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S Marcoux

Publications and source records attributed to S Marcoux.

At least 37 records · Page 2Linked to original sources
PubMed1998

Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994.

BACKGROUND: The rates of preterm birth have increased in many countries, including Canada, over the past 20 years. However, the factors underlying the increase are poorly understood. METHODS: We used data from the Statistics Canada live-birth and stillbirth data bases to determine the effects of changes in the frequency of multiple births, registration of births occurring very early in gestation, patterns of obstetrical intervention, and use of ultrasonographic dating of gestational age on the rates of preterm birth in Canada from 1981 through 1983 and from 1992 through 1994. All births in 9 of the 12 provinces and territories of Canada were included. Logistic-regression analysis and Poisson regression analysis were used to estimate changes between the two three-year periods, after adjustment for the above-mentioned determinants of the likelihood of preterm births. RESULTS: Preterm births increased from 6.3 percent of live births in 1981 through 1983 to 6.8 percent in 1992 through 1994, a relative increase of 9 percent (95 percent confidence interval, 7 to 10 percent). Among singleton births, preterm births increased by 5 percent (95 percent confidence interval, 3 to 6 percent). Multiple births increased from 1.9 percent to 2.1 percent of all live births; the rates of preterm birth among live births resulting from multiple gestations increased by 25 percent (95 percent confidence interval, 21 to 28 percent). Adjustment for the determinants of the likelihood of preterm birth reduced the increase in the rate of preterm birth to 3 percent among all live births and 1 percent among singleton births. CONCLUSIONS: The recent increase in preterm births in Canada is largely attributable to changes in the frequency of multiple births, obstetrical intervention, and the use of ultrasound-based estimates of gestational age.

Birth Rate↗
PubMed1998

Trends and variations in length of hospital stay for childbirth in Canada.

BACKGROUND: Early discharge after childbirth is widely reported. In this study the authors examined trends in maternal length of hospital stay in Canada from fiscal year 1984-85 through fiscal year 1994-95. They also examined variations in length of stay in 1994-95 in most of the Canadian provinces and the territories. METHODS: Epidemiologic analyses of the temporal and geographic variations in maternal length of hospital stay in Canada from 1984-85 to 1994-95 (even years only), based on hospital discharge data collected by the Canadian Institute for Health Information, with a total of 1,456,800 women for the 6 study years. RESULTS: Mean length of hospital stay decreased during the decade, from 5.3 days in 1984-85 to 3.0 days in 1994-95, with similar trends for both cesarean and vaginal delivery. The decrease resulted from both increasing rates of short stay (less than 2 days) and decreasing rates of long stay (more than 4 days). Substantial temporal and interprovincial variations in several medical and obstetric complications were also observed but did not explain the corresponding variations in length of stay. The reduction in length of hospital stay was not restricted to uncomplicated cases: there was an equivalent decrease in cases with complications. In 1994-95 the average length of hospital stay in Alberta was 2.6 days, 0.3 to 1.7 days shorter than in the other provinces and the territories. INTERPRETATION: Length of hospital stay for childbirth has decreased substantially in Canada in recent years, but there remain important interprovincial variations. These trends and variations are not likely due to changes or differences in patient-specific factors.

Canada↗
PubMed1998

Incidence of venographically proved deep vein thrombosis after knee arthroscopy.

