Lucie Morin

Determinants of unexplained antepartum fetal deaths

Objective To assess fetal, maternal, and pregnancy-related determinants of unexplained antepartum fetal death. Methods We conducted a hospital-based cohort study of 84,294 births weighing 500 g or more from 1961–1974 and 1978–1996. Unexplained fetal deaths were defined as fetal deaths occurring before labor without evidence of significant fetal, maternal, or placental pathology. Results One hundred ninety-six unexplained antepartum fetal deaths accounted for 27.2% of 721 total fetal deaths. Two thirds of the unexplained fetal deaths occurred after 35 weeks gestation. The following factors were independently associated with unexplained fetal death: maternal prepregnancy weight greater than 68 kg (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI] 1.85, 4.68), birth weight ratio (defined as ratio of birth weight to mean weight for gestational age) between 0.75 and 0.85 (OR 2.77; 95% CI 1.48, 5.18) or over 1.15 (OR 2.36; 95% CI 1.26, 4.44), fewer than four antenatal visits in women whose fetuses died at 37 weeks or later (OR 2.21; 95% CI 1.08, 4.52), primiparity (OR 1.74; 95% CI 1.26, 2.40), parity of three or more (OR 2.01; 95% CI 1.26, 3.20), low socioeconomic status (OR 1.59; 95% CI 1.14, 2.22), cord loops (OR 1.75; 95% CI 1.04, 2.97) and, for the 1978–1996 period only, maternal age 40 years or more (OR 3.69; 95% CI 1.28, 10.58). Trimester of first antenatal visit, low maternal weight, postdate pregnancy, fetal-to-placental weight ratio, fetal sex, previous fetal death, previous abortion, cigarette smoking, and alcohol use were not significantly associated with unexplained fetal death. Conclusion In this study, we identified several factors associated with an increased risk of unexplained fetal death.

Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes

ObjectivesTo examine the association between body mass index (BMI) and obstetrical and neonatal outcomes.MethodsWe conducted a cohort study comparing prepregnant BMI categories with obstetrical and neonatal outcomes using the McGill Obstetrical and Neonatal Database on all deliveries in 10xa0year period (1987–1997). Prepregnant BMI was categorized into underweight (<20), normal (20–24.9), overweight (25–29.9), obese (30–39.9), and morbidly obese (40+). Logistic regression analysis was used to adjust for age, smoking, parity, and preexisting diabetes using normal BMI as the reference.ResultsThe population consisted of underweight 4,312 (23.1%), normal weight 10,021 (53.8%), overweight 3,069 (16.5%), obese 1,137 (6.1%), and morbidly obese 104 (0.6%). As compared to women with normal BMIs, overweight, obese, and morbidly obese women had an increased risk of preeclampsia 2.28 (1.88–2.77), 4.65 (3.71–5.83), 6.26 (3.48–11.26); gestational hypertension 1.56 (1.35–1.81), 2.01 (1.64–2.45), 2.77 (1.60–4.78); gestational diabetes 1.89 (1.63–2.19), 3.22 (2.68–3.87), 4.71 (2.89–7.67); preterm birth 1.20 (1.04–1.38), 1.60 (1.32–1.94), 2.43 (1.46–4.05); cesarean section 1.48 (1.35–1.62), 1.85 (1.62–2.11), 2.92 (1.97–4.34); and macrosomia 1.66 (1.23–2.24), 2.32 (1.58–3.41), 2.10 (0.64–6.86). Underweight women were less likely to have: preeclampsia 0.67 (0.52–0.86), gestational hypertension 0.71 (0.60–0.83), gestational diabetes 0.82 (0.69–0.97), cesarean section 0.89 (0.81–0.97), shoulder dystocia 0.88 (0.80–0.96), birth injuries 0.40 (0.21–0.77), and macrosomia 0.43 (0.28–0.68) but more likely to have small for gestational age infants 1.54 (1.37–1.72) and intrauterine growth restricted infants 1.33 (1.07–1.67).ConclusionIn a large Canadian teaching hospital, increasing prepregnancy BMI category was associated with an increasing risk of adverse pregnancy outcomes. Underweight prepregnancy BMI was associated with a reduced risk of adverse pregnancy outcomes.

Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one‐step and two‐step methods

Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one‐step and two‐step methods. BJOG 2010;117:407–415.

Determinants and consequences of discrepancies in menstrual and ultrasonographic gestational age estimates

Objectivesu2003 To assess the association between maternal and fetal characteristics and discrepancy between last normal menstrual period and early (<20 weeks) ultrasound‐based gestational age and the association between discrepancies and pregnancy outcomes.

Pregnancy Outcomes in Women With and Without Gestational Diabetes Mellitus According to The International Association of the Diabetes and Pregnancy Study Groups Criteria

OBJECTIVE: To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. METHODS: We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (&agr; level of 0.05; two-tailed). RESULTS: The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92–29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79–3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95–1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92–6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53–2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84–2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42–1.26; P=.29) compared with group 2. CONCLUSION: Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. LEVEL OF EVIDENCE: II

Obstetrical factors related to nuchal cord

Background. To investigate the intrapartum factors related to umbilical cord nuchal loops (nuchal cord) with particular reference to shoulder dystocia.

Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes

Objectivesu2002 To determine thematic similarities and differences in the implementation of common‐content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes.

Does Availability of Fetal Fibronectin Testing in the Management of Threatened Preterm Labour Affect the Utilization of Hospital Resources

OBJECTIVESnTo examine how the availability of fetal fibronectin testing affects the utilization of hospital resources.nnnMETHODSnA comparison of the rates, duration, and costs of hospitalization for a prospective cohort of women who presented with preterm labour after fetal fibronectin (Ffn) testing became available, and a historical baseline cohort who presented with preterm labour before fetal fibronectin testing was available. The study included singleton pregnancies presenting between 24 and 34 weeks gestation with signs and symptoms of preterm labour. The women in each study cohort presented during a designated 20-week period.nnnRESULTSnWe examined the records of 116 subjects with comparable gestational age distributions in each 20-week period. During the study period when Ffn testing was available, 51 tests were performed. Four tests were invalid, and 12 subjects who were tested did not meeting the inclusion criteria. Admissions for preterm labour in the study period were significantly less than in the baseline cohort (12.1% vs. 24.1%, P = 0.03), with no difference in preterm births (8.6% vs. 7.8%). The mean length of stay per patient with preterm labour declined from 5.2 days to 0.6 days (P < 0.0001), and the mean cost per patient with preterm labour declined from

The predictive ability of conditional fetal growth percentiles.

3666 to

Obstetric implications of low-lying placentas diagnosed in the second trimester

581 (P < 0.0001). In the 20-week study period, there was a reduction in total length of hospital stay from 145 to 28 days, with an overall reduction in total cost from