-
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 12/2012; 34(12):1132-3.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
ABSTRACT: BackgroundDifficult and failed tracheal intubation may be more common in the obstetrical population. The objective of this study was
to determine the incidence of difficult and failed tracheal intubation in a Canadian tertiary care obstetric hospital and
to identify predictors.
MethodsMaternal, perinatal, and anesthetic information on all pregnant women or recently pregnant (up to three days postpartum) women
undergoing general anesthesia (GA) from 1984 to 2003 at the Izaac Walton Killam Health Centre (IWK) was abstracted from the
Nova Scotia Atlee Perinatal Database, and the information was augmented by chart review. The incidence and predictors of difficult
and failed tracheal intubation were determined. Analyses using logistic regression were performed for the complete GA cohort
and for the subgroup that had Cesarean delivery under GA.
ResultsThere were 102,587 deliveries of ≥20weeks gestation in the study population, with 3,107 GAs identified, 2,986 records reviewed,
and 2,633 GAs (88%) retained in the complete cohort. Difficult tracheal intubation was encountered in 123 of 2,633 (4.7%)
women in the complete cohort and 60 of 1,052 (5.7%) women in the Cesarean delivery subgroup. Only two failed tracheal intubations
were identified (0.08%) in the complete cohort, and both occurred during GAs for postpartum tubal ligation. The combined rate
of difficult/failed tracheal intubation remained stable over the 20years reviewed despite decreasing GA rates. Amongst the
complete cohort, maternal age ≥35yr, weight at delivery 90 to 99kg, and absence of labour predicted increased risks; while
weight at delivery 90 to 99kg and absence of labour amongst the Cesarean delivery subgroup predicted difficult/failed tracheal
intubation.
ConclusionPreviously accepted risk factors, such as labour, pre-existing medical conditions and obstetrical disorders, did not predict
an increased risk of difficult tracheal intubation, while maternal age ≥35yr, weight 90 to 99kg, and absence of active labour
were found to predict increased risk.
ContexteUne intubation trachéale difficile et l’échec de celle-ci pourraient être plus courants chez la population obstétricale. L’objectif
de cette étude était de déterminer l’incidence d’intubations trachéales difficiles et échouées dans un hôpital d’obstétrique
tertiaire canadien et d’identifier des prédicteurs possibles.
MéthodeLes données maternelles, périnatales et anesthésiques sur toutes les femmes enceintes ou ayant récemment accouché (jusqu’à
trois jours post-partum) ayant subi une anesthésie générale (AG) entre 1984 et 2003 au Centre de santé Izaac Walton Killam
(IWK) ont été récoltées de la Banque de données périnatales Atlee de Nouvelle-Écosse (Nova Scotia Atlee Perinatal Database), et complétées par la consultation des dossiers des patientes. L’incidence et les prédicteurs d’intubation trachéale difficile
ou échouée ont été déterminés. Des analyses ont été réalisées à l’aide de la méthode de régression logistique pour la cohorte
d’AG dans son ensemble et pour le sous-groupe de patientes ayant accouché par césarienne sous AG.
RésultatsAu total, il y a eu 102587 accouchements à≥20 semaines de grossesse dans la population à l’étude, 3107 AG identifiées,
2986 dossiers passés en revue dont 2633 (88%) ont été retenus dans la cohorte complète. L’intubation trachéale a été difficile
chez 123 des 2633 (4,7%) femmes de la cohorte complète et 60 des 1052 (5,7%) femmes dans le sous-groupe accouchement par
césarienne. Seulement deux échecs d’intubation ont été identifiés (0,08%) dans la cohorte complète, et les deux cas sont
survenus lors d’AG pour des ligatures tubaires en post-partum. L’incidence combinée d’intubation trachéale difficile/échouée
est demeurée stable au cours des 20 années passées en revue, malgré la réduction du taux d’AG. Dans la cohorte complète, un
âge maternel≥35 ans, un poids à l’accouchement de 90 à 99kg et l’absence de travail obstétrical étaient des prédicteurs
de risque; en revanche, un poids à l’accouchement de 90 à 99kg et l’absence de travail obstétrical dans le sous-groupe accouchement
par césarienne prédisaient une intubation trachéale difficile/échouée.
