Publications by authors named "Anne Berndl"

13 Publications

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Guideline No. 416: Labour, Delivery, and Postpartum Care for People with Physical Disabilities.

J Obstet Gynaecol Can 2021 Feb 22. Epub 2021 Feb 22.

Calgary, AB.

Objective: To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada.

Target Population: This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline.

Outcomes: Safe and compassionate care for people with physical disabilities who are giving birth.

Benefits, Harms, And Costs: Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth.

Evidence: A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed.

Validation Methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

Intended Audience: Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities.

Recommendations:
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http://dx.doi.org/10.1016/j.jogc.2021.02.111DOI Listing
February 2021

Directive clinique n 416 : Soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique.

J Obstet Gynaecol Can 2021 Feb 20. Epub 2021 Feb 20.

Calgary, Alb.

Objectif: Décrire les pratiques fondées sur des données probantes en matière de prise en charge des soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique au Canada.

Population Cible: La présente directive clinique aborde les besoins des personnes ayant un handicap physique en mettant l'accent sur les problèmes de santé qui affectent la force et la mobilité, ainsi que sur ceux qui touchent les fonctions ou structures neurologiques ou musculosquelettiques. Bien que certains aspects de cette directive puissent s'appliquer aux personnes ayant une déficience intellectuelle, un trouble neurodéveloppemental ou un handicap sensoriel (p. ex., perte auditive ou visuelle) seulement, les besoins de cette population sortent du cadre de la présente directive. RéSULTATS: Prestation de soins sûrs et empathiques aux personnes parturientes ayant un handicap physique. BéNéFICES, RISQUES ET COûTS: La mise en œuvre de la présente directive permettra aux fournisseurs de soins de santé de mieux connaître les complications particulières que peuvent présenter les personnes ayant un handicap physique pendant l'accouchement et la période post-partum, ce qui augmentera la probabilité d'un accouchement sécuritaire. DONNéES PROBANTES: Une revue de la littérature a été effectuée à l'aide des bases de données MEDLINE (474), Embase(36) et le Cochrane Central Register of Controlled Trials (CENTRAL; 28). Les résultats ont été filtrés pour obtenir des études observationnelles, des revues systématiques, des méta-analyses et des directives publiées en anglais depuis 2013. Les références de ces articles ont également été passées en revue. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la solidité des recommandations en utilisant la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PUBLIC VISé: Spécialistes en médecine fœto-maternelle, obstétriciens, médecins de famille, infirmières, sages-femmes, neurologues, physiatres et autres professionnels qui donnent des soins aux personnes ayant un handicap physique.
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http://dx.doi.org/10.1016/j.jogc.2021.02.112DOI Listing
February 2021

Fetal Ultrasound Challenges and Solutions for Scanning Pregnant People With Physical Disabilities: A Two-Year Initiative for Adaptation.

J Obstet Gynaecol Can 2021 Feb 9. Epub 2021 Feb 9.

Sunnybrook Health Science Centre, Toronto ON.

The Accessible Care Pregnancy Clinic provides consolidated pregnancy care, including ultrasound, for people with physical disabilities. Sonography was identified as likely presenting unique challenges for this population. Therefore, over a 2-year period, sonographers recorded notes describing ultrasound techniques and challenges on 136 scans from 23 patients. These notes, along with ongoing communication between sonographers, administrative staff, nurses, and physicians, informed troubleshooting, which included preparing equipment, scheduling extra time with patients, and including support people. Final feedback revealed that sonographers experienced increased comfort and skill scanning people with physical disabilities and felt tht longer booking times, larger space, and partnering with the individual throughout their pregnancy improved quality of care.
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http://dx.doi.org/10.1016/j.jogc.2021.01.013DOI Listing
February 2021

Women's health guidelines for the care of people with spina bifida.

J Pediatr Rehabil Med 2020 ;13(4):655-662

Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada.

Women and girls with spina bifida have specific health care concerns. It is essential that they, and their health care providers have access to information to help them make healthy choices throughout their lifespan. This article aims to address key aspects of health pertinent to girls and women with spina bifida and outlines the SB Women's Health Guidelines for the Care of People with Spina Bifida. Further research into this area is needed.
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http://dx.doi.org/10.3233/PRM-200757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838966PMC
January 2020

Prenatal counseling: Guidelines for the care of people with spina bifida.

