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S Marcoux

Publications and source records attributed to S Marcoux.

At least 55 records · Page 3Linked to original sources
PubMed1994

Factors associated with the inability of children with cerebral palsy to walk at six years: a retrospective study.

The objective of this study was to describe the locomotion level of children with cerebral palsy at six years and to identify the factors associated with the inability to walk. 264 quadriplegic or diplegic children were assessed. Characteristics of the neurological impairment, neuromotor activities, other medical conditions and sociodemographic variables were studied. 47 per cent of the children could not walk at six years. Topography of the impairment, persistence of certain primitive reflexes, inability to retain a sitting position at the time of the initial evaluation and a history of epilepsy were significantly associated with inability to walk. The sensitivity and specificity of the model for classifying the subjects as unable or able to walk at six years were 82 and 93 per cent, respectively.

Cerebral Palsy↗
PubMed1994

Prevention of perineal trauma by perineal massage during pregnancy: a pilot study.

Although the performance of perineal massage by a woman or her partner during the last weeks of pregnancy may help to prevent perineal trauma at delivery, the technique has never been evaluated rigorously. This study examined the feasibility of a randomized, controlled trial, and more specifically assessed the participation rate, the acceptability of the intervention, and whether or not an attending physician could remain blind to participants' groups. The pilot study was a single-blinded, randomized, controlled trial. Nulliparous women, 32 to 34 weeks pregnant, were recruited from June 8 to July 31, 1992, at the offices of family physicians and obstetricians who practice at the Hôpital du Saint-Sacrement in Quebec City. Women assigned to the intervention group practiced daily 10-minute perineal massage and completed a diary, and those in the control group had standard care. Women and attending physicians completed a questionnaire about the aspect of blindness. Among the 174 women who delivered during the study period, 104 (59.8%) were approached by a midwife and 46 (26.4%) were randomized. Twenty (91.0%) of the 22 women in the massage group returned their perineal massage diaries. Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. No woman in the control group practiced massage. The attending physician was aware of the woman's group in only three instances (6.7%). Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.

Adult↗
PubMed1993

Relation of caffeine intake during pregnancy to intrauterine growth retardation and preterm birth.

Whether caffeine intake during pregnancy is related to intrauterine growth retardation, low birth weight, and preterm birth remains unclear. The purpose of this population-based study is to assess these associations and to evaluate the interaction between caffeine intake and smoking. The study participants (n = 7,025) were women who lived in Quebec City, Canada, and the surrounding area who gave birth between January 1989 and October 1989 to a singleton liveborn neonate. Information on gestational age at delivery, caffeine intake (coffee, tea, chocolate, and colas) during pregnancy, and several potential confounders was obtained by telephone a few weeks after delivery. Birth weight was abstracted from the birth certificate. Caffeine consumption was associated with an increased risk of intrauterine growth retardation (birth weight less than the 10th percentile for sex and gestational age). For women whose average daily caffeine consumption was 0-10, 11-150, 151-300, or > 300 mg, the adjusted odds ratios for delivering a newborn with growth retardation were 1.00, 1.28 (95% confidence interval (CI) 1.04-1.59), 1.42 (95% CI 1.07-1.87), and 1.57 (95% CI 1.05-2.33), respectively. Caffeine intake, however, was not related to preterm delivery or low birth weight. We conclude that caffeine intake during pregnancy is a risk factor for intrauterine growth retardation.

Adult↗
PubMed1993

Effect of early amniotomy on the risk of dystocia in nulliparous women. The Canadian Early Amniotomy Study Group.

BACKGROUND: Early amniotomy has been advocated as a means of preventing dystocia, but its efficacy has not been studied prospectively. The purpose of this multicenter study was to determine whether routine early amniotomy reduces the risk of dystocia for nulliparous women in spontaneous labor. METHODS: We studied 925 nulliparous women in labor, who were stratified according to the degree of cervical dilatation (< 3 cm vs. > or = 3 cm) and randomly assigned to either early rupture of the membranes (amniotomy group) or conservative management of labor (conservative-management group). Dystocia was defined as a period of at least four hours after dilatation of the cervix to 3 cm had been reached during which the mean rate of cervical dilatation was less than 0.5 cm per hour. RESULTS: Dystocia was significantly less frequent in the amniotomy group than in the conservative-management group (34 percent vs. 45 percent; relative risk, 0.8; 95 percent confidence interval, 0.6 to 0.9). The median length of time from randomization to full dilatation was 136 minutes shorter in the amniotomy group, and there was a trend toward less frequent use of oxytocin among the women assigned to amniotomy (36 percent vs. 41 percent; relative risk, 0.9; 95 percent confidence interval, 0.8 to 1.0). In a stratified analysis, the frequency of dystocia associated with amniotomy was reduced only among women with > or = 3 cm initial dilatation. The cesarean-section rate was similar in the two groups (amniotomy, 12 percent; conservative management, 11 percent). There were no statistically significant differences in outcome between the infants delivered by the women in the two groups; the measures of an adverse outcome included admission to a neonatal intensive care unit, five-minute Apgar score below 7, and arterial cord-blood pH below 7.2. CONCLUSIONS: Early amniotomy is an effective method of shortening the duration of labor and reducing the frequency of dystocia among nulliparous women in labor, but it does not lower the rate of cesarean section.

