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Affiliation(s)
- John Van Aerde
- University of Alberta, Alberta, Canada
- Canadian Society of Physician Leaders, Ontario, Canada
| | - Marcio M Gomes
- University of Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Canada
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Hartney E, Melis E, Taylor D, Dickson G, Tholl B, Grimes K, Chan MK, Van Aerde J, Horsley T. Leading through the first wave of COVID: a Canadian action research study. Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34898142 DOI: 10.1108/lhs-05-2021-0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future. DESIGN/METHODOLOGY/APPROACH The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology. FINDINGS Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication. RESEARCH LIMITATIONS/IMPLICATIONS The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders' views of what may be required to re-define future health systems may change as the crisis shifts over time. PRACTICAL IMPLICATIONS The sponsoring organization of this research - the Canadian Health Leadership Network and each of its individual member partners - will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery. SOCIAL IMPLICATIONS This research has shown that there is an immediate need to develop innovative and influential leadership action - commensurate with its findings - to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations. ORIGINALITY/VALUE An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19's first wave using action research study design.
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Affiliation(s)
- Elizabeth Hartney
- Royal Roads University, Victoria, Canada and Canadian Health Leadership Network, Ottawa, Canada
| | - Ellen Melis
- Canadian Health Leadership Network, Ottawa, Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, Canada and Canadian Health Leadership Network, Ottawa, Canada
| | - Graham Dickson
- Professor Emeritus, Royal Roads University, Victoria, Canada and Canadian Health Leadership Network, Ottawa, Canada
| | - Bill Tholl
- Canadian Health Leadership Network, Ottawa, Canada
| | - Kelly Grimes
- Canadian Health Leadership Network, Ottawa, Canada
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada and Canadian Health Leadership Network, Ottawa, Canada
| | - John Van Aerde
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada and Canadian Health Leadership Network, Ottawa, Canada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada and Canadian Health Leadership Network, Ottawa, Canada
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Chan MK, Dickson G, Keegan DA, Busari JO, Matlow A, Van Aerde J. A tale of two frameworks: charting a path to lifelong learning for physician leaders through CanMEDS and LEADS. Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34738770 DOI: 10.1108/lhs-04-2021-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper was to determine the complementarity between the Canadian Medical Education Directions for Specialists (CanMEDS) physician competency and LEADS leadership capability frameworks from three perspectives: epistemological, philosophical and pragmatic. Based on those findings, the authors propose how the frameworks collectively layout pathways of lifelong learning for physician leadership. DESIGN/METHODOLOGY/APPROACH Using a qualitative approach combining critical discourse analysis with a modified Delphi, the authors examined "How complementary the CanMEDS and LEADS frameworks are in guiding physician leadership development and practice" with the following sub-questions: What are the similarities and differences between CanMEDS and LEADS from: An epistemological and philosophical perspective? The perspective of guiding physician leadership training and practice? How can CanMEDS and LEADS guide physician leadership development from medical school to retirement? FINDINGS Similarities and differences exist between the two frameworks from philosophical and epistemological perspectives with significant complementarity. Both frameworks are founded on a caring ethos and value physician leadership - CanMEDS (for physicians) and LEADS (physicians as one of many professions) define leadership similarly. The frameworks share beliefs in the function of leadership, embrace a belief in distributed leadership, and although having some philosophical differences, have a shared purpose (preparing for changing health systems). Practically, the frameworks are mutually supportive, addressing leadership action in different contexts and where there is overlap, complement one another in intent and purpose. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first paper to map the CanMEDS (physician competency) and LEADS (leadership capabilities) frameworks. By determining the complementarity between the two, synergies can be used to influence physician leadership capacity needed for today and the future.
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Affiliation(s)
- Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Graham Dickson
- School of Leadership Studies, Royal Roads University, Victoria, Canada and Canadian Society of Physician Leaders, Ottawa, Canada
| | - David A Keegan
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jamiu O Busari
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands and Department of Pediatrics, Horacio Oduber Hospital, Oranjestad, Aruba
| | - Anne Matlow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Dickson GS, Taylor D, Hartney E, Tholl B, Grimes K, Chan MK, Van Aerde J, Horsley T, Melis E. The relevance of the LEADS framework during the COVID-19 pandemic. Healthc Manage Forum 2021; 34:326-331. [PMID: 34496640 PMCID: PMC8547233 DOI: 10.1177/08404704211033002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
COVID-19 has created a unique context for the practice of leadership in healthcare. Given the significant use of the LEADS in a Caring Environment capabilities framework (LEADS) in Canada's health system, it is important to document the relevancy of LEADS. The authors reviewed literature, conducted research, and reflected on their own experience to identify leadership practices during the pandemic and related them to LEADS. Findings are presented in three sections: Hindsight (before), Insight (during), and Foresight (post). We profile the issue of improving long-term Care to provide an example of how LEADS can be applied in crisis times. Our analysis suggests that while LEADS appears to specify the leadership capabilities needed, it requires adaptation to context. The vision Canada has for healthcare will dictate how LEADS will be used as a guide to leadership practice in the current context or to shape a bolder vision of healthcare's future.
