Choosing Wisely Canada (CWC) is the national voice for reducing unnecessary tests and treatments in health care. In 2016 the SOGC began their CWC campaign, led by clinicians in partnership with the Canadian Medical Association, to engage health professionals and patients in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high-quality care.
The SOGC has recently published their final top 10 list of recommendations; these are the 5 related to perinatal care:
- Avoid the use of routine episiotomy in spontaneous vaginal births.
- Don’t do electronic fetal monitoring for low-risk women in labour; use intermittent auscultation.
- Don’t perform routine urinalysis (protein, glucose) at every antenatal visit (in low-risk normotensive women).
- Don’t perform umbilical artery Doppler studies as a routine screening test in uncomplicated pregnancies with normal fetal growth.
- Don’t use meperidine for labour analgesia due to its long-acting active metabolites and negative effects on neonatal behaviours.
Curious about the process undertaken to finalize the SOGC’s Top 10 Recommendations? Read the complete list of recommendations, the decision-making process, rationale and supporting evidence here.
Wiley’s FREE-to-View Supplement on Thinking Beyond Maternal Mortality – The International Journal of Gynecology & Obstetrics has published a brand new supplement on re-conceptualizing and measuring maternal morbidity. Click here to access the free supplement.
Canadian Fetal Health Surveillance Newsletter - The Canadian Fetal Health Surveillance (FHS) Steering Committee (C FHS SC) is excited to share several BIG changes to fetal health surveillance education in Canada. Check out all the details here in the current Edition of the FHS Newsletter.
Sickle Cell Awareness Day – About one in every 6,200 babies born in the Maritimes has Sickle Cell Disease (SCD), a genetic disease which causes red blood cells to become ‘sickle-shaped’. This sickle, or C-shaped red blood cell does not function as well in the body as normal round blood cells and can cause severe pain, organ failure, and even death in people with SCD.
On June 19th Canada celebrated the first National Sickle Cell Awareness Day; a day devoted to raising government and public awareness about the impact of Sickle Cell Disease (SCD). Goals of the campaign include: increasing knowledge related to the challenges and complications imposed on the patients and their care givers; the economic and financial impacts on patients, caregivers, and our health system; and the need for policies to advance SCD education, research, care and treatments. To learn more, visit the Sickle Cell Disease Association of Nova Scotia, a local public awareness and support network.
All infants born in Nova Scotia, New Brunswick and Prince Edward Island are screened for hemoglobinopathies, including Sickle Cell Disease. Newborn screening ensures that babies born with SCD are identified and placed on life saving treatments. Early interventions have been shown to prevent complications of sickle cell disease. Prenatally, women from Asian, African, Middle Eastern, Mediterranean & Hispanic descent are screened for hemoglobinopathies/thalassemia.
Recent Publications of Interest – Several publications have been recently released and are now available for your review. Several titles with links have been provided below for your information:
- JOGC – What Interventions Are Being Used to Prevent Preterm Birth and When?
- JOGC – Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia
- JOGC - Intrauterine Bakri Balloon and Vaginal Tamponade Combined with Abdominal Compression for the Management of Postpartum Hemorrhage
- JOGC - Maternal Characteristics for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndromes (GOS) Study
- JOGC - Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization Among Patients Admitted to Obstetrical Units: A Nested Case-Control Study
- JOGC - Perspectives of Immigrant Women on the Gender of Provider During Childbirth
- JOGC - Accelerated Titration of Oxytocin in Nulliparous Women with Labour Dystocia: Results of the ACTION Pilot Randomized Controlled Trial
- JOGC - Iron Deficiency and Risk of Maternal Depression in Pregnancy: An Observational Study
- JOGC - Factors Associated with Trial of Labour and Mode of Delivery in Robson Group 5: A Select Group of Women With Previous Caesarean Section
- JOGC – Commentary:
- JOGC - SOGC Clinical Practice Guidelines:
Revised RCP Orientation Learning Module - RCP has developed several self-directed Maternal Newborn Learning Modules to support the care of childbearing women, newborns, and families. These modules are currently housed on the RCP website. The RCP Hypertensive Disorders of Pregnancy (HDP) Learning Module has recently been revised and can be accessed on the RCP website. As each of the current learning modules are updated they will also be posted to the Provincial Learning Management System (LMS). Stay tuned for the updated Hypertension module to be posted on the Provincial Learning Management System.
ALARM Course - RCP is pleased to be a provider of the Advances in Labour and Risk Management (ALARM) course for 2018. The next course offering to be held at the IWK Health Centre is November 3-4, 2018 and is currently open for registration. Registration information can be found on the RCP website, in the new ALARM portal or by contacting firstname.lastname@example.org.
National Advisory Committee on Immunization (NACI) recommendation for Tdap in pregnancy - In late February, NACI issued a recommendation that immunization with Tdap vaccine should be offered in every pregnancy. The Society of Obstetricians & Gynaecologists of Canada subsequently updated their guideline regarding immunizations in pregnancy to reflect this change.
The Nova Scotia Department of Health and Wellness is currently working on a plan to address a number of key issues in preparation for implementation. Several of the key issues include:
- ensuring a sufficient supply of vaccine to meet the demand;
- creating public and professional messages and education materials including updates to the adult immunization schedule;
- introducing a physician billing code; and
- budget implications.
Care providers are encouraged to continue with current practice recommendations related to Tdap immunization in pregnant women until further communication occurs. In addition caregivers are reminded about the recommendation for wound management in all adults; i.e. Td every 10 years with 1 dose given as Tdap during adulthood.
Hypothermia for newborns with hypoxic-ischemic encephalopathy – The CPS has released a new position statement to guide care providers in therapeutic hypothermia - Hypothermia for newborns with hypoxic-ischemic encephalopathy. Therapeutic hypothermia is a standard of care for infants ≥36 weeks gestational age (GA) with moderate-to-severe hypoxic-ischemic encephalopathy. Because some studies included infants born at 35 weeks GA, hypothermia should be considered if they meet other criteria.
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