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 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...
June 21, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) today unveiled a top-ten list of commonly used obstetrical and gynaecologic tests and treatments which an expert review committee has determined usually do not add value to the care of patients. The list is part of the Choosing Wisely Canada initiative which encourages clinicians and patients to engage in conversations to avoid unnecessary tests while making smart and effective choices supporting high quality care.
“Research shows that 30% of what is done by health care providers confers no benefit to patients,” says Dr. George D. Carson, outgoing President of the SOGC. “As an obstetrician and President of the SOGC, I have made it an important part of my mandate for the SOGC to rigorously review common procedures. Unnecessary tests and treatments do not add value to care. In fact, they take away from care by potentially exposing patients to harm, leading to more testing to investigate false positives, sometimes risks from those investigations and contribute to stress for patients.”
June 21, 2017
Contraception has changed a lot in the past decades – but a new survey of Canadian women shows unintended pregnancies still remain high - at about 61%. And, in spite of the dozens of options now available to men and women, the birth control pill, condoms and withdrawal are still the top three contraception methods.
Preliminary results from the national survey were unveiled this morning at the Society of Obstetricians and Gynaecologists of Canada’s (SOGC’s) Annual Clinical and Scientific Conference. It compared data collected in a 2006 survey with the same survey in 2016. The report looks at trends, attitudes, and behaviours related to sexuality and contraception among over 3,200 Canadian women. Some of the findings remain consistent:
- Most women are not aware of the many contraception options that exist;
- Intrauterine Devices (IUDs) are one of the most effective methods available, but most women know very little about them;
- Women over 30 years old are less likely to use contraception or condoms.
June 20, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is pleased to announce the release of an exciting new website, PregnancyInfo.ca, to inform women who are pregnant, or planning to become pregnant about the relevant evidence-based information they need for a healthy pregnancy.
“This site covers questions from A-Z including important facts on nutrition, vaccination and the impact of the environment on pregnancy,” says Dr. Jennifer Blake, CEO SOGC. “In this era of fake news, women are looking for credible information. Our website incorporates the most recent clinical guideline data with practical advice from a committee of medical experts.” Research shows time and time again that when pregnant women are well informed about their needs and the needs of their growing baby, they will have healthier full-term pregnancies.
May 24, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has published a new Clinical Practice Guideline urging physicians to start talking to women as early as their 20s about the realities of their biological clock and the effects of age on reproductive potential.
Many Canadian couples choose, or are forced by circumstances, to delay child-bearing into their 30s and 40s—a time when women and men experience a natural decline in their fertility. The new guideline, Advanced Reproductive Age and Fertility, appears on the Journal of Obstetrics and Gynaecology Canada (JOGC) website at www.jogc.com. The guideline also cautions that assisted reproductive technology (ART) is not a fail-proof method to set back the clock.
May 23, 2017
NOTICE is hereby given that the Annual General Meeting of the Society of Obstetricians and Gynaecologists of Canada will be held:
Friday, June 23, 2017
07:00 - 08:00
The Westin Ottawa - (Governor General I Room)
May 9, 2017
Cannabis (marijuana) is the most commonly used illicit drug among pregnant women. Legalization of cannabis in Canada may reinforce the reputation of cannabis being a harmless drug and result in an increase of use among pregnant women.
Evidence-based data has shown that cannabis use during pregnancy can adversely affect the growth and development of the baby, and lead to long-term learning and behavioural consequences. There have been sufficient studies with comparable results, showing that cannabis use during pregnancy raises concerns of impaired neurodevelopment of the fetus, in addition to the adverse health consequences related to maternal and fetal exposure to the effects of smoking. Pregnancy is a critical time for the brain development of the baby and the adverse effects caused by cannabis exposure can be life-long.
The SOGC recommends that women who are pregnant or contemplating pregnancy should abstain from cannabis use during pregnancy.
May 5, 2017
The Honourable Jane Philpott, Minister of Health, today announced $3.6 million in federal funding for five projects aimed at preventing and screening for alcohol use in pregnancy. "Project leads will work with medical and allied health professionals, social service providers and researchers to equip frontline care providers with the tools, information and best practices they need to help screen, counsel and treat women at risk of using alcohol during pregnancy."
April 26, 2017
“In addition to keeping up-to-date with all their regular vaccinations, women of child-bearing age should be vaccinated against certain diseases such as rubella before they get pregnant. The Society of Obstetricians and Gynaecologists of Canada will be surveying health care providers and the public to better understand the information gaps in order to provide tools to get this message out.”
Dr. Jennifer Blake
Chief Executive Officer, The Society of Obstetricians and Gynaecologists of Canada
March 17, 2017
March 8, 2017
International Women’s Day is celebrated around the world on March 8th. It is a day to reflect on the progress and achievements that have been made to advance the health, well-being, and equal rights of women and to renew commitments to continue forging a better, more gender inclusive world.