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Affiliation(s)
- Graham Stewart Dickson
- Royal Roads University, Canadian Health Leadership Network, Vancouver, British Columbia, Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia, Canada
| | | | - Bill Tholl
- Canadian Health Leadership Network, Ottawa, Ontario, Canada
| | - Kelly Grimes
- Canadian Health Leadership Network, Ottawa, Ontario, Canada
| | - Ming-Ka Chan
- University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - John Van Aerde
- Canadian Society of Physician Leaders, Ottawa, Ontario, Canada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Ellen Melis
- Unlimited Potentialities, Canadian Health Leadership Network, Mumbai, Maharashtra, India
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Abstract
This article looks at the current state of health leadership in terms of expectations for professionalism: controlled entry, exit, and licensure/certification; a social contract to provide public services for the good of Canadians; and a unique body of knowledge and practice generally accepted. Looking to the future, and using the same three criteria, a compelling case for pursuing the professionalization of health leadership is made using LEADS as a roadmap. The article also outlines how to realize the professionalization of health leadership in Canada and why it is important to do so.
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Affiliation(s)
- Graham Dickson
- Canadian Health Leadership Network, Ottawa, Ontario, Canada.,Canadian Society of Physician Leaders, Ottawa, Ontario, Canada
| | - John Van Aerde
- Canadian Society of Physician Leaders, Ottawa, Ontario, Canada
| | - Bill Tholl
- Canadian Health Leadership Network, Ottawa, Ontario, Canada
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Abstract
Purpose The purpose of this paper is to provide a case study demonstrating that LEADS in a Caring Environment Capabilities Framework in Canada can assist physicians to be partners in leading health reform. Design/methodology/approach A descriptive case-based approach was followed, relying on existing documents, research papers and peer-reviewed articles, to substantiate the effect of LEADS on physician leadership in Canada. Findings The Canadian LEADS framework enables physicians to lead by providing them with access to best practices of leadership, acting as an antidote to fragmented leadership practice, setting standards for development and accountability and providing opportunities for efficient and effective system-wide leadership development and change. Research limitations/implications A formal systematic review of the literature was not conducted. Findings can only be generalized to other cases if the reader sees contextual similarities between the present study context and the other case's context. Practical implications This case demonstrates that national leadership frameworks have a role in facilitating physician leadership. Other national jurisdictions may wish to explore the Canadian case to determine how to use a common leadership language to engage physicians in health reform. Social implications Leadership is a key component of health reform. A common language and set of standards (LEADS) that can engage physicians will benefit patients and citizens in Canada. Originality/value This national case study shows how a nationally endorsed leadership framework such as LEADS can facilitate better physician leadership for health reform.
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Affiliation(s)
- Graham Dickson
- Royal Roads University , Victoria, Canada and Canadian Society of Physician Leaders, Ottawa, Canada
| | - John Van Aerde
- Department of Pediatrics, University of British Columbia , Vancouver, Canada
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Jeyaraman MM, Qadar SMZ, Wierzbowski A, Farshidfar F, Lys J, Dickson G, Grimes K, Phillips LA, Mitchell JI, Van Aerde J, Johnson D, Krupka F, Zarychanski R, Abou-Setta AM. Return on investment in healthcare leadership development programs. Leadersh Health Serv (Bradf Engl) 2017; 31:77-97. [PMID: 29412095 DOI: 10.1108/lhs-02-2017-0005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.