BACKGROUND: Deep vein thrombosis is a common, important complication of major orthopedic surgery, particularly knee arthroplasty. Knee arthroscopy is performed more frequently and in younger patients than knee arthroplasty. However, the true risk of deep vein thrombosis in patients who undergo this procedure is unknown. OBJECTIVE: To determine the incidence of deep vein thrombosis after knee arthroscopy in a large cohort of patients. METHODS: Consecutive patients scheduled for knee arthroscopy were eligible for the study. Enrolled study patients received no thromboprophylaxis. They were discharged home the day of surgery and underwent unilateral contrast venography approximately 1 week after their operation. The primary outcome measure was the incidence of venous thromboembolism. Risk factors for deep vein thrombosis were evaluated. RESULTS: Among the 184 patients who had adequate venography, deep vein thrombosis was detected in 33 (17.9%; 95% confidence interval, 12.7%-24.3%). Of these, 9 were proximal (4.9%; 95% confidence interval, 2.3%-9.1%). No patient died and no patient presented with clinically suspected pulmonary embolism. Of 33 patients, only 20 (60.6%) with deep vein thrombosis had symptoms while 13 (39.4%) were asymptomatic. The risk of deep vein thrombosis was significantly higher among patients who had a tourniquet applied for more than 60 minutes. CONCLUSIONS: The results of our study demonstrate that 17.9% of patients develop deep vein thrombosis after knee arthroscopy (most being either proximal or extensive). It is reasonable to perform a randomized trial to determine whether the incidence of deep vein thrombosis can be safely reduced in patients undergoing knee arthroscopy.

Adult↗
PubMed1998

Organochlorine exposure and the risk of endometriosis.

OBJECTIVE: To compare mean concentrations of organochlorine in women with a new diagnosis of endometriosis and in controls. DESIGN: Case-control study. SETTING: Women attending an institutional clinic of reproductive endocrinology. PATIENT(S): Cases and controls were selected among women who underwent laparoscopy for chronic pelvic pain, infertility, or tubal fulguration between January 1994 and December 1994. Eighty-six women with endometriosis and 70 controls, matched for the indication for laparoscopy, were recruited. MAIN OUTCOME MEASURE(S): Mean organochlorine plasma concentrations of 14 polychlorinated biphenyl congeners and 11 chlorinated pesticides were compared between the cases and controls. Analysis of covariance was used to adjust means for confounding variables, and odds ratios were estimated by logistic regression. RESULT(S): Crude geometric mean concentrations did not differ significantly between cases and controls for any of the organochlorine compounds. Similarly, crude or adjusted means of the sum of polychlorinated biphenyl congeners, the sum of chlordanes, or the sum of dichlorodiphenyltrichloroethanes did not differ between the groups. There was no significant linear trend in the adjusted odds ratios for endometriosis as organochlorine concentrations increased. CONCLUSION(S): These results suggest that exposure to polychlorinated biphenyls and chlorinated pesticides during adulthood is not associated with endometriosis in the general population.

Adult↗
PubMed1998

Fecundity of infertile women with minimal or mild endometriosis and women with unexplained infertility. The Canadian Collaborative Group on Endometriosis.

OBJECTIVE: To assess whether infertile women with minimal or mild endometriosis have lower fecundity than women with unexplained infertility. DESIGN: Prospective cohort study. SETTING: Twenty-three infertility clinics across Canada. PATIENT(S): Three hundred thirty-one infertile women aged 20-39 years. INTERVENTION(S): Diagnostic laparoscopy for infertility. Infertile women with minimal or mild endometriosis (n = 168) were compared with women with unexplained infertility (n = 263). Both groups were managed expectantly. The women were followed up for 36 weeks after the laparoscopy or, for those who became pregnant, for up to 20 weeks of the pregnancy. MAIN OUTCOME MEASURE(S): Fecundity refers to the probability of becoming pregnant in the first 36 weeks after laparoscopy and carrying the pregnancy for > or = 20 weeks. The fecundity rate is the number of pregnancies per 100 person-months. RESULT(S): Fecundity was 18.2% in infertile women with minimal or mild endometriosis and 23.7% in women without endometriosis (log-rank test). The fecundity rate was 2.52 per 100 person-months in women with endometriosis and 3.48 per 100 person-months in women with unexplained infertility. The crude and adjusted fecundity rate ratios were 0.72 and 0.83 (95% confidence interval = 0.53-1.32), respectively. CONCLUSION(S): The fecundity of infertile women with minimal or mild endometriosis is not significantly lower than that of women with unexplained infertility.

