Dorothy Shaw - Academia.edu (original) (raw)

Papers by Dorothy Shaw

Research paper thumbnail of When there are no abortion laws: A case study of Canada

Best Practice & Research Clinical Obstetrics & Gynaecology, 2019

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of r... more Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political and policy events prior to and since decriminalization. We explore implications for clinical care, health service and systems decisions, health policy and the epidemiology of abortion in the absence of criminal legislation. Since the criminal abortion law was struck down dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

Research paper thumbnail of Global Women's Health Education in Canadian Obstetrics and Gynaecology Residency Programs: A Survey of Program Directors and Senior Residents

Journal of Obstetrics and Gynaecology Canada, 2015

Objective: To become culturally competent practitioners with the ability to care and advocate for... more Objective: To become culturally competent practitioners with the ability to care and advocate for vulnerable populations, residents must be educated in global health priorities. In the field of obstetrics and gynaecology, there is minimal information about global women's health (GWH) education and interest within residency programs. We wished to determine within obstetrics and gynaecology residency programs across Canada: (1) current GWH teaching and support, (2) the importance of GWH to residents and program directors, and (3) the level of interest in a national postgraduate GWH curriculum. Methods: We conducted an online survey across Canada of obstetrics and gynaecology residency program directors and senior obstetrics and gynaecology residents. Results: Of 297 residents, 101 (34 .0%) responded to the survey and 76 (26%) completed the full survey. Eleven of 16 program directors (68 .8%) responded and 10/16 (62 .5%) provided complete responses. Four of 11 programs (36 .4%) had a GWH curriculum, 2/11 (18 .2%) had a GWH budget, and 4/11 (36 .4%) had a GWH chairperson. Nine of 10 program directors (90%) and 68/79 residents (86 .1%) felt that an understanding of GWH issues is important for all Canadian obstetrics and gynaecology trainees. Only 1/10 program directors (10%) and 11/79 residents (13 .9%) felt that their program offered sufficient education in these issues. Of residents in programs with a GWH curriculum, 12/19 (63 .2%) felt that residents in their program who did not undertake an international elective would still learn about GWH, versus only 9/50 residents (18 .0%) in programs without a curriculum (P < 0 .001). Conclusion: Obstetrics and gynaecology residents and program directors feel that GWH education is important for all trainees and is currently insufficient. There is a high level of interest in a national postgraduate GWH educational module .

Research paper thumbnail of Access to sexual and reproductive health services: Rights, priorities, commitments and actions

International Journal of Gynecology & Obstetrics, 2007

Research paper thumbnail of Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery doppler velocimetry: A randomized controlled clinical trial

American Journal of Obstetrics and Gynecology, 2003

The evaluation of the antenatal fetal heart rate (FHR) pattern with electronic fetal monitoring i... more The evaluation of the antenatal fetal heart rate (FHR) pattern with electronic fetal monitoring is a widely accepted screening test of fetal well-being. Nonstress tests (NSTs) are used in an attempt to reduce the incidence of fetal compromise at birth that is the result of placental insufficiency. 1 Fetal compromise has been associated with changes in baseline FHR, repetitive decelerations, and prolonged decreased variability of the FHR. 2 As a screening test, however, FHR analysis is time-consuming and often difficult to interpret, with a low sensitivity and a resulting high false-positive rate. 3 In addition, FHR changes may only represent current cardiorespiratory status of the fetoplacental unit and not reflect chronic placental reserves.

Research paper thumbnail of Abortion and human rights

Best Practice & Research Clinical Obstetrics & Gynaecology, 2010

Research paper thumbnail of Inter-pregnancy interval and pregnancy outcome

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

We conducted a one year study in department of OBG, KNH, IGMC, Shimla. 2 nd gravida women with hi... more We conducted a one year study in department of OBG, KNH, IGMC, Shimla. 2 nd gravida women with history of abortion in the previous pregnancy coming after 20 weeks of pregnancy were included. Their IPI were noted. All the antenatal, intrapartum and postpartum complications were recorded. Their modes of delivery were studied. Any poor neonatal outcome was also noted.

Research paper thumbnail of PIERS proteinuria: relationship with adverse maternal and perinatal outcome

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2011

To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot ... more To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes. We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse per...

