Antepartum Fetal Demise: Towards Diagnostic and Therapeutic Efficacy of Management.

Management of women presenting with intrauterine fetal demise is complex, with medical, psychological, emotional and social variables that need careful consideration when determining the best way forward. Need for diagnostic assessment needs to be balanced against the wishes of the grieving patient and family, to allow adequate data collection that can help with insight into etiology of the stillbirth as well as planning for management of the recurrence risk in a future pregnancy. Multidisciplinary involvement can aid the formulation of a sensitive patient-centered workup plan that can also enhance evolution of a therapeutic relationship of the patient with the caregivers.

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.

Guideline No. 452: Diagnosis and Management of Intrahepatic Cholestasis of Pregnancy.

Objective: To summarize the current evidence and to make recommendations for the diagnosis and management of intrahepatic cholestasis of pregnancy.

Target Population: Pregnant people with intrahepatic cholestasis of pregnancy.

Options: Diagnosing the condition using fasting or non-fasting bile acids, classifying disease severity, determining what treatment to offer, establishing how to monitor for antenatal fetal wellbeing, identifying when to perform elective birth.

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions.

Impact of inherited bleeding disorders on maternal bleeding and other pregnancy outcomes: A population-based cohort study.

Introduction: Increasing rate of postpartum haemorrhage (PPH) has been observed between 2003 and 2010 in Canada. Inherited bleeding disorders contribute to the risk of PPH.

Aim: To identify the trend in PPH in the last decade, assess the impact of bleeding disorders on pregnancy outcomes and evaluate their coagulation workup during pregnancy.

[Directive clinique n 441 : Surveillance prénatale du bien-être fœtal].

Objectif: Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales.

Population Cible: Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale.

Options: Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale.

Guideline No. 439: Diagnosis and Management of Vasa Previa.

Objective: To summarize the current evidence and to make recommendations for diagnosis and classification of vasa previa and for management of women with this diagnosis.

Target Population: Pregnant women with vasa previa or low-lying fetal vessels.

Options: To manage vasa previa in hospital or at home, and to perform a cesarean delivery preterm or at term, or to allow a trial of labour when a diagnosis of vasa previa or low-lying fetal vessels is suspected or confirmed.

[Directive clinique n 439 : Diagnostic et prise en charge du vasa prævia].

Objectif: Résumer les données probantes actuelles et énoncer des recommandations pour le diagnostic et la classification du vasa prævia et pour la prise en charge des femmes ayant reçu ce diagnostic.

Population Cible: Femmes enceintes présentant un vasa prævia ou des vaisseaux ombilicaux péricervicaux.

Options: En cas de diagnostic soupçonné ou confirmé de vasa prævia ou de vaisseaux ombilicaux péricervicaux, prendre en charge la patiente à l'hôpital ou à domicile, puis pratiquer une césarienne avant terme ou à terme ou entreprendre une épreuve de travail.

Technical Update No. 439: Antenatal Corticosteroids at Late Preterm Gestation.

Objective: To update recommendations for administration of antenatal corticosteroids in the late preterm period.

Target Population: Pregnant individuals at risk of preterm birth from 34 to 36 weeks gestation.

Options: Administration or non-administration of a single course of antenatal corticosteroids at 34 to 36 weeks gestation.

Prenatal Nutrition Care in Alberta: The Perspectives of Pregnant Women and Registered Dietitians.

Optimizing women's diets in pregnancy improves maternal and child health outcomes; however, the best format for supporting women's nutrition goals in pregnancy is not clear, and access to dietetic services is not standard in prenatal care in Alberta. This study explored women's perceptions about access to Registered Dietitians (RDs) throughout pregnancy and RDs experiences providing prenatal nutrition counselling. Two studies were conducted.

JOINT SOGC-CPS CLINICAL PRACTICE GUIDELINE: Guideline No. 424: Umbilical cord management in preterm and term infants.

Objective: To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity.

Target Population: Women who are pregnant with preterm or term singletons or twins.

Benefits Harms And Costs: In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity.

DIRECTIVE CLINIQUE CONJOINTE DE LA SOGC ET DE LA SCP: Directive clinique n 424 : Prise en charge du cordon ombilical chez le nourrisson prématuré ou à terme.

Objectif: Évaluer l'effet du clampage retardé du cordon et de la traite du cordon ombilical sur les risques de mortalité et de morbidité maternelles et néonatales en contexte de grossesses monofœtale ou gémellaire.

Population Cible: Femmes enceintes dont la grossesse monofœtale ou gémellaire est à terme ou avant terme.

BÉnÉfices Risques Et CoÛts: Chez les prématurés de grossesse monofœtale, le clampage retardé de 60 à 120 secondes idéalement, mais d'au moins 30 secondes, réduit le risque de mortalité et de morbidité.