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Affiliation(s)
- Maya M Jeyaraman
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada , and Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
| | | | - Aleksandra Wierzbowski
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada
| | - Farnaz Farshidfar
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada
| | - Justin Lys
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada
| | - Graham Dickson
- The Canadian Health Leadership Network (CHLNet), Ottawa, Canada
| | - Kelly Grimes
- The Canadian Health Leadership Network (CHLNet), Ottawa, Canada
| | - Leah A Phillips
- The Canadian Health Leadership Network (CHLNet), Ottawa, Canada , and College of Licensed Practical Nurse of Alberta, School of Public Health, University of Alberta , Edmonton, Canada
| | | | - John Van Aerde
- The Canadian Health Leadership Network (CHLNet), Ottawa, Canada and Department of Pediatrics, Faculty of Medicine, University of Alberta , Edmonton, Canada
| | - Dave Johnson
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada
| | - Frank Krupka
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada
| | - Ryan Zarychanski
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada , and Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba , Winnipeg, Canada , and Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
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Abstract
BACKGROUND Perinatal brachial plexus palsy (PBPP) is a flaccid paralysis of the arm at birth that affects different nerves of the brachial plexus supplied by C5 to T1 in 0.42 to 5.1 infants per 1000 live births. OBJECTIVES To identify antenatal factors associated with PBPP and possible preventive measures, and to review the natural history as compared with the outcome after primary or secondary surgical interventions. METHODS A literature search on randomized controlled trials, systematic reviews and meta-analyses on the prevention and treatment of PBPP was performed. EMBASE, Medline, CINAHL and the Cochrane Library were searched until June 2005. Key words for searches included 'brachial plexus', 'brachial plexus neuropathy', 'brachial plexus injury', 'birth injury' and 'paralysis, obstetric'. RESULTS There were no prospective studies on the cause or prevention of PBPP. Whereas birth trauma is said to be the most common cause, there is some evidence that PBPP may occur before delivery. Shoulder dystocia and PBPP are largely unpredictable, although associations of PBPP with shoulder dystocia, infants who are large for gestational age, maternal diabetes and instrumental delivery have been reported. The various forms of PBPP, clinical findings and diagnostic measures are described. Recent evidence suggests that the natural history of PBPP is not all favourable, and residual deficits are estimated at 20% to 30%, in contrast with the previous optimistic view of full recovery in greater than 90% of affected children. There were no randomized controlled trials on nonoperative management. There was no conclusive evidence that primary surgical exploration of the brachial plexus supercedes conservative management for improved outcome. However, results from nonrandomized studies indicated that children with severe injuries do better with surgical repair. Secondary surgical reconstructions were inferior to primary intervention, but could still improve arm function in children with serious impairments. CONCLUSIONS It is not possible to predict which infants are at risk for PBPP, and therefore amenable to preventive measures. Twenty-five per cent of affected infants will experience permanent impairment and injury. If recovery is incomplete by the end of the first month, referral to a multidisciplinary team is necessary. Further research into prediction, prevention and best mode of treatment needs to be done.
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Reis MD, Rempel GR, Scott SD, Brady-Fryer BA, Van Aerde J. Developing nurse/parent relationships in the NICU through negotiated partnership. J Obstet Gynecol Neonatal Nurs 2010; 39:675-83. [PMID: 21039850 DOI: 10.1111/j.1552-6909.2010.01189.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore parents' experience and satisfaction with care in the Neonatal Intensive Care Unit (NICU). DESIGN Qualitative design using an interpretive description method. SETTING A tertiary-level care 69-bed NICU. PARTICIPANTS Ten parents (nine mothers and one father) were interviewed. METHOD Parents were interviewed in person or via telephone, either following or close to discharge. Interviews were recorded, transcribed, and then analyzed using an evolving coding guide. RESULTS All parents indicated that the relationship they developed with the bedside nurse was the most significant factor affecting their satisfaction with their NICU experience. All parents described nursing actions of perceptive engagement, cautious guidance, and subtle presence, which facilitated the development of this relationship. Further analysis of the data revealed that parents portrayed nurses in ideal nurse/parent interactions as fulfilling the roles of teacher, guardian, and facilitator. CONCLUSION Developing a collaborative and effective nurse/parent relationship is the most significant factor affecting parents' satisfaction with their NICU experience. Providing nursing care in a manner that optimizes consistency and continuity of care facilitates the ability of both parties to develop this relationship.
