Incidence, Intrapartum Risk Factors, and Prognosis of Neonatal Hypoxic-Ischemic Encephalopathy Among Infants Born at 35 Weeks Gestation or More.

Introduction: Neonatal hypoxic-ischemic encephalopathy (HIE) is associated with neonatal mortality, acute neurological injury, and long-term neurodevelopmental disabilities; however, the association between intrapartum factors and HIE remains unclear.

Methods: This population-based cohort study used linked obstetrical and newborn data derived from the Nova Scotia Atlee Perinatal Database (NSAPD, 1988-2015) and the AC Allen Perinatal Follow-Up Program Database (2006-2015) for all pregnancies with live, non-anomalous newborns ≥35 weeks gestation, not delivered by pre-labour cesarean section. Temporal trends in HIE incidence were described, and logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI) for the association of intrapartum factors with HIE.

Operative vaginal delivery - An historical perspective.

This chapter will cover the evolution of forceps and vacuum-assisted delivery of the foetus in cephalic presentation. The options available before the development of obstetric forceps are briefly reviewed. The invention of the forceps in the early 17th century was followed by their evolution over four centuries with the introduction of the pelvic curve, axis-traction and rotational forceps.

Type of Labour in the First Pregnancy and Cumulative Perinatal Morbidity.

Objective: To estimate cumulative perinatal morbidity among infants delivered at term, according to the type of labour in the first pregnancy, when the first pregnancy was low risk.

Methods: In a 26-year population-based cohort study (1988-2013) using the Nova Scotia Atlee Perinatal Database, we identified the type of labour in successive pregnancies in low-risk, nulliparous women at term in their first pregnancy (who had at least one subsequent pregnancy), and also identified perinatal outcomes in subsequent deliveries according to the type of labour in the first pregnancy.

Results: A total of 37 756 pregnancies satisfied inclusion and exclusion criteria; of these, 1382 (3.

Type of Labour in the First Pregnancy and Cumulative Maternal Morbidity.

Objective: To estimate cumulative maternal morbidity among women who delivered at term in their first pregnancy on the basis of type of labour in the first pregnancy.

Methods: Using a 25-year population-based cohort (1988 to 2012) derived from the Nova Scotia Atlee Perinatal Database, we determined the type of labour in successive pregnancies in low-risk, nulliparous women at term in their first pregnancy (who had at least one subsequent pregnancy), and the maternal outcomes in subsequent deliveries based on the type of labour in the first pregnancy.

Results: A total of 36 871 pregnancies satisfied inclusion and exclusion criteria, 1346 of which were delivered by Caesarean section without labour in the first pregnancy.

Trends in the prevalence of cerebral palsy among very preterm infants (<31 weeks' gestational age).

Background: The birth prevalence of cerebral palsy varies over time among very preterm infants, and the reasons are poorly understood.

Objective: To describe the variation in the prevalence of cerebral palsy among very preterm infants over time, and to relate these differences to other maternal or neonatal factors.

Methods: A population-based cohort of very preterm infants was evaluated over a 20-year period (1988 to 2007) divided into four equal epochs.

Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year follow-up of a randomized controlled trial.

Objective: To report on a 3-year follow-up of women who underwent overlapping repair of a complete third-degree or fourth-degree obstetric tear.

Methods: Primiparous women sustaining a complete third-degree or a fourth-degree tear of the perineum were randomized to a primary sphincter repair using either an end-to-end or an overlapping surgical technique. At 1, 2, and 3 years, questionnaires on rates of flatal and fecal incontinence were mailed to participants.

Neonatal outcome following failed Kiwi OmniCup vacuum extraction.

Objective: To evaluate neonatal outcomes following failed vacuum extraction using the Kiwi OmniCup vacuum device.

Methods: We conducted a retrospective study of 288 failed vacuum deliveries using the OmniCup device. The neonatal morbidity was recorded for each delivery.

Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009).

