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The article presents study to identify maternal characteristics independently associated with pregnancies resulting in intrauterine fetal demise (IUFD). It mentions the cohort study of births taking place at the McGill University Health Centre in Montreal, Canada and comparison of maternal characteristics between pregnancies that resulted in IUFD and control pregnancies resulting in live newborns. It concludes lower levels of education and smoking during pregnancy are predictors of IUFD.

Objective: To examine the correlation between measurements of crown rump length (CRL), nuchal translucency (NT), and birth weight in dichorionic (DC) and monochorionic (MC) twin pregnancies. Methods: A retrospective analysis was performed on all twin term pregnancies delivered between 2001 and 2007 at the McGill University Health Center. Data collected included maternal age, CRL and NT measurement, results of glucose challenge test, birth weight and length, gestational age at delivery, and fetal gender. Results: The study population comprised 792 fetuses: 94 MC/DA and 698 DC/DA. Maternal age, gestational age at delivery, birth weight, and birth length were all significantly higher for the DC group. Male fetuses had significantly higher NT and higher birth weight than female fetuses. Discordance in CRL was found to correlate with discordance in birth weight in the entire study population (P<0.0001, R=0.25), in the DC twins (P<0.0001, R=0.275), but not in MC twins (R=0.10, P=0.33). CRL discordance above the 90th percentile (>12%) predicted 14/40 pregnancies with birth weight discordance above the 90th percentile (>24%) [P<0.001, LR=4.1 (2.6-6.2)]. CRL discordance above the 95th percentile (>16%) predicted 5/21 pregnancies with birth weight discordance above the 95th percentile (>30%) [P<0.001, LR=5.5 (2.6-10.4)]. NT discordance was correlated with CRL discordance (R=0.15, P<0.0001), but not with birth weight, regardless of chorionicity or gender. Conclusion: In twin pregnancies, CRL discordance in first trimester can predict discordance of more than 25% in neonatal birth weight. [ABSTRACT FROM AUTHOR]

Background: Pregnancy rhinitis manifests as nasal congestion, with resolution of symptoms after delivery. Eighteen to 30% of pregnant patients report symptoms of rhinitis. Pregnancy rhinitis may have an adverse effect on quality of life (QOL) and may cause obstructive sleep apnea (OSA), which in turn may adversely affect the outcome of pregnancy. Previous examinations of the prevalence of pregnancy rhinitis during different stages of pregnancy have been inconclusive. This study aimed to determine rhinosinusitis-specific QOL during different stages of pregnancy. Methods: A cross-sectional observation study of patients in the second and third trimesters of pregnancy using the 22-item Sino-Nasal Outcome Test (SNOT-22) was conducted in the obstetric clinic at McGill University Health Center in Montreal, Canada. Seventy-six low- risk pregnant patients were included in the study. Thirty-two patients were in the second trimester of pregnancy and 44 patients were in the third trimester. Results: Average item scores for the entire questionnaire were significantly higher (p = 0.041), indicating more severe impairment of QOL, in the third trimester in comparison with the second trimester. A comparison between women with and without preexisting allergic rhinitis, in both the second and the third trimesters, shows significantly higher SNOT-22 scores for the allergic group (p = 0.007). QOL was lower in the third trimester than in nonrhinosinusitis patients (p = 0.011). Conclusion: Rhinosinusitis-specific QOL is lower in the third trimester of pregnancy in comparison with the second trimester and also in comparison with nonrhinosinusitis patients. Increased awareness may enhance the QOL of pregnant patients, prevent OSA, and thereby positively influence the outcome of pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the risk of adverse pregnancy outcome among teenage mothers within a large tertiary referral center in Canada. Methods: All nulliparous singleton births in the McGill University Health Centre during 2001–2007 were retrieved using the "MOND" database. Patients were divided according to maternal age: <20 years (teenage), and between 20 and 39 years. Obstetric and neonatal complications were compared. Results: 9744 nulliparous women were included; 250 (2.6%) were teenage and 9494 (97.4%) were 20–39 years old. Teenage mothers tended to deliver earlier (38.0 vs 39.2 weeks gestation, P < 0.001) and had higher rates of extreme prematurity (OR 4.5, 95% CI 2.5–8.1). Babies of teenage mothers had lower birth weights (3014 g vs 3326 g, P < 0.001), higher rates of NICU admission (OR 2.1, 95% CI 1.5–3.0), congenital anomalies (OR 1.8, 95% CI 1.2–2.6) and combined perinatal and neonatal mortality (OR 3.8, 95% CI 1.9–7.5). Logistic regression analysis showed an association between young maternal age and the risk to have at least one adverse outcome (P < 0.001). Conclusions: Even within a large tertiary referral hospital, teenage mothers carry a greater risk of adverse pregnancy outcome, mainly due to preterm births. [Copyright &y& Elsevier]

