SOGC Working to Reduce Maternal Mortality & Morbidity – The Society of Obstetricians and Gynecologists of Canada (SOGC) is collaborating with experts from across Canada and around the world as well as provincial and perinatal partners to develop a National Canadian Surveillance System related to maternal mortality & morbidity. The focus of the work will be to develop a concrete strategy for the implementation of an identification, measurement, and national surveillance system to improve deficiencies in tracking the incidence of maternal mortality and severe morbidity in Canada. For more information go to the SOGC website.
New Requisitions: Maternal Serum Screening/Testing Samples - In collaboration with MFM service providers, the IWK Laboratory has updated the maternal serum testing requisitions. These new forms incorporate the necessary information for referral of samples to the IWK that was previously captured on the second form. Please discontinue use of the old requisitions. Old requisitions will no longer be accepted as of July 1, 2018.
New requisitions will be included in each mailed out screen report for the next few weeks. Requests for additional print copies can be made by fax on letterhead or coversheet to 902-470-7215 or electronic versions download from:
- http://www.iwk.nshealth.ca/sites/default/files/requisitions/MST-1st-trimester.pdf
- http://www.iwk.nshealth.ca/sites/default/files/requisitions/MST-2nd-trimester.pdf
And at:
French translation is underway; another notification will be sent when French-language versions of the requisitions are available.
RCP Chart Form Revisions- Effective April 1, 2018, there have been revisions made to the following RCP chart forms:
- RCP/02 – Maternal Assessment (Revised Feb. 2018)
- RCP/04 – Birth Record (Revised Feb. 2018)
- RCP/08 – Newborn Admission/Discharge (Revised Feb. 2018)
- RCP/09 – Newborn Nursing Assessment (Revised Feb. 2018)
Please discontinue use of old versions of these forms. Updated chart forms have been delivered to all the Maternal-Child Services across the province. In the meantime, RCP is working with the provincial Health Information Services team to ensure the carbonless chart forms are accessible in the E-Forms Repository. Your cooperation and understanding is greatly appreciated as we move through this new process. Additional print chart form copies can be found on the RCP website. You may also request copies of the Nova Scotia Prenatal Record using the online order form or by phone at 902-470-6798.
Coding Manual Changes – The above noted RCP chart form revisions has resulted in the addition of several new variables to the Nova Scotia Atlee Perinatal Database (NSAPD). The new variables for collection include:
- Delayed Cord Clamping (DCC)
- Cord Milking
- Critical Congenital Heart Disease (CCHD) Screening
- Supplementation – Indication
Fetal Health Surveillance Education Position Statement – The Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN) has recently released a new position statement related to fetal health surveillance (FHS) education for nurses. CAPWHN supports that FHS is a required nursing skill for nurses working with the perinatal population in Canada and that they must be educated and updated regularly about all FHS techniques as per current standards of practice, context, and client preference. To read the publication in full go to the CAPWHN website.
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 – Guest Editorial - Beyond Fetal Aneuploidy: A Call For A Contemporary Canadian Approach To Prenatal Screening
- JOGC – Commentary - Moderate Variability Does Not Rule Out Metabolic Acidemia: A Finding Which May Change How We Conceptualize Fetal Heart Rate Monitoring
- Reaffirmed SOGC Clinical Practice Guidelines:
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 joanne.ings@iwk.nshealth.ca.
Oral Immune Therapy: ‘Baby’s First Vaccination’ – Oral Immune Therapy (OIT) is mother’s own fresh colostrum or expressed breast milk (EBM) given as a small amount into the newborn’s buccal cavity; interacting with the newborn’s lymphoid tissue in the oropharynx and gut (Gephart & Weller, 2014). The IWK has found that OIT is safe, feasible and well-tolerated even for the most premature of newborns. OIT has the potential to provide many benefits including:
- Protection against necrotizing enterocolitis, sepsis, ventilator associated pneumonia
- Stimulation of gastro-intestinal tract prior to enteral feeds
- Enhanced maturation of oral feeding skills
- Reduced time to full enteral feeds
- Improved growth
- Enhanced breast-feeding outcomes
During a recent gathering of nursing leaders in maternal and child health, the topic of OIT was discussed and promoted for all newborns; but in particular for those transported for urgent care due to illness or prematurity. These newborns will experience separation from their mothers. During the time of planning and preparation for the newborn transport, mothers can be encouraged and assisted to express their colostrum, administering a small amount to the baby orally before departure.
