Search

Affecting 2–4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.

Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in Canada, we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders.

Hypertensive disorders are the most common medical complication of pregnancy. As such, a large part of antenatal care is dedicated to the detection of pre-eclampsia, the most dangerous of the hypertensive disorders. The highlights of this chapter include progress in the use of out-of-office blood pressure measurement as an adjunct to office blood pressure measurement, pre-eclampsia defined as proteinuria or relevant end-organ dysfunction, antihypertensive therapy for severe and non-severe hypertension and post-partum follow-up to mitigate the increased cardiovascular risk associated with any of the hypertensive disorders of pregnancy.

In Sherbrooke, the gestational diabetes mellitus (GDM) Regional Committee proposed GDM screening during the first trimester for all pregnant women based on a 50 g glucose challenge test (50 g GCT) followed directly by capillary self-monitoring blood glucose (SMBG) at home. We evaluated implementation of committee's recommendations on the clinical trajectory of women receiving prenatal care at our institution. We analyzed data collected systematically by the Blood Sampling in Pregnancy clinic from 2008 to 2011. We evaluated the clinical trajectory of 7710 pregnant women to assess GDM screening/diagnoses and referral rates to the diabetes care centre (DCC) for education and treatment during both the first and second trimesters. The Canadian Diabetes Association glycemic treatment targets in women with GDM were used as diagnosis thresholds and DCC referral decisions: Fasting glucose of 5.3 mmol/L and postprandial 2 h glucose of 6.7 mmol/L. We found that pregnant women were 28.0±4.8 years old, and their body mass indexes were 24.5±5.5 kg/m2. During the first trimester, 47% of women were screened for GDM, mostly (84%) using the 50 g GCT. Following SMBG, 5.7% were referred to the DCC. Only 32% of women with early GDM had >1 GDM risk factor. Thereafter, 67% of normoglycemic women screened during the first trimester were screened again during the second trimester. Among women screened during the second trimester, most screening was done using 50 g GCT, and 8.8% were referred to the DCC following SMBG. Implementation of 50 g GCT testing followed by direct home SMBG was well implemented in our area. The importance of early GDM screening and rescreening during the second trimester still needs to be emphasized.

This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and published by Pregnancy Hypertension(http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext) to provide a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy.

Public health authorities have been alarmed by the progressive rise in rates of Caesarean section in Canada, approaching one birth in three in several provinces. We aimed therefore to consider what were preventable obstetrical interventions in women with a low-risk pregnancy and to propose an analytic framework for the reduction of the rate of CS.

A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study(MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects.

The aim of this study was to ascertain the contribution of perceived maternal stress and other components of a psychosocial profile to the occurrence of complications of pregnancy.

Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. We developed and validated the fullPIERS model with the aim of identifying the risk of fatal or life-threatening complications in women with pre-eclampsia within 48 h of hospital admission for the disorder.

Microalbuminuria measurement is now widely available, but its use during and after pregnancy has not been clearly defined. This review will present a brief overview of microalbuminuria measurement and screening outside pregnancy, and discuss the diagnosis of microalbuminuria in pregnancy, the potential role of microalbuminuria in pregnancy for prediction and diagnosis of pre-eclampsia and for post partum assessment of long-term cardiovascular diseases. Several methods have been used in pregnancy for measurement of microalbuminuria. Screening is best performed by urinary spot albumin/creatinine ratio and cut-off values in the non-pregnant population are reasonable to be used in the first trimester. The roles of microalbuminuria screening in pregnancy remain unclear and further research is needed on the use of spot albumin/creatinine ratio for prediction and diagnosis of pre-eclampsia. Finally, the significance of persistent microalbuminuria beyond 6 weeks postpartum is also unclear. Microalbuminuria may represent generalized vascular disease or underlying renal disease. More research is needed into the natural history of microalbuminuria following hypertensive pregnancy, and any independent contribution of microalbuminuria to the heightened cardiovascular risk in these women.

To assess features of sleep among pregnant women.

