Intervention in labour and delivery has increased dramatically in recent years, but we are increasingly concerned that many interventions may be overused in some instances. This may have adverse consequence for newborn health as well as increased costs for the healthcare system. As the optimal use of these interventional tools is unknown, I am exploring areas these areas of obstetrical intervention in high risk pregnancy.
Lyons J and Pressey T and Bartholomew S and Liu S and Liston RM and Joseph KS
Delivery of breech presentation at term gestation in Canada, 2003-2011.
Lyons J and Pressey T and Bartholomew S and Liu S and Liston RM and Joseph KS and Canadian Perinatal Surveillance System (Public Health Agency of Canada)
Once more unto the breech: planned vaginal delivery compared with planned cesarean delivery.
Joseph KS and Pressey T and Lyons J and Bartholomew S and Liu S and Muraca G and Liston RM
Each year, approximately 2,400 newborn infants in British Columbia sustain severe trauma during childbirth, including injury to the skull, organs, or nerves. These injuries can lead to death or significant physical and intellectual disability. The majority of birth trauma occurs during difficult vaginal delivery and such deliveries can also cause injury to the mother that increases the risk of urinary or fecal incontinence, sexual dysfunction, and pelvic organ prolapse later in life. We propose to develop a prediction algorithm that will accurately identify women at high risk of birth trauma, for whom cesarean delivery could be used to prevent injury.
A second project is to establish optimal gestation for induction of labour in women diagnosed with insulin treated gestational diabetes to maximize unassisted delivery and to mazimize neonatal outcomes. The objectives are to quantify rates of adverse fetal and neonatal negative outcomes (stillbirth, shoulder dystocia, macrosomia, hypoglycemia, 5-minute apgar less than 4, seizures, NICU admission and assisted ventilation among women with gestational diabetes) stratified by week of gestation at the time of labour induction. A second objective is to quantify rates of vaginal, assisted vaginal and cesarean delivery among women with gestational diabetes stratified by week of gestation at the time of labour induction.Honours & Awards
Canadian Foundation for Women’s Health, Resident Researcher Award, March 2012
The Hamilton Wadham Award, Resident who embodies leadership, strong clinical skills and empathy for patients. June 2012