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Affiliation(s)
- Misty D Reis
- Department, School of Nursing, University of North Carolina, Greensboro, NC, USA
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Johnson ST, Bigam DL, Emara M, Slack G, Jewell LD, Obaid L, Korbutt G, Van Aerde J, Cheung PY. Effects of N-acetylcysteine on intestinal reoxygenation injury in hypoxic newborn piglets resuscitated with 100% oxygen. Neonatology 2009; 96:162-70. [PMID: 19332996 DOI: 10.1159/000210089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal asphyxia may lead to the development of ischemia-reperfusion induced intestinal injury, which is related to oxygen-derived free radical production. N-Acetylcysteine (NAC) is a thiol-containing antioxidant which increases intracellular stores of glutathione. OBJECTIVES Using a swine model of neonatal hypoxia-reoxygenation, we examined whether administration of NAC after resuscitation improved intestinal perfusion and reduced intestinal damage. METHODS Twenty-four piglets (1-4 days old, 1.4-2.2 kg) were anesthetized and acutely instrumented for continuous monitoring of superior mesenteric arterial flow and oxygen delivery. Alveolar hypoxia was induced for 2 h, followed by resuscitation with 100% oxygen for 1 h and 21% oxygen for 3 h. Animals were randomized to sham-operated, hypoxic control and NAC treatment (150 mg/kg i.v. at 0 or 10 min of reoxygenation followed by infusion 100 mg/kg/h) groups. During hypoxia-reoxygenation, intestinal tissue glutathione content, caspase-3 activity and reoxygenation injury were examined. RESULTS After 2 h of hypoxia, piglets were acidotic and hypotensive, with significantly depressed blood flow and oxygen delivery to the small intestine. Upon reoxygenation, hemodynamics recovered as did oxygen supply to the small intestine. After 4 h of reoxygenation, the NAC treatment improved mesenteric flow and oxygen delivery. Despite reducing the increase in caspase-3 activities after hypoxia-reoxygenation by NAC treatment, no significant differences in the glutathione content and histological grading of ileal injury were found among the experimental groups. CONCLUSIONS In newborn piglets with hypoxia-reoxygenation, NAC may improve mesenteric blood flow and oxygen delivery without significant effect on tissue glutathione content. The protective role of NAC in the reoxygenated intestine after severe hypoxia warrants further investigation.
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Affiliation(s)
- Scott T Johnson
- Department of Surgery, University of Alberta, Edmonton, Alta., Canada
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Johnson ST, Bigam DL, Emara M, Obaid L, Slack G, Korbutt G, Jewell LD, Van Aerde J, Cheung PY. N-acetylcysteine improves the hemodynamics and oxidative stress in hypoxic newborn pigs reoxygenated with 100% oxygen. Shock 2008; 28:484-90. [PMID: 17577140 DOI: 10.1097/shk.0b013e31804f775d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neonatal asphyxia may lead to cardiac and renal complications perhaps mediated by oxygen free radicals. Using a model of neonatal hypoxia-reoxygenation, we tested the hypothesis that N-acetylcysteine (NAC) would improve cardiac function and renal blood flow. Eighteen piglets (aged 1-4 days old, weighing 1.4-2.2 kg) were anesthetized and acutely instrumented for continuous monitoring of pulmonary and renal artery flow (cardiac index [CI] and renal artery flow index [RAFI], respectively) and mean blood pressure. Alveolar hypoxia was induced for 2 h, followed by resuscitation with 100% oxygen for 1 h and 21% oxygen for 3 h. Animals were randomized to sham-operated, hypoxic control, and NAC treatment (i.v. bolus of 150 mg/kg given at 10 min of reoxygenation followed by 100 mg/kg per h infusion) groups. Myocardial and renal tissue glutathione content and lipid hydroperoxide levels were assayed, and histology was examined. After 2 h of hypoxia, all animals were acidotic (pH 6.96 +/- 0.04) and in cardiogenic shock with depressed renal blood flow. Upon reoxygenation, CI and RAFI increased but gradually deteriorated later. The NAC treatment prevented the decreased CI, stroke volume, mean blood pressure, systemic oxygen delivery, RAFI, and renal oxygen delivery at 2 to 4 h of reoxygenation observed in hypoxic controls (versus shams, all P < 0.05). The myocardial and renal tissue glutathione content was significantly higher in the NAC treatment group (versus controls). The CI and RAFI at 4 h of reoxygenation correlated with the tissue glutathione redox ratio (r = 0.5 and 0.6, respectively, P < 0.05). There were no significant differences in heart rate, pulmonary artery pressure, systemic oxygen uptake, and tissue lipid hydroperoxide levels between groups. No histologic injury was found in the heart or kidney. In this porcine model of neonatal hypoxia and 100% reoxygenation, NAC improved cardiac function and renal perfusion, with improved tissue glutathione content.