Adult↗
PubMed1993

A prospective study of several potential biologic markers for early prediction of the development of preeclampsia.

OBJECTIVE: The purpose of this study was to prospectively evaluate the predictive performance of several potential biologic markers of preeclampsia used alone or in combination. STUDY DESIGN: A prospective cohort of 1366 nulliparous women was followed up longitudinally on three occasions during pregnancy. The predictive performance of the tests, used either alone or in combination (stepwise multiple logistic regression), was assessed and compared with that of the mean arterial pressure. RESULTS: Preeclampsia occurred in 109 of the pregnant women. At a specificity of 80% the sensitivity and the positive and negative predictive values for mean arterial pressure (at a threshold of 87 mm Hg) were 46.6%, 23.5%, and 92.0%, respectively, and the corresponding values for a multiple logistic model at 15 to 24 weeks that included some biologic markers, as well as the mean arterial pressure, were 57.1%, 26.9%, and 93.7%, respectively. CONCLUSION: Preeclampsia can be predicted by a combination of simple biologic tests with a performance similar to second-trimester mean arterial pressure. However, this procedure is insufficient in terms of clinical usefulness.

Biomarkers↗
PubMed1992

History of migraine and risk of pregnancy-induced hypertension.

This analysis assesses the relation between a history of migraine and the risk of preeclampsia or gestational hypertension. Cases (172 women with preeclampsia and 254 with gestational hypertension) and controls (505) were primiparae with no history of hypertension before pregnancy. Information on migraine attacks in the year before pregnancy was obtained after delivery. Migraine was reported by 16% of preeclamptic women, 12% of women with gestational hypertension, and 8% of the controls. Adjusted odds ratios (95% confidence interval) of preeclampsia and gestational hypertension were 2.44 (1.42-4.20) and 1.70 (1.02-2.85), respectively. We conclude that women who have a recent history of migraine may be at higher risk of pregnancy-induced hypertension.

Adult↗
PubMed1991

A controlled trial of corticosteroid injections into facet joints for chronic low back pain.

BACKGROUND: Chronic low back pain is a common problem with many treatments, few of which have been rigorously evaluated. This randomized, placebo-controlled trial was designed to evaluate the efficacy of injections of corticosteroid into facet joints to treat chronic low back pain. METHODS: Patients with chronic low back pain who reported immediate relief of their pain after injections of local anesthetic into the facet joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were randomly assigned to receive under fluoroscopic guidance injections of either methylprednisolone acetate (20 mg; n = 49) or isotonic saline (n = 48) in the same facet joints. Ninety-five patients were followed for six months and their condition assessed with scales of pain severity, back mobility, and limitation of function. RESULTS: After one month, none of the outcome measures evaluating pain, functional status, and back flexion differed clinically or statistically between the two study groups. Forty-two percent of the patients who received methylprednisolone and 33 percent of those who received placebo reported marked or very marked improvement (95 percent confidence interval for the difference, -11 to 28 percentage points; P = 0.53). The results were similar after three months. At the six-month evaluation, the patients treated with methylprednisolone reported more improvement, less pain on the visual-analogue scale, and less physical disability. The differences were reduced, however, when concurrent interventions were taken into account. Moreover, only 11 patients (22 percent) in the methylprednisolone group and 5 (10 percent) in the placebo group had sustained improvement from the first month to the sixth month (95 percent confidence interval for the difference, -2 to 26; P = 0.19). CONCLUSIONS: We conclude that injecting methylprednisolone acetate into the facet joints is of little value in the treatment of patients with chronic low back pain.

Adrenal Cortex Hormones↗
PubMed1991

Calcium intake from dairy products and supplements and the risks of preeclampsia and gestational hypertension.

