and volunteerism. The award was awarded at the Quebec CME earlier this month.
Dr. Roberge graduated in obstetrics and gynecology at the University of Montreal in 1995 and she has practiced as an Obstetrician/Gynaecologist at CISSS de la Côte-Nord (Baie-Comeau) for the past 22 years. While her clinical activities are high-risk pregnancy, ultrasound, general gynecology (basic uro-gynecologist) and colposcopy, she has admittedly always had difficulty saying “no” to worthy projects in Canada and around the world.
She is a member of the Society of Canadian Colposcopists (SCC) and the American Society of Colposcopists and Cervical Pathology (ASCCP), the American Association of Gynecologic Laparoscopists (AAGL). She is also actively involved in the ALARM International Committees and Global Health of the SOGC.
As a volunteer for the SOGC, Dr. Roberge has also participated in several international ALARM (AIP) expeditions in Burkina Faso, Ethiopia, Haïti, Mali and most currently in the Democratic Republic of Congo (DRC). Within the Mali project, she also contributed to the drafting of clinical guidelines and is now involved in supporting the implementation of post-AIP training follow-up and evaluation activities in the DRC project. Dr. Roberge is a member and volunteer for the Canadian Network for International Surgery. She is an instructor for classes FIRST and SOO (Structured Operative Obstetrics) and she taught in Tanzania and Uganda.
Dr. Roberge is also a strong community leader closer to home, and devotes extra time to working in a palliative care home, speaking to students at local schools, and helping to organize and fundraise for Terry Fox runs—anywhere and any cause she believes needs a helping hand.
Dr. Roberge represents the best and the most devoted of our profession.
October 12, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is delighted to announce the release of a new website, HerNutrition.ca, to help women of all ages and backgrounds make informed decisions about the food they eat. Accompanying the new website is a tongue-in-cheek social media campaign to raise awareness about healthy and not-so-healthy choices.
“So many medical issues can be avoided by proper nutrition and a healthy lifestyle. When it comes to their health, women are more likely to trust a recommendation that comes from health care professionals,” says Dr. Jennifer Blake, CEO. “We have adapted important nutrition data put together by dietitians, researchers and experts in women’s health to provide nutrition guidance for women at all stages of life. Our newest website makes the information accessible and easy to understand, with tips for implementing the recommendations.”
Nutrients are the building blocks of long-term health. It is estimated that about one-third of all cancers can be prevented by eating well, being active, and maintaining a healthy body weight. As women, we have the opportunity to shape the future health of our children and grandchildren through the choices we make before and during pregnancy, and with our children, friends, and family at the dinner table and in the grocery store. When it comes to the food we eat, there are so many options, some healthy, some not; it can be daunting to make choices that meet our needs—especially when those needs keep changing as we age.
October 6, 2017
The SOGC is delighted that the late Dr. Emily Stowe has been inducted into the Canadian Medical Hall of Fame (CMFH). Dr. Stowe was the first Canadian female physician and accoucheur (doctor trained in childbirth). She graduated from the New York Medical College for Women in 1867 and set up her practice in Toronto that same year. The launch of Dr. Stowe’s career also marks Canada’s 150th birthday.
The Canadian Medical Hall of Fame Laureates are individuals whose contributions to medicine and the health sciences have led to extraordinary improvements in human health. On this special occasion, we applaud Dr. Stowe's contribution to improving the care of women in Canada. Her work truly embodies the 2020 vision of the SOGC: Quality of Care, Education, Advocacy and Growing Stronger.
A special thanks to Carine Trazo, a former SOGC summer student and history major, now Coordinator, Communities of Practice with The Society of Gynecologic Oncology of Canada, who first suggested the SOGC spearhead an application for Dr. Stowe’s recognition.
September 20, 2017
Zika virus is a mosquito-transmitted virus that generally causes mild symptoms, but is associated with microcephaly in infants whose mothers contract Zika virus during pregnancy.
Pregnant women and those who are considering becoming pregnant, are urged to take precautions against mosquito bites if travel to endemic regions cannot be postponed.
The Public Health Agency of Canada (PHAC) has advised that pregnant women, or women planning to become pregnant should avoid travel to south Florida and to countries with the mosquito-borne Zika virus. PHAC is continuing to monitor Zika's spread and has prepared useful background information for health care providers to help identify and treat the illness.
Please see below for links related to the latest guidance on Zika virus. Information in this post will be updated as new information regarding changing evidence and emerging consensus becomes available.