On this special day, we also celebrate the important work that SOGC members are doing every day to advance the health of women. As experts in the field of women’s health, we are at the forefront of providing care and compassion to women, as well as a voice for those women whose message goes unheard.
On International Women's Day, and every day, the SOGC renews its commitment to ensuring that every woman has access to quality sexual and reproductive health care services.
We continue to work hard to provide our members with the tools and resources they need for their practice.
As we advocate for every woman’s right to access the full gamut of sexual and reproductive health services, we encourage our members to complete the SOGC’s online Medical Abortion Training Program and to stay abreast of the latest SOGC Clinical Practice Guidelines.
However you decide to celebrate, the SOGC would love to hear from you! Let us know what you will be doing on March 8th and tell us what International Women’s Day means to you.
March 2, 2017
The SOGC welcomes the Canadian government’s ongoing support for women’s health and reproductive rights in Canada and around the world.
Today, International Development Minister Marie Claude Bibeau joined representatives from more than 50 countries by announcing Canada is donating up to $20 million to an international “safe abortion” fund.
The announcement was made at the “She Decides” forum being held in Brussels in the wake of U.S. President Donald Trump’s decision to cut $600 million in federal funding to international groups that perform or provide information on abortions. Holland took the lead earlier this year by establishing the nongovernmental organization, She Decides, to raise money for aid groups and UN agencies working in family planning and women's rights.
“Women around the world need to have control of their bodies,” says Dr. Jennifer Blake, CEO of the SOGC. “As a health organization that advocates for the sexual and reproductive rights of women, it is critical for barriers to be coming down in 2017, not to be thrown in the path of millions of girls and women who deserve choice and the freedom to choose.”
The Brussels meeting will also work towards developing a common strategy to limit the impact of the U.S. decision.
February 15, 2017
As many Canadians are now dreaming of beach holidays, The Society of Obstetricians and Gynaecologists of Canada urges women who are pregnant or considering becoming pregnant, to follow Public Health Agency of Canada (PHAC) guidelines and consider avoiding or delaying travel to areas with reported mosquito-borne Zika virus.
The number of confirmed Zika cases in Canada has risen to 476 from people who contracted the virus after travelling or through sexual contact, including 27 pregnant women. Zika is transmitted by mosquitos in a number of countries, including Mexico, much of Central and South America, the Caribbean and parts of Florida and Texas. Zika infections in pregnant women can sometimes lead to infections in the baby as well, and can cause severe birth defects.
If travel cannot be avoided or postponed, women who are pregnant or considering becoming pregnant are advised to:
- Follow strict mosquito bite protection;
- Delay conception for at least two months after travel to ensure the virus has cleared their body;
- Male partners should use condoms for six months post travel or avoid having sex with their partner for the duration of the pregnancy.
Zika symptoms may include fever, headaches, pink eye, skin rashes, and joint and muscle aches. The illness is usually quite mild and lasts only a few days. Many people who contract Zika have no symptoms at all. There is presently no vaccine or medication that protects against Zika virus infection,
February 12, 2017
February 12th – 18th is Sexual and Reproductive Health Awareness Week. The SOGC encourages members and colleagues to join our partners at Action Canada for Sexual Health and Rights in promoting sexual and reproductive health in Canada.
As part of SRH Week, Action Canada has developed a handbook for health care providers working with clients from diverse communities. This book provides tips and strategies for building healthy relationships with your patients and clients. Having the right language, skills, and tools to create an affirming and inclusive environment can help ensure that all patients feel safe accessing the services they need.
We encourage you to be a part of the solution. Set aside some time this week to learn how to best provide care to diverse ethnic, cultural and religious groups, Indigenous communities, the LGBTQ community, sex workers, people with disabilities, youth, and more.
February 7, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) joins women’s health advocates around the world in opposing the recent actions of President Trump to reinstate the Mexico City Policy, also known as the Global Gag Rule, which bars U.S. funding for organizations and family planning providers if they perform, council on, or mention abortion. The Global Gag Rule causes real and serious harm to women around the world and it backtracks years of progress on international development and on advancing women’s sexual and reproductive health and rights.
We reaffirm our commitment, as Canadians and as health professionals, to continue to support the reproductive health and rights of women around the world.
The SOGC is pleased to have endorsed the following statements and we encourage our members to take similar steps to advocate on behalf of women around the world.
- Action Canada for Sexual Health and Rights: Joint Public Statement Regarding US Re-enactment of Global Gag Rule
- Canadian Allies for Reproductive Rights: A letter of Action in Response to Trump’s ‘Gag Rule’
January 23, 2017
In collaboration with the College of Family Physicians of Canada and the Canadian Pharmacists Association, the SOGC is pleased to announce the availability of the online Medical Abortion Training Program.