ConclusionLes facteurs de risque précédemment acceptés, tels que le travail obstétrical, des conditions médicales préexistantes et les
troubles obstétricaux, n’ont pas prédit un risque accru d’intubation trachéale difficile, alors qu’il a été observé qu’un
âge maternel≥35 ans, un poids de 90 à 99kg et l’absence de travail obstétrical actif prédisaient un risque accru.
Canadian Journal of Anaesthesia 04/2012; 58(6):514-524. · 2.35 Impact Factor
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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. · 3.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Difficult and failed tracheal intubation may be more common in the obstetrical population. The objective of this study was to determine the incidence of difficult and failed tracheal intubation in a Canadian tertiary care obstetric hospital and to identify predictors.
Maternal, perinatal, and anesthetic information on all pregnant women or recently pregnant (up to three days postpartum) women undergoing general anesthesia (GA) from 1984 to 2003 at the Izaac Walton Killam Health Centre (IWK) was abstracted from the Nova Scotia Atlee Perinatal Database, and the information was augmented by chart review. The incidence and predictors of difficult and failed tracheal intubation were determined. Analyses using logistic regression were performed for the complete GA cohort and for the subgroup that had Cesarean delivery under GA.
There were 102,587 deliveries of ≥20 weeks gestation in the study population, with 3,107 GAs identified, 2,986 records reviewed, and 2,633 GAs (88%) retained in the complete cohort. Difficult tracheal intubation was encountered in 123 of 2,633 (4.7%) women in the complete cohort and 60 of 1,052 (5.7%) women in the Cesarean delivery subgroup. Only two failed tracheal intubations were identified (0.08%) in the complete cohort, and both occurred during GAs for postpartum tubal ligation. The combined rate of difficult/failed tracheal intubation remained stable over the 20 years reviewed despite decreasing GA rates. Amongst the complete cohort, maternal age ≥35 yr, weight at delivery 90 to 99 kg, and absence of labour predicted increased risks; while weight at delivery 90 to 99 kg and absence of labour amongst the Cesarean delivery subgroup predicted difficult/failed tracheal intubation.
Previously accepted risk factors, such as labour, pre-existing medical conditions and obstetrical disorders, did not predict an increased risk of difficult tracheal intubation, while maternal age ≥35 yr, weight 90 to 99 kg, and absence of active labour were found to predict increased risk.
Canadian Anaesthetists? Society Journal 04/2011; 58(6):514-24. · 2.31 Impact Factor
-
Laura A Magee,
Peter von Dadelszen, Victoria M Allen,
John M Ansermino,
François Audibert,
Jon Barrett,
Rollin Brant,
Emmanuel Bujold,
Joan M G Crane,
Nestor Demianczuk, [......],
Bruno Piedboeuf,
Graeme Smith,
Anne Synnes,
Mark Walker,
Wendy Whittle,
Stephen Wood,
Tang Lee,
Jing Li,
Beth Payne,
Robert M Liston
[show abstract]
[hide abstract]
ABSTRACT: The Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birth.
Women were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks' gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage. Data were collected by review of maternal and infant charts, entered directly into standardized electronic data forms and uploaded to the CPN via a secure network.
Between 2005 and 2009, the CPN enrolled 2524 women from 14 hospitals including those with preterm labour and contractions (27.4%), short cervix without contractions (16.3%), prolapsing membranes (9.4%), antepartum hemorrhage (26.1%), and preterm prelabour rupture of membranes (23.0%). The mean gestational age at enrolment was 25.9 ± 1.9 weeks and the mean gestation age at delivery was 29.9 ± 5.1 weeks; 57.0% delivered at < 29 weeks and 75.4% at < 34 weeks. Complication rates were high and included serious maternal complications (26.7%), stillbirth (8.2%), neonatal death (16.3%), neonatal intensive care unit admission (60.7%), and serious neonatal morbidity (35.0%).
This national dataset contains detailed information about women at risk of very preterm birth. It is available to clinicians and researchers who are working with one or more CPN collaborators and who are interested in studies relating processes of care to maternal or perinatal outcomes.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 02/2011; 33(2):111-20.
-
[show abstract]
[hide abstract]
ABSTRACT: The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 12/2010; 32(12):1140-6.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the need for increased doses of postpartum rhesus immune globulin in a woman at risk for rhesus alloimmunization.
