[show abstract][hide abstract] ABSTRACT: Objectif : L'allaitement maternel exclusif est recommandé durant les six premiers mois de vie. L'avis du professionnel suivant la grossesse influence le choix d'allaiter ou non. Nous avons voulu vérifier si les obstétriciens-gynécologues et les résidents en obstétrique-gynécologie québécois prodiguent des conseils en ce sens et examiner différents aspects de leur rapport au counseling en allaitement. Méthode : Un questionnaire évaluant cinq aspects du rapport à l'allaitement a été utilisé : pratique et confiance, attitudes, formation, connaissances. Nous avons communiqué par courriel avec les résidents en obstétrique-gynécologie du Québec et les membres de l'Association des obstétriciens et gynécologues du Québec possédant une adresse électronique valable pour les inciter à répondre au questionnaire paraissant sur un site Internet sécurisé. Résultats : Seulement 49 % des obstétriciens-gynécologues et 35 % des résidents offrent périodiquement du counseling en allaitement. Par ailleurs, respectivement 56 % et 35 % des deux groupes ont confiance en leur capacité à répondre aux besoins des patientes qui allaitent, tandis que 79 % des premiers et 93 % des seconds croient qu'il est de leur responsabilité d'offrir ce counseling. Les obstétriciens-gynécologues ont réussi en moyenne 82 % des questions vérifiant les connaissances théoriques. Seulement 16 % des obstétriciens-gynécologues et 22 % des résidents considèrent avoir reçu une formation au moins adéquate pour soutenir les femmes qui allaitent. Conclusion : Les répondants ont trop peu intégré le counseling en allaitement à leur pratique, malgré des connaissances théoriques adéquates et la conviction que ce rôle est important et leur revient. Un enseignement plus pratique pourrait améliorer leur confiance et les inciter à intégrer cette pratique au suivi obstétrical.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 02/2011; 33(2):145-152.
[show abstract][hide abstract] ABSTRACT: We verified whether oxidative stress indices (oxidized low-density lipoproteins and malondialdehyde) and inflammatory biomarkers (circulating C-reactive protein, interleukin-6, tumour necrosis factor-α, serum amyloid A and soluble intercellular vascular cell adhesion molecule) are increased in the umbilical vein of placental insufficiency induced intra-uterine growth restricted neonates.
The prospective cohort study, involving 3 tertiary care centers, consists of 200 consecutively recruited pregnant women carrying twins. We chose the twin pregnancy model because both fetuses share the same maternal environment, thereby avoiding potential confounding factors when comparing oxidative stress and inflammation biomarkers. We analysed only twin pairs with one with intra-uterine growth restriction (N=38) defined as fetal growth<10th percentile with abnormal Doppler of the umbilical artery. Blood samples were taken at birth from the umbilical vein. Intra-pair comparisons on the biomarkers were performed using the Student paired t-test.
We observed increased cord blood levels of oxidized low-density lipoproteins, (2.394 ± .412 vs 1.296 ± .204, p=.003) but not of malondialdehyde in growth restricted neonates when compared to their normal counterparts. Although indices of inflammation tended to be increased in cord blood from growth restricted newborns, the difference did not reach statistical significance.
In the twin model, intra-uterine growth restriction is associated with low-density lipoprotein oxidation without apparent dysregulation of inflammation biomarkers.
Increased oxidized low-density lipoproteins are observed in growth restricted twins compared to their co-twins with normal growth at birth.
European journal of obstetrics, gynecology, and reproductive biology 02/2011; 156(1):46-9. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the contingent use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery, and to validate the use of phosphorylated IGFBP-1 as a predictor of preterm delivery.
We recruited 71 women with a clinical diagnosis of preterm labour between 24 and 34 weeks, and tested for the presence of fFN and IGFBP-1 in the cervicovaginal secretions of all women immediately before CL measurement.
Among the 66 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 62 women with complete results, the mean gestational age at recruitment was 29.4 +/- 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively, and for a positive IGFBP-1, they were 17%, 93%, 20%, and 91%, respectively. A policy of contingent use of fFN (in which the test was assumed to be positive if CL < or = 15 mm, and fFN was only measured if the CL was between 16 and 30 mm) gave sensitivity, specificity, positive and negative predictive values of 80%, 61%, 17%, and 97%, respectively for delivery within two weeks. Using this contingent use protocol, only one third of women needed fFN screening after CL measurement.
In this study, IGFBP-1 screening did not predict preterm delivery and fFN screening provided the best predictive capacity. A policy of contingent use of testing for fFN after CL measurement, or contingent use of CL measurement after fFN screening (depending on available resources) is a promising approach to limit use of resources.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 04/2010; 32(4):307-12.
[show abstract][hide abstract] ABSTRACT: Breech presentation is a complication in 3% to 4% of singleton pregnancies at term. On the strength of a large study published in the early 2000s, the American College of Obstetricians and Gynecologists (ACOG) recommended Caesarean section be routinely performed in such cases. However, French gynaecologists continue to perform vaginal breech deliveries. Through various observational studies, they have shown that their management approach, although different from the one used in North America, is safe. In 2006, the ACOG declared that vaginal delivery of a breech presentation may be acceptable under specific circumstances. In this analysis, we compare North American and French practices and present a protocol of care for the management of term breech presentation based on French recommendations.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2010; 32(3):238-43.
[show abstract][hide abstract] ABSTRACT: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women.
In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions.
Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes.
Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.
American journal of obstetrics and gynecology 03/2010; 202(3):239.e1-239.e10. · 3.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare pain relief in postpartum women receiving analgesia administered by nurses with the relief achieved by use of self-administered medication (SAM).