J Pediatr Rehabil Med 2020 ;13(4):461-466

Developmental Pediatrics, Portland, Oregon Health and Science University, OR, USA.

As the diagnosis of Spina Bifida (SB) is often made prenatally, SB-specific prenatal counseling is needed. It is essential to provide information about medical care and lifelong impact of this diagnosis, treatment options available to women carrying fetuses affected, and resources that will assist in the care of individuals with SB. This article outlines the SB Prenatal Counseling Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and acknowledges that further research in SB prenatal counseling is warranted.
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http://dx.doi.org/10.3233/PRM-200735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838969PMC
January 2020

Comparing Foley Catheter to Prostaglandins for Cervical Ripening in Multiparous Women.

J Obstet Gynaecol Can 2020 Jul 28;42(7):853-860. Epub 2020 Jan 28.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON. Electronic address:

Objective: This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations.

Methods: This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE-CR group) or dinoprostone vaginal gel (PGE-gel group). The primary outcome was the ripening-to-delivery interval.

Results: A total of 229 women met the study criteria (Foley group: 95; PGE-CR group: 83; PGE-gel group: 51). Women in the Foley group had a significantly shorter ripening-to-delivery interval compared with women in the PGE-CR group (16.2 ± 9.2 hours vs. 27.0 ± 14.8 hours; P < 0.001) and were more likely to deliver within 12 hours (47.4% vs. 12.0%; P < 0.001; adjusted relative risk [aRR] 3.87; 95% confidence interval [CI] 2.07-7.26) and within 24 hours (78.9% vs. 49.4%; P < 0.001; aRR 1.61; 95% CI 1.26-2.06). Women in the Foley group were also less likely to require a second ripening method compared with women in the PGE-CR group (1.1% vs. 8.4%; P = 0.018; aRR 7.26; 95% CI 2.99-17.62). These differences were not observed when comparing the Foley and the PGE-gel groups. The cesarean section rate was similar among the Foley group (9.5%), PGE-CR group (9.6%; P = 0.970), and PGE-gel group (11.8%; P = 0.664).

Conclusion: In multiparous women requiring cervical ripening, all methods of cervical ripening have a similar success rate. However, the use of a PGE-CR insert is associated with a considerably longer interval to delivery compared with a Foley catheter or PGE gel.
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http://dx.doi.org/10.1016/j.jogc.2019.11.001DOI Listing
July 2020

Women with physical disability in pregnancy resident education: a national survey as a needs assessment for curriculum improvement in obstetrics and gynaecology in Canada.

BMJ Open 2019 07 9;9(7):e024505. Epub 2019 Jul 9.

Obstetric and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Objectives: To explore the current status to which Canadian obstetrics and gynaecology (Ob-Gyn) programmes teach residents about pregnancy in patients with physical disabilities, and to assess the level of interested in providing formal education sessions in this field. This study also assesses the residents' perception of their knowledge and their comfort level caring for women with physical disabilities (WWPD), which will further determine the need for incorporation of this topic into the residency curriculum.

Design: Cross-sectional survey.

Setting: All Canadian English accredited Ob-Gyn residency programmes.

Participants: Programme directors and residents.

Main Outcome Measures: The current self-reported education and exposure Canadian Ob-Gyn residents have surrounding WWPD in pregnancy, and if there is an interest in further education in this area.

Methods: An online survey was developed and distributed to all Canadian English accredited Ob-Gyn residency programme directors and residents. Answers were collected over a 2-month period in 2017, which consisted of an initial email and two email reminders. Questions were in three key areas: demographic characteristics, knowledge gap and level of interest in a formal method of education.

Results: Eighty-four residents and nine programme directors participated in the surveys. Eighty-six per cent of residents and all programme directors responded that there are no formal scheduled training sessions on WWPD as part of the residency curriculum. Two-thirds of the residents reported being uncomfortable with the management issues surrounding a woman with a disability in pregnancy. A vast majority of residents (91.67%) and all programme directors have an interest in incorporating this topic into the residency curriculum to meet the need of pregnant women with disabilities.