This case-control study assessed the relation of calcium intake in the first 20 weeks of pregnancy to the risks of preeclampsia and gestational hypertension. All subjects (172 women with preeclampsia, 251 women with gestational hypertension, and 505 controls) were primiparae who delivered in Quebec City or Montreal, Quebec, Canada, between April 1984 and December 1986. Dietary calcium intake was not associated with preeclampsia. For gestational hypertension, adjusted odds ratios in successive quartiles gradually decreased from 1.00 in the lowest quartile to 0.81, 0.66, and 0.60 in the highest quartile. These results provide additional support for the view that calcium intake during pregnancy may be inversely related to the risk of gestational hypertension.

Calcium, Dietary↗
PubMed1991

Time trends in characteristics and outcome of twin pregnancies.

This study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birthweight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.

Birth Weight↗
PubMed1990

Surgical staples in cesarean section: a randomized controlled trial.

This randomized controlled trial compares the use of the Auto Suture Poly CS 57 disposable surgical stapler (n = 98) with standard hysterectomy (n = 102) in low transverse cesarean sections. Subjective assessment of blood loss by the surgeon resulted in lower mean (+/- SEM) total blood loss estimates in the stapled group (492 +/- 24 ml) than in the nonstapled group (579 +/- 38 ml) (p = 0.05). However, surgeon's estimation of blood loss as a result of the hysterotomy and blood loss estimated by the hemoglobin deficit measured on the second postoperative day did not significantly differ between the two groups. The use of the stapling device tended to lengthen the total operating time, which averaged 42.5 minutes in the group with the staples and 39.2 minutes in the group with the standard hysterotomy (p = 0.05). The risk of febrile morbidity, the frequency of endometritis, and the length of hospitalization were similar in the two groups. Our results do not support the routine use of the Auto Suture Poly CS 57 disposable surgical stapler in low transverse cesarean sections.

Adult↗
PubMed1989

The effect of cigarette smoking on the risk of preeclampsia and gestational hypertension.

This case-control study assessed the relation of cigarette smoking during pregnancy to the risk of preeclampsia and gestational hypertension. All subjects were primiparous women without a history of high blood pressure who gave birth in Quebec City or Montreal, Canada, hospitals between 1984 and 1986. Cases (172 women with preeclampsia and 251 with gestational hypertension) and 505 controls were interviewed at the hospital after delivery. Adjusted relative risks were estimated by polychotomous logistic regression. Compared with women who had never smoked, women who were smokers at the onset of pregnancy had a reduced risk of preeclampsia (relative risk = 0.51, 95% confidence interval 0.34-0.77). Relative risks of preeclampsia decreased with increases in the number of cigarettes smoked daily at the onset of pregnancy: Relative risks among smokers of less than 11, 11-20, and more than 20 cigarettes per day were 0.79, 0.56, and 0.38, respectively (test for trend: p = 0.0002). The protective effect of smoking on preeclampsia was stronger for women who continued to smoke after 20 weeks of pregnancy. While smoking tended to reduce the risk of gestational hypertension, this effect was less evident than that for preeclampsia. Relative risks varied little with severity of disease as based on gestational age at the onset of hypertension, maximal blood pressure and, for preeclampsia, amount of proteinuria. The reduction in mean birth weight attributable to smoking during pregnancy was similar among cases and controls. Nicotine inhibition of thromboxane A2 production might explain the decreased risk of pregnancy-induced hypertension among smokers. Despite these findings, the harmful consequences of smoking on pregnancy outcome outweigh its protective effect against pregnancy-induced hypertension.

Birth Weight↗
PubMed1989

The effect of leisure time physical activity on the risk of pre-eclampsia and gestational hypertension.

