Each year, approximately 2,400 newborn infants in British Columbia sustain severe trauma during childbirth, including injury to the skull, organs, or nerves. These injuries can lead to death or significant physical and intellectual disability. The majority of birth trauma occurs during difficult vaginal delivery and such deliveries can also cause injury to the mother that increases the risk of urinary or fecal incontinence, sexual dysfunction, and pelvic organ prolapse later in life. We propose to develop a prediction algorithm that will accurately identify women at high risk of birth trauma, for whom cesarean delivery could be used to prevent injury.
A second project is to establish optimal gestation for induction of labour in women diagnosed with insulin treated gestational diabetes to maximize unassisted delivery and to mazimize neonatal outcomes. The objectives are to quantify rates of adverse fetal and neonatal negative outcomes (stillbirth, shoulder dystocia, macrosomia, hypoglycemia, 5minute apgar <4, seizures, NICU admission and assisted ventilation among women with gestational diabetes) stratified by week of gestation at the time of labour induction. A second objective is to quantify rates of vaginal, assisted vaginal and cesarean delivery among women with gestational diabetes stratified by week of gestation at the time of labour induction.