Canadian Perinatal Network
Encyclopedia
The Canadian Perinatal Network (CPN) is made up of Canadian
researcher
s who collaborate on research issues relating to perinatal care. The network commenced in September 2005, and includes members from 24 tertiary perinatal units.
CPN will enable health care professionals, researchers, and administrators to participate actively in clinical, epidemiologic, health services, health policy, and informatics
research aimed at improving the effectiveness and efficiency of perinatal care.
Primary Goals of CPNο Joint examination of the whole spectrum of risks and their interactions, from the antenatal and obstetric to the neonatal periods, on maternal and perinatal outcomesο Iterative hypothesis testing and acquisition of new knowledge about obstetric practices associated with good or poor maternal and perinatal outcomes, which will inform the care of women and babies in Canadaο Longitudinal monitoring of obstetric practices and resource use known to be associated with a decrease in adverse events, which will inform knowledge transfer
activitiesο Longitudinal monitoring of outcomes and resource use, which will be important for auditing quality of care and providing information that is critical to planning of care and resource allocation
.
of pregnancies at high risk of very preterm birth at 220 to 28+6 weeks' gestation.
In Canada, more than 350,000 babies are born each year. Preterm birth complicates 7.6% of births, with variations of ±15% between provinces. Preterm birth is the most important cause of perinatal mortality
and morbidity, and is recognized to hold the greatest potential for improvement of health outcomes.
BILBO ObjectivesIn women at risk of very preterm birth at 220 – 28+6 weeks gestation, CPN seeks to identify obstetric practices that may be associated with good maternal or perinatal outcomes. The Network’s specific objectives are:1. To examine variations in outcomes and practices for the major causes of spontaneous and indicated very preterm birth among Canadian tertiary perinatal units;2. To identify obstetric practices that are associated with favourable and unfavourable outcomes for further intervention studies of the major causes of very preterm birth, after correction for pregnancy
(maternal and fetal) characteristics [and for perinatal outcomes, also neonatal risk markers and neonatal intensive care practices]; and3. To study variations in resource use associated with obstetric practice and tertiary perinatal characteristics, after adjustment for baseline population risks.
, database design/maintenance, national networks, medical informatics, and statistical modelling.
This project involves 24 tertiary perinatal units across Canada and focus on the major determinants of spontaneous and indicated very preterm birth (at 22+0–28+6 weeks): spontaneous preterm labour, shortened cervix, prolapsing
membranes, preterm prelabour rupture of membranes, intrauterine growth restriction
(abdominal circumference), gestational hypertension (with/without proteinuria
), and antepartum haemorrhage. Commencing August 2006, CPN will enroll all (N=4,500) such women at risk of very preterm birth, who are admitted to a Canadian tertiary perinatal unit. Data collection
proceeds from the maternal and neonatal/infant/paediatric records, and include adverse perinatal and maternal outcomes, patient mix (including maternal demographics, past medical/obstetric history, characteristics of current pregnancy), neonatal care (for perinatal outcomes), and specific key obstetric practices (including maternal transport, cervical cerclage
, amnioinfusion
, fetal and maternal surveillance, pharmacological and non-pharmacological therapy, and pregnancy prolongation).
Research Goals1. Determine crude outcome incidence rates among centres. 2. Examine variations in outcomes and practices among tertiary perinatal units, using staged multivariate logistic and linear regression analysis
.3. Associate obstetric practice differences with outcomes variation.4. Compare crude measures of resource use.5. Analyze resource use variation among centres.
Relevance of ResearchFor the major causes of very preterm birth, this study will determine whether there are inter-institutional variations in maternal or perinatal outcomes that can be accounted for by variability in obstetric practice, after correction for differences in patient mix. This information will be used to improve outcomes (for both mothers and babies) and reduce costs, by targeting practices for trials of effectiveness.
This project will also form the basis of the Canadian Perinatal Network (CPN), one of a number of national networks designed to cover maternal, fetal, newborn and paediatric health. Data collection for CPN will be linked to the Canadian Neonatal Network
(CNN) that has been an effective vehicle for both the generation of new knowledge, and the translation of existing knowledge into clinical practice.