Adult↗
PubMed1998

Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian Collaborative Group on Endometriosis.

The objective of this case-control study is to identify factors associated with the prevalence of minimal or mild endometriosis among infertile women. Cases (N = 329) were women diagnosed by laparoscopy with minimal or mild endometriosis and without any other factors explaining their infertility. Controls (N = 262) were women in whom the infertility remained unexplained after a diagnostic laparoscopy. Selected characteristics were documented by means of a face-to-face interview before the laparoscopy. The prevalence of minimal or mild endometriosis was higher in women age 25 years or older, in those who reported menarche at the age of 13 years [prevalence odds ratio (POR) = 1.63; 95% confidence interval (CI) = 1.02-2.60] or older (POR = 1.73; 95% CI = 1.07-2.78), menstrual cycles of 27 days or less (POR = 1.63; 95% CI = 1.02-2.60), or caffeine intake of 300 mg per day or more (POR = 1.33; 95% CI = 0.91-1.94). The prevalence of minimal or mild endometriosis was inversely related to body mass index. Parous women were less likely to have endometriosis (POR = 0.61; 95% CI = 0.39-0.96) than were nulliparous women. Education, duration of infertility, and smoking status were not related to the presence of endometriosis.

Adult↗
PubMed1998

Does sweeping of the membranes reduce the need for formal induction of labour? A randomised controlled trial.

OBJECTIVE: 1. To evaluate the effectiveness of sweeping of the membranes to reduce the need for a formal induction of labour; 2. to evaluate the side effects of this intervention. DESIGN: A randomised controlled clinical trial. SETTING: Three tertiary care hospitals of the province of Quebec, Canada. POPULATION: Two hundred women for whom non-urgent induction of labour was medically indicated. METHODS: Women were randomly allocated to sweeping of membranes, or vaginal examination for Bishop scoring only. MAIN OUTCOME MEASURES: 1. Cumulative incidence and relative risk of induction of labour by either oxytocin, prostaglandins or amniotomy; 2. women's discomfort and side effects attributable to sweeping of the membranes. RESULTS: Women allocated to sweeping of the membranes required formal induction of labour less frequently than women in the control group, but this difference was not statistically significant (49% vs 60%, RR 0.83, 95% CI 0.64-1.07). Pain during vaginal examination and other side effects were more frequently reported by women allocated to the sweeping group. CONCLUSIONS: The observed reduction in the need for formal induction of labour is smaller than in previous studies. Side effects and discomfort associated with sweeping of the membranes must be taken into account when counselling women who require induction of labour.

Adult↗
PubMed1997

Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis.

BACKGROUND: Minimal or mild endometriosis is frequently diagnosed in infertile women. It is often treated by resection or ablation of the lesions, but whether this improves fertility has not been established. We carried out a randomized, controlled trial to determine whether laparoscopic surgery enhanced fecundity in infertile women with minimal or mild endometriosis. METHODS: We studied 341 infertile women 20 to 39 years of age with minimal or mild endometriosis. During diagnostic laparoscopy the women were randomly assigned to undergo resection or ablation of visible endometriosis or diagnostic laparoscopy only. They were followed for 36 weeks after the laparoscopy or, for those who became pregnant during that interval, for up to 20 weeks of pregnancy. RESULTS: Among the 172 women who had resection or ablation of endometriosis, 50 became pregnant and had pregnancies that continued for 20 weeks or longer, as compared with 29 of the 169 women in the diagnostic-laparoscopy group (cumulative probabilities, 30.7 percent and 17.7 percent, respectively; P=0.006 by the log-rank test). The corresponding rates of fecundity were 4.7 and 2.4 per 100 person-months (rate ratio, 1.9; 95 percent confidence interval, 1.2 to 3.1). Fetal losses occurred in 20.6 percent of all the recognized pregnancies in the laparoscopic-surgery group and in 21.6 percent of all those in the diagnostic-laparoscopy group (P=0.91). Four minor operative complications (intestinal contusion, slight tear of the tubal serosa, difficult pneumoperitoneum, and vascular trauma) were reported (three in the surgery group and one in the control group). CONCLUSIONS: Laparoscopic resection or ablation of minimal and mild endometriosis enhances fecundity in infertile women.