Conclusions: This survey indicated that there is both a need for and interest in education in the area of pregnancy and physical disability in the Canadian Ob-Gyn residency programme. This information suggests that the development of educational materials in this area should be considered to address an unmet need with the ultimate goal of improving the care provided to WWPD in pregnancy. Future projects in this area should focus on content development taking into account the CanMEDS and competency-based medical education framework.
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http://dx.doi.org/10.1136/bmjopen-2018-024505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624047PMC
July 2019

Pregnancy 5 Years After Onset of Amyotrophic Lateral Sclerosis Symptoms: A Case Report and Review of the Literature.

J Obstet Gynaecol Can 2019 Jul 7;41(7):974-980. Epub 2018 Dec 7.

Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.

Background: Pregnancy in patients with amyotrophic lateral sclerosis (ALS) is extremely rare and often results in delivery of a healthy baby when patients are in the early stages of the disease.

Case: This report describes the case of a successful pregnancy 5 years after ALS onset. Significant worsening of weakness, unsteady balance, and dysphagia were noticed around the third trimester. A healthy child was delivered at term by planned Caesarean section. After delivery the patient developed remarkable weakness, dysphagia, and dysarthria.

Conclusion: A literature search found 22 cases through PubMed and Ovid, with key words "amyotrophic lateral sclerosis" and "pregnancy." Both slow progression and rapid progression of ALS during pregnancy have been reported. Worsening of symptoms seems to be common, but little is still known about the influence of pregnancy on ALS onset and progression.
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http://dx.doi.org/10.1016/j.jogc.2018.09.015DOI Listing
July 2019

Placenta percreta.

CMAJ 2018 02;190(6):E168

Maternal Fetal Medicine (O'Connor); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (Berndl), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.

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http://dx.doi.org/10.1503/cmaj.171411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809218PMC
February 2018

Pregnancy Outcome in Cartilage-Hair Hypoplasia, a Rare Form of Dwarfism.

Case Rep Obstet Gynecol 2017 31;2017:4737818. Epub 2017 Jan 31.

Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.

. This case report discusses the pregnancy outcome of a patient with cartilage-hair hypoplasia, a rare form of dwarfism, and multiple previous orthopedic surgeries. Literature on pregnancy outcomes in patients with cartilage-hair hypoplasia is limited. . A 32-year-old patient with cartilage-hair hypoplasia presented at 12 weeks' gestation to the high-risk obstetrics clinic for care. Preterm labor resulted in cesarean delivery at 34 weeks' gestation with general anesthetic. Breastfeeding was stopped at 6 weeks due to neonatal complications. . Pregnancy and delivery were uncomplicated. A multidisciplinary approach allowed for effective management during pregnancy and postnatal care. This is the first known documented case of prenatal care, delivery, and breastfeeding in a woman with this rare disorder.
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http://dx.doi.org/10.1155/2017/4737818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306987PMC
January 2017

Does cervical ripening at term using a high volume foley catheter result in a lower caesarean section rate than a low volume foley catheter? A systematic review and meta-analysis.

J Obstet Gynaecol Can 2014 Aug;36(8):678-687

Department of Obstetrics and Gynecology, McMaster University, Hamilton ON; Departments of Radiology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON.

Cervical ripening with a Foley catheter before induction of labour is a common obstetrical intervention. In this study we aimed to evaluate primarily the relationship between high or low volume Foley catheters used for cervical ripening and Caesarean section, and secondarily the relationship between Foley catheter volume, cervical ripeness, and time to delivery. We searched Medline and Embase from their inceptions with the assistance of an experienced librarian. All abstracts and complete articles were independently reviewed by two reviewers, according to predefined inclusion criteria. Six hundred forty-eight abstracts were identified, and 30 complete articles were read in full. Three articles with a total of 575 participating women met the inclusion criteria. The rate of Caesarean section with use of 80 mL Foley catheters was not significantly different from the rate using 30 mL Foley catheters (RR 0.82; 95% CI 0.48 to 1.41). A favourable cervix (which was defined heterogeneously) was more common with high volume catheters (RR 1.72; 95% CI 1.46 to 2.04), and failure to deliver in 24 hours was lower (RR 0.70; 95% CI 0.54 to 0.90). High volume Foley catheters improve the likelihood of a favourable cervix and chance of delivery in 24 hours more than low volume Foley catheters. As a more favourable cervix before induction of labour is associated with a lower rate of Caesarean section, a randomized controlled trial comparing high and low volume Foley catheters for cervical ripening using Caesarean section as the primary outcome is warranted.
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http://dx.doi.org/10.1016/S1701-2163(15)30509-0DOI Listing
August 2014