Research paper thumbnail of Safe Surgery Globally by 2030

Anesthesia & Analgesia, Apr 1, 2018

Research paper thumbnail of International Women’s Day, March 8: Reflections on Global Maternity Experiences

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of Constat de mes trois années à titre de présidente de la Fédération internationale de gynécologie et d’obstétrique

Journal of Obstetrics and Gynaecology Canada, 2009

Research paper thumbnail of Drivers and Dilemmas of Female Genital Cosmetic Surgery

Ethical Issues in Women's Healthcare, 2019

Female genital cosmetic surgery includes many procedures undertaken at the request of the woman a... more Female genital cosmetic surgery includes many procedures undertaken at the request of the woman and is the fastest-growing area of cosmetic surgery, despite calls for avoidance or extreme caution from professional organizations responsible for women’s health. Low genital self-image is presumed to drive requests, but root causes have not been studied. The vast majority of these surgeries are not indicated medically, have unknown long-term effects, and are being performed in a private-pay environment in a context of significant ethical concerns regarding informed consent, autonomy and beneficence, and conflict of interest. This chapter explores normal physiologic development of female genitalia as it pertains to knowledge of what is “normal,” self-image and the drivers of genital self-image, concerns about specific procedures, and statements of professional organizations. Ethical tensions and dilemmas for clinicians highlight physicians’ ethical responsibility to provide accurate info...

Research paper thumbnail of Participation de la SOGC aux activités internationales en obstétrique et gynécologie

Journal of Obstetrics and Gynaecology Canada, 2019

Research paper thumbnail of Reflections on Three Years as President of the International Federation of Gynecology and Obstetrics

Journal of Obstetrics and Gynaecology Canada, 2009

T he last three years for FIGO have been a whirlwind of activity. There has been unprecedented mo... more T he last three years for FIGO have been a whirlwind of activity. There has been unprecedented momentum-finally!-in addressing maternal and newborn morbidity and mortality. Recent events that confirm this include the resolution from the UN Human Rights Council on maternal mortality, and the unanimous all-party motion in our Canadian Parliament to recommit to addressing maternal and newborn morbidity and mortality at home and abroad. The latter occurred through the collaboration of FIGO, ICM, SOGC, and the White Ribbon Alliance, which is illustrative of the team approach we see as the way forward to bring about universal access to reproductive health. Probably the most significant individual with whom we have developed a relationship is Sarah Brown, the remarkable wife of the UK Prime Minister and patron of the White Ribbon Alliance. It was through her passion, advocacy, and determination that the Global Campaign for Maternal Mortality was launched, with FIGO as a founding member.

Research paper thumbnail of A tale of two countries: women’s reproductive rights in Ireland and the US

Research paper thumbnail of Patchy progress on the ICPD: are we asking the right questions?

The Lancet Global Health, 2020

Research paper thumbnail of Domestic Violence—A Cry for Help

Research paper thumbnail of Chirurgie esthétique génitale chez la femme

Journal of Obstetrics and Gynaecology Canada, 2013

DÉCLARATION DE PRINCIPE DE LA SOGC Chirurgie esthétique génitale chez la femme La présente déclar... more DÉCLARATION DE PRINCIPE DE LA SOGC Chirurgie esthétique génitale chez la femme La présente déclaration de principe a été rédigée par le comité de pratique clinique-gynécologie et le comité d'éthique, et approuvée par le comité exécutif et le Conseil de la Société des obstétriciens et gynécologues du Canada.

Research paper thumbnail of The worldwide epidemic of female obesity

Best Practice & Research Clinical Obstetrics & Gynaecology, 2015

The rapidly rising number of individuals who are overweight and obese has been called a worldwide... more The rapidly rising number of individuals who are overweight and obese has been called a worldwide epidemic of obesity with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;35% of adults today considered to be overweight or obese. Women are more likely to be overweight and obese than their male counterparts, which has far-reaching effects on reproductive health and specifically pregnancy, with obese women facing an increased risk of gestational diabetes, preeclampsia, operative delivery, fetal macrosomia, and neonatal morbidity. The etiology of obesity is highly complex encompassing genetic, environmental, physiologic, cultural, political, and socioeconomic factors, making it challenging to develop effective interventions on both a local and global scale. This article describes the extent and the cost of the obesity epidemic, which, although historically seen as a disease of high-income countries, is now clearly a global epidemic that impacts low- and middle-income countries and indigenous groups who bear an ever-increasing burden of this disease.

