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Published Articles

This section includes articles that have been published in scientific journals. All or some of the authors of each article are from Perinatal Services BC.

Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes

Journal of Obstetrics and Gynaecology Canada, 000(000):1-7, 2018.

DOI: 10.1016/j.jogc.2018.11.014

On October 17th, 2018, the Government of Canada legalized the production, sale and possession of cannabis. Little is known about how this change will affect pregnant women and infants. Our study examines the impact of maternal cannabis use in pregnancy on birth outcomes. Using British Columbia’s Perinatal Data Registry, we determined that women who use cannabis in pregnancy have a 47% increased risk of having a spontaneous preterm birth, a 27% increased risk of a small-for-gestational age infant and a 184% increased risk of intrapartum stillbirth. Our results suggest that maternal cannabis use in pregnancy may be harmful to fetal growth and development. Given the current evidence, it is safest for women to abstain from using cannabis in pregnancy.

Province-wide Biliary Atresia Home Screening Program in British Columbia: Evaluation of the First 2 Years

Journal of Pediatric Gastroenterology and Nutrition, 66(6): 845-849, June 2018.

DOI: 10.1097/MPG.0000000000001950

Biliary atresia (BA), a rare newborn liver disease, is the leading cause of liver-related death in children. Early disease recognition and timely surgical Kasai hepatoportoenterostomy (KP) offers long-term survival without liver transplant. Universal BA screening in Taiwan using infant stool color cards (ISCCs) has proven effectiveness. We report our experience with infant stool color card (ISCC) BA screening in a province-wide program in British Columbia (BC). The objective of this study is to assess program performance and cost from launch April 1, 2014 to March 31, 2016.

An Economic Model of Professional Doula Support in Labor in British Columbia

Journal of Midwifery & Women's Health, 62: 607–613. 

Spending on care in childbirth represents a sizable portion of health care budgets, which has created a growing interest in potential clinical tools that could be used to improve patient experience and population health at a lower cost. One possible such tool is continuous support in labor from a trained doula. This article outlines an economic model of universal doula support in British Columbia. 

Interpregnancy Interval and Adverse Pregnancy Outcomes: An Analysis of Successive Pregnancies

Obstet Gynecol. 2017 Mar;129(3):408-415. 
DOI: 10.1097/AOG.0000000000001891

This study examines the association between interpregnancy interval and maternal-neonate health when matching women to their successive pregnancies to control for differences in maternal risk factors and compare these results with traditional unmatched designs.

Read the related editorial: Interpregnancy Interval and Pregnancy Outcomes: Causal or Not?

Obstet Gynecol. 2017 Mar;129(3):405-407. 
DOI: 10.1097/AOG.0000000000001913

Safety of Labour and Delivery Following Closures of Obstetric Services in Small Community Hospitals

CMAJ 2016. DOI:10.1503/cmaj.160461

In recent decades, many smaller hospitals in BC have stopped providing planned obstetric services. This study examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities.

There is also an accompanying podcast with the editor of CMAJ.

Prevalence of Gestational Diabetes among Chinese and South Asians: A Canadian population-based analysis

Journal of Diabetes and Its Complications
Published online October 19, 2016

There is considerable geographic variation in gestational diabetes mellitus rates. This study used data from BC and Alberta to determine the impact of ethnicity on GDM prevalence and neonatal outcomes.

Management of Spontaneous Labour at Term in Healthy Women

J Obstet Gynaecol Can 2016;38(9):843-865 
DOI: 10.1016/j.jogc.2016.04.093

To provide guidance for the intrapartum management of spontaneous labour, whether normal or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes.

Rationale and recommendations for improving definitions, registration requirements and procedures related to fetal death and stillbirth

BJOG 2016; DOI: 10.1111/1471-0528.14242

Despite increased attention being paid to stillbirth-related

issues in recent years, problems with definitions and procedures associated with stillbirth registration continue to plague public health surveillance and clinical care. This article presents the deliberations of a Consensus Conference held in Vancouver in October 2015, with the goal of improving fetal death registration procedures.

Sex Ratios Among Births in British Columbia, 2000-2013

J Obstet Gynaecol Can 2016;-(-):1-9
DOI: 10.1016/j.jogc.2016.06.005

Previous studies have reported distorted sex ratios among
live births within specific immigrant groups in Canada. This study carried out an investigation into sex ratios in British Columbia.

CMAJ Open 2016; 4(1):E33-40
DOI: 10.9778/cmajo.20150063

Routine surveillance of congenital anomalies has shown recent increases in ankyloglossia (tongue-tie) in BC. This study examined the temporal trends in ankyloglossia and its surgical treatment (frenotomy).