Canadian guidelines for the Zika virus:
- SOGC Infectious Disease Committee - Zika FAQ
- Canadian Recommendations on the Prevention and Treatment of Zika Virus
Further Canadian resources:
- Statement from the Chief Public Health Officer of Canada and Ontario's Chief Medical Officer of Health on the first positive case of sexually transmitted Zika Virus
- PHAC Laboratory Testing Recommendations for Zika Virus
- PHAC Information for Health Professionals
- PHAC Zika Surveillance Data
- PHAC Public Health Notice
- PHAC Travel Health Notice
North American joint statement:
- The BMJ Clinical Review - Zika virus
- The BMJ Practice Pointer - Zika virus: management of infection and risk
- US Food and Drug Administration - Recommendations to reduce the risk of Zika virus transmission by human cells, tissues and cellular and tissue-based products
- Public Health England - Guidance for primary care on Zika virus infection
- Public Health England - Updated travel advice for pregnant women
- Update: Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016
- Society for Maternal Fetal Medicine statement: "Ultrasound Screening for Fetal Microcephaly Following Zika Virus Exposure"
- ACOG Practice Advisory
- CDC Interim Guidelines for Prevention of Sexual Transmission of Zika Virus
- Update: CDC Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure
- CDC Interim Guidelines for Pregnant Women During a Zika Virus Outbreak
- Interim RCOG/RCM/PHE/HPS clinical guidelines on Zika Virus Infection and Pregnancy - Information for Healthcare Professionals
- Zika virus - an update for clinicians (Public Health England)
- RCOG Interim algorithm for assessing pregnant women with a history of travel to areas with active Zika virus transmission
September 20, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) today released a ground-breaking Clinical Practice Guideline to raise awareness among health care professionals on how to screen for and manage substance during pregnancy. Even though the health risks to the fetus are well known, at least 11% of Canadian women report smoking or drinking alcohol during pregnancy, and another 1-2% admit to using opioids and cannabis.
“These situations can be very challenging”, says Dr. Jocelynn Cook, Chief Scientific Officer at the SOGC. “Effective harm reduction requires education about non-judgemental support strategies that vary greatly, depending on the addiction. Ultimately care, including care for withdrawal symptoms with medical management, will lead to improved health outcomes for both the mother and the baby.”
September 1, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian College of Medical Geneticists (CCMG) have released a new clinical guideline that recommends all pregnant women in Canada — regardless of age — be offered the option of a first trimester ultrasound and a prenatal screening test for the most common fetal aneuploidies (e.g. Down syndrome) and major congenital anomalies.
The landscape of prenatal screening and diagnosis has changed considerably in the last decade with the rapid development of new technologies, particularly the introduction of non-invasive prenatal testing or NIPT (using circulating DNA in maternal blood) and chromosomal microarray analysis of amniotic fluid.
The Update on Prenatal Screening for Fetal Aneupoloidy, Fetal Anomalies, and Adverse Pregnancy Outcomes provides guidance to maternity care providers on the impact they may have on prenatal counselling, screening and diagnosis. It replaces three existing guidelines and updates two others to become the most comprehensive document in Canada on the issue to date.
“Patients who opt for testing no longer have to choose invasive procedures like amniocentesis as a first line test and can opt for lower risk options first to detect structural abnormalities earlier in their pregnancy,” says Dr. Blake, CEO SOGC. “Earlier detection can also be beneficial in determining birth dates or whether the mother is carrying twins. But these new tools also increase the need for earlier provider-patient counselling about the risks, benefits and alternatives in testing—including the right to no testing prior to any screening, and the risk of false positives.”
August 23, 2017
The SOGC endorses this letter written by Dr. Jocelyn Bérubé and Dr. Édith Guilbert, clarifying the recent questions about mood and the levonorgestrel IUD. This letter originally appeared on Dr. Jocelyn Bérubé's website, in response to an article published in the Journal de Montreal in June 2017 (http://www.journaldemontreal.com/actualite/societe/mirena).
An article about the “omerta,” or the “code of silence” around the side effects of the Mirena IUD, and in particular those relating to mood, was published recently and has caused many women to worry.
The following data is provided for your information:
- The Canadian monograph of the product (Mirena) reports the frequency of side effects found in the studies conducted prior to the approval of the product. Cited is a frequency of between 1% and less than 10% for psychiatric disorders, such as depression, decline in libido, and nervousness.
- Several studies have been published concerning the possible risk of depression associated with Mirena; here are the findings:
+ JAMA Psychiatry 2016 September; 2387: Slight increase in risk of depression among users of Mirena, in particular during adolescence. Study included numerous methodological biases. (Level II)
+Arch Gynecol Obstet. 2014 Sep; 290(3):507-11: The quality-of-life scores increased whereas those relating to depression did not change after 6 months of using Mirena. (Level II)
+ Contraception. 2012 Nov; 86(5):470-80: No association was found between the use of Mirena, the length of its use, and higher scores on the Beck Depression Inventory. (Level II)
+ Hum Reprod. 2011 Nov; 26(11):3085-93: The use of Mirena seems to be associated with a positive effect on mental health. (Level II)
+ J Sex Med. 2012 Apr; 9(4):1065-73: No difference in sexual function or symptoms of depression between users of the copper IUD and those of Mirena. (Level II)
+ Int J Behav Med. 2007; 14(2):70-5: The use of Mirena compared to hysterectomy in women with menorrhagia is associated with more symptoms of depression. (Level I)
+ JAMA. 2004 Mar 24; 291(12):1456-63: The use of Mirena compared to hysterectomy in women with menorrhagia does not change quality-of-life elements or psycho-social well-being. (Level I)
In response to this short scientific review, I think we can say that the risk of mental health problems specifically linked to the Mirena IUD seems difficult to determine. However, it is possible that some women are particularly sensitive to progesterone (Levonorgestrel in Mirena) and that symptoms increase in women with a tendency for depression or anxiety.
