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Canada and maternal mortality

Joseph Ting, Ashley Roberts, Anne Synnes, Roderick Canning, Jaya Bodani, Luis Monterossa, Prakesh S Shah
BACKGROUND: Neonatal fungaemia is associated with adverse neonatal outcomes and higher overall healthcare expenditure. Our objective is to review the epidemiology of invasive fungal infections (IFIs) in neonates in Canada. METHODS: A retrospective cohort study using data collected by the Canadian Neonatal Network (CNN) was conducted. Using a nested matched cohort study design, risk factors and outcomes of neonates born <33 weeks gestation (n=39,305) during 2003-2013 were compared between neonates diagnosed with an IFI during their stay to infection-free controls...
March 15, 2018: Pediatric Infectious Disease Journal
Marie-Jocelyne Martel, Catherine Jane MacKinnon
OBJECTIVE: To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. OUTCOME: Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. EVIDENCE: MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam...
March 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Laura Schummers, Jennifer A Hutcheon, Michele R Hacker, Tyler J VanderWeele, Paige L Williams, Thomas A McElrath, Sonia Hernandez-Diaz
BACKGROUND: First deliveries in women older than 35, 40, or 45 are at increased risk for adverse pregnancy outcomes compared with those in younger women. However, specific relationships between each additional year of maternal age and pregnancy risks remain unclear, and absolute risks at each maternal age are not known. METHODS: Using a population-based cohort of nulliparous women in British Columbia, Canada, from 2004-2014 (n=203,414), We examined relationships between maternal age (modeled flexibly to allow curvilinear shapes) and pregnancy outcomes using logistic regression...
March 6, 2018: Epidemiology
Olina Dagher, Nassiba Alami Laroussi, Michel Carrier, Renzo Cecere, Eric Charbonneau, Simon de Denus, Nadia Giannetti, Line Leduc, Bernard Cantin, Asmaa Mansour, Nancy Poirier, Marie-Josée Raboisson, Michel White, Anique Ducharme
BACKGROUND: Despite reports of successful pregnancies in heart transplant (HTx) recipients, many centers recommend their patients against maternity. METHODS: We reviewed our provincial experience of pregnancy in HTx recipient by performing charts review of all known gestations following HTx in the province of Quebec (Canada), stratified between planned and unplanned pregnancies. Long-term survival was compared to HTx recipient women of childbearing age who didn't become pregnant...
February 26, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Yvonne M Cargill, Catherine Jane MacKinnon
OBJECTIVE: To provide guidelines for operative vaginal birth in the management of the second stage of labour. OPTIONS: Non-operative techniques, episiotomy, and Caesarean section are compared to operative vaginal birth. OUTCOME: Reduced fetal and maternal morbidity and mortality. EVIDENCE: MEDLINE and Cochrane databases were searched using the key words ''vacuum" and "birth" as well as "forceps" and "birth" for literature published in English from january 1970 to June 2004...
February 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Kenneth Lim, Kimberly Butt, Joan M Crane
OBJECTIVES: To review (1) the use of ultrasonographic-derived cervical length measurement in predicting preterm birth and (2) interventions associated with a short cervical length. OUTCOMES: Reduction in rates of prematurity and/or better identification of those at risk, as well as possible prevention of unnecessary interventions. EVIDENCE: Published literature was retrieved through searches of PubMed and The Cochrane Library up to December 2009, using appropriate controlled vocabulary and key words (preterm labour, ultrasound, cervix, incompetent cervix, transvaginal, transperineal, cervical length, fibronectin)...
February 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
M C Niederwerder, R A Hesse
Swine enteric coronaviruses, including porcine epidemic diarrhoea virus (PEDV) and porcine deltacoronavirus (PDCoV), have emerged and spread throughout the North American swine industry over the last four years. These diseases cause significant losses within the pork industry and within the first year after PEDV introduction, approximately 10% of the US herd died due to the disease. Similar to other enteric coronaviruses, such as transmissible gastroenteritis virus (TGEV), these emerging swine enteric coronavirus diseases (SECD) are age-dependent, with high morbidity and mortality in neonatal pigs...
February 2, 2018: Transboundary and Emerging Diseases
Orli Silverberg, Alison L Park, Eyal Cohen, Deshayne B Fell, Joel G Ray
Importance: Women with an infant with preterm birth (PTB) or who was severely small for gestational age (SGA) are at higher future risk of premature cardiovascular disease and related death. Objective: To determine the risk of cardiac disease or death among women with an infant with both PTB and SGA. Design, Setting, and Participants: This population-based cohort study used electronic health records from the province of Ontario, Canada, where health care is universally available, between April 1, 2002, and March 31, 2016...
January 31, 2018: JAMA Cardiology
Prakesh S Shah, Sarah D McDonald, Jon Barrett, Anne Synnes, Kate Robson, Jonathan Foster, Jean-Charles Pasquier, K S Joseph, Bruno Piedboeuf, Thierry Lacaze-Masmonteil, Karel O'Brien, Sandesh Shivananda, Nils Chaillet, Petros Pechlivanoglou
BACKGROUND: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems...
January 18, 2018: CMAJ Open
Nathalie Auger, Laura Arbour, Mireille E Schnitzer, Jessica Healy-Profitós, Geneviève Nadeau, William D Fraser
PURPOSE: To assess the pregnancy outcomes of women with spina bifida. MATERIALS AND METHODS: We analyzed a population-based cohort of 397 pregnant women with spina bifida and 1,083,211 without spina bifida who delivered infants in hospitals in Quebec, Canada, 1989-2013. Outcomes included maternal and infant morbidity and mortality at delivery. We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association of maternal spina bifida with pregnancy outcomes, accounting for maternal characteristics...
