Clinical Consensus No. 455: Fetal Sex Determination and Disclosure.

Objective: To provide guidance on ultrasound review of the fetal perineum as well as fetal sex determination and disclosure.

Target Population: All individuals with ongoing pregnancies.

Options: To include a review of the fetal perineum and determination of fetal sex as a component of the anatomic review during the routine second-trimester obstetric ultrasound and adhere to patient wishes regarding the disclosure of fetal sex.

Neonatal Adverse Outcomes among Hospital Livebirths in Canada: A National Retrospective Study.

Introduction: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.

Methods: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022.

Diabetes mellitus in pregnancy across Canada.

Background: Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes.

Methods: This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD).

Validation of Ultrasound Dating Protocols Using Data From Twins Conceived Through In Vitro Fertilization in Nova Scotia: A Retrospective Cohort Study.

Objectives: Clinical practice guidelines recommend determining gestational age (GA) for twin pregnancies using the fetal crown rump length (CRL) of the larger fetus. This study investigated whether the CRL of the larger or smaller fetus at 11-14 weeks best predicted in vitro fertilization (IVF) assigned GA.

Methods: A retrospective cohort study of twin pregnancies conceived by IVF ± intracytoplasmic sperm injection, 2004-2022, generated GA estimations for each co-twin CRL at the 11-14 week ultrasound, to determine which fetus (smaller or larger) more consistently predicted IVF-assigned GA.

Guideline No. 421: Point of Care Ultrasound in Obstetrics and Gynaecology.

Objective: To provide an opinion regarding the usefulness of point of care ultrasound in obstetrics and gynaecology.

Target Population: Women with pregnancy-related complications or issues who could benefit from an urgent bedside sonographic evaluation.

Options: Point of care ultrasound is a readily accessible option, requiring few resources.

Stillbirth in Canada: anachronistic definition and registration processes impede public health surveillance and clinical care.

The archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks' gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth.

Database Autopsy: An Efficient and Effective Confidential Enquiry into Maternal Deaths in Canada.

Background: Maternal death surveillance in Canada relies on hospitalization data, which lacks information on the underlying cause of death. We developed a method for identifying underlying causes of maternal death, and quantified the frequency of maternal death by cause.

Methods: We used data from the Discharge Abstract Database for fiscal years 2013 to 2017 to identify women who died in Canadian hospitals (excluding Quebec) while pregnant or within 1 year of the end of pregnancy.

N 375 - Directive clinique sur l'utilisation de l'échographie au premier trimestre.

Objectif: Révision des indications cliniques de l'échographie du premier trimestre. RéSULTATS: L'échographie au premier trimestre offre des avantages cliniques démontrés. DONNéES PROBANTES: Les données probantes ont été révisées au moyen de recherche dans Medline et selon la bibliographie des articles pertinents.

No. 375-Clinical Practice Guideline on the Use of First Trimester Ultrasound.

Objective: This guideline reviews the clinical indications for first trimester ultrasound.

Outcome: Proven clinical benefit has been reported from first trimester ultrasound.

Evidence: A Medline search and bibliography reviews in relevant literature provided the evidence.

Predictors for surgical intervention and surgical outcomes in neonates with cystic fibrosis.

Background/purpose: To identify prenatal and perinatal predictors of surgery and describe surgical findings/outcomes of neonates with Meconium Ileus (MI) secondary to Cystic Fibrosis (CF).

Methods: Potential risk factors (prenatal bowel echogenicity, CF genotype, birthweight, prematurity and sex) for MI and surgery were examined in a retrospective cohort of neonates with CF presenting to a tertiary center between 1997 and 2015. Following univariable analysis, predictors of MI and surgery were determined using multivariable logistic regression.

No. 359-Obstetric Ultrasound Biological Effects and Safety.

Objective: To review the biological effects and safety of obstetric ultrasound.

Outcome: Outline the circumstances in which safety may be a concern with obstetric ultrasound.

Evidence: The 2005 version of this guideline was used as a basis and updated following a Medline search and review of relevant publications.

Effect of Folic Acid Food Fortification in Canada on Congenital Heart Disease Subtypes.

Background: Previous studies have yielded inconsistent results for the effects of periconceptional multivitamins containing folic acid and of folic acid food fortification on congenital heart defects (CHDs).

Methods: We carried out a population-based cohort study (N=5 901 701) of all live births and stillbirths (including late-pregnancy terminations) delivered at ≥20 weeks' gestation in Canada (except Québec and Manitoba) from 1990 to 2011. CHD cases were diagnosed at birth and in infancy (n=72 591).

A Woman With Marfan Syndrome in Pregnancy: Managing High Vascular Risk With Multidisciplinary Care.

Background: Women with connective tissue disorders are at risk for cardiovascular complications during pregnancy, but there are no guidelines for pregnant women with aortic root diameter>45 mm or with rapid aortic widening. We describe the issues of practical significance in the management of pregnancy and delivery in a woman with Marfan syndrome (MFS).

Case: A pregnant woman with MFS presented for tertiary care at 26 weeks' gestation.

Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies.

Objective: To provide updated information on the pre- and post-conception use of oral folic acid with or without a multivitamin/micronutrient supplement for the prevention of neural tube defects and other congenital anomalies. This will help physicians, midwives, nurses, and other health care workers to assist in the education of women about the proper use and dosage of folic acid/multivitamin supplementation before and during pregnancy.

Evidence: Published literature was retrieved through searches of PubMed, Medline, CINAHL, and the Cochrane Library in January 2011 using appropriate controlled vocabulary and key words (e.