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Objective: To review the existing data regarding varicella zoster virus infection (chickenpox) in pregnancy, interventions to reduce maternal complications and fetal infection, and antepartum and peripartum management ., Methods: The maternal and fetal outcomes in varicella zoster infection were reviewed, as well as the benefit of the different treatment modalities in altering maternal and fetal sequelae., Evidence: Medline was searched for articles and clinical guidelines published in English between January 1970 and November 2010., Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table)., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To assess whether prolonged second stage of labour influences the gestational age at the subsequent delivery., Methods: We performed a retrospective cohort study. Clinical information was retrieved from the McGill Obstetrical and Neonatal Database for the period of January 2001 to February 2008. We evaluated primiparous women with term singleton pregnancies who reached the second stage of labour. Women were divided into two groups, according to the duration of the second stage: delivery after more than three hours of full cervical dilatation, or delivery within three hours. The primary outcome measured was the incidence of spontaneous preterm births at the subsequent delivery., Results: Among 1818 women whose records were available for analysis, 416 women (22.9%) had a prolonged second stage of labour in their first delivery. Women with a prolonged second stage in their first delivery did not deliver prematurely more often in the successive delivery than those women whose second stage was not prolonged (rate of preterm birth 4.3% in the prolonged second stage group and 5.5% in the normal second stage group; P = 0.3)., Conclusion: In our population of primiparous women with a singleton term delivery, a prolonged second stage of labour lasting more than three hours was not associated with preterm birth at their subsequent delivery.

Objective: To review the existing data regarding varicella zoster virus infection (chickenpox) in pregnancy, interventions to reduce maternal complications and fetal infection, and antepartum and peripartum management., Methods: The maternal and fetal outcomes in varicella zoster infection were reviewed, as well as the benefit of the different treatment modalities in altering maternal and fetal sequelae., Evidence: Medline was searched for articles and clinical guidelines published in English between January 1970 and November 2010., Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table)., Recommendations: 1. Varicella immunization is recommended for all non-immune women as part of pre-pregnancy and postpartum care. (II-3B) 2. Varicella vaccination should not be administered in pregnancy. However, termination of pregnancy should not be advised because of inadvertent vaccination during pregnancy. (II-3D) 3. The antenatal varicella immunity status of all pregnant women should be documented by history of previous infection, varicella vaccination, or varicella zoster immunoglobulin G serology. (III-C) 4. All non-immune pregnant women should be informed of the risk of varicella infection to themselves and their fetuses. They should be instructed to seek medical help following any contact with a person who may have been contagious. (II-3B) 5. In the case of a possible exposure to varicella in a pregnant woman with unknown immune status, serum testing should be performed. If the serum results are negative or unavailable within 96 hours from exposure, varicella zoster immunoglobulin should be administered. (III-C) 6. Women who develop varicella infection in pregnancy need to be made aware of the potential adverse maternal and fetal sequelae, the risk of transmission to the fetus, and the options available for prenatal diagnosis. (II-3C) 7. Detailed ultrasound and appropriate follow-up is recommended for all women who develop varicella in pregnancy to screen for fetal consequences of infection. (III-B) 8. Women with significant (e.g., pneumonitis) varicella infection in pregnancy should be treated with oral antiviral agents (e.g., acyclovir 800 mg 5 times daily). In cases of progression to varicella pneumonitis, maternal admission to hospital should be seriously considered. Intravenous acyclovir can be considered for severe complications in pregnancy (oral forms have poor bioavailability). The dose is usually 10 to 15 mg/kg of BW or 500 mg/m² IV every 8 h for 5 to 10 days for varicella pneumonitis, and it should be started within 24 to 72 h of the onset of rash. (III-C) 9. Neonatal health care providers should be informed of peripartum varicella exposure in order to optimize early neonatal care with varicella zoster immunoglobulin and immunization. (III-C) Varicella zoster immunoglobulin should be administered to neonates whenever the onset of maternal disease is between 5 days before and 2 days after delivery. (III-C).

Question: One of my patients gave birth to a baby later diagnosed with HIV infection. I did not offer this patient HIV screening, as I thought she was at low risk. What are the recommendations for HIV testing and what might be the implications of not screening for HIV?, Answer: Although screening is currently recommended by all relevant authorities in Canada, more than 10% of women are not screened antenatally, increasing their babies' risk for infection. This rate represents a failure that is probably a combination of omission at times by clinicians, embarrassment about discussing the issue on the part of either the physician or the patient, and poor counseling. All Canadian women should receive appropriate antenatal counseling for HIV screening.