Research paper thumbnail of Global mapping exercise of Canadian maternal, newborn, and child health initiatives

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012

Accomplishing the ambitious targets set by the United Nations Global Strategy to save the lives o... more Accomplishing the ambitious targets set by the United Nations Global Strategy to save the lives of 16 million women and children in low income countries by 2015 requires that governments, development partners, civil society, academics, and the corporate sector create new partnerships and collaborations. The Canadian Network for Maternal, Newborn and Child Health was a pilot initiative to determine possible synergies between Canadian organizations. The main purpose of this project was to develop an online, up-to-date, interactive tool to examine the nature, scope, and type of Canadian maternal, newborn, and child health (MNCH) activities and to promote collaborative efforts among Canadian organizations. Relevant Canadian organizations and institutions were identified and invited to complete a survey/mapping exercise if they were based in Canada and currently engaged in MNCH programming in low income countries. Google Maps was used to portray MNCH-related activities worldwide, includi...

Research paper thumbnail of Chorionic villus sampling: Analysis of fetal losses to delivery, placental pathology, and cervical microbiology

Prenatal Diagnosis, 1991

A population of 1639 patients were seen for chorionic villus sampling (CVS). Embryonic death was ... more A population of 1639 patients were seen for chorionic villus sampling (CVS). Embryonic death was identified at ultrasound in 5.3 per cent of patients. The number of patients undergoing CVS was 1551, with 1416 transcervical procedures and 135 transabdominal procedures. The most common indication for CVS was advanced maternal age. Spontaneous pregnancy losses identified by increased risk of pregnancy loss with increasing aspiration attempts. The total fetal loss for this population was 5.4 per cent with the pregnancy loss estimated due to procedure being 1.2 per cent. Analysis of placentae from patients having CVS and amniocen‐tesis showed no differences. Microbiological assessment prior to CVS was similar to previous publications.

Research paper thumbnail of When there are no abortion laws: A case study of Canada

Best Practice & Research Clinical Obstetrics & Gynaecology, 2019

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of r... more Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political and policy events prior to and since decriminalization. We explore implications for clinical care, health service and systems decisions, health policy and the epidemiology of abortion in the absence of criminal legislation. Since the criminal abortion law was struck down dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

Research paper thumbnail of Global Women's Health Education in Canadian Obstetrics and Gynaecology Residency Programs: A Survey of Program Directors and Senior Residents

Journal of Obstetrics and Gynaecology Canada, 2015

Objective: To become culturally competent practitioners with the ability to care and advocate for... more Objective: To become culturally competent practitioners with the ability to care and advocate for vulnerable populations, residents must be educated in global health priorities. In the field of obstetrics and gynaecology, there is minimal information about global women's health (GWH) education and interest within residency programs. We wished to determine within obstetrics and gynaecology residency programs across Canada: (1) current GWH teaching and support, (2) the importance of GWH to residents and program directors, and (3) the level of interest in a national postgraduate GWH curriculum. Methods: We conducted an online survey across Canada of obstetrics and gynaecology residency program directors and senior obstetrics and gynaecology residents. Results: Of 297 residents, 101 (34 .0%) responded to the survey and 76 (26%) completed the full survey. Eleven of 16 program directors (68 .8%) responded and 10/16 (62 .5%) provided complete responses. Four of 11 programs (36 .4%) had a GWH curriculum, 2/11 (18 .2%) had a GWH budget, and 4/11 (36 .4%) had a GWH chairperson. Nine of 10 program directors (90%) and 68/79 residents (86 .1%) felt that an understanding of GWH issues is important for all Canadian obstetrics and gynaecology trainees. Only 1/10 program directors (10%) and 11/79 residents (13 .9%) felt that their program offered sufficient education in these issues. Of residents in programs with a GWH curriculum, 12/19 (63 .2%) felt that residents in their program who did not undertake an international elective would still learn about GWH, versus only 9/50 residents (18 .0%) in programs without a curriculum (P < 0 .001). Conclusion: Obstetrics and gynaecology residents and program directors feel that GWH education is important for all trainees and is currently insufficient. There is a high level of interest in a national postgraduate GWH educational module .