Fetal echocardiography assists in determining optimal delivery site.

J Obstet Gynaecol Can 2014 Mar;36(3):210-215

Department of Pediatrics, McMaster University, Hamilton ON.

Objective: Congenital heart disease is one of the most common types of structural fetal abnormalities and a major cause of perinatal morbidity and mortality. Fetal echocardiography aids in the diagnosis of congenital heart disease, which allows management planning for parents and physicians, including continuation or termination of the pregnancy and triaging for location of delivery. This is a key component of planning, as transport of neonates entails risks, costs, and parental stress. In this study, we examined the outcomes of pregnancies with fetal cardiac anomalies diagnosed at a single tertiary care centre. We aimed to assess whether the system of directing affected pregnancies to either a tertiary and quaternary care centre is effective.

Methods: We identified pregnancies with fetal cardiac anomalies diagnosed on fetal echocardiography between 2005 and 2009. Information about diagnosis, pregnancy outcome, delivery location, and surgical management was collected. This information was analyzed retrospectively.

Results: Anomalies were demonstrated in 120 fetal echocardiography studies. Four of the babies (3.3%) were stillborn, and 27 (22.5%) pregnancies were terminated. There were 89 live born babies, and 74 of these (61.7%) survived the neonatal period. Fifteen babies (12.5%) died as neonates. Thirty-two pregnant women were triaged to deliver at the quaternary centre with pediatric cardiac surgery services, and 20 of these babies underwent surgery. Two of the 89 live born babies (2.2%) required emergency transfer.

Conclusion: Fetal echocardiography is an important contributor to efficient use of pediatric cardiac services and minimizes need for neonatal transfer. Contemporary use of fetal echocardiography is associated with optimized delivery location.
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http://dx.doi.org/10.1016/S1701-2163(15)30628-9DOI Listing
March 2014

Fetal movement monitoring: how are we doing as educators?

J Obstet Gynaecol Can 2013 Jan;35(1):22-8

Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.

Objective: When decreased fetal movement is noticed, delay in seeking care is associated with poor perinatal outcomes, including stillbirth. Health care providers are responsible for educating women about normal fetal movement and the appropriate actions they should take if it decreases. This study aimed to demonstrate our pregnant population's understanding of normal fetal movement and responses to decreased fetal movement, and to potentially guide educational interventions to improve perinatal outcomes.

Methods: We surveyed 304 pregnant women (over 26 weeks' gestation) during clinic visits at the IWK Health Centre, Halifax, NS. Information collected in the survey included demographics, knowledge about normal fetal movement, monitoring techniques, and response to decreased fetal movement.

Results: Eighteen percent of women (55/298) demonstrated knowledge of normal fetal movement and fetal monitoring, indicating that they would seek assessment promptly if they experienced decreased fetal movement. Although 54.7% of participants (164/300) would contact a health care professional if they noticed decreased fetal movement, approximately two thirds of participants were unable to describe normal fetal movement or monitoring techniques. Almost 30% of participants (90/304) did not identify daily fetal movement as normal, and 37.5% (114/304) reported it may be normal for fetal movement to stop around their due date. Written and verbal communication regarding fetal movement from a health care provider significantly increased the likelihood of appropriate intended self-management in the context of decreased fetal movement.

Conclusion: Education influences the anticipated behaviour of pregnant women regarding decreased fetal movement. Specific areas of misinformation which may guide future education strategies are identified. There is room for improvement in this area of patient education.
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http://dx.doi.org/10.1016/s1701-2163(15)31044-6DOI Listing
January 2013