Using data from the Nova Scotia Atlee Perinatal Database (NSAPD) and the Rh Program of Nova Scotia Database, Rh negative women delivering infants with a birth weight greater than 500 grams and gestational age greater than 20 weeks at the IWK Health Centre from 1998 to 2007 were identified. Within this population, Rh(D) negative women who received both antepartum and postpartum anti-D prophylaxis were identified. Logistic regression was used to estimate peripartum predictive factors for elevated postpartum Kleihauer and the need for administration of additional rhesus immune globulin.
The NSAPD and Rh Program Database identified 4323 Rh negative women who received both antepartum and postpartum prophylaxis from 1998 and 2007. Following logistic regression, a postpartum Kleihauer value of > 0.2% was found to be predicted by multiparity (OR 1.47; 95% CI 1.03 to 2.08), multiple gestation (OR 3.03; 95% CI 1.61 to 5.70), antepartum risks for fetomaternal hemorrhage (OR 63.6; 95% CI 30.2 to 134), and Caesarean section (OR 2.03; 95% CI 1.42 to 2.91). A postpartum Kleihauer value of > 0.5% was found to be predicted by antepartum risks for fetomaternal hemorrhage (OR 29.1; 95% CI 12.9 to 65.5), and Caesarean section (OR 2.01; 95% CI 1.18 to 3.42).
While there are recognized events that increase the risk for Rh(D) alloimmunization, multiparity, multiple gestation, and Caesarean section should be additional factors for consideration, especially with rising rates of CS. Adequate postpartum prophylaxis may be optimized by conducting routine screening for fetomaternal hemorrhage, especially when lower doses of Rh(D) immune globulin are administered.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 08/2010; 32(8):739-44.
-
[show abstract]
[hide abstract]
ABSTRACT: With a growing understanding of genetic disorders in the scientific and lay literature, it is becoming increasingly important to consider risk factors based on family history and ethnicity for identifying individuals for whom genetic testing is indicated and will be most beneficial. A pedigree helps to identify patients and families who have an increased risk for genetic disorders, to optimize counselling, screening, and diagnostic testing, with the goal of disease prevention or early diagnosis and management of the disease. Information should be updated periodically as new information regarding family history is acquired. This review was designed to provide a rationale for and an approach to obtaining a three-generation pedigree for patients who are seen as new assessments or those under ongoing care by primary care or specialist physicians, as well to summarize some resources available for constructing a useful pedigree.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 07/2010; 32(7):663-72.
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the contribution of select maternal groups to temporal trends in Caesarean section (CS) rates.
Using the Nova Scotia Atlee Perinatal Database, all deliveries by CS during the 24-year period from 1984 to 2007, at the Women's Hospital, IWK Health Centre were identified. Deliveries by CS were classified into groups using parity (nullipara/multipara), plurality (singleton/multiple), presentation (cephalic/breech/transverse), gestational age (term/preterm), history of previous CS (previous CS/no previous CS), and labour (spontaneous/induced/no labour). CS rates in each group and the contribution of each group to the overall CS rate was determined for three eight-year epochs. The risk of CS in each group over time, accounting for identified maternal, fetal, and obstetric practice factors, was evaluated using logistic regression.
Of 113,016 deliveries, 23,232 (20.6%) were identified as deliveries by CS meeting the inclusion and exclusion criteria. The CS rate rose from 16.8% in 1984 to 1991 to 26.8% in 2000 to 2007 (P < 0.001). The biggest contributors to the overall CS rate in the last study epoch (2000-2007) were nulliparous women with singleton, cephalic, term pregnancies with spontaneous or induced labour; women with singleton, cephalic, term pregnancies with previous CS; and women with breech presentation. Adjusted analyses explained some increases in the rate of CS and demonstrated reduced risks in others.
Only some temporally increased CS rates in select maternal groups remain increased after adjusting for confounding variables. The identification of potentially modifiable maternal risk factors, re-evaluation of the indications and techniques for induction of labour in nulliparous women, provision of clinical services for vaginal birth after Caesarean section, and external cephalic version for selected breech presentation are important clinical management areas to consider for safely lowering the Caesarean section rate.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 07/2010; 32(7):633-41.
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate maternal and neonatal outcomes in women with preterm prelabour rupture of membranes (PPROM) who delivered at 34+0 to 36+6 weeks' gestation, particularly in those who had an obstetrically indicated delivery.