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Affiliation(s)
- Scott T Johnson
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Allen VM, Armson BA, Wilson RD, Allen VM, Blight C, Gagnon A, Johnson JA, Langlois S, Summers A, Wyatt P, Farine D, Armson BA, Crane J, Delisle MF, Keenan-Lindsay L, Morin V, Schneider CE, Van Aerde J. Archivée: Tératogénicité associée aux diabètes gestationnel et préexistant. Journal of Obstetrics and Gynaecology Canada 2007. [DOI: 10.1016/s1701-2163(16)32652-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Allen VM, Armson BA, Wilson RD, Allen VM, Blight C, Gagnon A, Johnson JA, Langlois S, Summers A, Wyatt P, Farine D, Armson BA, Crane J, Delisle MF, Keenan-Lindsay L, Morin V, Schneider CE, Van Aerde J. Teratogenicity Associated With Pre-Existing and Gestational Diabete. Journal of Obstetrics and Gynaecology Canada 2007; 29:927-934. [DOI: 10.1016/s1701-2163(16)32653-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Oppenheimer L, Armson A, Farine D, Keenan-Lindsay L, Morin V, Pressey T, Delisle MF, Gagnon R, Robert Mundle W, Van Aerde J. Archivée: Diagnostic et prise en charge du placenta praevia. Journal of Obstetrics and Gynaecology Canada 2007. [DOI: 10.1016/s1701-2163(16)32400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Min JK, Claman P, Hughes E, Cheung AP, Claman P, Fluker M, Goodrow GJ, Graham J, Graves GR, Lapensée L, Min JK, Stewart S, Ward S, Chee-Man Wong B, Armson AB, Delisle MF, Farine D, Gagnon R, Keenan-Lindsay L, Morin V, Mundle W, Pressey T, Schneider C, Van Aerde J. Directive clinique en ce qui concerne le nombred’embryons à transférer à la suite de la fécondation in vitro. Journal of Obstetrics and Gynaecology Canada 2006. [DOI: 10.1016/s1701-2163(16)32248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leduc L, Farine D, Armson BA, Brunner M, Crane J, Delisle MF, Gagnon R, Keenan-Lindsay L, Morin V, Mundle RW, Scheider C, Van Aerde J. Archivée: Mortinaissance et deuil : Lignes directrices pour l’enquête faisant suite à une mortinaissance. Journal of Obstetrics and Gynaecology Canada 2006. [DOI: 10.1016/s1701-2163(16)32173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND In the neonate, umbilical venous catheters (UVC) are inserted and advanced blindly to a predetermined length from the umbilicus. The reported rates for UVC misplacement into the liver (and occasionally the spleen) range from 20 to 37%. Radiographs are routinely used to confirm the positioning of UVCs. This involves movement of often critically ill infants, as well as radiation exposure. This pilot study examines the potential value of confirming UVC placement in neonates using ECG. METHODS In critically ill neonates, a conductive Johans ECG adapter was connected to a UVC. A satisfactory tracing (lead II) was obtained (right arm lead connected to the adapter) when the UVC was filled with saline solution allowing the catheter tip to become a unipolar ECG electrode. The UVC was then advanced from the umbilicus until the tip reached the inferior vena cava (IVC) within the thoracic region, as demonstrated by appearance of normal sized QRS complexes with small P-waves. A small QRS indicated the catheter was below the diaphragm. The appearance of a tall positive P-wave indicated the tip was at the right atrium level. The UVC was then withdrawn until the P-wave size returned to normal. The final UVC position was later confirmed by X-ray. RESULTS Eight neonates were studied. The figure shows typical ECG tracings when the UVC was placed in the liver, IVC, and right atrium, respectively. Three malpositioned catheters were detected (2 into liver and 1 into spleen). CONCLUSIONS Based on these cases, the insertion of UVCs in neonates can be guided with ECG by observing sequential and characteristic alterations in P-waves and QRS complexes, thereby reducing the use of X-rays. In addition, this technique could prove to be beneficial in remote healthcare facilities where X-ray machines may not be readily available and quick intravenous access is required to transport sick neonates to major centers.
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Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital and Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Clandinin MT, Larsen B, Van Aerde J. Reduced bone mineralization in infants fed palm olein-containing formula: a randomized, double-blinded, prospective trial. Pediatrics 2004; 114:899-900; author reply 899-900. [PMID: 15342879 DOI: 10.1542/peds.2004-0752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fung Kee Fung K, Eason E, Crane J, Armson A, De La Ronde S, Farine D, Keenan-Lindsay L, Leduc L, Reid GJ, Aerde JV, Wilson RD, Davies G, Désilets VA, Summers A, Wyatt P, Young DC. Prevention of Rh alloimmunization. J Obstet Gynaecol Can 2003; 25:765-73. [PMID: 12970812 DOI: 10.1016/s1701-2163(16)31006-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide guidelines on use of anti-D prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in Canadian women. OUTCOMES Decreased incidence of Rh alloimmunization and minimized practice variation with regards to immunoprophylaxis strategies. EVIDENCE The Cochrane Library and MEDLINE were searched for English-language articles from 1968 to 2001, relating to the prevention of Rh alloimmunization. Search terms included: Rho(D) immune