Research paper thumbnail of Access to sexual and reproductive health services: Rights, priorities, commitments and actions

International Journal of Gynecology & Obstetrics, 2007

Research paper thumbnail of Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery doppler velocimetry: A randomized controlled clinical trial

American Journal of Obstetrics and Gynecology, 2003

The evaluation of the antenatal fetal heart rate (FHR) pattern with electronic fetal monitoring i... more The evaluation of the antenatal fetal heart rate (FHR) pattern with electronic fetal monitoring is a widely accepted screening test of fetal well-being. Nonstress tests (NSTs) are used in an attempt to reduce the incidence of fetal compromise at birth that is the result of placental insufficiency. 1 Fetal compromise has been associated with changes in baseline FHR, repetitive decelerations, and prolonged decreased variability of the FHR. 2 As a screening test, however, FHR analysis is time-consuming and often difficult to interpret, with a low sensitivity and a resulting high false-positive rate. 3 In addition, FHR changes may only represent current cardiorespiratory status of the fetoplacental unit and not reflect chronic placental reserves.

Research paper thumbnail of Abortion and human rights

Best Practice & Research Clinical Obstetrics & Gynaecology, 2010

Research paper thumbnail of Inter-pregnancy interval and pregnancy outcome

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

We conducted a one year study in department of OBG, KNH, IGMC, Shimla. 2 nd gravida women with hi... more We conducted a one year study in department of OBG, KNH, IGMC, Shimla. 2 nd gravida women with history of abortion in the previous pregnancy coming after 20 weeks of pregnancy were included. Their IPI were noted. All the antenatal, intrapartum and postpartum complications were recorded. Their modes of delivery were studied. Any poor neonatal outcome was also noted.

Research paper thumbnail of PIERS proteinuria: relationship with adverse maternal and perinatal outcome

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2011

To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot ... more To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes. We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse per...

Research paper thumbnail of Safe Surgery Globally by 2030

Anesthesia & Analgesia, Apr 1, 2018

Research paper thumbnail of International Women’s Day, March 8: Reflections on Global Maternity Experiences

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of Constat de mes trois années à titre de présidente de la Fédération internationale de gynécologie et d’obstétrique

Journal of Obstetrics and Gynaecology Canada, 2009

Research paper thumbnail of Drivers and Dilemmas of Female Genital Cosmetic Surgery

Ethical Issues in Women's Healthcare, 2019

Female genital cosmetic surgery includes many procedures undertaken at the request of the woman a... more Female genital cosmetic surgery includes many procedures undertaken at the request of the woman and is the fastest-growing area of cosmetic surgery, despite calls for avoidance or extreme caution from professional organizations responsible for women’s health. Low genital self-image is presumed to drive requests, but root causes have not been studied. The vast majority of these surgeries are not indicated medically, have unknown long-term effects, and are being performed in a private-pay environment in a context of significant ethical concerns regarding informed consent, autonomy and beneficence, and conflict of interest. This chapter explores normal physiologic development of female genitalia as it pertains to knowledge of what is “normal,” self-image and the drivers of genital self-image, concerns about specific procedures, and statements of professional organizations. Ethical tensions and dilemmas for clinicians highlight physicians’ ethical responsibility to provide accurate info...

Research paper thumbnail of Participation de la SOGC aux activités internationales en obstétrique et gynécologie

Journal of Obstetrics and Gynaecology Canada, 2019

Research paper thumbnail of Reflections on Three Years as President of the International Federation of Gynecology and Obstetrics

Journal of Obstetrics and Gynaecology Canada, 2009

T he last three years for FIGO have been a whirlwind of activity. There has been unprecedented mo... more T he last three years for FIGO have been a whirlwind of activity. There has been unprecedented momentum-finally!-in addressing maternal and newborn morbidity and mortality. Recent events that confirm this include the resolution from the UN Human Rights Council on maternal mortality, and the unanimous all-party motion in our Canadian Parliament to recommit to addressing maternal and newborn morbidity and mortality at home and abroad. The latter occurred through the collaboration of FIGO, ICM, SOGC, and the White Ribbon Alliance, which is illustrative of the team approach we see as the way forward to bring about universal access to reproductive health. Probably the most significant individual with whom we have developed a relationship is Sarah Brown, the remarkable wife of the UK Prime Minister and patron of the White Ribbon Alliance. It was through her passion, advocacy, and determination that the Global Campaign for Maternal Mortality was launched, with FIGO as a founding member.

