Delay of Fetal Anatomy Ultrasound Assessment Based on Maternal Body Mass Index Does Not Reduce the Rate of Inadequate Visualization.

Objectives: To determine whether delay of initial anatomy ultrasound based on the maternal body mass index (BMI) reduces the rate of inadequate visualization compared to standard timing at 18 to 19 weeks.

Methods: A retrospective study of singleton anatomy assessments was conducted at a tertiary care center in the 2-year period before (A, 2012-2014) and after (B, 2014-2016) protocol initiation. Assessments in period B were scheduled on the basis of the BMI in the first trimester: lower than 25 kg/m , 18 to 19 weeks; 25 to 29.

No. 239-Obesity in Pregnancy.

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.

N 129-L'exercice physique pendant la grossesse et le postpartum.

Objectif: Énoncer une directive canadienne visant à informer les fournisseurs de soins obstétricaux des répercussions, pour la mère, le fœtus et le nouveau-né, des exercices de conditionnement aerobique et musculaire pendant la grossesse. RéSULTATS ATTENDUS: Effets sur la morbidité maternelle, fœtale et néonatale et mesures de la forme physique maternelle.

Preuves: Une recherche sur MEDLINE des articles, publiés en anglais de 1966 à 2002, appartenant aux catégories suivantes : études sur le conditionnement aérobique et musculaire chez des femmes ne faisant pas jusque-là d'exercice et chez des femmes actives avant leur grossesse, ainsi que des études sur les répercussions du conditionnement aérobique et musculaire sur les issues précoces et tardives de la grossesse ou sur les issues néonatales; rapports de synthèse et méta-analyses portant sur l'exercice pendant la grossesse.

No. 129-Exercise in Pregnancy and the Postpartum Period.

Objective: To design Canadian guidelines advising obstetric care providers of the maternal, fetal, and neonatal implications of aerobic and strength-conditioning exercises in pregnancy.

Outcomes: Knowledge of the impact of exercise on maternal, fetal, and neonatal morbidity, and of the maternal measures of fitness.

Evidence: MEDLINE search from 1966 to 2002 for English language articles related to studies of maternal aerobic and strength conditioning in a previously sedentary population, maternal aerobic and strength conditioning in a previouslyactive population, impact of aerobic and strength conditioning on early and late pregnancy outcomes, and impact of aerobic and strength conditioning on neonatal outcomes, as well as for review articles and meta-analyses related to exercise in pregnancy.

We Should Proceed With Caution When It Comes to Antenatal Corticosteroids After 34 Weeks.

The Society for Maternal-Fetal Medicine recently released a statement supporting the use of antenatal corticosteroids for women at high risk of late preterm birth. This followed a trend of increasing use of antenatal corticosteroids after 34 weeks' gestation, based on evidence for decreased respiratory morbidity. The absolute benefits, however, are relatively small.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth.

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.

Emergency Caesarean Section in Obese Parturients: Is a 30-Minute Decision-to-Incision Interval Feasible?

Objective: To determine the effect of obesity on decision-to-incision and decision-to-delivery time intervals in emergency Caesarean section.

Methods: We performed a retrospective study of emergency Caesarean sections performed between 2005 and 2009. Indications for emergency Caesarean section were defined as those posing an immediate threat to the life of the mother or fetus.

Creation of plastinated placentas as a novel teaching resource for medical education in obstetrics and gynaecology.

Introduction: Knowledge of the gross anatomy of the placenta is fundamental in order to help identify potential complications during pregnancy. The placenta is difficult to study without a three-dimensional appreciation of its structure. The aim of this study was to develop a collection of plastinated placenta specimens and accompanying clinical educational materials to provide learning resources for placental abnormalities and their associated pregnancy outcomes.

Thromboembolism in the obese pregnant woman.

We sought to quantify the added risk of thromboembolism in the obese parturient, evaluate risk factors for thromboembolism in the obese parturient, and provide suggestions as to when and in what form thromboembolism prophylaxis should be considered. Although recent guidelines from national colleges and advisory groups have attempted to guide the clinician in thromboprophylaxis in the obese parturient, the lack of adequate prospective series and trials has lead to some contrary recommendations. The arbitrary use of bed rest in the obese patient is a significant risk factor for venous thromboembolism without proven benefit.

Brachial artery flow-mediated dilation is not affected by pregnancy or regular exercise participation.

