Dual diagnosis of trisomy 21 and lethal perinatal Gaucher disease as a cause of non-immune hydrops fetalis in a twin pregnancy for a consanguineous couple.

Non-immune hydrops is a prenatal finding which can occur due to an underlying genetic diagnosis such as common chromosomal aneuploidy (Trisomy 21, Turner syndrome etc.). It is extremely rare to have more than one genetic cause of hydrops fetalis in a single pregnancy.

Myometrial Defect in a Subsequent Pregnancy After Uterine Artery Embolization for Postpartum Hemorrhage, in the Absence of Leiomyomas or Previous Uterine Surgery.

Background: Pregnancy occurring after uterine artery embolization are often complicated by adverse fetal and obstetric outcomes.

Case: This report describes the case of a myometrial defect in a subsequent pregnancy after uterine artery embolization for postpartum hemorrhage. A 26-year-old G2, P2 woman had a vaginal delivery of twins 2 years earlier that required uterine artery embolization for postpartum hemorrhage.

Increased Insulin-like Growth Factor Binding Protein-1 Phosphorylation in Decidualized Stromal Mesenchymal Cells in Human Intrauterine Growth Restriction Placentas.

Intrauterine growth restriction (IUGR) is often caused by placental insufficiency, which is believed to be associated with decreased delivery of oxygen and nutrients to the placental barrier. We recently reported that hypoxia and/or leucine deprivation triggered hyperphosphorylation of insulin-like growth factor binding protein-1 (IGFBP-1) in decidualized human immortalized endometrial stromal cells (HIESCs), resulting in decreased insulin-like growth factor-1 (IGF-1) bioactivity. To test the hypothesis that human IUGR is associated with increased decidual IGFBP-1 phosphorylation at discrete sites, we used IUGR and gestational age matched appropriate for gestational age (AGA) placentas ( n=5 each).

Atonic Postpartum Hemorrhage: Blood Loss, Risk Factors, and Third Stage Management.

Objective: Atonic postpartum hemorrhage rates have increased in many industrialized countries in recent years. We examined the blood loss, risk factors, and management of the third stage of labour associated with atonic postpartum hemorrhage.

Methods: We carried out a case-control study of patients in eight tertiary care hospitals in Canada between January 2011 and December 2013.

The Impact of Standardized Acuity Assessment and a Fast-Track on Length of Stay in Obstetric Triage: A Quality Improvement Study.

To prospectively assess the impact of a standardized 5-category Obstetrical Triage Acuity Scale (OTAS) and a fast-track for lower-acuity patients on patient flow. Length of stay (LOS) data of women presenting to obstetric triage were abstracted from the electronic medical record prior to (July 1, 2011, to March 30, 2012) and following OTAS implementation (April 1 to December 31, 2012). Following computerized simulation modeling, a fast-track for lower acuity women was implemented (January 1, 2013, to February 28, 2014).

Acuity Assessment in Obstetrical Triage.

Objective: A five-category Obstetrical Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The purposes of this study were: (1) to compare the inter-rater reliability (IRR) in tertiary and community hospital settings and measure the intra-rater reliability (ITR) of OTAS; (2) to establish the validity of OTAS; and (3) to present the first revision of OTAS from the National Obstetrical Triage Working Group.

Methods: To assess IRR, obstetrical triage nurses were randomly selected from London Health Sciences Centre (LHSC) (n = 8), Stratford General Hospital (n = 11), and Chatham General Hospital (n= 7) to assign acuity levels to clinical scenarios based on actual patient visits.

Women's Satisfaction With Obstetric Triage Services.

Objective: To determine the satisfaction of pregnant women who presented at a triage unit in an obstetric birthing care unit with obstetric triage services.

Design: Qualitative descriptive with conventional content analysis.

Setting: Individual audio recorded telephone interviews with women after discharge from a tertiary care hospital's obstetric triage unit.

Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.

