Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity.

Background: The mode of delivery for women with a previous cesarean delivery remains contentious. We conducted a study comparing maternal and infant outcomes after attempted vaginal birth after cesarean delivery versus elective repeat cesarean delivery.

Methods: We used data from the Discharge Abstract Database that includes all hospital deliveries in Canada (excluding Quebec).

Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks Gestation.

Background: Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22-28 weeks' gestation.

Methods: We prospectively recruited women with singleton pregnancies admitted at 22-28 weeks' gestation to tertiary hospitals of the Canadian Perinatal Network between 2005 and 2009.

Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada.

Background: Administration of magnesium sulphate (MgSO4) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice recommendations based on relevant clinical evidence exists, ongoing controversies about aspects of this treatment remain. Given this, we anticipated managed knowledge translation (KT) would be needed to facilitate uptake of the guidelines into practice.

Magnesium Sulphate for Eclampsia and Fetal Neuroprotection: A Comparative Analysis of Protocols Across Canadian Tertiary Perinatal Centres.

Background: Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for eclampsia prophylaxis and treatment.

Delivery of breech presentation at term gestation in Canada, 2003-2011.

Objective: To examine neonatal mortality and morbidity rates by mode of delivery among women with breech presentation at term gestation.

Methods: We carried out a population-based cohort study examining neonatal outcomes among term, nonanomalous singletons in breech presentation among all hospital deliveries in Canada (excluding Quebec) between 2003 and 2011. Mode of delivery was categorized into vaginal delivery, cesarean delivery in labor, and cesarean delivery without labor.

Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage.

Objective: To quantify the contribution of placenta accreta to the rate of postpartum hemorrhage and severe postpartum hemorrhage.

Methods: All hospital deliveries in Canada (excluding Quebec) for the years 2009 and 2010 (N=570,637) were included in a retrospective cohort study using data from the Canadian Institute for Health Information. Placenta accreta included placental adhesion to the uterine wall, musculature, and surrounding organs (accreta, increta, or percreta).

Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study.

Objective: To examine whether changes in postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors explain the increase in obstetric acute renal failure in Canada.

Design: Retrospective cohort study.

Setting: Canada (excluding the province of Quebec).

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

Background: The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency.

Methods: We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003.

Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010.

Objective: Increases in postpartum hemorrhage have been reported from several countries. We assessed temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada between 2003 and 2010.

Methods: We carried out a population-based cohort study of all hospital deliveries in Canada (excluding Quebec) from 2003 to 2010 (n = 2 193 425), using data from the Canadian Institute for Health Information.

Gestational age-specific severe maternal morbidity associated with labor induction.

Objective: The purpose of this study was to examine the association between labor induction and gestational age-specific severe maternal morbidity.

Study Design: Our study was restricted to women who delivered singletons at 37-42 weeks' gestation who had no pregnancy complications from 2003-2010 (n = 1,601,253) in Canada (excluding Quebec). Using a pregnancies-at-risk approach, the week-specific rates of specific morbidity after induction were contrasted with rates among ongoing pregnancies.

Trends in postpartum hemorrhage from 2000 to 2009: a population-based study.

Background: Postpartum hemorrhage, a major cause of maternal death and severe maternal morbidity, increased in frequency in Canada between 1991 and 2004. We carried out a study to describe the epidemiology of postpartum hemorrhage in British Columbia, Canada, between 2000 and 2009.

Methods: The study population included all women residents of British Columbia who delivered between 2000 and 2009.

Incidence, risk factors, and associated complications of eclampsia.

Objective: To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.

Methods: We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information.

Temporal trends in maternal mortality in Canada II: estimates based on hospitalization data.

Objectives: World Health Organization reports based on Canadian Vital Statistics data suggest a recent increase in maternal mortality rates in Canada. Since Vital Statistics data typically provide inaccurate estimates of maternal mortality, we examined temporal trends in Canada using hospitalization data.

Methods: We identified in-hospital deaths among women aged 15 to 54 years from the Canadian Institute for Health Information's hospitalization database from 1996-1997 to 2007-2008.

Temporal trends in maternal mortality in Canada I: estimates based on vital statistics data.

Objectives: Vital Statistics and World Health Organization reports show a recent increase in maternal mortality in Canada. We carried out a study of temporal trends, regional variations, and causes of death in Canadian maternal mortality using Vital Statistics data.

Methods: We used Vital Statistics death registrations to ascertain maternal deaths between 1981 and 2007.

The Canadian Perinatal Network: a national network focused on threatened preterm birth at 22 to 28 weeks' gestation.

Objective: The Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birth.

Methods: Women were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks' gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage.

Maternal mortality and severe maternal morbidity surveillance in Canada.

The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.

Temporal trends and regional variations in severe maternal morbidity in Canada, 2003 to 2007.

Objective: To identify temporal trends and regional variations in severe maternal morbidity in Canada using routine hospitalization data.

Methods: We used a previously identified set of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10CA) and Canadian Classification of Interventions (CCI) codes to estimate rates of severe maternal morbidity in Canada (excluding Quebec) for 2003 to 2007 using the Discharge Abstract Database of the Canadian Institute for Health Information (CIHI). Rates and 95% confidence intervals were calculated by year and within each province and territory and contrasted using the chi-square or Fisher exact test.

Severe maternal morbidity in Canada, 2003 to 2007: surveillance using routine hospitalization data and ICD-10CA codes.

Objective: To examine the feasibility of using routine labour and delivery hospitalization data and international classification of diseases (ICD-10CA) codes for carrying out surveillance of severe maternal morbidity in Canada.

Methods: We identified ICD-10CA diagnosis codes and Canadian Classification of Interventions (CCI) procedure codes associated with severe maternal illness. Severe maternal morbidity rates in Canada (excluding Quebec) for the period 2003 to 2007 were estimated using the Discharge Abstract Database of the Canadian Institute for Health Information.

The active implementation of pregnancy hypertension guidelines in British Columbia.

Objective: To reduce maternal and perinatal morbidity and mortality associated with the hypertensive disorders of pregnancy by using an active model of guideline implementation.

Methods: This study used a preintervention and postintervention cohort comparison design. We interrogated the British Columbia Perinatal Database Registry for 6 years of existing prospectively gathered data (fiscal years 2000-2001 to 2005-2006), introduced the hypertensive disorders of pregnancy guidelines, and assessed the incidence of the combined adverse maternal and perinatal outcomes for the next 2 years (fiscal years 2006-2007 and 2007-2008).

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group.

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.

The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.

Objective: Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth.

Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants.

Objective: To determine the risks and benefits of an elective Caesarean section (CS) at term in healthy nulliparous women.

Methods: We conducted a population-based cohort study of deliveries between 1994 and 2002. Using bivariate and multivariable techniques, we compared maternal and neonatal outcomes in healthy nulliparous women who had undergone elective pre-labour CS (using breech presentation as a surrogate) with those in women who had undergone spontaneous labour with anticipated vaginal delivery (SL) at full term.