Directive clinique N 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum.

Objectif: La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum.

Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care.

Objective: This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care.

Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care.

Objective: This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care.

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.

[Le diabète pendant la grossesse].

Objectif: La présente Directive passe en revue les données probantes liées au diagnostic et à la prise en charge obstétricale du diabète durant la grossesse.

Issues: Les issues évaluées étaient les issues maternelles à court et à long terme, dont la prééclampsie, la césarienne, le diabète éventuel et d'autres complications cardiovasculaires et les issues fœtales, dont les anomalies congénitales, la mortinaissance, la macrosomie, le traumatisme de la naissance, l'hypoglycémie et les effets à long terme. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed et The Cochrane Library au moyen d'un vocabulaire contrôlé (termes MeSH « diabète » et « grossesse ») appropriés.

Diabetes in Pregnancy.

Objective: This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy.

Outcomes: The outcomes evaluated were short- and long-term maternal outcomes, including preeclampsia, Caesarean section, future diabetes, and other cardiovascular complications, and fetal outcomes, including congenital anomalies, stillbirth, macrosomia, birth trauma, hypoglycemia, and long-term effects.

Evidence: Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (MeSH terms "diabetes" and "pregnancy").

Maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus: a population-based study.

Objective: To determine maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus (SLE).

Methods: In a retrospective cohort study using the Nova Scotia Atlee Perinatal Database, 97 pregnancies in women with SLE, with 99 live births, were compared with 211 355 pregnancies in women without SLE and their 214 115 babies. All were delivered in Nova Scotia between 1988 and 2008.

Fetal movement monitoring: how are we doing as educators?

Objective: When decreased fetal movement is noticed, delay in seeking care is associated with poor perinatal outcomes, including stillbirth. Health care providers are responsible for educating women about normal fetal movement and the appropriate actions they should take if it decreases. This study aimed to demonstrate our pregnant population's understanding of normal fetal movement and responses to decreased fetal movement, and to potentially guide educational interventions to improve perinatal outcomes.

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.

Up-down determination of the ED(90) of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing Cesarean delivery.

Introduction: Use of the lowest effective dose of oxytocin may reduce side effects. This study was designed to determine the effective dose (ED)(90) of oxytocin infusion for an elective Cesarean delivery (CD) to prevent uterine atony.

Methods: The participants were ASA I and II, non-obese, non-labouring adult women undergoing an elective CD at term with a singleton gestation.

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.

Abnormal antenatal sonogram: an indicator of disease severity in children with posterior urethral valves.

Purpose: To review the association of an abnormal prenatal sonogram with most recent serum creatinine in patients with proven posterior urethral valves (PUV).

Methods: Since 1992, all live-born patients between 1992-2004 with clinically proven PUV, with postnatally proven PUV, from 2 pediatric tertiary care centers, were reviewed for age at diagnosis, most recent serum creatinine, presence of chronic renal failure (CRF) (serum creatinine >2 standard deviations above normal for age), or end stage renal disease (dialysis or transplant). Available antenatal reports from the 2 centres and surrounding community hospitals were reviewed for gestational age (GA) at the time of ultrasound, volume of amniotic fluid, and urinary-tract abnormality.

Factors associated with maternal morbidity in the Term Breech Trial.

Objective: In the Term Breech Trial, the risk of maternal morbidity in women who delivered after planning for a caesarean section (CS) was not significantly different from those who delivered after planning for a vaginal birth. We undertook secondary analyses to determine factors associated with maternal morbidity among 2078 women.

Methods: By using multiple logistic regression analyses, we determined the effect of prelabour CS, CS during early labour, CS during active labour, vaginal birth, and other factors on maternal morbidity.

Maternal outcomes in pregnancies complicated by obesity.

Objective: To investigate the relationship between prepregnancy obesity and maternal outcomes.

Methods: A 15-year, population-based cohort study using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in obese and nonobese women. Prepregnancy weight of 55-75 kg was considered nonobese, and weight greater than 90 kg was considered obese.

Prevention and detection of diabetic embryopathy.

Congenital anomalies are more common in the offspring of women with type 1 and type 2 diabetes mellitus. Herein we define those anomalies more commonly found in the offspring of women with diabetes mellitus, and examine the role of hyperglycemia in their pathogenesis. We then discuss methods for the optimal screening and detection of embryopathy.

Factors associated with adverse perinatal outcome in the Term Breech Trial.

Background: In the Term Breech Trial, the risk of adverse perinatal outcome was lower with planned cesarean section versus planned vaginal birth. We undertook secondary analyses to determine factors associated with adverse perinatal outcome.

Study Design: By using multiple logistic regression analyses, we determined the effect of prelabor cesarean section, cesarean section during early labor, cesarean section during active labor versus vaginal birth, and other factors, on adverse perinatal outcome.