Research paper thumbnail of A tale of two countries: women’s reproductive rights in Ireland and the US

Research paper thumbnail of Patchy progress on the ICPD: are we asking the right questions?

The Lancet Global Health, 2020

Research paper thumbnail of Domestic Violence—A Cry for Help

Research paper thumbnail of Chirurgie esthétique génitale chez la femme

Journal of Obstetrics and Gynaecology Canada, 2013

DÉCLARATION DE PRINCIPE DE LA SOGC Chirurgie esthétique génitale chez la femme La présente déclar... more DÉCLARATION DE PRINCIPE DE LA SOGC Chirurgie esthétique génitale chez la femme La présente déclaration de principe a été rédigée par le comité de pratique clinique-gynécologie et le comité d'éthique, et approuvée par le comité exécutif et le Conseil de la Société des obstétriciens et gynécologues du Canada.

Research paper thumbnail of The worldwide epidemic of female obesity

Best Practice & Research Clinical Obstetrics & Gynaecology, 2015

The rapidly rising number of individuals who are overweight and obese has been called a worldwide... more The rapidly rising number of individuals who are overweight and obese has been called a worldwide epidemic of obesity with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;35% of adults today considered to be overweight or obese. Women are more likely to be overweight and obese than their male counterparts, which has far-reaching effects on reproductive health and specifically pregnancy, with obese women facing an increased risk of gestational diabetes, preeclampsia, operative delivery, fetal macrosomia, and neonatal morbidity. The etiology of obesity is highly complex encompassing genetic, environmental, physiologic, cultural, political, and socioeconomic factors, making it challenging to develop effective interventions on both a local and global scale. This article describes the extent and the cost of the obesity epidemic, which, although historically seen as a disease of high-income countries, is now clearly a global epidemic that impacts low- and middle-income countries and indigenous groups who bear an ever-increasing burden of this disease.

Research paper thumbnail of Global mapping exercise of Canadian maternal, newborn, and child health initiatives

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012

Accomplishing the ambitious targets set by the United Nations Global Strategy to save the lives o... more Accomplishing the ambitious targets set by the United Nations Global Strategy to save the lives of 16 million women and children in low income countries by 2015 requires that governments, development partners, civil society, academics, and the corporate sector create new partnerships and collaborations. The Canadian Network for Maternal, Newborn and Child Health was a pilot initiative to determine possible synergies between Canadian organizations. The main purpose of this project was to develop an online, up-to-date, interactive tool to examine the nature, scope, and type of Canadian maternal, newborn, and child health (MNCH) activities and to promote collaborative efforts among Canadian organizations. Relevant Canadian organizations and institutions were identified and invited to complete a survey/mapping exercise if they were based in Canada and currently engaged in MNCH programming in low income countries. Google Maps was used to portray MNCH-related activities worldwide, includi...

Research paper thumbnail of Chorionic villus sampling: Analysis of fetal losses to delivery, placental pathology, and cervical microbiology

Prenatal Diagnosis, 1991

A population of 1639 patients were seen for chorionic villus sampling (CVS). Embryonic death was ... more A population of 1639 patients were seen for chorionic villus sampling (CVS). Embryonic death was identified at ultrasound in 5.3 per cent of patients. The number of patients undergoing CVS was 1551, with 1416 transcervical procedures and 135 transabdominal procedures. The most common indication for CVS was advanced maternal age. Spontaneous pregnancy losses identified by increased risk of pregnancy loss with increasing aspiration attempts. The total fetal loss for this population was 5.4 per cent with the pregnancy loss estimated due to procedure being 1.2 per cent. Analysis of placentae from patients having CVS and amniocen‐tesis showed no differences. Microbiological assessment prior to CVS was similar to previous publications.