Objective: To determine the antecedent factors, morbidity, and mortality associated with disseminated intravascular coagulation (DIC) in a Nova Scotia tertiary maternity hospital over a 30-year period.

Methods: Cases of DIC were identified from the Nova Scotia Atlee Perinatal Database for the years 1980 to 2009 and the hospital charts reviewed. The clinical diagnosis of DIC was confirmed or refuted using a combination of the International Society of Thrombosis and Haemostasis scoring system and an obstetrical DIC-severity staging system.

The influence of changing post-term induction of labour patterns on severe neonatal morbidity.

Objective: To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity.

Methods: This population-based cohort study used data from the Nova Scotia Atlee Perinatal Database to evaluate the effect of post-term induction of labour on stillbirth and neonatal mortality and severe neonatal morbidity in low-risk pregnancies. The study population included all pregnant women ≥ 40 weeks' gestation delivering in Nova Scotia from 1988 to 2008 who underwent induction of labour with a single fetus in cephalic presentation.

Contribution of select maternal groups to temporal trends in rates of caesarean section.

Objective: To estimate the contribution of select maternal groups to temporal trends in Caesarean section (CS) rates.

Methods: Using the Nova Scotia Atlee Perinatal Database, all deliveries by CS during the 24-year period from 1984 to 2007, at the Women's Hospital, IWK Health Centre were identified. Deliveries by CS were classified into groups using parity (nullipara/multipara), plurality (singleton/multiple), presentation (cephalic/breech/transverse), gestational age (term/preterm), history of previous CS (previous CS/no previous CS), and labour (spontaneous/induced/no labour).

Overlapping compared with end-to-end repair of third- and fourth-degree obstetric anal sphincter tears: a randomized controlled trial.

Objective: To compare overlapping repair with end-to-end repair of obstetric tears and to investigate which procedure results in a higher rate of flatal incontinence.

Methods: One-hundred forty-nine primiparous women sustaining a complete third- or a fourth-degree tear of the perineum were assigned randomly to a primary sphincter repair using either an end-to-end (n=75) or an overlapping surgical technique (n=74) using 3-0 polyglyconate. Outcome measures at 6 months included rates of flatal and fecal incontinence, quality-of-life scores, integrity of the internal and external anal sphincters by anal ultrasonography, and anal sphincter function as reflected by anal manometry.

Maternal and perinatal outcomes with increasing duration of the second stage of labor.

Objective: To estimate maternal and perinatal outcomes among women with increasing duration of the second stage of labor.

Methods: A population-based cohort study was conducted among women with low-risk, singleton, vertex, nonanomalous deliveries at or after 37 weeks of gestation between 1988 and 2006. Individual maternal (hemorrhagic, infectious, and traumatic), perinatal (birth depression, infectious, and traumatic), and composite outcomes were evaluated with increasing duration of the second stage.

Maternal critical care in obstetrics.

Objective: To determine the factors leading to maternal critical care in a tertiary obstetric hospital and the associated trends.

Methods: We conducted a review of the medical records of all women who required transfer for critical care from a free-standing obstetric unit to a general hospital over a 24-year period (1982-2005).

Results: During the 24-year period there were five maternal deaths directly associated with 122,001 deliveries (4.

The use of intraoperative cystoscopy by general gynaecologists in Canada.

Background: The primary purpose of this study was to determine the intraoperative cystocopy practices of Canadian gynaecologists. The secondary aim was to identify barriers for the use of cystoscopy in this same population.

Methods: An 18-item questionnaire was sent to all active members of the Society of Obstetricians and Gynaecologists of Canada.

Epidemiology of obstetric critical care.

In the last 20 years, in developed countries, maternal mortality rates have fallen such that analysis of cases of severe maternal morbidity is necessary to provide sufficient numbers to give a clinically relevant assessment of the standard of maternal care. Different approaches to the audit of severe maternal morbidity exist, and include need for intensive care, organ system dysfunction and clinically defined morbidities. In both developed and developing countries, the dominant causes of severe morbidity are obstetric haemorrhage and hypertensive disorders.