The training program has been developed at the request of Health Canada and Celopharma, and consists of six modules that review scientific evidence on Medical Abortion.
The intention of the program is to train health care professionals regarding the safe use of PRMifegymiso as per the Health Canada approved Canadian Product Monograph and to register trained physicians and pharmacists for the distribution of PRMifegymiso.
The Medical Abortion Training Program is available at: https://sogc.org/online-courses/courses.html
January 20, 2017
The SOGC joins the Society of Canadian Colposcopists (SCC), the Society of Gynecologic Oncology of Canada (GOC), the College of Family Physicians of Canada (CFPC), and the Association des obstétriciens et gynécologues du Québec to reaffirm that the Gardasil HPV vaccine, based on the very extensive evidence available to us, and now that the vaccine has been available in Canada for 10 years, is safe, and that vaccination remains one of the recommended actions for prevention of cervical cancer and other HPV-associated diseases.
- Read the full joint position statement (PDF)
- Read the joint reply to "Urgent call for a moratorium on the HPV vaccination" published in Le Devoir (French only)
January 9, 2017
Flu season is well underway. The Public Health Agency of Canada estimates that each year between 10 and 20 per cent of Canadians get influenza. Canada’s National Advisory Committee on Immunization encourages all Canadians over the age of six months to get a flu shot. This is particularly important for pregnant women, who are at a higher risk for complications.
- Immunization: Before and during pregnancy
- Immunization in pregnancy (guideline)
- Benefits of influenza vaccine in pregnancy for the fetus and the infant younger than six months (Canadian Paediatric Society)
It is also crucial for health care professionals to be immunized, to protect themselves and their patients. The Public Health Agency of Canada (PHAC) and Immunize Canada have created several resources that are designed to help front-line health care professionals fight the flu this season. Examples include:
January 6, 2017
The Society of Obstetricians and Gynaecologists of Canada (SOGC) wishes to reassure members and concerned women that the recent publication regarding Diclectin (doxylamine/pyridoxine) did not relate to patient safety, nor did it contradict any of the many studies showing efficacy of Diclectin. It did not bring forward any new information.
The overwhelming body of evidence shows that Diclectin is safe and effective for treating nausea and vomiting in pregnancy. Our guideline, The Management of Nausea and Vomiting of Pregnancy, released in December 2016, reviews the use of Diclectin and other pharmacologic treatments, of which Diclectin was found to be an appropriate first choice, and many non-pharmacological options such as dietary manipulation, ginger supplements or acupressure.
The researcher published work that was done in 1970—47 years ago, that did not show any concerns with Diclectin. In fact, that study showed Diclectin to be effective. The study however, had minor methodological flaws and, therefore, was never published. It should be noted that the research was conducted in the 1970s and research methodology has improved since then. No findings adverse to the doxylamine/pyridoxine option were found in the study or its subsequent review.
The conclusions drawn by the SOGC Guideline Committee were based on a body of more current and methodological evidence. Even if the research from the 1970s was dismissed, it is irrelevant to the strength and conclusions of our recent Guideline.
Health Canada conducted an independent review of Diclectin as part of its product review policy in the summer of 2016. It concluded that Diclectin's benefits continue to outweigh its risks, when used as authorized. The results of the Health Canada report can be reviewed here.
Nausea and vomiting in pregnancy is a common condition causing significant distress for many pregnant women. Healthcare providers should continue to assist women with this condition including recommending Diclectin, if indicated. Women should remain assured that this drug is very safe and moderately effective.
If you have any concerns, please contact the SOGC at firstname.lastname@example.org.
- See the PDF statement
- Health Canada Summary Safety Review - DICLECTIN (doxylamine and pyridoxine combination) - Assessing Safety in pregnancy
January 5, 2017
If someone were to tell a woman going through menopause that the hot flashes she is experiencing are all in her head, there would, no doubt, be a mass outcry denouncing this kind of misinformation.
Yet a recent CBC story suggesting “vaginal atrophy” is largely a promotion by big pharma, and not a painful condition suffered by women, has gone, as yet, unchallenged.
Only about 20% of women in Canada are lucky enough to consider themselves asymptomatic during menopause. But up to 80% claim to suffer from at least one menopausal symptom including mood swings, irritability, interrupted sleep, hot flashes or vaginal dryness.
In spite of the fact that about half the population over 50 are in various degrees of physical discomfort from these diverse symptoms, we still aren’t talking about it. Yet in multiple surveys women indicate they avoid intimacy, starting with menopause, because they are worried about painful sex.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) is a leading authority on women’s health in Canada. We believe it is time women stopped suffering in silence. Menopause is a natural step in the aging process that not only impacts most women experiencing it; it also has a profound impact on their partners. For improved quality of life, we must stop the culture of ignorance that surrounds menopause and set the record straight.
December 14, 2016
The latest issue of the JOGC is now available online at http://jogc.com/current