Matern Child Health J 2015; July
DOI: 10.1007/s10995-015-1791-1

The objective of this study was to establish the feasibility of implementing a  previously-published clinical standardized performance indicator, the Adverse Outcome Index (AOI), using routinely-collected data in a population-based perinatal database and to examine variation in the indicator over time and between hospitals.

Validating the BC Perinatal Data Registry: A Chart Re-Abstraction Study

BMC Pregnancy & Childbirth 2015; 15:123
DOI: 10.1186/s12884-015-0563-7

The BC Perinatal Data Registry (BCPDR) contains individual-level obstetrical and neonatal medical chart data for virtually all births occurring in British Columbia. The objective of this study was to assess the validity of information in the BCPDR by performing a provincial chart re-abstraction study.

Rationalizing Definitions and Procedures for Optimizing Clinical Care and Public Health in Fetal Death and Stillbirth

Obstet Gynecol 2015; 125:784-8
DOI: 10.1097/AOG.0000000000000717

Perinatal Services BC and BC Women’s Hospital authors collaborated on this paper, which discusses the need to update the definition of stillbirth to distinguish timing of fetal death and the timing of stillbirth. The authors also suggest modernization of the stillbirth registration process to consider the burden on some grieving families. With this article, we intend to stimulate local, national and international dialogue that will rationalize fetal death definitions, registration criteria, and associated procedures and ultimately improve clinical care and public health. 

See related editorial: 

Stillbirth and Fetal Death: Time for Standard Definitions and Improved Reporting

J Obstet Gynaecol Can 2014;36(5):391-399

To estimate the probability of spontaneous onset of labour
among women with uncomplicated pregnancies who have
reached 41+0 weeks and to examine the influence of maternal characteristics on this event.

Using Inter-institutional Practice Variation to Understand the Risks and Benefits of Routine Labour Induction at 41+0 Weeks
BJOG 2014
DOI: 10.1111/1471-0528.13007

Population-based retrospective cohort study of inter-institutional variation in labour induction practices for women at or beyond 41+0 weeks’ gestation to evaluate the risks and benefits of routine labour induction at 41+0 weeks’ gestation for mother and newborn.‎

Maternal, Care Provider, and Institutional-Level Risk Factors for Early Term Elective Repeat Cesarean Delivery: A Population-Based Cohort Study

Matern Child Health J 2014; 18:22-28
DOI: 10.1007/s10995-013-1229-6

To identify maternal, care provider, and institutional-level risk factors for early term (37-38 weeks) elective repeat cesarean delivery in a population-based cohort. Retrospective cohort study of women in the British Columbia Perinatal Data Registry, BC, Canada, 2008-2011, with an elective repeat cesarean delivery at term. Absolute percent differences (risk differences) in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time (day of the week, time of year), and annual institutional obstetrical volume.


Determinants of increases in stillbirth rates from 2000 to 2010

CMAJ 2013 

After decades of decline, stillbirth rates have increased in several industrialized countries in recent years. We examined data from British Columbia in an attempt to explain this unexpected phenomenon.‎

Examining caesarean section rates in Canada using the Robson classification system
J Obstet Gynaecol Can 2013; 35(3):206-214

To determine the groups within the obstetric population contributing most substantially to the Caesarean section rate in five Canadian provinces. All hospitals and health authorities can use this standardized classification system as part of a quality improvement initiative to monitor Caesarean section rates. This classification system identifies relevant areas for interventions and resources to reduce rates of Caesarean section.

Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: A population-based retrospective cohort study
BJOG 2013;120:853-862

Increases in atonic postpartum haemorrhage have been reported from several countries in recent years. This study attempted to determine the potential cause of the increase in atonic and severe atonic postpartum haemorrhage.


Trends in postpartum hemorrhage from 2000 to 2009: a population-based study

BMC Pregnancy and Childbirth 2012, 12:108 
DOI: 10.1186/1471-2393-12-108

Postpartum hemorrhage, a major cause of maternal death and severe maternal morbidity, increased in frequency in Canada between 1991 and 2004. We carried out a study to describe the epidemiology of postpartum hemorrhage in British Columbia, Canada, between 2000 and 2009.‎


Trends in postpartum hemorrhage from 2000 to 2009: a population-based study

BMC Pregnancy and Childbirth 2012, 12:108 
DOI: 10.1186/1471-2393-12-108

Postpartum hemorrhage, a major cause of maternal death and severe maternal morbidity, increased in frequency in Canada between 1991 and 2004. We carried out a study to describe the epidemiology of postpartum hemorrhage in British Columbia, Canada, between 2000 and 2009.‎

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