Adult↗
PubMed1997

Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.

BACKGROUND: Although epidural corticosteroid injections are commonly used for sciatica, their efficacy has not been established. METHODS: In a randomized, double-blind trial, we administered up to three epidural injections of methylprednisolone acetate (80 mg in 8 ml of isotonic saline) or isotonic saline (1 ml) to 158 patients with sciatica due to a herniated nucleus pulposus. All patients had Oswestry disability scores higher than 20 (on a scale of 1 to 100, with scores of 20 or less indicating minimal disability, and higher scores greater disability). RESULTS: At three weeks, the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group (95 percent confidence interval for the difference, -7.1 to 2.2). Differences in improvements between the groups were not significant, except for improvements in the finger-to-floor distance (P=0.006) and sensory deficits (P=0.03), which were greater in the methylprednisolone group. After six weeks, the only significant difference was the improvement in leg pain, which was greater in the methylprednisolone group (P=0.03). After three months, there were no significant differences between the groups. The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group (95 percent confidence interval for the difference, -9.3 to 5.4). At 12 months, the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group (P=0.90). CONCLUSIONS: Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus, this treatment offers no significant functional benefit, nor does it reduce the need for surgery.

Adult↗
PubMed1997

Multivariate analysis of risk factors for operative delivery in nulliparous women. Canadian Early Amniotomy Study Group.

OBJECTIVE: Our purpose was to develop predictive models of operative delivery in nulliparous women on the basis of sociodemographic, anthropometric, and obstetric risk factors. STUDY DESIGN: Data were obtained prospectively on 925 nulliparous women in spontaneous term labor with a single fetus in cephalic presentation. Operative delivery was defined as either a midforceps or a cesarean delivery. Variables were grouped into two categories: those that could be assessed at admission and those appearing during labor. Multiple logistic regression was used to identify variables predictive of operative delivery. RESULTS: Among variables that can be documented at admission, independent predictors of operative delivery were maternal age and height, pregnancy weight gain, smoking status, gestational age, and admission cervical dilatation. Of these, maternal age > or = 35 years was the most strongly related to operative delivery. When variables documented later during labor were added to this first model, variables retained in the second model were age and height, smoking status, presence of dystocia, epidural analgesia, and fetal heart rate tracing abnormalities. The adjusted odds ratio of operative delivery in the presence of epidural anesthesia was 3.4 (95% confidence interval 2.0 to 5.8). This association was similar in the presence or absence of dystocia. When the specificity was in the range of 85%, the first and second models have sensitivities of 34% and 48%, respectively, and positive predictive values of 39% and 46%, respectively, which is higher than the a priori risk of operative delivery in the study population (21%). CONCLUSIONS: The models, based on data easily available, may help to predict the need for midforceps or cesarean section in low-risk nulliparous women. Before application in a clinical setting, these statistical models require validation in a separate cohort. The observed association between epidural anesthesia and operative delivery deserves interest but clinical trials are required to determine whether this relation is causal.

Adult↗
PubMed1997

Early amniotomy increases the frequency of fetal heart rate abnormalities. Amniotomy Study Group.

