Victoria M Allen

University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada

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Publications (94)123.5 Total impact

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    ABSTRACT: Objective: To review the evidence and provide recommendations on the general management of a pregnant woman exposed to or infected with Ebola virus disease (EVD). Outcomes: Outcomes evaluated include general principles of approach and specific aspects of management of EVD relevant to pregnancy. Evidence: Published literature was retrieved through searches of Medline, EMBASE, and CINAHL in October 2014 using appropriate controlled vocabulary and key words (Ebola and pregnancy; hemorrhagic fever and pregnancy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English. Searches were updated and incorporated in the guideline to November 7, 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty societies. Values: The quality of evidence in this document was rated using the criteria described in Report of the Canadian Task Force on Preventive Health Care (Table 1). Conclusion: Individuals incubating EVD but who do not yet have symptoms are not infectious. The chance of a pregnant woman presenting with EVD in Canada is minimal, as are the chances of her infecting others if reasonable precautions are in place. Evidence of maternal-fetal transmission is limited and anecdotal.
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    ABSTRACT: To conduct a population-based study to assess rates of optimal, suboptimal, and questionably appropriate administration of antenatal corticosteroid (betamethasone or dexamethasone) use. All live births in Nova Scotia, Canada, from 1988 to 2012 were included in the study. Temporal trends in optimal (proportion of live births at 24-34 weeks of gestation exposed to antenatal corticosteroids between 24 hours and 7 days before delivery), suboptimal (proportion of live births at 24-34 weeks of gestation exposed to antenatal corticosteroids less than 24 hours or more than 7 days before delivery), and questionably appropriate exposure to antenatal corticosteroids (proportion of live births 35 weeks of gestation or greater exposed to antenatal corticosteroids) were quantified using odds ratios (ORs) and 95% confidence intervals (CIs). Among 246,459 live births between 1988 and 2012, 2.5% received a partial or a full course of antenatal corticosteroids. The rate of antenatal corticosteroid exposure for neonates born between 28 and 32 weeks of gestation increased from 39.5% in 1988-1992 to 79.3% in 2008-2012, whereas exposure for those born at 33-34 weeks of gestation increased from 14.3 to 49.7%. Optimal antenatal corticosteroid receipt increased from 10% in 1988 to 23% in 2012 (OR 2.7, 95% CI 1.6-4.5), suboptimal administration increased from 7 to 34% (OR 6.7, 95% CI 3.9-11.6), and questionably appropriate administration increased from 0.2% in 1988 to 1.7% in 2012 (OR 7.5, 95% CI 4.9-11.3). Of the women who received antenatal corticosteroids in 2012, 52% delivered at 35 weeks of gestation or greater. Temporal increases in optimal exposure to antenatal corticosteroids have been matched by increases in suboptimal and questionably appropriate receipt of antenatal corticosteroids, highlighting the need for accurate preterm delivery prognostic models. LEVEL OF EVIDENCE:: II.
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    ABSTRACT: Cesarean delivery is a common surgical procedure with anticipated substantial postoperative pain. The addition of a transversus abdominis plane block (TAPB) to a multimodal analgesic regimen that includes intrathecal morphine may provide improved early pain outcomes and decrease the risk of chronic post-surgical pain. The purpose of this research was to assess the ability of an ultrasound-guided TAPB with low-dose ropivacaine to decrease early postoperative pain, opioid consumption, and risk of developing persistent pain when compared with a placebo block. Eighty-three women were randomly assigned to either a treatment (0.25% ropivacaine) or control group (0.9% saline) in this double-blind trial, and 74 women were included in the final analysis. Ultrasound-guided TAPBs were performed with an injection of 20 mL of study solution per side. The primary outcome measures of this study were: pain at rest and pain after movement measured with a numeric rating scale, results of the Quality of Recovery-40 (QoR-40) questionnaire, and opioid consumption at 24 hr. These were used with an a priori sample size calculation to detect a 30% reduction in pain scores, a 10% improvement in QoR-40 score, and a 50% reduction in opioid consumption. Health quality and physical functioning were assessed using the Short Form 36 (SF-36®) Health Survey at 30 days and six months. Assessment at 24 hr after Cesarean delivery revealed no clinically important differences between groups in postoperative pain, QoR-40, or opioid consumption. There were no clinically important differences between groups regarding measures of nausea, pruritus, vomiting, urine retention (2, 24, and 48 hr postoperatively), 24-hr QoR-40 sub-dimensions, or the SF-36 Health Survey (30 days and six months postoperatively). Ultrasound-guided TAPB did not improve postoperative pain, quality of recovery, or opioid consumption 24 hr following surgery. Similar health and functioning (SF-36) at 30 days and six months were reported by both groups. This trial was registered at ClinicalTrials.gov number: NCT01261637.