STUDY OBJECTIVE: To assess the relation between leisure time physical activity (LTPA) during the first 20 weeks of pregnancy and the risk of developing pre-eclampsia and gestational hypertension. DESIGN: Case-control study carried out over a 28 month period with retrospective data collection. SETTING: Six hospitals in Quebec City and four hospitals in Montreal. PARTICIPANTS: 172 women with pre-eclampsia, 254 with gestational diabetes, 505 controls. All were primiparous, with no history of high blood pressure before pregnancy (unless due to oral contraceptive use), or during the first 20 weeks of gestation. Cases were defined using recognised criteria, and 97% of those eligible agreed to be interviewed. Controls delivered in same hospital immediately after cases and had no more than one reading of elevated blood pressure during pregnancy; 96% of those eligible agreed to be interviewed. MEASUREMENTS AND MAIN RESULTS: Participants were interviewed in hospital a few days after delivery using a questionnaire. Information was collected on type, frequency and average duration of any LTPA performed regularly during the first 20 weeks of pregnancy, together with medical, obstetric and sociodemographic details. It was found that women who performed regular LTPA had a reduced risk of pre-eclampsia (adjusted RR 0.67, 95% CI 0.46-0.96) and gestational hypertension (aRR 0.75, 95% CI 0.54-1.05), and the relative risks decreased as the average time spent in LTPA increased (aRR for pre-eclampsia among women with low, moderate and high energy expenditure: 1.00, 0.77 and 0.57, p = 0.01). The same trend was present for gestational hypertension (1.00, 0.80 and 0.71, respectively, p = 0.08). CONCLUSIONS: Leisure time physical activity during the first half of pregnancy is likely to reduce the risk of pre-eclampsia and gestational hypertension.

Case-Control Studies↗
PubMed1989

Postmenopausal hormones and the incidence of rheumatoid arthritis.

This case-control study assessed whether postmenopausal use of hormones reduces the incidence of rheumatoid arthritis (RA). Cases had classical or definite RA. Controls were patients with primary osteoarthritis or soft tissue rheumatism. Information on exposure was obtained by telephone interview. Compared to women who had never used postmenopausal hormones before onset of rheumatologic symptoms, adjusted relative risk (95% confidence limits) for past and current users were 0.95 (0.56-1.60) and 0.89 (0.49-1.63), respectively. Among current users, the association was not related to the duration of use. Our results provide little support for the hypothesis that use of postmenopausal hormones has a protective effect on the development of RA.

Arthritis, Rheumatoid↗
PubMed1989

Feeding and urine cotinine values in babies whose mothers smoke.

In Canada, 8% to 20% of infants are breast-fed by mothers who smoke. To determine whether breast-feeding increases infants' exposure to tobacco smoke products, urinary cotinine excretion was measured in 172 babies, 33 of whom were breast-fed. A milk sample was taken from the mothers who were breast-feeding, and cotinine was measured with gas chromatography. The breast-fed babies had a median cotinine to creatinine ratio of 433 ng/mg, whereas the bottle-fed babies' median was 200 ng/mg (P less than 10(-4)). Similar differences were observed after adjustment for the number of cigarettes smoked by the mother and by other smokers in the home in the previous 24 hours. The correlation coefficient between the number of cigarettes smoked by the mother and the breast milk cotinine concentration was significant (r = .69, P = 2 X 10(-4)). Moreover, urine cotinine values from the breast-fed babies increased with higher concentrations of cotinine in the mother's milk (r = .56, P = .02). These results provide evidence that breast-feeding increases exposure to tobacco smoke components in infants whose mothers smoke. This is yet another argument for strongly encouraging women who smoke to stop smoking during pregnancy and lactation.

Adult↗
PubMed1987

Maternal and neonatal morbidity in instrumental deliveries with the Kobayashi vacuum extractor and low forceps.

Risks to the mother and newborn associated with the use of the Kobayashi Silastic vacuum extractor (n = 293) were compared with those associated with the use of low forceps (n = 468) in a retrospective chart review. Third or fourth degree perineal tears and vaginal and cervical lacerations were all observed less frequently among women delivered with the vacuum extractor. The need for post-partum bladder catheterization was also reduced for these women. Babies born by the means of the vacuum extractor ran an increased risk of cephalhematoma and neonatal jaundice. No difference in major neonatal morbidity was observed between the two groups. The Kobayashi instrument appears to be a useful alternative to forceps in low vaginal instrumental deliveries.

Birth Injuries↗
PubMed1983

[Incidence of and indications for cesarean sections in the Quebec, Canada region 1973 and 1979].

This study describes the frequency of cesarean sections and their indications in eleven hospitals located in the Quebec City area, in 1973 and 1979. Information on cesarean sections was abstracted from hospital records. Birth certificates provide the information on all deliveries. From 1973 to 1979, the cesarean delivery rate increased from 7.9 to 13.6 per 100 deliveries. Repeat cesarean sections account for 40.4% of this increase, while primary cesarean sections for dystocia, breech presentation and fetal distress explain respectively 21.1%, 21.1% and 12.3% of the rise. Prolonged labour, prolonged rupture of membranes, general anesthesia and pre-term repeat cesarean section were observed less frequently among cesarean sections in 1979. Moreover, Apgar scores were higher in 1979 than in 1973.

Adult↗