globulin, Rh iso- or allo-immunization, anti-D, anti-Rh, WinRho, Rhogam, and pregnancy. Additional publications were identified from the bibliographies of these articles. All study types were reviewed. Randomized controlled trials were considered evidence of highest quality, followed by cohort studies. Key individual studies on which the principal recommendations are based are referenced. Supporting data for each recommendation is briefly summarized with evaluative comments and referenced. VALUES The evidence collected was reviewed by the Maternal-Fetal Medicine and Genetics Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the Evaluation of Evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS 1. Anti-D Ig 300 microg IM or IV should be given within 72 hours of delivery to a postpartum nonsensitized Rh-negative woman delivering an Rh-positive infant. Additional anti-D Ig may be required for fetomaternal hemorrhage (FMH) greater than 15 mL of fetal red blood cells (about 30 mL of fetal blood). Alternatively, anti-D Ig 120 microg IM or IV may be given within 72 hours of delivery, with testing and additional anti-D Ig given for FMH over 6 mL of fetal red blood cells (12 mL fetal blood). (I-A) 2. If anti-D is not given within 72 hours of delivery or other potentially sensitizing event, anti-D should be given as soon as the need is recognized, for up to 28 days after delivery or other potentially sensitizing event. (III-B) 3. There is poor evidence regarding inclusion or exclusion of routine testing for postpartum FMH, as the cost-benefit of such testing in Rh mothers at risk has not been determined. (III-C) 4. Anti-D Ig 300 microg should be given routinely to all Rh-negative nonsensitized women at 28 weeks' gestation when fetal blood type is unknown or known to be Rh-positive. Alternatively, 2 doses of 100-120 microg may be given (120 microg being the lowest currently available dose in Canada): one at 28 weeks and one at 34 weeks. (I-A) 5. All pregnant women (D-negative or D-positive) should be typed and screened for alloantibodies with an indirect antiglobulin test at the first prenatal visit and again at 28 weeks. (III-C) 6. When paternity is certain, Rh testing of the baby's father may be offered to all Rh-negative pregnant women to eliminate unnecessary blood product administration. (III-C) 7. A woman with "weak D" (also known as Du-positive) should not receive anti-D. (III-D) 8. A repeat antepartum dose of Rh immune globulin is generally not required at 40 weeks, provided that the antepartum injection was given no earlier than 28 weeks' gestation. (III-C) 9. After miscarriage or threatened abortion or induced abortion during the first 12 weeks of gestation, nonsensitized D-negative women should be given a minimum anti-D of 120 microg. After 12 weeks' gestation, they should be given 300 microg. (II-3B) 10. At abortion, blood type and antibody screen should be done unless results of blood type and antibody screen during the pregnancy are available, in which case antibody screening need not be repeated. (III-B) 11. Anti-D should be given to nonsensitized D-negative women following ectopic pregnancy. A minimum of 120 microg should be given before 12 weeks' gestation and 300 microg after 12 weeks' gestation. (III-B) 12. Anti-D should be given to nonsensitized D-negative women following molar pregnancy because of the possibility of partial mole. Anti-D may be withheld if the diagnosis of complete mole is certain. (III-B) 13. At amniocentesis, anti-D 300 microg should be given to nonsensitized D-negativeesis, anti-D 300 microg should be given to nonsensitized D-negative women. (II-3B) 14. Anti-D should be given to nonsensitized D-negative women following chorionic villous sampling, at a minimum dose of 120 microg during the first 12 weeks' gestation, and at a dose of 300 microg after 12 weeks' gestation. (II-B) 15. Following cordocentesis, anti-D Ig 300 microg should be given to nonsensitized D-negative women. (II-3B) 16. Quantitative testing for FMH may be considered following events potentially associated with placental trauma and disruption of the fetomaternal interface (e.g., placental abruption, blunt trauma to the abdomen, cordocentesis, placenta previa with bleeding). There is a substantial risk of FMH over 30 mL with such events, especially with blunt trauma to the abdomen. (III-B) 17. Anti-D 120 microg or 300 microg is recommended in association with testing to quantitate FMH following conditions potentially associated with placental trauma and disruption of the fetomaternal interface (e.g., placental abruption, external cephalic version, blunt trauma to the abdomen, placenta previa with bleeding). If FMH is in excess of the amount covered by the dose given (6 mL or 15 mL fetal RBC), 10 microg additional anti-D should be given for every additional 0.5 mL fetal red blood cells. There is a risk of excess FMH, especially when there has been blunt trauma to the abdomen. (III-B) 18. Verbal or written informed consent must be obtained prior to administration of the blood product Rh immune globulin. (III-C) VALIDATION: These guidelines have been reviewed by the Maternal-Fetal Medicine Committee and the Genetics Committee, with input from the Rh Program of Nova Scotia. Final approval has been given by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.
