Browsing by Author "Ross, Susan"

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    Progesterone in women with arrested premature labor, a report of a randomised clinical trial and updated meta-analysis
    (2017-08-02) Wood, Stephen; Rabi, Yacov; Tang, Selphee; Brant, Rollin; Ross, Susan
    Abstract Background Progesterone may be effective in prevention of premature birth in some high risk populations. Women with arrested premature labor are at risk of recurrent labor and maintenance therapy with standard tocolytics has not been successful. Methods Randomized double blinded clinical trial of daily treatment with 200 mg vaginal progesterone in women with arrested premature labor and an updated meta-analysis. Results The clinical trial was terminated early after 41 women were enrolled. Vaginal progesterone treatment did not change the median gestational age at delivery: 36+2 weeks versus 36+4 weeks, p = .865 nor increase the mean latency to delivery: 44.5 days versus 46.6 days, p = .841. In the updated meta-analysis, progesterone treatment did reduce delivery <37 weeks gestation and increase latency to delivery, but this treatment effect was not evident in the high quality trials: (OR 1.23, 95% CI 0.91, 1.67) and (−0.95 days, 95% CI −5.54, 3.64) respectively. Conclusion Progesterone is not effective for preventing preterm birth following arrested preterm labor.
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    The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada
    (2008-01-01) McIsaac, Warren J; Prakash, Preeti; Ross, Susan
    INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices.METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first-line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone-resistant Escherichia coli may need to be monitored.
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    Vitamin D during Pregnancy
    (2016) Aghajafari, Fariba; Ross, Susan; O'Beirne, Maeve; Field, Catherine; Eliasziw, Misha; Dewey, Deborah
    Vitamin D plays an important role in promoting healthy pregnancy and fetal development. There is a lack of knowledge on (1) the effect of vitamin D deficiency/ insufficiency on pregnancy and neonatal outcomes, (2) the association between maternal plasma vitamin D concentration and dietary intake, and (3) the prevalence of vitamin D deficiency/ insufficiency during pregnancy and the contribution of vitamin D metabolites to estimate vitamin D. This dissertation attempts to address these knowledge gaps about vitamin D during pregnancy. In a systematic review and meta-analysis of observational studies, low maternal 25(OH)D concentrations were found to be associated with higher risks of gestational diabetes (pooled OR 1.49, 95% CI: 1.18 to 1.89), preeclampsia (pooled OR 1.79, 95% CI: 1.25 to 2.58), small for gestational age (SGA) (pooled OR 1.85, 95% CI: 1.52 to 2.26) and lower birth weight (weighted mean difference: -130.92 g (95% CI: -186.69 to -75.14). However, that quality of individual studies was not always optimal due to inconsistent reporting on confounding factors. The two studies in this work involved pregnant women from a large Alberta cohort study to measure vitamin D. 3-epi-25(OH)D3 was found in all of the pregnant women’s blood in mid-pregnancy, at the time of delivery and in cord blood. When the 3-epimer was included in the estimation of status, the prevalence of vitamin D <75 nmol/L was significantly lower (P<0.005). A significant relationship between maternal reported dietary vitamin D intake and plasma 25(OH)D and 3-epi-25(OH)D3 concentration were identified. Consuming the Recommended Dietary Allowance (RDA) (600 IU/ day) was found to be insufficient to achieve vitamin D <75 nmol/L in half of participants. This research highlighted the potentially important association between maternal vitamin D status and pregnancy health and the variability that can arise in study results when different measures of vitamin D status are used. In addition, it extends the literature suggesting that current RDA may not be adequate to ensure that Canadian pregnant women achieving vitamin D status. Furthermore, this research showed that the method employed to measure vitamin D in pregnant women and cord blood can influence the estimates of status.