We conducted a population-based study of late preterm singleton births complicated by PPROM, using data from the Nova Scotia Atlee Perinatal Database from 1988 to 2006. The study cohort was categorized by type of labour (spontaneous, induced, no labour), and each group's characteristics prior to delivery, and their outcomes were compared after accounting for potential confounding variables.
From a total population of 164 384 pregnancies, 2618 deliveries were identified as having PPROM. Among these, 2180 (83.3%) delivered between 34+0 and 36+6 weeks' gestation. Adjusted analyses showed no differences in risk between those women entering labour spontaneously (n = 1296) and those with obstetrically indicated delivery (labour induction or Caesarean section without labour, n = 698). Additional adjusted analyses evaluating only women with obstetrically indicated delivery showed that rates of chorioamnionitis (OR 0.27; 95% CI 0.08 to 0.93), composite perinatal morbidity/mortality (OR 0.39; 95% CI 0.25 to 0.62), neonatal depression at birth (OR 0.22; 95% CI 0.06 to 0.86), and respiratory distress syndrome (OR 0.17; 95% CI 0.06 to 0.47) were significantly lower in those delivering at 36 weeks (n = 458) than in those delivering at 34 to 35 weeks (n = 240).
This large population-based study suggests that in pregnancies complicated by PPROM rates of adverse maternal and perinatal outcomes at 36 weeks' gestational age are at least comparable to those in pregnancies delivering at 34 to 35 weeks, and these rates may be further reduced by delivery after 36 completed weeks if spontaneous labour has not occurred.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 06/2010; 32(6):555-60.
-
[show abstract]
[hide abstract]
ABSTRACT: Cervical cerclage may be indicated in specific clinical situations in an attempt to reduce the risk of preterm delivery. Preterm prelabour rupture of membranes (PPROM) occurs sometimes in the presence of a cerclage, and these pregnancies are at substantial risk of adverse maternal, fetal, and neonatal outcomes that may be attributed to complications associated with infectious morbidity and preterm birth. The benefits of retaining a cerclage in situ with ruptured membranes are unclear. This systematic review identified studies estimating maternal and perinatal morbidity and mortality associated with pregnancies with cerclage complicated by PPROM, in order to clarify the consequences of cerclage retention.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 05/2010; 32(5):448-52.
-
[show abstract]
[hide abstract]
ABSTRACT: The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada. Résumé Le Système canadien de surveillance périnatale a fourni une analyse exhaustive de la mortalité maternelle et de la morbidité maternelle grave au Canada, et a identifié plusieurs limites importantes en ce qui concerne les systèmes nationaux existants de collecte de données maternelles, y compris la variabilité pour ce qui est du détail et de la qualité des données sur la mortalité. Le rapport du Système canadien de surveillance périnatale a recommandé la mise sur pied d'un système national continu d'analyse et de signalement, ainsi que le maintien d'une uniformité dans les définitions et les classifications de la mortalité maternelle et de la morbidité maternelle grave, et ce, afin d'améliorer la surveillance de la mortalité maternelle et de la morbidité maternelle grave. En utilisant des articles et des études d'analyse ayant examiné la mortalité maternelle en général (par opposition avec la mortalité maternelle associée à des stratégies de prise en charge ou à des pathologies particulières), les classifications, la terminologie et les statistiques comparatives portant sur la morbidité grave et la mortalité maternelles ont été analysées et utilisées pour évaluer les lacunes des méthodes passées et actuelles de collecte de données et pour chercher des solutions visant à répondre au besoin d'établir un système national amélioré et uniforme de surveillance de la mortalité maternelle et de la morbidité maternelle grave au Canada.
J Obstet Gynaecol Can. 01/2010; 32(12):1140-1146.
-
[show abstract]
[hide abstract]
ABSTRACT: Domperidone is increasingly prescribed to improve breast milk volume despite a lack of evidence regarding its effects on breast milk composition. We examined the effect of domperidone on the nutrient composition of breast milk.
Forty-six mothers who had delivered infants at <31 weeks' gestation, who experienced lactation failure, were randomly assigned to receive domperidone or placebo for 14 days. Protein, energy, fat, carbohydrate, sodium, calcium, and phosphate levels in breast milk were measured on days 0, 4, 7, and 14, serum prolactin levels were measured on days 0, 4, and 14, and total milk volume was recorded daily. Mean within-subject changes in nutrients and milk volumes were examined.