    Canadian Anaesthetists? Society Journal 04/2014; 61(7). DOI:10.1007/s12630-014-0162-5 · 2.31 Impact Factor
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    ABSTRACT: The birth prevalence of cerebral palsy varies over time among very preterm infants, and the reasons are poorly understood.
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    ABSTRACT: The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.
    BMC Pregnancy and Childbirth 03/2014; 14(1):117. DOI:10.1186/1471-2393-14-117 · 2.15 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Abstract Background: Physicians are required to maintain and sustain professional roles during their careers, making the Professional Role an important component of postgraduate education. Despite this, this role remains difficult to define, teach and assess. Objective: To (a) understand what program directors felt were key elements of the CanMEDS Professional Role and (b) identify the teaching and assessment methods they used. Methods: A two-step sequential mixed method design using a survey and semi-structured interviews with Canadian program directors. Results: Forty-six program directors (48% response rate) completed the questionnaire and 10 participated in interviews. Participants rated integrity and honesty as the most important elements of the Role (96%) but most difficult to teach. There was a lack of congruence between elements perceived to be most important and most frequently taught. Role modeling was the most common way of informally teaching professionalism (98%). Assessments were most often through direct feedback from faculty (98%) and feedback from other health professionals and residents (61%). Portfolios (24%) were the least used form of assessment, but they allowed residents to reflect and stimulated self-assessment. Conclusion: Program directors believe elements of the Role are difficult to teach and assess. Providing faculty with skills for teaching/assessing the Role and evaluating effectiveness in changing attitudes/behaviors should be a priority in postgraduate programs.
    Medical Teacher 03/2014; DOI:10.3109/0142159X.2014.890281 · 2.05 Impact Factor
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    ABSTRACT: To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.
    BMC Pregnancy and Childbirth 03/2014; 14(1):96. DOI:10.1186/1471-2393-14-96 · 2.15 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Purpose: To evaluate the impact of a parent-directed instructional pamphlet about managing pain during infant vaccinations.Design and Sample: New mothers hospitalized following birth of an infant at two hospitals participated in a "before-and-after" study. In the "after" phase, the pamphlet was passively inserted in discharge packages at the intervention hospital.Main Outcomes: Maternal knowledge and self-reported use of pain-management interventions during routine infant two-month vaccinations.Results: Altogether, 354 mothers participated. A two-way (site, phase) ANOVA revealed no interaction (site 3 phase) in knowledge or use of pain-management strategies after routine two-month infant vaccinations; hence, there was no evidence of a benefit provided by the pamphlet. However, within the intervention site, only 21 percent of mothers read the pamphlet. Reading the pamphlet was associated with higher knowledge. This suggests some possible benefits of the pamphlet, provided that mothers read it.