This randomized trial included women in spontaneous or induced labour or admitted for elective Caesarean section (CS). Women were stratified according to the mode of delivery. In the standard group, nurses administered the medications. In the SAM group, women kept the medications at the bedside and recorded each dose. The women were asked to record their pain level with a validated scale before and one hour after the administration of analgesia. A global pain score was calculated using the mean of these scores, and the satisfaction of patients and nurses with the process was recorded.
We recruited 345 women for the study. Eleven women (3.15 %) were lost to follow-up. We analyzed data from 197 women in the vaginal delivery arm and 133 women in the CS arm. There was no difference between the global pain scores before and one hour after the administration of analgesia in each group, independent of the mode of delivery. Women who used SAM and had a vaginal delivery were significantly more likely to have used no medication (P = 0.02) or to have used acetaminophen (P = 0.008), and fewer of these women took naproxen (P = 0.05). No significant difference was seen in women who had CS. Narcotic use was similar in each group. Women who used SAM were more likely to indicate that they would choose this method again and recommend it to others. The level of satisfaction with SAM expressed by nurses did not change after the study.
Postpartum pain relief was similar for women who had standard administration of medication by nurses and those who had SAM. More women using SAM used either no medication or acetaminophen only, and more women using SAM were highly satisfied with their method of pain relief. Use of self-administered medication should be considered for every postpartum unit.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 01/2008; 29(12):975-81.
[show abstract][hide abstract] ABSTRACT: To investigate obstetricians perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians solutions for implementing these guidelines in practice.
This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups.
The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients motivations.
Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.
Bulletin of the World Health Organisation 11/2007; 85(10):791-7. · 5.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: The paper gives an illustration and reminder of the risk of problems with placentation resulting from IVF and embryo transfer. Reported here is one neonatal death related to vasa praevia when the condition was not diagnosed antenatally and a neonatal survival when vasa praevia was detected antenatally. A search of the English literature was performed using PubMed for 'vasa praevia and in vitro fertilization'. There were four articles that directly addressed this relationship. Case reports of IVF-embryo transfer pregnancies with vasa praevia and also studies that look at the incidence of vasa praevia in such pregnancies are included in this report. Hence, since vasa praevia is thought to be caused by a disturbed orientation of the blastocyst at implantation, it is probably related to the IVF-embryo transfer procedure. Screening of all IVF-embryo transfer pregnancies with transvaginal sonography and colour Doppler to rule out vasa praevia is recommended in the second trimester.
[show abstract][hide abstract] ABSTRACT: To study the effect of sublingual nitroglycerine as a tocolytic on the success rate of external cephalic version (ECV) in nulliparous and parous women.
A retrospective case-controlled study of all ECV cases from February 1996 to February 2000 in a single centre. The rates of successful ECV were compared between women who had their ECV before February 1998 (control group), those who had their ECV after February 1998 and received 0.8 mg sublingual nitroglycerine spray as a tocolytic agent, and those who had their ECV after February 1998 and received no tocolytic agents. Nulliparous and parous women were studied separately. Data were collected for parity, gestational age, maternal age, placental localization, and side effects. Chi-square and Kruskal-Wallis tests were performed for statistical comparison.
Of 150 women who had their ECV after February 1998, 120 (80%) received sublingual nitroglycerine (group 1: cases using 0.8 mg sublingual nitroglycerine spray as a tocolytic agent) and were compared to the 30 patients who did not receive sublingual nitroglycerine or other tocolytics after February 1998 (group 2) and to 137 patients who had their ECV before February 1998 (control group). Of the women who received sublingual nitroglycerine, 5 (4%) had hypotension and 7 (6%) had headaches and/or nausea. The rate of successful ECV was 27% in group 1 versus 30% in group 2 (p = 0.86) versus 28% in the control group (p = 0.88) for nulliparous patients, and 67% versus 80% (p = 0.30) versus 51% (p = 0.09) respectively for parous women. However, the success rate was increased overall in parous women after the introduction of nitroglycerine as a tocolytic for ECV in February 1998 (71% vs. 51%, p = 0.02).
Although the success rate of ECV has increased in recent years, the use of sublingual nitroglycerine as a tocolytic was not associated with this higher success rate. A randomized, controlled trial is needed.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 04/2003; 25(3):203-7.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate chorionicity and zygosity as risk factors for adverse perinatal outcomes in twins.
A population-based, retrospective cohort study was conducted of all twin deliveries in Nova Scotia, Canada, from 1988 to 1997. Chorionicity was established by histologic examination. Zygosity was determined by chorionicity, sex, and infant blood group. Three groups were established: monochorionic/monozygotic twins, dichorionic/dizygotic twins, and dichorionic/majority monozygotic twins.
Outcomes from 1008 twin pregnancies were analyzed. Monochorionic/monozygotic twins had lower mean birth weights compared with dichorionic/dizygotic twins. Rates of perinatal mortality of at least 1 twin were significantly higher among monochorionic/monozygotic twins relative to dichorionic/dizygotic twins (relative risk, 2.5; 95% CI, 1.1-2.5). Dichorionic/majority monozygotic twins had similar perinatal outcomes compared with dichorionic/dizygotic twins.
Monochorionicity increases the risk of adverse perinatal outcome, whereas the effect of zygosity is less clear. Because chorionicity can be determined by prenatal ultrasound scanning, this information should be considered in the prenatal care of twin pregnancies.
American Journal of Obstetrics and Gynecology 04/2002; 186(3):579-83. · 3.88 Impact Factor