OBJECTIVE: To determine whether early amniotomy, when practised as an isolated intervention, increases the hourly rate of fetal heart rate record abnormalities. DESIGN: This is a secondary analysis of the results of a multicentre randomised trial of early versus late amniotomy in labour. SETTING: Secondary and tertiary level teaching hospitals. INTERVENTION: Early amniotomy versus an attempt to conserve the amniotic membranes. MAIN OUTCOME MEASURES: The hourly rates of early, mild variable, severe variable and late decelerations; caesarean section rates. RESULTS: Severe variable decelerations, when classified as categorical events (> or = 1/h to 2/h, > or = 2/h to < 4/h, > or = 4/h), were more frequent in the amniotomy group (chi2 for trend = 5.7, P = 0.017). The mean hourly rates of severe variable and late fetal heart rate decelerations were increased in the amniotomy group (severe variable: amniotomy group 1.4/h, control 0.7/h, P = 0.021; late: amniotomy group 3.3/h, control 2.3/h, P = 0.011). Although the overall rate of caesarean was similar in the two groups (OR 1.2; 95% CI 0.8-1.8), there was an increase in caesarean section for fetal distress (OR 2.3; 95% CI 1.1-4.5) associated with amniotomy. CONCLUSION: Our data suggest that early amniotomy increases the hourly rate of severe variable fetal heart rate decelerations without evidence of an adverse effect on neonatal outcome. In settings where the diagnosis of fetal compromise is based primarily on electronic monitoring, caesarean section for fetal distress may be increased by early amniotomy.

Adult↗
PubMed1997

Uses and limitations of routine hospital admission/separation records for perinatal surveillance.

This study examined the quality of data for delivering mothers and their newborns (April 1, 1984 to March 31, 1995) recorded by the Canadian Institute for Health Information (CIHI). The number of illogical and out-of-range values in the CIHI data were quite few; the occurrence of maternal and infant diseases estimated from CIHI data was quite similar to that in the literature; and major medical/obstetric complications recorded in CIHI were, in general, good predictors of adverse pregnancy outcomes. The authors conclude that CIHI data contain some of the information pertinent to perinatal surveillance that may be used to monitor maternal and infant health and to assess intrapartum care and hospital resource utilization. To adequately monitor and analyze patterns of health determinants and outcomes in all pregnant women and their infants in Canada, additional data collection mechanisms are needed to cover all recognized pregnancies and to collect antenatal and postpartum information and more detailed information on intrapartum care.

Adolescent↗
PubMed1996

Correlation between the gross motor function measure scores and gait spatiotemporal measures in children with neurological impairments.

Twenty six children with a diagnosis of cerebral palsy and four with a diagnosis of head injury, aged between 1 and 8 years, participated in this study, undertaken to determine the relation between spatiotemporal measures (STM) of gait (velocity, cadence, stride length, and cycle duration) and the results of a standardized clinical test of motor function. STM were assessed by a clinical videographic gait test (VGT) whereas the Gross Motor Function Measure (GMFM) was used to assess motor function. For the total group of children, significant linear relations (r = 0.91, r = 0.93; p < 0.0001) were obtained between gait velocity and the GMFM sections D and E which include gait-related activities. These indicate that velocity is a parameter capable of reflecting functional locomotor behavior of these children. The results suggest that GMFM sections D and E may be used as locomotor predictors. The effect of walking with or without support was also investigated. The correlation between gait velocity and the GMFM(E) score was higher (r = 0.69) in the group of children walking with support than in those walking without (r = 0.35). The first group were younger and walked at velocities under 45 cm/s whereas children walking without support were older and walked at velocities ranging from 55 to 110 cm/s. These results suggest that the GMFM(E) score becomes less discriminant at gait velocities above 45 cm/s.

Cerebral Palsy↗
PubMed1995

Relation between infant feeding and infections during the first six months of life.