A 5-category Obstetric Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The objectives of this study were as follows: (1) to test the interrater reliability of OTAS and (2) to determine the distribution of patient acuity and flow by OTAS level. To test the interrater reliability, 110 triage charts were used to generate vignettes and the consistency of the OTAS level assigned by 8 triage nurses was measured.

Bone status in activity-restricted pregnant women assessed using calcaneal quantitative ultrasound.

Objective: Pregnancy-induced bone loss may be further exacerbated by activity restriction (AR). The authors compared the bone status of AR hospitalized (≥7 days) pregnant women in the third trimester to ambulatory (AM) women at the same gestational age, using a prospective cross-sectional design.

Method: AR was quantified in AR women by daily step counts using a pedometer for 7 consecutive days.

Risk of pregnancy-related hypertension within 5 years of exposure to drinking water contaminated with Escherichia coli O157:H7.

The authors evaluated the risk for pregnancy-related hypertension among previously healthy women who conceived within 5 years of exposure to drinking water contaminated with Escherichia coli O157.H7 in Walkerton, Canada (2000). Chronic hypertension was defined as systolic/diastolic blood pressure >/=140/90 mm Hg before 20 weeks gestation; gestational hypertension was defined as new onset systolic/diastolic blood pressure >/=140/90 mm Hg >/=20 weeks gestation.

An international trial of antioxidants in the prevention of preeclampsia (INTAPP).

Objective: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women.

Study Design: In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions.

IL-6 and TNFalpha across the umbilical circulation in term pregnancies: relationship with labour events.

Objective: We have determined venous and arterial cord blood levels for IL-6 and TNFalpha at the time of delivery to assess gestational tissue versus fetal sources in labouring and non-labouring patients at term, and the relationship to labour events.

Methods: Fifty-five patients were studied (elective cesarean section n=24, and labouring n=31) with blood sampling from a clamped segment of cord after delivery of the fetus and from the cord at its insertion into the placenta after delivery of the placenta, with subsequent measurement of blood gases, pH, IL-6 and TNFalpha.

Results: Umbilical cord levels for IL-6 were increased by 4 fold in low risk labouring patients, and a further 6 fold when showing histologic chorioamnionitis, but with no evident effect of nuchal cord with 'variable' fetal heart rate decelerations, fetal acidemia, nor of labour duration.

Nutrition and exercise prevent excess weight gain in overweight pregnant women.

Purpose: To determine the effect of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) for overweight (OW) and obese (OB) pregnant women on pregnancy weight gain, birth weight, and maternal weight retention at 2 months postpartum.

Methods: This is a single-arm intervention matched by prepregnant body mass index, age, and parity to a historical cohort (4:1). Women with a prepregnancy body mass index of > or = 25.

Risk of pregnancy-related hypertension within five years of exposure to bacteria-contaminated drinking water.

Exposure to Escherichia coli O157:H7 may result in subclinical kidney injury manifesting as hypertension during pregnancy. We evaluated the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water. Ontario Ministry of Health Antenatal forms were used to determine outcomes and risk factors.

Prevalence, management, and outcomes of preterm prelabour rupture of the membranes of women in Canada.

Objectives: To determine the prevalence of preterm prelabour rupture of the membranes (PPROM) at Canadian university-affiliated perinatal referral centres, to assess the different management strategies, and to review neonatal outcomes.

Methods: Twelve Canadian university-affiliated perinatal referral centres provided information on their management of PPROM, and 9 participated in data collection to determine prevalence. All women presenting with PPROM during a 2-week period were observed until delivery, and obstetric and neonatal outcome data were subsequently obtained.

Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth.

Objective: To estimate to what extent computerized fetal heart rate (FHR) parameters are affected by labor and to estimate the relationship between FHR parameters and the degree of fetal metabolic acidosis in laboring patients at term.

Methods: Fifty-one women between 37 and 42 weeks' gestational age were recruited prospectively in the following groups: 1) nonlaboring women, and 2) laboring women requiring fetal scalp electrode for continuous electronic FHR monitoring. Computerized FHR analysis was performed for 1 hour within 6 hours of delivery in the nonlaboring group and continuously throughout labor in the laboring group.