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To improve the quality and access to care for all Ontarians, the reports and recommendations found in this section have been developed under the leadership if the Maternal-Neonatal Committee <insert link>. The development of this information is led by subject matter experts from across Ontario. All reports and recommendations are grounded in evidence, experience and a shared goal to improve the delivery and quality of care for pregnant individuals, babies and families in Ontario.

Current reports are listed below.

See view historical reports and recommendations see PCMCH Publications

 

Early Pregnancy Loss in the Emergency Department

Early Pregnancy Loss in the Emergency Department It is estimated that 1 in 5 pregnant individuals will experience an early pregnancy loss, defined as a loss that occurs at less than 20 weeks into the pregnancy. Experiencing a pregnancy loss can be a very emotional and traumatic time for expectant parents. When patients experience the symptoms of an early pregnancy loss, they frequently seek medical care in an Emergency Department (ED).  Because these cases represent a small proportion of total ED visits (less than 1%), healthcare providers and other staff in the ED may not have as much experience addressing the emotional and bereavement needs that commonly accompany this experience. The physical and emotional care that healthcare providers can offer to individuals experiencing an early pregnancy loss has an important impact on their long-term emotional well-being. As such, it is critical that healthcare providers working in EDs attend to the patients’ psychological and emotional needs in an empathetic, caring environment. Compassionate care acknowledges pregnancy loss as a loss of life and considers the spiritual, emotional and cultural expressions of the pain that accompanies the loss of a baby. In partnership with Health Quality Ontario and the Champlain Maternal Newborn Regional Program the Provincial Council for Maternal and Child Health convened an Expert Advisory Panel in 2017. This group was tasked with the development of […]

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Fetal Fibronectin Testing

Fetal Fibronectin Testing

fFN testing assists clinicians in determining whether a woman, who may be at risk of preterm birth, requires admission to hospital and/or transfer to a high risk perinatal unit. Evaluation of the testing protocol revealed significant cost savings to health provider organizations and the system as a whole, as well as increased quality and safety of care to mothers and their newborns.

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Levels of Maternal-Newborn Care

Levels of Maternal-Newborn Care Currently, Ontario has 96 hospitals that provide maternal and newborn care and services. Of these,  49 hospitals have Neonatal Intensive Care Units (NICUs) or Special Care Nurseries (SCNS). Working in partnership with the regional and local health organizations, each hospitals works to deliver services within a standardized levels of care definitions. The Ontario Levels of Maternal and Newborn Care by Hospital The Ontario Levels of Maternal and Newborn Care by Hospital are now available by clicking on the link below (updated October, 2019).

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Maternal-Newborn Gap Analysis

Maternal-Newborn Gap Analysis A review of low volume, rural, and remote intrapartum services in Ontario. The Provincial Council for Maternal and Child Health completed an analysis to look at access to safe, high-quality intrapartum care services in lower volume centres (less than 500 births a year) across the province. The gap analysis utilized a mixed-methods approach including: An environmental scan Findings from interviews with representatives from lower volume intrapartum care sites Data from the Better Outcomes Registry & Network (BORN) and Institute for Clinical Evaluative Sciences (ICES). Findings: Key Themes Geography is associated with quality and access to care; Wide variations in models of care, staffing models, and human resources strategies; and Knowledge and involvement of regional maternal-child networks. Download a copy Maternal-Newborn Gap Analysis (August, 2018) HERE. For more information please contact info@pcmch.on.ca

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Neonatal Consult, Transfer & Transport Process for Patients Requiring a Higher Level of Care

Effective May 1, 2018, hospital-based Most Responsible Providers (MRP) in Ontario will contact CritiCall Ontario at 1-800-668-4357 (HELP) to access advice/consultation from a higher level of care for neonatal patients with an acute condition who are less than or equal to 28 days of age or corrected age of less than or equal to 44 weeks, and/or less than or equal to 5kg, and for whom medical, surgical and/or diagnostic care is not available locally. https://www.criticall.org/ For questions, please contact info@pcmch.on.ca.     Resources Instructions for Accessing Neonatal Consult, Transfer and Transport Support for Patients Requiring a Higher Level of Care Tips for Communicating Your Patient’s Needs During Consultation with a Neonatologist Frequently Asked Questions CritiCall Ontario Backgrounder and Fact Sheet

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Ontario Perinatal Record

Ontario Perinatal Record Ontario Perinatal Record (OPR) The OPR replaces the Ontario Antenatal Record 1 and 2. Please order the new OPR and destroy remaining Antenatal 1 and 2 forms. The updated Ontario Perinatal Record is the 5th revision and replaces the 2005 version. The OPR update and User Guide development was undertaken in 2017 by a provincial committee representing practitioners using the current antenatal record including obstetricians, midwives, family physicians, nurses and nurse practitioners, as well as other stakeholders that support high quality maternity care such as Best Start, Public Health, BORN Ontario and PCMCH.   To order: Go to the Ministry of Health and Long-Term Care’s Central Forms Repository (edit hyperlink – http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWE&TIT=&NO=5046-64) Note: When ordering the OPR, there is now only one form that needs to be ordered (form number: 5046-64 “Ontario Perinatal Record set”), not two separate forms like the previous Antenatal 1 and 2. Extra copies of page 3 are available if you require more room to record subsequent visits (form number: 5060-64 “Perinatal Record 3″). 2017 Ontario Perinatal Record Ontario Perinatal Record User Guide – Updated August 2018 OPR Committee Membership List If you have any questions or comments about the OPR, please send them to info@pcmch.on.ca.

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Safe Administration of Oxytocin

Safe Administration of Oxytocin As oxytocin is a high alert medication, there is heightened risk of causing significant patient harm when used in error. This report focused on identifying best practice recommendations that can be applied to low risk pregnant patients who are eligible for oxytocin for augmentation or induction of labour. Reducing variation in care and reinforcing safe drug administration principles, helps to reduce adverse outcomes associated with the misuse of oxytocin. To support implementation of these best practices, various tools have been created such as a standardized order set and safety checklist. In report has been formally endorsed by the following organizations: Society of Obstetricians and Gynaecologists of Canada Ontario College Of Family Physicians Association of Ontario Midwives Canadian Association of Perinatal and Women’s Health Nurses Health Insurance Reciprocal of Canada   Safe Administration of Oxytocin – Download Report Sample Tools: Standardized Oxytocin Order Set Standardized Oxytocin Label Disagreeing with the plan of care algorithm Deciding about medication administration algorithm Pre-Use Safety Checklist In-Use Safety Checklist Pamphlet on IV Oxytocin for Induction and Augmentation of Labour – English  Pamphlet on IV Oxytocin for Induction and Augmentation of Labour – French For additional information info@pcmch.on.ca  

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Vaginal Birth After Caesarean Quality Standard

The Provincial Council for Maternal and Child Health and Health Quality Ontario collaborated on the development of this quality standard. This quality standard addresses care for people who have had a Caesarean birth and are planning their next birth. It focuses on care for people who are pregnant with one baby who is head-down and at full term. The primary goals of this quality standard are to improve access to safe vaginal birth after Caesarean delivery and promote informed shared decision-making. Achieving these objectives is also expected to increase Ontario’s rate of planned vaginal births after Caesarean over time. If you have any questions regarding the VBAC Quality Standard and/or the accompanying resources, please contact info@pcmch.on.ca or QualityStandards@HQOntario.ca.

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