Maternal and infant characteristics, serum prolactin level, and breast milk volume and composition were not significantly different between domperidone and placebo groups on day 0. By day 14, breast milk volumes increased by 267% in the domperidone-treated group and by 18.5% in the placebo group (P = .005). Serum prolactin increased by 97% in the domperidone group and by 17% in the placebo group (P = .07). Mean breast milk protein declined by 9.6% in the domperidone group and increased by 3.6% in the placebo group (P = .16). Changes in energy, fat, carbohydrate, sodium, and phosphate content were also not significantly different between groups. Significant increases were observed in breast milk carbohydrate (2.7% vs -2.7%; P = .05) and calcium (61.8% vs -4.4%; P = .001) in the domperidone versus placebo groups. No significant adverse events were observed among mothers or infants.
Domperidone increases the volume of breast milk of preterm mothers experiencing lactation failure, without substantially altering the nutrient composition.
PEDIATRICS 12/2009; 125(1):e107-14. · 4.47 Impact Factor
-
Alain Gagnon,
R Douglas Wilson, Victoria M Allen,
François Audibert,
Claire Blight,
Jo-Ann Brock,
Valerie A Désilets,
Jo-Ann Johnson,
Sylvie Langlois,
Lynn Murphy-Kaulbeck,
Philip Wyatt
[show abstract]
[hide abstract]
ABSTRACT: To provide information to genetic counsellors, midwives, nurses, and physicians who are involved in the prenatal care of women dealing with prenatally diagnosed isolated or multiple structural congenital anomalies.
To provide better counselling for women and families who are dealing with the diagnosis of a fetal structural anomaly.
Published literature was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library for relevant articles using appropriate controlled vocabulary (e.g., structural congenital anomalies, prenatal ultrasound diagnosis of congenital anomalies, invasive testing results, and diagnosis of genetic syndromes; soft markers of aneuploidy were not included in this search) and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and material from between 1985 and 2008 incorporated in the guideline. 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.
The evidence obtained was reviewed by the Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC). Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care.
Findings of isolated or multiple fetal anomalies on prenatal ultrasound examination always lead to stressful times for women and families. Although a proportion of such anomalies can be explained by chromosomal abnormalities (aneuploidy, unbalanced translocation, deletions, or duplications), others may represent recognizable syndromes with another genetic basis (microdeletion or autosomal dominant, recessive, or X-linked inheritance). Providing accurate information and relevant reproductive genetic counselling to these women and families will allow them to make informed decisions. This is not easily accomplished because of the limited information available prenatally. This document does not provide an extensive description of every syndrome but rather a framework of reference. No cost-benefit analysis is provided.
1. When a fetal structural anomaly is identified, the pregnant woman should be offered a timely consultation with a trained genetic counsellor and with a maternal-fetal medicine specialist and/or a medical geneticist. The counselling should be unbiased and respectful of the patient's choice, culture, religion, and beliefs. (III-A) 2. Patients should be informed that prenatal ultrasound at 18 to 20 weeks can detect major structural anomalies in approximately 60% of such cases. (II-2A) 3. When a fetal structural anomaly is suspected or identified, a referral to a tertiary ultrasound unit should be made as soon as possible to optimize therapeutic options. (II-2A) 4. In ongoing pregnancies with fetal structural anomalies, ultrasound examination should be repeated (at a frequency depending on the anomaly) to assess the evolution of the anomaly and attempt to detect other anomalies not previously identified, as this may influence the counselling as well as the obstetrical or perinatal management. (II-2B) 5. Once a fetal structural anomaly is identified by 2-D ultrasound, other imaging techniques such as fetal echocardiography, 3-D obstetrical ultrasound, ultrafast fetal MRI, and, occasionally, fetal X-ray and fetal CT scan (using a low-dose protocol) may be helpful in specific cases. (II-2A) 6. Parental imaging should be considered in specific cases, depending on the fetal anomaly identified (e.g., potential dominant inheritance). (III-A) 7. Parental blood testing and invasive prenatal testing may also be required to clarify the diagnosis for a fetus with isolated or multiple structural anomalies. (II-2A) 8. Women should receive information regarding the abnormal ultrasound findings in a clear, sympathetic, and timely fashion, and in a supportive environment that ensures privacy. Referral to the appropriate pediatric or surgical subspecialist(s) should be considered to provide the most accurate information possible concerning the anomaly or anomalies and the associated prognosis. (II-2 B) 9. Parents should be informed that