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Objective To investigate obstetricians' perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians' solutions for implementing these guidelines in practice. Methods This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. Findings The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals' motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients' motivations. Conclusion Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals' perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices. Resume Identification des elements empachant ou facilitant la mise en oeuvre des directives visant a reduire les taux d'accouchement par cesarienne au Quebec Objectifs Etudier la perception par les obstetriciens des directives en matiere de pratiques cliniques visant la prise en charge du travail et l'accouchement par les voies naturelles des femmes ayant anterieurement accouche par cesarienne et identifier les elements qui, dans la pratique, entravent ou facilitent la mise en ceuvre de solutions obstetricales conformes a ces directives. Methodes L'etude qualitative a ete menee dans trois hopitaux de Montreal representant environ 10 % des naissances au Quebec. On a procede a une collecte de donnees parmi 10 groupes thematiques, puis a 6 entretiens semi-structures. Deux chercheurs ont en commun analyse les transcriptions integrales de ces entretiens selon A manual for the use of focus groups. Resultats Les elements empechant ou facilitant la mise en oeuvre des directives qui ont ete identifies peuvent etre classes en trois categories : 1) niveau hospitalier (politiques de prise en charge et de l'etablissement notamment) ; 2) niveau du departement (politiques locales, facteurs lies a l'encadrement et a l'organisation, incitations economiques et disponibilites en equipements et en personnel notamment) ; 3) motivations et mentalites des professionnels de sante (preoccupations medico-legales, niveaux de competences, acceptation des directives et strategies utilisees pour appliquer les recommandations notamment) et 4) motivations des patientes. Conclusion L'identification des elements empechant ou facilitant l'adoption des directives est un moyen important pour guider le developpement de strategies efficaces. Les resultats de cette etude laissent a penser que cette adoption peut s'effectuer mieux si les perceptions des professionnels de la sante locaux sont prises en compte dans l'elaboration de recommandations plus acceptables et plus utiles. Nos resultats etayent aussi l'hypothese selon laquelle les obstetriciens cherchent a mettre en oeuvre les meilleures pratiques, mais ont besoin d'outils et d'aides reposant sur des elements factuels pour evaluer leurs pratiques et ameliorer leurs performances. En outre, le controle par des pairs des pratiques, preconise par des dirigeants politiques, a ete identifie par les obstetriciens comme la strategie la plus appropriee pour ameliorer l'application des directives dans leur activite. Resumen Identificacion de los factores que impiden o favorecen la aplicacion de protocolos orientados a reducir las tasas de cesarea en Quebec Objetivo Investigar las ideas de los obstetras acerca de los protocolos clinicos relativos al manejo del trabajo de parto y el parto vaginal tras una cesarea anterior, e identificar los factores que impiden o favorecen la aplicacion de esos protocolos en la practica y las soluciones de los obstetras a ese fin. Metodos Este estudio cualitativo se llevo a cabo en tres hospitales de Montreal que concentran alrededor del 10% de los nacimientos en Quebec. Se reunieron datos de 10 grupos de discusion, a lo que siguieron seis entrevistas semiestructuradas. Dos investigadores analizaron conjuntamente las transcripciones literales ateniendose a un manual de manejo de grupos de discusion. Resultados Los factores que impiden o favorecen la aplicacion de los protocolos pueden clasificarse en cuatro categorias: 1) el nivel hospitalario, en particular la gestion y las politicas hospitalarias; 2) el nivel departamental, con inclusion de las politicas locales, el liderazgo, los factores organizacionales, los incentivos economicos y la disponibilidad de equipo y personal; 3) las motivaciones y actitudes de los profesionales sanitarios, incluidos los problemas medico-legales, los niveles de aptitud, la aceptacion de las directrices y las estrategias usadas para poner en practica las recomendaciones, y 4) las motivaciones de las pacientes. Conclusion La identificacion de los factores que impiden o facilitan la adopcion de las recomendaciones ayuda a orientar la formulacion de estrategias eficaces. Los resultados de este estudio parecen indicar que, cuando se tienen en cuenta las impresiones de los profesionales sanitarios locales, es posible fomentar la adopcion de los protocolos. Nuestros resultados respaldan tambien la idea de que los obstetras procuran aplicar las practicas optimas, pero requieren datos probatorios y apoyo para evaluar su forma de trabajar y mejorar su desempeno. Ademas, dichos profesionales han identificado las actividades de examen por homologos preconizadas por personas de reconocida influencia como la estrategia mas apropiada para fomentar el uso de los protocolos en el ejercicio de su trabajo. [TEXT NOT REPRODUCIBLE IN ASCII], Background The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. (1) The caesarean delivery rate in Canada increased steadily from 17.5% [...]

OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. PATIENTS AND METHODS. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. RESULTS. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63.2% and 40.8%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69.1% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14.5 vs 3.7 days). CONCLUSIONS. Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine. Key Words selective serotonin reuptake inhibitors, venlafaxine, pregnancy, neonates, prematurity, SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) and venlafaxine are prescribed for pregnant women with depressive or anxiety disorders. (1-3) Several studies show that these treatments late in pregnancy have potential effects [...]

The measurement of the lower uterine segment (LUS) seems to be the best technique available to estimate the risk of uterine rupture, but there is a great heterogeneity in the techniques used. It appears necessary to standardize the interventions and their teaching prior to extending the use of the LUS measurement to clinical settings beyond well-defined research purposes.

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Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases., Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada., Evidence: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed., Values: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.