We assessed the effect of the method of feeding on respiratory and gastrointestinal illnesses during the first 6 months of life among 776 infants born in New Brunswick, Canada. During a 1-year period, these infants were drawn from the offspring of a population of primiparous women in the province who, after at least 36 weeks of pregnancy, gave birth to one normal infant weighing 2500 gm or more. Data were collected by means of a self-administered standardized questionnaire mailed to every mother a week before her infant reached 6 months of age. The crude incidence density ratio (IDR) revealed a protective effect of breast-feeding on respiratory illnesses (IDR = 0.66; 95% confidence interval (CI), 0.52 to 0.83), on gastrointestinal illnesses (IDR = 0.53; 95% CI, 0.27 to 1.04) and on all illnesses (IDR = 0.67; 95% CI, 0.54 to 0.82). The protective effect of breast-feeding on respiratory illnesses persisted even after adjustment for age of the infant, socioeconomic class, maternal age, and cigarette consumption (adjusted IDR = 0.78; 95% CI, 0.61 to 1.00). Moreover, if we distinguished ear infection from other respiratory illnesses, we observed a separate protective effect for these two types of events. The results of this retrospective cohort study suggest a protective effect of breast-feeding in our population during the first 6 months of life.

Bottle Feeding↗
PubMed1995

Maternal work during pregnancy and the risks of delivering a small-for-gestational-age or preterm infant.

OBJECTIVE: The objective of this study was to assess the relation of some maternal job characteristics to the risks of delivering a small-for-gestational-age or preterm infant. METHODS: Altogether 4390 women who lived in Quebec City, Canada, and the surrounding area, and who gave birth between January and October 1989 to a singleton liveborn neonate were included. Information on gestational age at delivery, job characteristics, nonoccupational physical activities, and several potential confounders was obtained in a telephone interview a few weeks after the delivery. Birthweight was recorded from the birth certificate. RESULTS: The risk of having a small-for-gestational-age infant (birthweight lower than the 10th percentile for gestational age and gender) was increased among the women who worked at least 6 h a day in a standing position. The adjusted odds ratios (OR) were 1.00, 1.13 [95% confidence interval (95% CI) 0.83-1.55], and 1.42 (95% CI 1.02-1.95) for the women working in a standing position < 3, 3-5, and > or = 6 h a day, respectively. The risk for a small-for-gestational-age infant also slightly increased as the gestational age at work cessation increased. A modest increment in the risk of delivering preterm (OR, 1.45, 95% CI 0.84-2.49) was observed for the women working regularly in the evening or at night. Physical effort, lifting heavy objects, and long workhours were not related to either a small-for-gestational-age or a preterm infant. CONCLUSIONS: The results indicate that prolonged standing and working late into pregnancy may increase the risk of delivering a small-for-gestational-age infant, whereas regular evening or night work may be a risk factor for preterm birth.

Adult↗
PubMed1994

Passive smoking during pregnancy and the risk of delivering a small-for-gestational-age infant.

The objective of this population-based study was to assess the association between environmental exposure to tobacco smoke during pregnancy and the risk of delivering a small-for-gestational-age (SGA) infant (< 10th percentile). A total of 4,644 nonsmoking women who lived in the Quebec City area and who gave birth between January and October 1989 to a singleton liveborn neonate were included in the analysis. Information on gestational age at delivery, maternal passive smoking at home and at work, and several potential confounders was obtained by a telephone interview with the mother a few weeks after delivery. Birth weight was abstracted from the birth certificate. Overall, passive smokers were at little or no higher risk of having a SGA infant than unexposed women (adjusted odds ratio = 1.09, 95% confidence interval (CI) 0.85-1.39). Passive exposure to tobacco smoke at home only was not related to SGA. However, small increments in risks were observed in women exposed to passive smoking at work only, and risks increased consistently with weekly duration, number of weeks, and intensity of exposure. When compared with unexposed mothers, women exposed to tobacco smoke in the workplace for 1-14, 15-34, and > or = 35 hours per week had adjusted odds ratios of 1.13 (95% CI 0.79-1.61), 1.17 (95% CI 0.73-1.87), and 1.36 (95% CI 0.91-2.09), respectively. This latter odds ratio was close to that observed among women who smoked actively 1-5 cigarettes per day. Although not conclusive, the results are compatible with the hypothesis that environmental exposure to tobacco smoke during pregnancy may be related to a modest increase in the risk of delivering a SGA infant.

Adult↗