Whether brachial artery FMD (flow-mediated dilation) is altered in pregnancy by 28-35 weeks compared with non-pregnant women remains controversial. The controversy may be due to limitations of previous studies that include failing to: (i) test non-pregnant controls in the mid-late luteal phase, (ii) account for effects of pregnancy on the dilatory shear stimulus, (iii) account for physical activity or (iv) control for inter-individual variation in the time to peak FMD. In the present study, brachial artery FMD was measured in 17 active and eight sedentary pregnant women (34.

SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010.

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.

Modification of angiogenic factors by regular and acute exercise during pregnancy.

This cross-sectional study examined mechanisms through which exercise might alter preeclampsia risk by estimating the effects of acute and chronic exercise on angiogenic markers in healthy pregnant women with different amounts of regular exercise participation. Serum-soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) were measured before and after 20 min of moderate-intensity cycle ergometry in normotensive, nonsmoking pregnant (16 active, 9 inactive, 34.1+/-1.

Low flow-mediated constriction occurs in the radial but not the brachial artery in healthy pregnant and nonpregnant women.

Radial artery diameter decreases when a wrist cuff is inflated to stop blood flow to distal tissue. This phenomenon, referred to as low flow-mediated vasoconstriction (L-FMC), was proposed as a vascular function test. Recommendations that L-FMC be measured concurrently with flow-mediated dilation (FMD) were based on radial artery data.

Obesity in pregnancy.

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.

Mechanisms of activity-related breathlessness in healthy human pregnancy.

We examined the contribution of alterations in central ventilatory control, static and dynamic respiratory mechanics and their interaction to exertional breathlessness in healthy human pregnancy. Detailed ventilatory, respiratory mechanical/muscular and perceptual responses to incremental cycle exercise were compared in the third trimester (TM(3)) and again approximately 5 months post-partum (PP) in women with (B, n = 12) and without (NB, n = 15) clinically significant activity-related breathlessness (measured by the baseline dyspnea index). In contrast to NB, breathlessness intensity ratings were significantly higher at any given work rate during exercise in TM(3) versus PP within B.

Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction.

Objectives: To compare mid-trimester serum relaxin concentration (SRC) in primiparous women with or without pelvic floor dysfunction (PFD--stress urinary incontinence (SUI), genital prolapse).

Design: Nested observational cohort study.

Setting: Urogynecology clinic of affiliated University hospital.

Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensation.

Unlabelled: The aim of this study was to identify the physiological mechanisms of exertional respiratory discomfort (breathlessness) in pregnancy by comparing ventilatory (breathing pattern, airway function, operating lung volumes, oesophageal pressure (P(oes))-derived indices of respiratory mechanics) and perceptual (breathlessness intensity) responses to incremental cycle exercise in 15 young, healthy women in the third trimester (TM(3); between 34 and 38 weeks gestation) and again 4-5 months postpartum (PP). During pregnancy, resting inspiratory capacity (IC) increased (P < 0.01) and end-expiratory lung volume decreased (P < 0.

Fetal heart rate response to maternal hypocapnia and hypercapnia in late gestation.

Objective: To examine the effects of acute maternal hypocapnia and hypercapnia on electronic fetal heart rate (FHR) patterns in late gestation.

Methods: Thirty-five women with healthy singleton pregnancies performed a modified carbon dioxide (CO2) rebreathing procedure between 34 and 38 weeks of pregnancy. Prior to rebreathing, subjects hyperventilated for five minutes to reduce end-tidal CO2 tensions (PETco2) below 23 Torr (hypocapnia).

Physiological mechanisms of hyperventilation during human pregnancy.

This study examined the role of pregnancy-induced changes in wakefulness (or non-chemoreflex) and central chemoreflex drives to breathe, acid-base balance and female sex hormones in the hyperventilation of human pregnancy. Thirty-five healthy women were studied in the third trimester (TM(3); 36.3+/-1.

Prosthetic heart valves and arrhythmias in pregnancy.

The majority of women with bioprosthetic valves do not require anticoagulation during pregnancy. In women with mechanical valves, a detailed discussion of the advantages and disadvantages of the three anticoagulant options (warfarin, unfractionated heparin and low molecular weight heparin) is indicated. The majority of women with arrhythmias during pregnancy have a benign increased rate of atrial or ventricular premature beats.