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Abstract
OBJECTIVES (1) To heighten awareness of the grieving process of the mother and her family experiencing the death of a baby; (2) to offer suggestions to health-care providers of the type of support that will achieve optimal grief resolution. OPTIONS Early, late, or no interventions for women and families who experienced stillbirths. OUTCOME Success of health-care providers in preventing, recognizing, and treating psychological problems in the bereaved parents and families, and also in helping these families to build meaningful experiences and positive memories from their loss. EVIDENCE English-language articles and their references on grief and bereavement after perinatal death, through a search of MEDLINE, the Cochrane Library, and publications of other national bodies including the Canadian Paediatric Society, and the American College of Obstetricians and Gynecologists.
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Crane J, Armson A, Brunner M, De La Ronde S, Farine D, Keenan-Lindsay L, Leduc L, Schneider C, Van Aerde J. Antenatal corticosteroid therapy for fetal maturation. J Obstet Gynaecol Can 2003; 25:45-52. [PMID: 12548324 DOI: 10.1016/s1701-2163(16)31081-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the benefits and risks of antenatal corticosteroid therapy for fetal maturation. OPTIONS To administer antenatal corticosteroids or not to women at risk of preterm birth. OUTCOMES Perinatal morbidity, including: respiratory distress syndrome, intraventricular hemorrhage, infection, adrenal suppression, somatic and brain growth; perinatal mortality; and maternal morbidity, including infection and adrenal suppression. EVIDENCE MEDLINE and PubMed searches 1996 to August 2002 for English-language articles related to antenatal corticosteroid therapy for fetal maturation, the Cochrane Library, and national statements including that of the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists, and the Royal College of Obstetricians and Gynaecologists. VALUES The evidence obtained was reviewed and evaluated by the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS AND HARMS: A single course of corticosteroids reduces perinatal mortality, respiratory distress syndrome, and intraventricular hemorrhage. Information regarding repeat courses of corticosteroids is limited and conflicting, with many studies being retrospective and non-randomized. Some studies suggested a reduction in respiratory distress syndrome with repeat courses, but some found increased rates of neonatal and maternal infection; fetal, neonatal, and maternal adrenal suppression; decreased fetal or neonatal somatic and brain growth; and increased perinatal mortality. RECOMMENDATIONS The SOGC supports the recommendations of the NIH Consensus Development Panel: 1. All pregnant women between 24 and 34 weeks' gestation who are at risk of preterm delivery within 7 days should be considered candidates for antenatal treatment with a single course of corticosteroids. (I-A) 2. Treatment should consist of two 12 mg doses of betamethasone given IM 24 hours apart, or four 6 mg doses of dexamethasone given IM 12 hours apart (I-A). There is no proof of efficacy for any other regimen. 3. Because of insufficient scientific data from randomized clinical trials regarding efficacy and safety, repeat courses of corticosteroids should not be used routinely (II-2E) but be reserved for women participating in randomized controlled trials. VALIDATION This Committee Opinion has been reviewed and approved by the Maternal-Fetal Medicine Committee of the SOGC and approved by SOGC Council.
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Berger H, Crane J, Farine D, Armson A, De La Ronde S, Keenan-Lindsay L, Leduc L, Reid G, Van Aerde J. Screening for gestational diabetes mellitus. J Obstet Gynaecol Can 2002; 24:894-912. [PMID: 12417905 DOI: 10.1016/s1701-2163(16)31047-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this document is to briefly review the existing data regarding the effect of a diagnosis of gestational diabetes mellitus (GDM), the different screening and diagnostic practices for GDM, and, finally, outline the recommended options for GDM screening in Canada. OPTIONS Consideration has been given to the existing screening practices for GDM including universal screening, risk factor-based screening, and the option of not screening for GDM. OUTCOMES The short- and long-term maternal-fetal outcomes in GDM were reviewed with emphasis given to examination of the data regarding the effect of diagnosis and treatment of GDM on these outcomes. EVIDENCE A comprehensive search of the literature from 1990 through April 2002 using MEDLINE and the Cochrane Database and a review of randomized controlled trials (RCTs) was undertaken. Additional studies and clinical guidelines published outside this time frame but with specific clinical relevance were also reviewed. The level of evidence of the recommendations in this document has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS I. A single approach of testing for GDM cannot be recommended at the present as there is not enough evidence-based data proving the beneficial effect of a large screening program. Until a large prospective RCT shows a clear clinical benefit for screening and consequently treating GDM, recommendations will by necessity be based on consensus or expert opinion. Each of the following approaches is acceptable. a. Routine screening of women at 24-28 weeks of gestation may be recommended with the 50 g glucose challenge test (GCT), using a threshold of 7.8 mmol/L (140 mg/dL), except in those women who fulfill the criteria for low risk, which includes the following: * maternal age < 25 * Caucasian or