To study the platelet function response to low-dose ASA with the Platelet Function Analyzer (PFA-100) in pregnant women and to identify maternal characteristics associated with non-responsiveness.

Documenter les taux d’allaitement de la naissance à six mois ainsi que les facteurs facilitant et contraignant la poursuite de l’allaitement chez les femmes en Estrie (Québec). enquête par questionnaire postal auprès de 374 mères ayant allaité et analyse de données d’archives. Taux d’allaitement de 86,3% à la naissance et 75% à la sortie de l’hôpital auprès de toutes les mères ayant donné naissance à un enfant en 2004–2005. Chez les 272 mères ayant répondu au questionnaire, des taux d’allaitement de 67,3% et 47,4% respectivement à trois et six mois ont été enregistrés. Les résultats indiquent que 8,9% des enfants reçoivent exclusivement du lait maternel après le troisième mois. Au cours de la première semaine de vie de l’enfant, 27,9% des mères avaient cessé d’allaiter. Le soutien des infirmières est au premier rang des facteurs facilitant l’allaitement. Les principaux motifs évoqués par les mères pour mettre fin à leur allaitement sont des problèmes d’allaitement et la fatigue. Les taux d’allaitement en Estrie (Québec) ont augmenté significativement au cours des cinq dernières années et se comparent à ceux de l’ensemble du Canada. Toutefois, l’allaitement maternel exclusif jusqu’à six mois est une pratique rare et les mesures de soutien à l’allaitement à l’hôpital et dans la communauté donnent des résultats. To document breastfeeding rates from birth to six months as well as the factors facilitating and constraining the continuation of breastfeeding in women in the Eastern Townships of Quebec and to compare these to the results obtained in 1999. Postal questionnaire sent to 374 mothers who had breastfed and analysis of archival data. Breastfeeding rates were 86.3% at birth and 75% at discharge from hospital in all mothers who gave birth to a child in 2004–2005. Breastfeeding rates in the 272 mothers who answered the questionnaire were reported to be 67.3% and 47.4% at three and six months respectively. Results indicate that 8.9% of infants were still receiving breast milk exclusively after the third month. However, 27.9% of the mothers had stopped breastfeeding during the infant’s first week. Support from the nurses was the primary factor facilitating breastfeeding. The main reasons the mothers gave for stopping breastfeeding were problems with breastfeeding and fatigue. Breastfeeding rates in this area of Quebec have increased significantly in the past five years and are comparable with those in the rest of Canada. Breastfeeding exclusively up to six months is rare, and initiatives to support breastfeeding mothers in the hospital and in the community are having success.

To assess the efficacy of a screening tool to be used by nurses to determine which economically disadvantaged pregnant women are most likely to benefit from a dietitian’s intensive intervention.

Objectives: To determine the prevalence of preterm prelabour rupture of the membranes (PP ROM) at Canadian university-affiliated perinatal referral centres, to assess the different management strategies, and to review neonatal outcomes.

Objectives:(1) To evaluate whether clinical variables reflecting the multiorgan dysfunctions of preeclampsia can predict adverse maternal outcomes of preeclampsia; (2) to determine the usefulness of the mean platelet volume (MPV):platelet ratio as a novel measure of platelet consumption in predicting the severity of preeclampsia.

Objectives: (1) To assess the frequency of influenza and influenza-like illness (ILI) during pregnancy; (2) to explore the associated risk of adverse maternal and fetal outcomes.

Objectives: to measure the effect of 0.4mg of sublingual nitroglycerin spray on uterine activity in normal spontaneous or oxytocin-induced term labor and to evaluate the maternal and fetal side effects.

Objective To assess the performance of four previously reported Doppler abnormalities of uterine artery velocity waveforms (presence of a protodiastolic notch, peak systolic over protodiastolic velocities (A:C ratio) > 2.5, peak systolic over end diastolic velocities (A:B ratio) > 90th centile, resistance index (RI) ([A‐B]/A) ≥0.58) in predicting pre‐eclampsia, low birthweight and prematurity.

