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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To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. ⋯ The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C).