Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC
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J Obstet Gynaecol Can · Jan 2013
Practice GuidelineSurgical safety checklist in obstetrics and gynaecology.
To provide guidance on the implementation of a surgical safety checklist in the practice of obstetrics and gynaecology. ⋯ Implementation of the guideline recommendations will improve the health and well-being of women undergoing obstetrical or gynaecologic surgery. Summary Statements and Recommendations Summary Statements 1. Surgery may account for up to 40% of all hospital adverse events. (II-2) 2. Good communication is essential for safer surgical care, as communication failure is common in the operating room. (III) 3. The concept of a surgical safety checklist has been studied globally, and there have been decreases in complications and mortality when the checklist has been implemented. (II-1) 4. Emergency cases such as a "crash" Caesarean section will require a modified approach that is centre- and situation-dependent. (III) 5. The SOGC endorses the adoption of the surgical safety checklist in obstetrics and gynaecology. (III) Recommendations 1. The surgical safety checklist should be adopted by all surgical care providers and their respective institutions to improve patient safety. (II-1A) 2. Surgeons should be familiar with, advocate for the use of, and participate in all 3 parts of the surgical safety checklist. (II-1A) 3. The surgical safety checklist may be modified and adapted for use in surgical obstetrics cases. (II-2A).
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J Obstet Gynaecol Can · Nov 2012
One size does not fit all: differences in newborn weight among mothers of Philippine and other East Asian origin.
To determine the likelihood that infants born to Filipina, other East Asian, and Canadian-born women may be misclassified as small for gestational age when using conventional Canadian birth weight curves rather than those specific to their world region. ⋯ Infants of mothers born in the Philippines weigh significantly less than those of Canadian-born women or mothers emigrating from other East Asian countries. Those who use birth weight curves should consider these differences.
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Lyme disease results from the bite of a black-legged tick, populations of which have now become established in parts of Nova Scotia, southeastern Quebec, southern Ontario from the Thousand Islands through the geographic regions on the north shore of Lake Ontario and Lake Erie, southeastern Manitoba, and British Columbia's Lower Mainland, Fraser Valley, and Vancouver Island. It takes more than 24 hours of attachment to transfer the spirochete Borrelia burgdorferi to the bitten animal or human. The diagnosis of Lyme disease is primarily clinical, with early Lyme disease characterized by a skin lesion (erythema migrans, a bull's-eye rash), which expands out from the site of the tick bite, and is often accompanied by influenza-like symptoms, arthralgia, myalgia, and fever. ⋯ The management of pregnant women with a tick bite or suspected Lyme disease should be similar to that of non-pregnant adults, except that doxycyline, the first line antibiotic of choice, should not be used in pregnant women because of risk of permanent tooth discolouration and possible impact on bone formation in the fetus. An algorithm for the management of tick bites in pregnancy is presented. Clinical, serological, and epidemiological studies have all failed to demonstrate a causal association between infection with B. burgdorferi and any adverse pregnancy outcomes regardless of whether maternal exposure occurs before conception or during pregnancy itself.
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J Obstet Gynaecol Can · Nov 2012
ReviewThe safety of methimazole and propylthiouracil in pregnancy: a systematic review.
Hyperthyroidism is one of the most common endocrine disorders in pregnant women, and it can severely complicate the course and outcome of pregnancy. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Traditionally, MMI has been considered to have clearer evidence of teratogenicity than PTU. Recent studies suggest that PTU can be hepatotoxic, leading to a United States Food and Drug Administration "black box alert." We wished to systematically review the effects of PTU and MMI during pregnancy, and to compare maternal and fetal safety. ⋯ MMI causes a specific pattern of rare teratogenic effects after first trimester exposure, while PTU therapy may be followed by rare but severe hepatotoxic sequelae. It is therefore appropriate to use PTU to treat maternal hyperthyroidism during the first trimester of pregnancy, and to switch to MMI for the remainder of the pregnancy.
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J Obstet Gynaecol Can · Sep 2012
A contemporary approach to the obstetric management of women with heart disease.
Recommendations for the peripartum obstetric management of women with heart disease have included early induction of labour, shortening the second stage of labour during vaginal delivery, and low threshold for elective Caesarean section, although such techniques may result in complications. The objective of this study was to determine whether a less aggressive approach without routine preterm induction, shortening of the second stage, or Caesarean section adversely affects the mother or neonate. ⋯ This large study has shown that in women with heart disease, avoidance of early induction of labour, rare use of Caesarean section for cardiac indications, and selective use of invasive monitoring produces safe obstetric outcomes.