It is important that physicians who prescribe the Mirena IUD warn their patients about possible side effects, including mood-related ones. However, in no case is the use of this IUD contraindicated for those with a history of depression or current depression. With these patients, it may be prudent to follow-up their side effects and to ensure that a depressive mood is not exacerbated.
It is important to always put side effects in perspective along with the beneficial effects of a contraceptive method. The Mirena IUD is the most effective reversible method of contraception on the market (let’s not forget the devastating consequences of an unplanned pregnancy) and reduces excessive menstrual bleeding by 75% to 80% (let’s also not forget the devastating effects of menorrhagia).
We hope this information will be useful.
Jocelyn Bérubé and Édith Guilbert
August 16, 2017
SOGC President, Dr. Michael R. Bow, asks for member support to urge the Government of Canada to reconsider the proposed tax reforms affecting private corporations:
"As your President, I have written to the Minister of Finance, The Honourable William Morneau, on behalf of the SOGC. My letter speaks to representing the 3,600 plus member health care professionals of the SOGC who are concerned by the proposed reforms to Canadian tax law that will affect private corporations. It highlights that we are concerned not only for ourselves, but for the millions of independent small business owners and operators across the country who will also be affected by the proposed changes.
I invite you to read our letter to the Minister, and urge you to to write, call, or meet with your local MP and your provincial or territorial representative to share your own input on how these proposed changes will affect you and your practice. We know from past efforts that individual doctors talking directly to their local politicians can make an enormous difference."
The SOGC and its members join many other organizations who are bringing their concerns to the government. We are asking for your help in urging the Government of Canada to reconsider this important matter. Click here to add your name to the Federation of Medical Women of Canada's petition and click here to personalize a version of the CMA’s letter.
June 26, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has published a new clinical guideline to assist physicians in the treatment of primary dysmenorrhea - a common menstrual pain disorder that affects millions of women around the world.
Primary dysmenorrhea is defined as pain that occurs before and/or during a period - with no underlying pelvic pathology such as endometriosis. The disorder accounts for significant time lost from work, school and other activities, yet it is often under-treated in women of all ages. Many women consider the pain associated with their period - even if it is severe and incapacitating - as normal and do not seek medical assistance.
The Primary Dysmenorrhea Consensus Guideline, which appears on the Journal of Obstetrics and Gynaecology Canada (JOGC) website at www.jogc.com, outlines simple, effective therapies for physicians to use that are also widely available. This guideline revises and updates the original guideline released in December 2005.
June 23, 2017
The Society of Obstetricians and Gynaecologists (SOGC) is delighted to announce the appointment of Dr. Michael Bow as the 74th President of the Society. Dr. Bow is a Clinical Professor in Obstetrics and Gynecology at the University of Alberta. For the past 25 years, he has worked in active practice at the Grey Nun’s Hospital in Edmonton as a General Obstetrician/Gynecologist.
Dr. Bow will serve in this role from June 2017 until June 2018.
“I am very much looking forward to working with the Board, our members, and SOGC staff to improve the safe and effective delivery of women’s sexual and reproductive health care in Canada”, Dr. Bow told the Annual Clinical Scientific Conference in Ottawa, Ontario.
June 22, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is committed to developing a Gender-Inclusive Language Policy to promote sensitivity to LGBTQ+ individuals in both health care research and practice. This is in response to a recent study that cites 43.9% of transgender people in Ontario have reported an unmet health care need in the past year alone due, in part, to negative experiences with health care providers and a lack of access to transition-related services.
“Breaking down the barriers between health care practitioners and transgender people starts with cultural sensitivity. The SOGC is developing a Gender-Inclusive Language Policy to help build bridges between health care providers and members of LGBTQ+ communities who are seeking access to affirming and culturally sensitive health care services.”
June 21, 2017
The Canadian Women’s Health Foundation (CFWH) and The Society of Obstetricians and Gynaecologists of Canada (SOGC) are pleased to announce this year’s recipients of the Journalism Awards for Excellence in Women’s Health Reporting. The Awards go to journalists who have provided a valuable service to public health in print and broadcast categories. They were handed out tonight at the CFWH Gala as part of the SOGC’s Annual Clinical and Scientific Conference in Ottawa from June 20-23.
The recipient of the 2017 print award is Lauren Vogel from the Canadian Medical Association Journal (CMAJ) for her two-part feature...