Type III Vasa Previa Associated with Resolution of a Low-Lying Placenta: Case Report and Literature Review.

Vasa previa occurs when fetal vessels lie above the cervical os. A novel type of vasa previa, known as type III, is characterized by an abnormal branching of fetal vessels from the placenta in the absence of velamentous cord insertion (as seen in type I) or multilobed placenta (as seen in type II). Here, we present a case of a type III vasa previa after a resolution of a low-lying placenta.

The fetal scalp electrode shortage is an urgent patient safety issue.

There is currently a shortage of fetal scalp electrodes because of a recent recall due to concerns about the breakage of the electrode tip with possible injury to the neonate. Although the recall is presumably intended to improve safety, the resulting shortage of fetal scalp electrodes poses risks to patients because of inadequate fetal heart rate monitoring in cases where an adequate signal cannot be obtained with external fetal monitoring and/or when maternal heart rate artifact cannot be resolved by repositioning of transducers and application of a maternal pulse oximeter.

Mise à jour technique n 429 : Artéfact de la fréquence cardiaque maternelle pendant la surveillance du bien-être fœtal per partum.

Objectif: Améliorer les issues périnatales et réduire au minimum le risque d'erreurs chez les fournisseurs en améliorant leurs connaissances sur les stratégies de détection des artéfacts de la fréquence cardiaque maternelle per partum et sur les modes d'intervention lorsque de tels artéfacts sont soupçonnés.

Population Cible: Toutes les parturientes.

Options: L'artéfact de la fréquence cardiaque maternelle peut être détecté à l'aide de caractéristiques cliniques ou de la technologie.

Technical Update No. 429: Maternal Heart Rate Artefact During Intrapartum Fetal Health Surveillance.

Objective: To improve perinatal outcomes and minimize provider error by increasing awareness of strategies to detect intrapartum maternal heart rate artefact and to respond when such artefact is suspected.

Target Population: All pregnant patients during labour.

Options: Maternal heart rate artefact may be detected based on clinical features or through technology.

Unrecognized maternal heart rate artefact in cases of perinatal mortality reported to the United States Food and Drug Administration from 2009 to 2019: a critical patient safety issue.

Background: Maternal heart rate artefact is a signal processing error whereby the fetal heart rate is masked by the maternal pulse, potentially leading to danger by failure to recognize an abnormal fetal heart rate or a pre-existing fetal death. Maternal heart rate artefact may be exacerbated by autocorrelation algorithms in modern fetal monitors due to smooth transitions between maternal and fetal heart rates rather than breaks in the tracing. In response, manufacturers of cardiotocography monitors recommend verifying fetal life prior to monitoring and have developed safeguards including signal ambiguity detection technologies to simultaneously and continuously monitor the maternal and fetal heart rates.

Prediction of Hypoxic Acidemia in Last 2 Hours of Labour in Low-Risk Women.

Objective: Prediction of hypoxic acidemia in neonates using cardiotocogram (CTG) features continues to be challenging. The objective of this study was to explore the association between contraction frequency and fetal heart rate characteristics with hypoxic acidemia in low-risk women in labour.

Methods: Cases were singleton, vertex, in labour with umbilical artery pH ≤7.

Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking.

Background: Public banking of umbilical cord blood units (CBUs) containing higher numbers of cells ensures timely engraftment after transplantation for increasing numbers of patients. Delayed clamping of the umbilical cord after birth may benefit some infants by preventing iron deficiency. Implications of delayed cord clamping for public cord blood banking remains unclear.

The incidence of maternal artefact during intrapartum fetal heart rate monitoring.

Objective: To determine the incidence of maternal heart rate artefact (MHRA) when monitoring fetal heart rate (FHR) in labour and to determine obstetrical factors associated with MHRA.

Methods: In a prospective observational study, maternal and fetal heart rates were displayed simultaneously to document the superimposition of the maternal heart rate (MHR) on FHR tracings. All women in labour who were undergoing external fetal monitoring (EFM) at the Ottawa Hospital from October 2011 to March 2012 were eligible.

The importance of a late first trimester placental sonogram in patients at risk of abnormal placentation.

Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality.

Shoulder dystocia documentation: an evaluation of a documentation training intervention.

Objective: To evaluate the quality and content of nurse and physician shoulder dystocia delivery documentation before and after MORE training in shoulder dystocia management skills and documentation.

Methods: Approximately 384 charts at the Ottawa Hospital General Campus involving a diagnosis of shoulder dystocia between the years of 2000 and 2006 excluding the training year of 2003 were identified. The charts were evaluated for 14 key components derived from a validated instrument.

A multidisciplinary checklist for management of suspected placenta accreta.

Rates of abnormally invasive placentation have been escalating. The condition requires meticulous planning to ensure safety at delivery. Although placenta accreta remains the most common reason for Caesarean hysterectomy in developed nations, medical and surgical therapies have allowed fertility preservation.