To determine if platelet angiotensin II binding density during the second or third trimester of pregnancy can be used as a marker for early detection of women who will develop preeclampsia.

To evaluate the effects of smoking cessation before or early in pregnancy on maternal airway function and birth weight.

Objective: to describe the current state of preterm birth in Canada and to ascertain the effectiveness of published preventive strategies.

Medical Technology Assessment (MTA) has become increasingly relevant to members of the medical community. This is due to both economic and social constraints. More and more physicians are either confronted by, or expected to participate in this activity. The objective of this review is to examine the relevance of MTA to the discipline of obstetrics and gynaecology, and to assess its potential implications for health care providers. Medical Technology Assessment seeks to improve the quality of care through the synthesis of the findings of health research. Thus, it is urgent to improve medical evaluative research directly linked to important decisions to be made in the health care system. It is suggested that every health care provider in obstetrics and gynaecology and the Society of Obstetricians and Gynaecologists of Canada participate in MTA activities which should lead to an increase in both professional autonomy and social credibility.

Teenage pregnancy in Guinea, West Africa, is exceedingly prevalent (10% of all maternity admissions). In a descriptive prospective study, the authors attempt to explain the socio-cultural factors associated with such a high rate. The median maternal age was 15 years while 34.0 percent were 12 to 13 years old. Half of these adolescents never attended school and 62 percent were already married before the legal age (17 years old). More than 85 percent were married without their parents’ consent. Tradition beliefs together with limited access to perinatal care explained the non-attendance for prenatal visits, late referral and diet restrictions. Potential solutions include better education for school-age girls, community awareness, medical involvement and political enforcement.

Le présent résumé directif présente un sommaire des données qui ont été évaluées dans le cadre de la directive clinique rédigée par le groupe de travail canadien sur les troubles hypertensifs de la grossesse et publiée dans Pregnancy Hypertension(http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext), en vue d’offrir une approche raisonnable envers le diagnostic, l’évaluation et la prise en charge des troubles hypertensifs de la grossesse.

Cord blood concentrations of insulin, growth hormone (GH), triiodothyronine (T3), thyroxine (T4), and thyroidstimulating hormone (TSH) from 20 patients treated with oral salbutamol were compared with those of 18 matched patients who had not received any betamimetic agents. No significant difference was found in circulating insulin, T3, T4, and TSH between both groups. However, GH levels were significantly higher in the treated group (36.5 ± 17.4 ng/mL) than in the control group (17.4 ± 6.6 ng/mL; P< .001). The unexpected increase in GH levels in the treated group could reflect either fluctuating fetal blood glucose in response to episodic betamimetic administration or direct fetal pituitary production through adrenergic stimulation.

To determine if microalbumin excretion can predict the development of premature delivery.

Nearly 10 of pregnant women have hypertension, which can increase both perinatal and maternal risk. While there have been several randomized controlled trials examining hypertension in pregnant women, they were not consistent enough to determine blood-pressure targets for pregnant women experiencing hypertension. Current guidelines are debated over treatment goals between less-tight control (blood pressure elevated but not threatening) and tight control. The Control of Hypertension in Pregnancy Study evaluated perinatal and maternal outcomes of nonsevere hypertension in pregnancy by comparing less-tight control and tight control.

Complications of pregnancy are usually attributed to biomedical risk factors. There is circumstantial evidence that some psychosocial factors also contribute to preterm birth, gestational hypertension or preeclampsia, intrauterine growth restriction, and other pregnancy-related complications.

Maternal deaths from preeclampsia primarily result in cases with eclampsia, uncontrolled hypertension, or progressing HELLP syndrome. Delivery is the only cure for preeclampsia. Management strategies involve determination of risk factors to predict which pregnancies are at high risk for adverse maternal outcomes. Previous attempts to develop risk assessment models that could identify potential predictive risk factors for adverse outcomes occurring at any time after admission with preeclampsia have been unsuccessful.

This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy (HD).