member of other ethnic group with low prevalence of diabetes * pregnant body mass index (BMI) </= 27 * no previous history of GDM or glucose intolerance * no family history of diabetes in first-degree relative * no history of GDM-associated adverse pregnancy outcomes. The diagnostic test can be the 100 g oral glucose tolerance test (OGTT), as recommended by ACOG, or the 75 g OGTT, according to the American Diabetes Association (ADA) criteria. Use of the World Health Organization (WHO) criteria will approximately double the number of women diagnosed with GDM without an apparent clinical benefit. (III-C) b. A small but significant number of Canadian obstetricians and centres have a policy of non-screening for GDM. Until evidence is available from large RCTs that show a clear benefit from screening for glucose intolerance in pregnancy, the option of not screening for GDM is considered acceptable. Conversely, there are no compelling data to stop screening when it is practiced. (III-C) c. The clinician should consider the recommendation of the Fourth International Workshop-Conference that women considered at high risk for GDM should undergo a diagnostic test as early in pregnancy as possible and that testing should be repeated at 24-28 weeks if initial results are negative. (III-C) d. If GDM is diagnosed, glucose tolerance should be re-assessed with a 75 g OGTT 6-12 weeks postpartum in order to identify women with persistent glucose intolerance. (III-C)2. A large RCT is needed to quantify the advantages and dis-advantages of routine screening for GDM. Furthermore, the need for universally accepted, outcome-based diagnostic criteria for GDM is emphasized. (III-C) VALIDATION: This guideline was reviewed by the SOGC Maternal-Fetal Medicine Committee. SPONSOR The Society of Obstetricians and Gynaecologists of Canada.
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Wilson RD, Davies G, Desilets V, Reid GJ, Shaw D, Summers A, Wyatt P, Young D, Crane J, Armson A, de la Ronde S, Farine D, Leduc L, Van Aerde J. Cystic fibrosis carrier testing in pregnancy in Canada. J Obstet Gynaecol Can 2002; 24:644-51. [PMID: 12196844 DOI: 10.1016/s1701-2163(16)30196-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the role of cystic fibrosis (CF) testing within the Canadian health care environment. METHODS The Genetics and Maternal Fetal Medicine Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) reviewed Preconception and Prenatal Carrier Screening for Cystic Fibrosis Clinical and Laboratory Guidelines produced by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics (ACMG) and other educational material from ACOG and ACMG. RESULTS Background information related to cystic fibrosis, genetic mutation analysis, and one large clinical cystic fibrosis screening trial are reviewed. EVIDENCE The quality of evidence reported in this document has been described using the Evaluation of Evidence criteria outlined in the report of the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS 1. CF testing in pregnancy is indicated for individuals who may be at increased risk for CF due to considerations of family history or clinical manifestations. (II-2A). 2. Before CF screening could be undertaken, each province/territory would have to review the ethnic diversity of its reproductive population to ensure that CF screening would be appropriate. (III-C). 3. Screening of all women during pregnancy for CF carrier status cannot be recommended at this time. (III-C).
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Kent N, Leduc L, Crane J, Farine D, Hodges S, Reid GJ, Van Aerde J. PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM (VTE) IN OBSTETRICS. J SOGC 2000; 22:736-749. [PMID: 12457202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
OBJECTIVE: to identify risk factors for venous thromboembolism (VTE) in the peripartum period and to provide guidelines for risk assessment and thromboprophylactic measures for VTE in pregnant women. Guidelines for diagnostic testing and for acute and long term treatment of VTE are also provided.OPTIONS: specific subgroups of pregnant women are defined and appropriate prophylactic measures are outlined. OUTCOMES: venous thromboembolism remains a major cause of morbidity and mortality in pregnancy and the postpartum period. Identification of risk and adequate prophylaxis can decrease the incidence of VTE.EVIDENCE: evidence was gathered using Medline (National Library of Medicine) to identify relevant studies and from bibliographies of articles thus identified.RECOMMENDATIONS: although evidence is lacking to date from Grade I studies (properly controlled randomized studies) in pregnant patients, there is good evidence to support the role of prophylaxis in reducing the incidence of VTE in patients identified to be at risk in the non-pregnant population (II B). Based on risk assessment more patients should be considered for thromboprophylaxis, including women with a past history of a VTE and a known thrombophilia on long-term anticoagulation, women with a past history of a VTE, women with a known thrombophilia who have never experienced a VTE and potentially considered in women at the time of Caesarean section (II B; III C). The occurrence of VTE is effectively reduced by the use of low dose unfractionated heparin. Experience with low molecular weight heparin and pregnancy is building, but is limited at present. Unfractionated heparin remains the standard for the treatment of VTE in pregnancy at the present time. Following initial heparinization for the treatment of VTE, patients should be continued on anticoagulation throughout pregnancy and for six to 12 weeks postpartum or a total of three months of anticoagulation (II A).
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