January 12, 2018: Disability and Rehabilitation
Amy Metcalfe, Yasser Sabr, Jennifer A Hutcheon, Lois Donovan, Janet Lyons, Jason Burrows, K S Joseph
Context: Multiple consensus statements decree that women with diabetes mellitus should have comparable birth outcomes to women without diabetes mellitus; however, there is a scarcity of contemporary population-based studies on this issue. Objective: To examine temporal trends in obstetric interventions and perinatal outcomes in a population-based cohort of women with type 1, type 2, or gestational diabetes mellitus compared with a control population. Design: Cross-sectional study...
December 1, 2017: Journal of the Endocrine Society
A Pels, L C Kenny, Z Alfirevic, P N Baker, Peter von Dadelszen, C Gluud, C T Kariya, B W Mol, A T Papageorghiou, A G van Wassenaer-Leemhuis, W Ganzevoort, K M Groom
BACKGROUND: Severe, early-onset fetal growth restriction due to placental insufficiency is associated with a high risk of perinatal mortality and morbidity with long-lasting sequelae. Placental insufficiency is the result of abnormal formation and function of the placenta with inadequate remodelling of the maternal spiral arteries. There is currently no effective therapy available. Some evidence suggests sildenafil citrate may improve uteroplacental blood flow, fetal growth, and meaningful infant outcomes...
December 28, 2017: BMC Pregnancy and Childbirth
Sharilyn J Hoobin, Jonathan D Byer, Mehran Alaee, R Stephen Brown, Peter V Hodson
The embryotoxicity of extracts of American eels (Anguilla rostrata) was measured to determine whether maternally derived contaminants contribute to the declining recruitment of eels to Lake Ontario. Sexually maturing, large yellow and silver eels were sampled in 2007 and 2008 from 5 locations in eastern Canada, including Lake Ontario; positive controls included eels from the Hudson River, United States, and Canal Dessel-Schoten, Belgium (European eel, Anguilla anguilla). Japanese medaka eggs were injected immediately after fertilization with 1 or 10 nL of eel extract and, after 12 d, scored for signs of toxicity...
November 30, 2017: Environmental Toxicology and Chemistry
Siyi He, Tom Kosatsky, Audrey Smargiassi, Marianne Bilodeau-Bertrand, Nathalie Auger
INTRODUCTION: Outdoor heat increases the risk of preterm birth and stillbirth, but the association with placental abruption has not been studied. Placental abruption is a medical emergency associated with major morbidity and mortality in pregnancy. We determined the relationship between ambient temperature and risk of placental abruption in warm seasons. MATERIAL AND METHODS: We performed a case-crossover analysis of 17,172 women whose pregnancies were complicated by placental abruption in Quebec, Canada from May to October 1989-2012...
February 2018: Environment International
Joel G Ray, Alison L Park, Deshayne B Fell
BACKGROUND: Few researchers have evaluated neonatal mortality in the combined presence of preterm birth (PTB) and small-for-gestational age (SGA) birth weight. None differentiated between infants with and without anomalies, considered births starting at 23 weeks' gestation, or defined SGA at a more pathologic cutpoint less than the fifth percentile. METHODS: We completed a population-based cohort study within the province of Ontario, Canada, from 2002 to 2015. Included were 1 676 110 singleton hospital live births of 23 to 42 weeks' gestation...
December 2017: Pediatrics
Jocelynn L Cook, Mina Majd, Jennifer Blake, Jon Yosef Barrett, Sylvie Bouvet, Patricia Janssen, Marian Knight, Sarka Lisonkova, Heather Scott, Suzanne Tough, Tom Wong
Maternal mortality and severe maternal morbidity are devastating for women, their families, and care providers. International efforts have been made to develop and to implement data collection, management, and surveillance systems that capture pregnancy-related information that can be assessed and used to improve health and system outcomes. At present, Canada does not have a national enquiry process to review maternal deaths, severe morbidity, and near misses, and has not set targets for maternal mortality reduction...
November 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
R Douglas Wilson
OBJECTIVE: To inform reproductive and other health care providers about genetic and fetal risk information to consider during a woman/couples' pre-conception evaluation, including considerations for genetic risk assessment, genetic screening, or testing to allow for improved counselling and informed choice. OPTIONS: This genetic information can be used for patient education, planning, and possible pre-conception and/or prenatal testing. OUTCOMES: This information may allow improved risk assessment for pre-conception counselling for individual patients and their families...
October 11, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Jenny Ruducha, Carlyn Mann, Neha S Singh, Tsegaye D Gemebo, Negussie S Tessema, Angela Baschieri, Ingrid Friberg, Taddese A Zerfu, Mohammed Yassin, Giovanny A Franca, Peter Berman
BACKGROUND: 3 years before the 2015 deadline, Ethiopia achieved Millennium Development Goal 4. The under-5 mortality decreased 69%, from 205 deaths per 1000 livebirths in 1990 to 64 deaths per 1000 livebirths in 2013. To understand the underlying factors that contributed to the success in achieving MDG4, Ethiopia was selected as a Countdown to 2015 case study. METHODS: We used a set of complementary methods to analyse progress in child health in Ethiopia between 1990 and 2014...
November 2017: Lancet Global Health
Robert Gagnon
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...
October 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Lucie Morin, Kenneth Lim
OBJECTIVE: To review the literature with respect to the use of diagnostic ultrasound in the management of twin pregnancies. To make recommendations for the best use of ultrasound in twin pregnancies. OUTCOMES: Reduction in perinatal mortality and morbidity and short- and long-term neonatal morbidity in twin pregnancies. Optimization of ultrasound use in twin pregnancies. EVIDENCE: Published literature was retrieved through searches of PubMed and the Cochrane Library in 2008 and 2009 using appropriate controlled vocabulary (e...
October 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
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