Obesity in Pregnancy : No. 239, February 2010

Objective

To review the evidence and provide recommendations for the counselling and management of obese parturients.

Outcomes

Outcomes evaluated include the impact of maternal obesity on the provision of antenatal and intrapartum care, maternal morbidity and mortality, and perinatal morbidity and mortality.

Evidence

Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to April 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The evidence obtained was reviewed and evaluated by the Maternal Fetal Medicine and Clinical Practice Obstetric Committees of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.

Benefits, Harms, and Costs

Implementation of the recommendations in this guideline should increase recognition of the issues clinicians need to be aware of when managing obese women in pregnancy, improve communication and consultation amongst the obstetrical care team, and encourage federal and provincial agencies to educate Canadians about the values of entering pregnancy with as healthy a weight as possible.     

Guidelines for the Management of Vasa Previa : No. 231, August 2009

Objectives

To describe the etiology of vasa previa and the risk factors and associated condition, to identify the various clinical presentations of vasa previa, to describe the ultrasound tools used in its diagnosis, and to describe the management of vasa previa.

Outcomes

Reduction of perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short-term and long-term maternal morbidity and mortality.

Evidence

Published literature on randomized trials prospective cohort studies, and selected retrospective cohort studies was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library, using appropriate controlled vocabulary (e.g., selected epidemiological studies comparing delivery by Caesarean section with vaginal delivery studies comparing outcomes when vasa previa is diagnosed antenatally vs. intrapartum) and key words (e.g. vasa previa). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated into the guideline to October 1, 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and from national and international medical specialty societies.

Values

The evidence collected was reviewed by the Diagnostic Imaging Committee and the Maternal Fetal Medicine Committee 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 Preventive Health Care.

Benefits, Harms, and Costs

The benefit expected from this guideline is facilitation of optimal and uniform care for pregnancies complicated by vasa previa.

Sponsors

The Society of Obstetricians and Gynaecologists of Canada.     

Active management of the third stage of labour: Prevention and treatment of postpartum hemorrhage : No. 235 October 2009 (Replaces No. 88, April 2000)

Objective

To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000.

Evidence

Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the full text acquired if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Scale and the levels of evidence definitions of the Canadian Task Force on Preventive Health Care.

Values

The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care.

Sponsor

The Society of Obstetricians and Gynaecologists of Canada.     

Immunization in pregnancy : No. 220, December 2008

Objective

To review the evidence and provide recommendations on immunization in pregnancy.

Outcomes

Outcomes evaluated include effectiveness of immunization, and risks and benefits for mother and fetus.

Evidence

The Medline and Cochrane databases were searched for articles published up to June 2007 on the topic of immunization in pregnancy.

Values

The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.

Benefits, Harms, and Costs

Implementation of the recommendations in this guideline should result in more appropriate immunization of pregnant and breastfeeding women, decreased risk of contraindicated immunization, and better disease prevention.     

Substance use in pregnancy : No. 256, April 2011

Objective

To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers.

Options

This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy.

Outcomes

Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation.

Evidence

Medline, PubMed, CINAHL, and The Cochrane Library were searched for articles published from 1950 using the following key words: substance-related disorders, mass screening, pregnancy complications, pregnancy, prenatal care, cocaine, cannabis, methadone, opioid, tobacco, nicotine, solvents, hallucinogens, and amphetamines. Results were initially restricted to systematic reviews and randomized control trials/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. Searches were updated on a regular basis and incorporated in the guideline up to December 2009. Grey (unpublished) literature was also identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1).

Benefits, harms, and costs

This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality.     

Management of meconium at birth : No. 224, April 2009

Objective

To provide clinician direction that is based on the best evidence available on suctioning at the perineum for infants born with meconium stained amniotic fluid.

Evidence

The Medline database was searched for articles published in English from 2000 to 2008 on the topic of management of meconium at birth.

Values

The recommendation was made according to guidelines developed by the Canadian Task Force on Preventive Health Care.     

Adhesion prevention in gynaecological surgery : No. 243, June 2010

Objectives

To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery.

Options

Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively.Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation.

Outcomes

The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease.

Evidence

Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.     

Ovulation Induction in Polycystic Ovary Syndrome : No. 242, May 2010

Objective

To review current non-pharmacologic and pharmacologic options for ovulation induction in women with polycystic ovary syndrome (PCOS).

Options

This guideline reviews the evidence for the various options for ovulation induction in PCOS.

Outcomes

Ovulation, pregnancy and live birth rates, risks, and side effects are the outcomes of interest.

Evidence

Published literature was retrieved through searches of Medline using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and of health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The evidence gathered was reviewed and evaluated by the Reproductive Endocrinology and Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was quantified using the Canadian Task Force on Preventive Health Care.

Benefits, Harms, and Costs

Benefits include weight reduction and improvements in ovulation, pregnancy, and live birth rates. Potential harms include medication side effects and multiple pregnancies.

Validation

These guidelines have been reviewed and approved by the Reproductive Endocrinology and Infertility Committee of the SOGC.

Sponsor

The Society of Obstetricians and Gynaecologists of Canada.     

Oral contraceptives and the risk of venous thromboembolism: An update : No. 252, December 2010

Objective

To provide current and emerging evidence on oral contraceptives and the risk of venous thromboembolism.

Evidence

Articles published in English from 2005 were retrieved through searches of PubMed and Medline, using the following terms: venous thromboembolism, VTE, contraception, oral contraceptives, hormonal contraception. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table).     

Management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS) : No. 225, April 2009

Objective

This document summarizes the limited experience of SARS in pregnancy and suggests guidelines for management.

Outcomes

Cases reported from Asia suggest that maternal and fetal outcomes are worsened by SARS during pregnancy.

Evidence

Medline was searched for relevant articles published in English from 2000 to 2007. Case reports were reviewed and expert opinion sought.

Values

Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.