    Neonatal network: NN 03/2014; 33(2):74-82. DOI:10.1891/0730-0832.33.2.74
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    ABSTRACT: Background: Intrauterine devices provide an extremely effective, long-term form of contraception that has the benefit of being reversible. Historically, the use of certain intrauterine devices was associated with increased risk of pelvic inflammatory disease. More recent evidence suggests that newer devices do not carry the same threat; however, certain risk factors can increase the possibility of infection. Objectives: To review the risk of infection with the insertion of intrauterine devices and recommend strategies to prevent infection. Outcomes: The outcomes considered were the risk of pelvic inflammatory disease, the impact of screening for bacterial vaginosis and sexually transmitted infections including chlamydia and gonorrhea; and the role of prophylactic antibiotics. Evidence: Published literature was retrieved through searches of PubMed, Embase, and The Cochrane Library on July 21, 2011, using appropriate controlled vocabulary (e.g., intrauterine devices, pelvic inflammatory disease) and key words (e.g., adnexitis, endometritis, IUD). An etiological filter was applied in PubMed. The search was limited to the years 2000 forward. There were no language restrictions. Grey (unpublished) literature was identified through searching the web sites of national and international medical specialty societies. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table). Recommendations 1. All women requesting an intrauterine device should be counselled about the small increased risk of pelvic inflammatory disease in the first 20 days after insertion. (II-2A) 2. All women requesting an intrauterine device should be screened by both history and physical examination for their risk of sexually transmitted infection. Women at increased risk should be tested prior to or at the time of insertion; however, it is not necessary to delay insertion until results are returned. (II-2B) 3. Not enough current evidence is available to support routine screening for bacterial vaginosis at the time of insertion of an intrauterine device in asymptomatic women. (II-2C) 4. Routine use of prophylactic antibiotics is not recommended prior to intrauterine device insertion, although it may be used in certain high-risk situations. (I-C) 5. Standard practice includes cleansing the cervix and sterilizing any instruments that will be used prior to and during insertion of an intrauterine device. (III-C) 6. In treating mild to moderate pelvic inflammatory disease, it is not necessary to remove the intrauterine device during treatment unless the patient requests removal or there is no clinical improvement after 72 hours of appropriate antibiotic treatment. In cases of severe pelvic inflammatory disease, consideration can be given to removing the intrauterine device after an appropriate antibiotic regimen has been started. (I-B) 7. An intrauterine device is a safe, effective option for contraception in an HIV-positive woman. (I-B) 8. An intrauterine device can be considered a first-line contraceptive agent in adolescents. (I-A).
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2014; 36(3):266-74.
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    ABSTRACT: Animal studies and epidemiological evidence suggest an association between prenatal exposure to drinking water with elevated nitrate (NO3-N) concentrations and incidence of congenital anomalies. This study used Geographic Information Systems (GIS) to derive individual-level prenatal drinking-water nitrate exposure estimates from measured nitrate concentrations from 140 temporally monitored private wells and 6 municipal water supplies. Cases of major congenital anomalies in Kings County, Nova Scotia, Canada, between 1988 and 2006 were selected from province-wide population-based perinatal surveillance databases and matched to controls from the same databases. Unconditional multivariable logistic regression was performed to test for an association between drinking-water nitrate exposure and congenital anomalies after adjusting for clinically relevant risk factors. Employing all nitrate data there was a trend toward increased risk of congenital anomalies for increased nitrate exposure levels though this was not statistically significant. After stratification of the data by conception before or after folic acid supplementation, an increased risk of congenital anomalies for nitrate exposure of 1.5-5.56 mg/L (2.44; 1.05-5.66) and a trend toward increased risk for >5.56 mg/L (2.25; 0.92-5.52) was found. Though the study is likely underpowered, these results suggest that drinking-water nitrate exposure may contribute to increased risk of congenital anomalies at levels below the current Canadian maximum allowable concentration.
    International Journal of Environmental Research and Public Health 02/2014; 11(2):1803-23. DOI:10.3390/ijerph110201803 · 1.99 Impact Factor
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    ABSTRACT: As pregnant women are considered a high-risk group for severe influenza illness, current recommendations advise vaccination of all pregnant women with inactivated influenza vaccine. Nevertheless, rates of maternal influenza vaccination have historically been low, possibly reflecting ongoing concerns about vaccine safety. Until recently, the majority of evidence concerning safety of influenza vaccination during pregnancy was limited to post-marketing pharmacovigilance studies; however, in the past 5 years, one randomized clinical trial and a number of observational studies reflecting seasonal trivalent inactivated influenza vaccines and monovalent H1N1 influenza vaccines have been published. This review summarizes the evidence pertaining to fetal and neonatal outcomes following influenza vaccination during pregnancy for comparative analytic studies published between 2008 and August 2013. Since the majority of these studies are observational in nature, issues related to study quality are also addressed.
