Labour of Love
This Level 3 Reproductive Risk oral drug is now used to induce labour at Sunnybrook for patients who meet criteria.
What is misoprostol?
Not used if previous full thickness uterine surgery or known fetal compromise
Treating this after the diagnosis of bacterial vaginosis has recently been shown to reduce recurrence.
What is the male partner?
NEJM March 2025- In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of −2.6 recurrences per person-year (95% CI, −4.0 to −1.2; P<0.001).
(metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days).
Domperidone, a prokinetic agent, is also used off label to help with milk supply by stimulating release of this hormone.
What is prolactin?
This supplement is recommended to help prevent preeclampsia in women with low dietary intake.
What is calcium?
SOGC guideline: For all women with low dietary intake of calcium (<900 mg/d), oral calcium supplementation of at least 500 mg/d is suggested to prevent preeclampsia (conditional, low).
This type of reaction requires IV iron to be stopped temporarily until the reaction abates, and then the IV iron may resumed at a slower rate.
What is a Fishbane reaction?
This class of drugs is commonly used for cervical ripening prior to labour induction.
What are prostaglandins?
Examples, dinoprostone insert (Cervidil) or gel (Prostin E2) or misoprostol.
Preparing your coffee this way has been shown to reduce cafestol, a fatty substance associated with increased LDL levels.
What is "using a paper filter"?
Cafestol is a fatty substance within the oil of coffee beans that is found in the coffee grounds
Dark roast has less cafestol.
In randomized trials, high consumption of unfiltered coffee (median, 6 cups per day) increased low-density lipoprotein cholesterol levels by 0.46 mmol per liter, as compared with filtered coffee, predicting an estimated 11% higher risk of major cardiovascular events
Unlike bromocriptine, this D2-dopamine receptor agonist has the Health Canada indication for the prevention of physiological lactation in the puerperium.
What is cabergoline (Dostinex)?
Cabergoline directly stimulates D2-dopamine receptors on pituitary lactotrophs resulting in inhibition of prolactin secretion.
-single 1 mg dose (2 x 0.5 mg tab) during the first day postpartum
In a 2022 SOGC guideline, this supplement is recommended to be taken starting 2-3 months pre-conception and throughout pregnancy and breastfeeding.
What is folic acid?
Standard care: Women at low or moderate risk of folic acid-sensitive anomalies (i.e., women with no previous pregnancy affected by a neural tube defect) should take either a daily 0.4 mg folic acid supplement (low-risk women) or a daily 1.0 mg folic acid supplement (moderate-risk women).
3. High-risk care: Two pre-conception options can be considered to prevent neural tube defect recurrence. The first is a standard care option consisting of daily supplementation with 4-5 mg of folic acid. The second is a personalized option using a pre-conception assessment of maternal serum folic acid to determine the appropriate dosage of folic acid supplementation.
4. At 12 weeks gestation, all pregnant women, regardless of their risk of folic acidesensitive anomalies, should take an oral folic acid supplementation dosage of 0.4 mg daily in a multivitamin tablet formulation, and continue supplementation throughout pregnancy and breastfeeding.
This supplement is commonly given with traditional iron salts to improve absorption.
What is vitamin C?
If prophylactic enoxaparin is given within this time window, epidural access will be avoided.
What is 12h?
This technology allows a personal insulin pump and continuous glucose monitor to communicate to one another with computer programming.
What is a hybrid closed-loop insulin delivery system?
It’s called a hybrid system, as the user still must manually account for individual insulin needs — for example, before eating — and confirm the amount of insulin to be delivered.
This medication has been given to pregnant patients off-label for decades to help the baby's lungs produce surfactant that is essential for breathing at birth.
What is betamethasone?
Betamethasone (12mg IM q24h x2doses) can reduce the risk of respiratory distress syndrome (RDS) in premature infants
This mineral is given IV to patients delivering preterm to reduce the incidence of cerebral palsy?
What is magnesium (sulfate)?
Dosing oral iron this far apart may result in optimal iron absorption.
What is every other day?
This endogenous hormone produced in the pineal gland may have a role in the onset of labour.
What is melatonin?
- observational study of 19 000 pregnant women, it was noted the peak onset of spontaneous labor occurs between 2 and 3 a.m. at night,
- mothers with higher circulating levels of endogenous melatonin have more measurable uterine contractions
Melatonin use intrapartum may also be associated with neonatal hypoglycemia.- Milo Study 2024
This is the first and only non-hormonal neurokinin B antagonist indicated for moderate to severe VMS associated with menopause (e.g. hot flashes and night sweats) that received Health Canada approval in December 2024.
What is VEOZAH (fezolinetant)?
- 45mg po daily (contraindicated in renal (CrCl<30) and hepatic (cirrhosis) disease
-works by blocking neurokinin B (NKB) binding on the kisspeptin/neurokinin/dynorphin (KNDy) neuron, helping restore the balance in the brain's temperature control center (the hypothalamus).
This medication with Health Canada approval for hypertension and stable angina is used off-label in patients experiencing preterm contractions to relax the uterus.
What is nifedipine?
This supplement is important to administer prior to administration of any dextrose containing fluids for patients admitted with hyperemesis gravidarum.
What is thiamine?
Used to prevent Wernicke's Encephalopathy.
Note: chronic alcohol use, with or without malnutrition, reduces intestinal thiamine absorption by up to 50%, severely limiting the ability of even large oral doses to correct tissue deficiencies
IV iron extravasation can result in permanent skin staining or tattooing requiring this intervention to remove.
What is laser therapy?
VTE prophylaxis must always be delayed at least 12h after this common event in the Birthing Unit.
What is an epidural catheter insertion?
This oral product containing oral GnRH, estrogen and progestin is indicated in premenopausal women for the management of heavy menstrual bleeding associated with uterine fibroids and for the management of moderate to severe pain associated with endometriosis.
What is Myfembree?
relugolix 40mg, estradiol 1mg, and norethindrone acetate 0.5mg tablets
1 tab po daily, initiated as early as possible after the onset of menses but no later than 5 days after menses has started.
This tuberculosis medication is used off-label in refractory cases of intrahepatic cholestasis of pregnancy because it has the ability to reduce bile acids.
What is rifampin?
-dose range 300-1200 mg/d
This supplement, recently highlighted in a clinical practice guideline published in AJOG MFM 2024, is associated with increase risk of preterm birth and early preterm birth in individuals with low intake or low blood levels.
What is docosahexaenoic acid (DHA)?
600 to 1000 mg/d of docosahexaenoic+ eicosapentaenoic acid, or docosahexaenoic acid alone, should preferably begin in the second trimester of pregnancy (not later than approximately 20 weeks’ gestation) and continue until approximately 37 weeks’ gestation or until childbirth
This newly marketed product is the first prescription oral iron available in Canada, approved for adults with iron deficiency anemia (IDA) who are unresponsive or intolerant to other oral iron preparations.
What is ACCRUFeR® (ferric maltol)?
231.5mg (30 mg elemental iron) capsule po BID (empty stomach)
non-salt-based, non-polysaccharide oral therapy composed of stable ferric (Fe3+) iron complexed with a naturally occurring sugar derivative, maltol. The maltol iron complex passes through the stomach minimizing gastrointestinal side effects.