Application of 3-d angiography in the management of placenta percreta treated with repeat uterine artery embolization.

Background: Rising Caesarean section rates have increased rates of abnormally invasive placentation. In the management of such invasive placentation, hysterectomy may result in greater morbidity than more conservative measures. Non-surgical interventions such as uterine artery embolization (UAE) attempt to decrease placental perfusion and augment placental resorption.

The Ottawa hospital quality incident notification system for capturing adverse events in obstetrics.

Objective: To describe the design and implementation of a Quality Incident Notification (QIN) system in an obstetrical unit and provide an analysis of the frequency and nature of events captured by the system.

Methods: We implemented a system to capture quality events, consisting of an on-line form that was easily accessible to all levels of staff. A list of quality indicators was developed to indicate potential safety concerns, near misses, or poor outcomes that required closer scrutiny.

A teaching encounter card to evaluate clinical supervisors across clerkship rotations.

Background: Evaluation of faculty teaching is critical to improving the educational experience for both students and faculty.

Aim: Our objectives were to implement an evaluation system, using the teaching encounter card, across multiple rotations in the clerkship and determine the feasibility, reliability and validity of this evaluation tool in this expanded setting.

Methods: Students were asked to rate clinical supervisors on nine teaching behaviours using a 6-point rating scale and asked whether they would like to nominate the teacher for a clinical teaching award.

Comparison of maternal risk factors between placental abruption and placenta previa.

The purpose of this study was to compare risk factors between placental abruption and placenta previa among primiparous and multiparous singleton pregnancies. We analyzed data from a population-based retrospective cohort with singleton pregnancies in the United States for 1995 to 2000. Maternal risk factors for placenta previa and placental abruption were examined using multiple logistic regressions.

Compliance of medical students with voluntary use of personal data assistants for clerkship assessments.

Background: For several years, final-year students at McMaster University have been required to complete 10 mini-CEX type assessments per rotation. A similar system was being introduced at Ottawa.

Purpose: To facilitate data capture, we decided to introduce a personal data assistant (PDA)-based system and evaluate its impact.

Knowledge to action: implementing a guideline for second stage labor.

Purpose: To quantify practice changes associated with implementing a clinical practice guideline for the second stage of labor in term nulliparous women with epidural anesthesia and to describe the lessons learned about knowledge translation. The main clinical practice guideline recommendation was waiting up to 2 hours before pushing after full dilatation.

Design And Methods: Pre- and post-evaluation of clinical outcomes and knowledge translation strategies associated with implementing the second stage of labor clinical practice guideline at two birthing units within a large teaching hospital.

Adherence to guidelines on the management of dystocia and cesarean section rates.

The purpose of this study was to investigate to what extent the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines on dystocia are being followed, and whether adherence to the guidelines is related to cesarean section rates. Data were extracted from a maternity database for nulliparous women with singleton, cephalic pregnancies at 37 or more completed weeks of gestation for a 4-year period. Patients delivered by elective cesarean section were excluded.

RETIRED: Diagnosis and management of placenta previa.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Relationship between intertwin delivery interval and metabolic acidosis in the second twin.

This study sought to assess the relationship between intertwin delivery interval (ITDI) and metabolic acidosis in the second twin at birth using a retrospective twin delivery cohort from a tertiary-level teaching hospital. Twin births were identified from an obstetrical database during a 10-year period from 1994 to 2004. Mean arterial cord pH and base deficit among different ITDIs were compared by analysis of variance.

Adverse events detected by clinical surveillance on an obstetric service.

Objective: Adverse events are adverse patient outcomes resulting from medical care. We performed this study to estimate the rate of adverse events and potential adverse events-errors that have a high likelihood of causing patient harm-occurring during obstetric care.

Methods: This was a prospective cohort study of an obstetric unit in a teaching hospital.

The Ottawa Hospital's Clinical Practice Guideline for the Second Stage of Labour.

The management of the second stage of labour remains controversial, and there are very few comprehensive evidence-based clinical practice guidelines to assist care providers. We describe an approach to developing a local clinical practice guideline that included extensive review of the literature; use of a guideline appraisal instrument to assess methodological rigour, content, clarity and applicability; use of a recommendation matrix; drafting a local guideline; obtaining formal feedback; making revisions; and designing an implementation and evaluation plan. Recommendations from this guideline include timelines for the total length of second stage, waiting time, and pushing time.

Prediction of risk for shoulder dystocia with neonatal injury.

Objective: The purpose of this study was to develop a predictive model of risk for shoulder dystocia (ShD) with injury.

Study Design: Medical records in 3 urban university teaching hospitals were reviewed to identify and characterize 498 cases of ShD, including 90 with neonatal injury and a comparison group with of 622 with vaginal delivery (VgD) without ShD. The data were subjected to logistic regression modeling to find the best combination of variables to discriminate between the injury and VgD groups.