    Expert Review of Vaccines 12/2013; 12(12):1417-30. DOI:10.1586/14760584.2013.851607 · 4.22 Impact Factor
  • Victoria M Allen, Heather M Scott, Thomas F Baskett
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 12/2012; 34(12):1132-3.
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    ABSTRACT: Objective: Millennium Development Goal 5A, to decrease the maternal mortality ratio by three quarters between from 1990 to 2015, is proving difficult to achieve in many developing countries, including those in Mesoamerica. In this preliminary report from Belize we describe the major steps taken recently to improve maternal outcomes, leading to the achievement of Millennium Development Goal 5A in 2011, confounding all predictions. Methods: In mid-2007, Belize deployed the world's first integrated countrywide health information system (BHIS), with eight embedded prevention/management domains. These included one centred on maternal health and covering best practices in prenatal, intrapartum, and postpartum care. The Ministry of Health and local maternal health care leaders used ongoing BHIS maternal data aggressively to detect health care system problems and to intervene to change outcomes. The maternal mortality ratios per 100 000 live births for 2005 to 2011 (i.e., from two years before BHIS deployment to four years after) were calculated from death and live birth data using Belize vital statistics. Results: The maternal mortality ratio fell from 134.1 in 2005 to zero in 2011, with the major sustained drop occurring from 2008 onwards, coincident with implementation of the BHIS. The annual number of live births did not change over this time. Conclusion: Exceeding all expectations, Belize achieved Millennium Development Goal 5A in 2011, with a reduction in the maternal mortality ratio of well over three quarters. The drop in maternal mortality ratio was temporally associated with the introduction of the BHIS and its embedded maternal health domain. BHIS data were used aggressively to monitor and continuously improve maternal health care.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 10/2012; 34(10):913-6.
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    ABSTRACT: Objective: To determine whether neonatal outcomes differ between women vaccinated during pregnancy and those not vaccinated. Methods: Self-reported history of receipt of influenza vaccination during pregnancy was collected from women at the time of admission for obstetrical delivery at the IWK Health Centre in Halifax, Nova Scotia, beginning in April 2006. The cohort for this study included women who delivered a singleton infant prior to November 2009, reflecting the pre-pandemic H1N1 vaccination period. Neonatal outcomes were compared using logistic regression between vaccinated and non-vaccinated women. Results: Overall, 1957 of 9781 women (20%) included in the cohort received influenza vaccine during their pregnancy. The adjusted odds ratio and 95% confidence interval for a small for gestational age infant (lowest 10th percentile birth weight for gestational age and sex) was 0.80 (95% CI 0.65 to 0.95) for vaccinated women relative to non-vaccinated women. The adjusted odds ratio for a low birth weight infant was 0.74 (95% CI 0.58 to 0.95). Rates of preterm birth and a composite indicator of adverse neonatal outcomes were lower among vaccinated women, but were not statistically significant. The effects of maternal vaccination on neonatal outcomes did not differ between high- and low-risk women. Conclusion: As evidence continues to mount in support of improved neonatal outcomes associated with receiving influenza vaccination during pregnancy, enhanced public health measures are necessary to encourage pregnant women to receive the influenza vaccine.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 08/2012; 34(8):714-20.
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    ABSTRACT: Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease. To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD. Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital. Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.