major or minor fetal structural anomalies, whether isolated or multiple, may be part of a genetic syndrome, sequence, or association, despite a normal fetal karyotype. (III-A) 10. If early or urgent postnatal management may be required, delivery at a centre that can provide the appropriate neonatal care should be considered. (III-A) 11. When any congenital structural anomaly has been identified prenatally, a comprehensive newborn assessment is essential for diagnosis and counselling on the etiology, prognosis, and recurrence risk for future pregnancies, especially when the etiology has not been clearly identified prenatally. (III-A) 12. In cases of termination of pregnancy, stillbirth, or neonatal death, the health professional should encourage the performance of a complete autopsy by a perinatal or pediatric pathologist to provide maximum information on the diagnosis and etiology of the structural fetal anomaly or anomalies. When a complete autopsy is refused, the health professional should encourage the performance of at least a partial or external autopsy (including X-rays and photographs). (III-A) VALIDATION: This committee opinion has been prepared by the Genetics Committee of the SOGC and approved by the Executive of the SOGC.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 09/2009; 31(9):875-81, 882-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Arterial tortuosity syndrome is a rare, autosomal recessive, severe, connective tissue disorder caused by a mutation in the SLC2A10 gene. We describe the pregnancy and delivery with this high-risk connective tissue disorder involving generalized abnormalities of the vasculature.
A woman with an undefined connective tissue disorder was referred for tertiary prenatal care. Diagnostic imaging demonstrated multiple pulmonary artery aneurysms and arterial tortuosity, consistent with a clinical diagnosis of arterial tortuosity syndrome. With a team considering all potential complications, a delivery plan was undertaken involving cesarean delivery and intensive perioperative and postpartum monitoring. The outcome was optimal for mother and neonate. Concurrent molecular testing demonstrated homozygosity for the SLC2A10 gene.
Optimal maternal, fetal and neonatal outcomes were obtained with comprehensive multidisciplinary care and close maternal and fetal surveillance.
Obstetrics and Gynecology 09/2009; 114(2 Pt 2):494-8. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate maternal and perinatal outcomes among women with increasing duration of the second stage of labor.
A population-based cohort study was conducted among women with low-risk, singleton, vertex, nonanomalous deliveries at or after 37 weeks of gestation between 1988 and 2006. Individual maternal (hemorrhagic, infectious, and traumatic), perinatal (birth depression, infectious, and traumatic), and composite outcomes were evaluated with increasing duration of the second stage. Logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for all outcomes and to account for confounding variables, including maternal age, prelabor rupture of membranes, augmentation of labor, antibiotics in labor, regional analgesia, gestational age, birth weight, and year of birth. Effect modification caused by method of delivery was considered.
From a population of 193,823 women, 121,517 women met inclusion and exclusion criteria, of whom 63,404 (52%) were nulliparous. There was an increase in risk of maternal obstetric trauma, postpartum hemorrhage, puerperal febrile morbidity and composite maternal morbidity, and low 5-minute Apgar score, birth depression, admission to the neonatal intensive care unit, and composite perinatal morbidity among both nulliparous women and multiparous women, with increasing duration of the second stage of labor. Method of delivery only modified the effect of duration of second stage among nulliparous women.
Risks of both maternal and perinatal adverse outcomes rise with increased duration of the second stage, particularly for duration longer than 3 hours in nulliparous women and longer than 2 hours in multiparous women.
II.
Obstetrics and Gynecology 07/2009; 113(6):1248-58. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The goal of any skin closure technique is to produce appropriate skin approximation and adequate healing while minimizing pain, wound complications, cost, and scarring; the technique should be quick, cost-effective, and simple, while maximizing wound cosmesis and patient satisfaction. Although many studies have shown the superiority of staples for speed of closure, it is unclear if staples give a superior cosmetic result or reduce pain. Several randomized controlled trials have found that sutures are superior for cosmesis and that they decrease postoperative pain and are more cost-effective. There remains a paucity of data on wound infections and complications associated with closure technique. This review summarizes studies to date evaluating outcomes associated with wound closure using staples and sutures in repairing abdominal incisions and, in particular, assesses outcomes in the obstetric population with a Pfannenstiel incision.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 07/2009; 31(6):514-20.
