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Please cite this paper as: Sword W, Kurtz Landy C, Thabane L, Watt S, Krueger P, Farine D, Foster G. Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. BJOG 2011;118:966–977. Objective To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge. Design A prospective cohort study. Setting Eleven hospitals in Ontario, Canada. Sample A total of 2560 women ≥16 years of age who delivered singleton, live infants at term. Methods Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression. Main outcome measure Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression. Results Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73–10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46–6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99–4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19–2.80); urinary incontinence (OR 1.79; 95% CI 1.06–3.03); multiparity (OR 1.59; 95% CI 1.22–2.08); low mental health functioning (OR 1.20; 95% CI 1.15–1.25); low subjective social status (OR 1.16; 95% CI 1.02–1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03–1.22); low social support (OR 1.06; 95% CI 1.03–1.09); and low physical health functioning (OR 1.03; 95% CI 1.003–1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed. Conclusions Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.

Objective To review the evidence and provide recommendations for the counselling and management of obese parturients. Outcomes Outcomes evaluated include the impact of maternal obesity on the provision of antenatal and intrapartum care, maternal morbidity and mortality, and perinatal morbidity and mortality. Evidence Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to April 2009. 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. Values The evidence obtained was reviewed and evaluated by the Maternal Fetal Medicine and Clinical Practice Obstetric Committees of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs Implementation of the recommendations in this guideline should increase recognition of the issues clinicians need to be aware of when managing obese women in pregnancy, improve communication and consultation amongst the obstetrical care team, and encourage federal and provincial agencies to educate Canadians about the values of entering pregnancy with as healthy a weight as possible.

Objectives To describe the etiology of vasa previa and the risk factors and associated condition, to identify the various clinical presentations of vasa previa, to describe the ultrasound tools used in its diagnosis, and to describe the management of vasa previa. Outcomes Reduction of perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short-term and long-term maternal morbidity and mortality. Evidence Published literature on randomized trials prospective cohort studies, and selected retrospective cohort studies was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library, using appropriate controlled vocabulary (e.g., selected epidemiological studies comparing delivery by Caesarean section with vaginal delivery studies comparing outcomes when vasa previa is diagnosed antenatally vs. intrapartum) and key words (e.g. vasa previa). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated into the guideline to October 1, 2008. 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 from national and international medical specialty societies. Values The evidence collected was reviewed by the Diagnostic Imaging Committee and the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs The benefit expected from this guideline is facilitation of optimal and uniform care for pregnancies complicated by vasa previa. Sponsors The Society of Obstetricians and Gynaecologists of Canada.

Objectives: To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth.

The relationship between instantaneous changes in fetal head station and cervical dilatation within the individual contraction during the active stage of labor were studied and an index of labor progress was suggested. Cervix dilatation and fetal head station were measured continuously in 30 nullipara women (mean age 27.5, standard deviation 4.8). The continuous measurements enabled the analysis of each variable and the analysis of the relations between these two variables. The relationship between the head station and the cervical dilatation were demonstrated by plotting one against the other during a contraction. This led to the definition of a contraction vector that integrates the interaction between the two variables. The angle of this vector, that indicates this relation, was plotted against mean head station to demonstrate change along the delivery process regardless of time to normalize the progress and allow comparison between different women with different labor durations. This plot showed a sharp change from almost zero into a steep curve at about zero head station. A zero angle indicates that the cervix dilates during a contraction with little effect on head station while a steep angle indicates a significant effect of cervical dilatation on head station during the contraction. The contraction-vector angle reflects the changing intra-contraction relationship between head station and cervical dilatation. The angle of this vector may serve as an indicator of labor progress.

Objective This document summarizes the limited experience of SARS in pregnancy and suggests guidelines for management. Outcomes Cases reported from Asia suggest that maternal and fetal outcomes are worsened by SARS during pregnancy. Evidence Medline was searched for relevant articles published in English from 2000 to 2007. Case reports were reviewed and expert opinion sought. Values Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.

Purpose We evaluated the role of umbilical artery Doppler velocimetry in the surveillance of pregnancies complicated by systemic lupus erythematosus (SLE). Methods We retrospectively studied 56 women with SLE whose pregnancies were managed at our perinatal center between 1988 and 1995. Results Absent or reversed end-diastolic flow velocity was detected in 6 (11%) of 56 patients. This subgroup of patients had an increased risk of pre-eclampsia, intrauterine growth restriction, cesarean section, and preterm delivery. Conclusions A high incidence (11%) of abnormal umbilical artery waveforms was detected. This finding was associated with an increased risk of maternal and fetal complications. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:379–382, 1998.

Background: Induction of labor has become common practice in many Western countries, but few studies have assessed women's views. Methods: A randomized, controlled trial was conducted at 72 hospitals in six countries. Five thousand forty-one women meeting eligibility criteria, with no contraindications for induction of labor or expectant management, were randomly assigned to four groups: induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management followed by induction with either oxytocin or with prostaglandin E2 gel if complications developed. The three main outcome measures were evaluations of the treatment received, perceived control during childbirth, and evaluations of the experience of trial participation. Results: Questionnaires were completed by 81.9 percent of the sample. No significant differences occurred between the two induction groups. Compared with the expectant management groups, induced women were less likely to report there was nothing they liked about their treatment and less likely to report that the treatment caused additional worry. No between-group differences occurred in experienced control during childbirth. Women in the induction groups were more likely to be willing to participate in the study again and to feel reassured. Conclusions: Women's preferences should be considered when making decisions about their method of management when membranes rupture before labor. Obtaining participants' views is both feasible and worthwhile when evaluating forms of medical care. (BIRTH 24:4, December 1997)

Objective To provide clinician direction that is based on the best evidence available on suctioning at the perineum for infants born with meconium stained amniotic fluid. Evidence The Medline database was searched for articles published in English from 2000 to 2008 on the topic of management of meconium at birth. Values The recommendation was made according to guidelines developed by the Canadian Task Force on Preventive Health Care.

The accuracy of the diagnosis of placenta previa using transvaginal sonography (TVS) was compared to that of the traditional transabdominal sonography (TAS). Seventy seven women were scanned by both methods and each sonographic diagnosis was compared to the placental location at delivery. TVS was superior to TAS in diagnosing placenta previa and invariably correct in ruling it out. TVS (and TAS) failed to predict the placental location at delivery only in women diagnosed as having marginal placenta previa prior to 35 weeks gestation. The use of the vaginal probe significantly improved the accuracy of the diagnosis of placenta previa.

Ultrasonic and direct biometric measurements of nine fetal baboons were made during 23 evaluations. Both the femur length and the biparietal diameter were correlated to gestational age. These initial results have facilitated intrauterine surgery. The data presented will help in determining adequate fetal growth and in dating the baboon pregnancy.