    Chronic Diseases and Injuries in Canada 06/2012; 32(3):113-20. · 1.22 Impact Factor
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    ABSTRACT: To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. The outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization. Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to < 100 000 CFU/mL, and high (significant) colony counts refer to ≥ 100 000 CFU/mL. Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to February 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table). The recommendations in this guideline are designed to help clinicians identify pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided. 1. Treatment of any bacteriuria with colony counts ≥ 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. (II-2A) 2. Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease. (II-2A) 3. Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth. (II-2E) 4. Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. (II-2D).
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 05/2012; 34(5):482-6.
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    ABSTRACT: To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity. This population-based cohort study used data from the Nova Scotia Atlee Perinatal Database to evaluate the effect of post-term induction of labour on stillbirth and neonatal mortality and severe neonatal morbidity in low-risk pregnancies. The study population included all pregnant women ≥ 40 weeks' gestation delivering in Nova Scotia from 1988 to 2008 who underwent induction of labour with a single fetus in cephalic presentation. Major congenital anomalies and pre-existing or severe gestational hypertension and diabetes were excluded. Women delivering post-term from 1994 to 2008 (after the Post-term Pregnancy Trial) were compared with women delivering from 1988 to 1992 to evaluate outcomes with changing maternal characteristics and obstetric practice patterns. Evaluation and comparison of time epochs (1988 to 1992, 1994 to 1998, 1999 to 2003, and 2004 to 2008) demonstrated an increased risk for perinatal mortality or severe neonatal morbidity, especially low five-minute Apgar score, among both nulliparous and multiparous women. There were no significant differences in the risks for stillbirth or perinatal mortality over time. Comparable relationships were demonstrated in a subgroup of lower risk women. The increase in post-term induction of labour with time is associated with a significant increase in severe neonatal morbidity, especially among infants born to multiparous women. Evaluation of the antepartum and intrapartum management of these low-risk pregnancies may provide additional information to reduce morbidity.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 04/2012; 34(4):330-40.
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    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 10/2011; 33(10):1044-6.
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    ABSTRACT: The purpose of this study was to determine whether maternal hospitalization for a respiratory-related condition during influenza season results in an increased risk of neonatal morbidity. With the use of a 13-year population-based cohort study of all singleton live births in Nova Scotia (1990-2002), neonatal outcomes were compared between women with and without hospital admission for respiratory illness during influenza season at any time in pregnancy. Logistic regression analyses were performed to examine infant outcomes and to estimate relative risks and 95% confidence intervals. Infants who were born to mothers who had been hospitalized for respiratory illness during influenza season at any time during pregnancy were more likely to be small for gestational age (15.3% vs 9.7%; adjusted relative risk, 1.66; 95% confidence interval, 1.11-2.49) and to have lower mean birthweight (3348.5 ± 498.2 g vs 3531.3 ± 504.1 g; β score, -86.67; P < .009) than were infants who were born to women without an influenza-season respiratory hospitalization during pregnancy. Our findings in a cohort of singleton infants who were born in a high-resource setting support the findings that were described in Bangladesh that demonstrated an increased number of small-for-gestational-age infants and a lower mean birthweight among babies who were born to mothers who were not protected by influenza vaccine.
    American journal of obstetrics and gynecology 06/2011; 204(6 Suppl 1):S54-7. DOI:10.1016/j.ajog.2011.04.031 · 3.97 Impact Factor

Publication Stats

2k Citations
123.50 Total Impact Points

Institutions

  • 2014
    • University of Prince Edward Island
      • Department of Health Management
      Charlottetown, Prince Edward Island, Canada
  • 2001–2014
    • Dalhousie University
      • Department of Obstetrics and Gynaecology
      Halifax, Nova Scotia, Canada
    • University of Toronto
      • Department of Obstetrics and Gynaecology
      Toronto, Ontario, Canada
    • Mount Sinai Hospital, Toronto
      • Department of Obstetrics and Gynecology
      Toronto, Ontario, Canada
  • 2009
    • Society of Obstetricians and Gynaecologists of Canada
      Montréal, Quebec, Canada
  • 2006–2009
    • IWK Health Centre
      Halifax, Nova Scotia, Canada