If the newborn is being transferred by LifeFlight, the LifeFlight team will rely on home hospital care providers to assist mothers to express and collect their colostrum or breastmilk. It’s helpful to communicate with the transport team that OIT is available and assist parents to get close to their newborn to give the OIT. Parents administering the OIT provides a unique opportunity to provide immune protection to their new baby, prior to the separation of family members and to make a memory that will last a lifetime.
More information is available from Brenda Hewitt, Clinical Nurse Specialist, IWK NICU (Brenda.hewitt@iwk.nshealth.ca) or by telephoning the Lactation Consultant Nurses for the IWK NICU @ 902 -470-3941.
Resource: IWK Colostrum collection information leaflet
References:
- Gephart, S. & Weller, M. (2014). Colostrum as Oral Immune Therapy to Promote Neonatal Health. Advances in Neonatal Care 14(1) 44-51.
- Pletsch, D., Ulrich, C., Angelini, M., Fernandes, G. & Lee, D.S.C. (2013). Mothers’ “Liquid Gold”: A quality improvement initiative to support early colostrum delivery via oral immune therapy (OIT) to premature and critically ill newborns. Nursing Leadership 26: 34-42.
Nova Scotia Breastfeeding and Baby-Friendly Initiative Update - As you are aware, the health system in Nova Scotia has undergone a transformation. Breastfeeding and Baby-Friendly Initiative work has continued during this time and has been led by many stakeholders across the two health authorities; the IWK Health Centre and the Nova Scotia Health Authority (NSHA). For a detailed update describing some of this work at the provincial level go to the RCP website.
New 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.
Across the country, provinces and territories will need to develop plans to implement this recommendation if it is to be included as part of their publicly funded immunization programs. Many key issues need to be considered such as:
- 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
- implications to the budget.
Until these issues can be addressed, care providers may find that the Tdap supply is not sufficient to immunize all pregnant women. Setting priorities for immunization may be necessary, for example offering Tdap to women who have not had an adult booster in the past 10 years. Please note that, until final decisions about these processes are in place in Nova Scotia, public funding for Tdap in every pregnancy is not in place. Further updates will be shared as they become available.
Canadian Pediatric Society: Supporting Families Experiencing Perinatal Loss - Perinatal loss is one of the most devastating events a family can experience. CPS’ Fetus and Newborn Committee has created a new practice point focusing on circumstances likely to involve health care professionals. Recommendations are provided for compassionate communication, bereavement, sibling care and counselling to support families.
Canadian Public Health Association Resources on Cannabis – The Canadian Public Health Association (CPHA) provides a number of resources related to cannabis, including reports specific to the Nova Scotia context as well as a webinar series. Although not all this information is specific to the perinatal population, with legalization on the horizon, this information may serve as a relevant resource to care providers.
More Cannabis Resources - As the date for decriminalization of cannabis approaches, health care providers are looking for information to help support their conversations about cannabis use with childbearing women and families. Approaches that consider health equity, harm reduction and a trauma-informed perspective are important. A number of resources have been provided below:
1. Evidence Brief:
Canada’s Lower-Risk Cannabis Use Guidelines
2. Centre of Excellence for Women’s Health:
3. SOGC Public Awareness Campaign Re: Cannabis (part one of a two-part campaign):
Pregnancy Info Website
4. The American College of Obstetricians and Gynecologists (ACOG):
5. New Brunswick Medical Society:
Legalization of Recreational Cannabis
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