Funding for CPN has been provided by CIHR (2002–8, Neonatal-perinatal Interdisciplinary Capacity Enhancement Grant and 2005–2009 Operating Grant) and the MSFHR (2003–8, through the Centre for Health Innovation and Improvement, Child and Family Research Institute of British Columbia).
and definitions from existing perinatal and neonatal databases. It was noted that this network should be created with collaboration and convergence of data in mind, in particular with other well-established national networks like the Canadian Neonatal Network (CNN) and the Canadian Perinatal Surgery Network (CAPSNet) through the Maternal-Infant Care Network (MICare). In particular, babies identified by CPN as NICU (Neonatal Intensive Care Unit
) babies will be linked to the CPN database via the infant’s CNN identification number – a link that provides the unique opportunity for researchers to participate in collaborative projects on a national scale and trace effects all the way from pregnancy to pediatric health.
In creating the definition for CPN’s data field
s, it was clear that there is no standardization in the published literature for most obstetric or neonatal terms in common use. For example, perinatal mortality
is defined differently by reproductive care programs in Canadian provinces (e.g., WHO definition by birth at ≥28 weeks versus birth at ≥20 weeks or ≥500g). Furthermore, what constitutes reduced biological growth potential is variably defined, ranging from birth weight
<2500g, to birth weight <3rd percentile for gestational age
and gender. With future convergence in mind, CPN terminology was not created independently; rather, it was drawn from the proposed Canadian Perinatal Programs Coalition Minimal Dataset and the CNN database manual.
Massey KA, Magee LA, Dale S,Claydon J, Morris TJ, von Dadelszen P, Liston RM and Ansermino JM. A Current Landscape of Provincial Perinatal Data Collection in Canada. Journal of Obstetrics and Gynaecology of Canada. March 2009.
Massey KA, Morris TJ, Liston RM, von Dadelszen P, Ansermino JM, and Magee LA “Building Knowledge in Maternal and Infant care” in Medical Informatics in Obstetrics and Gynecology. Edited by David Parry and Emma Parry. Auckland New Zealand November 2008.
Massey KA, Ansermino JM von Dadelszen P, Morris TJ, Liston RM, Magee LA. What is SNOMED CT and why should the ISSHP care? Hypertension in Pregnancy. February 2009.
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
researcher
Researcher
A researcher is somebody who performs research, the search for knowledge or in general any systematic investigation to establish facts. Researchers can work in academic, industrial, government, or private institutions.-Examples of research institutions:...
s who collaborate on research issues relating to perinatal care. The network commenced in September 2005, and includes members from 24 tertiary perinatal units.
CPN will enable health care professionals, researchers, and administrators to participate actively in clinical, epidemiologic, health services, health policy, and informatics
Health informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
research aimed at improving the effectiveness and efficiency of perinatal care.
Primary Goals of CPNο Joint examination of the whole spectrum of risks and their interactions, from the antenatal and obstetric to the neonatal periods, on maternal and perinatal outcomesο Iterative hypothesis testing and acquisition of new knowledge about obstetric practices associated with good or poor maternal and perinatal outcomes, which will inform the care of women and babies in Canadaο Longitudinal monitoring of obstetric practices and resource use known to be associated with a decrease in adverse events, which will inform knowledge transfer
Knowledge transfer
Knowledge transfer in the fields of organizational development and organizational learning is the practical problem of transferring knowledge from one part of the organization to another part of the organization. Like Knowledge Management, Knowledge transfer seeks to organize, create, capture or...
activitiesο Longitudinal monitoring of outcomes and resource use, which will be important for auditing quality of care and providing information that is critical to planning of care and resource allocation
Resource allocation
Resource allocation is used to assign the available resources in an economic way. It is part of resource management. In project management, resource allocation is the scheduling of activities and the resources required by those activities while taking into consideration both the resource...
.
CPN centres
CPN comprises the following hospital sites:- Victoria General HospitalVictoria General HospitalVictoria General Hospital is an acute care facility located in View Royal, British Columbia, Canada, a western suburb of Victoria. VGH, as it is commonly known, provides emergency, general surgery and medical treatment services...
, Victoria, BC - BC Women's Hospital & Health Centre, Vancouver, BC
- Royal Columbian HospitalRoyal Columbian HospitalThe Royal Columbian Hospital is the oldest hospital in the Canadian province of British Columbia and one of the busiest in the Fraser Health Authority...
, New Westminster, BC - Foothills Medical CentreFoothills Medical CentreFoothills Medical Centre is the largest hospital in Alberta, Canada and is located in the City of Calgary. It is one of Canada's most recognized medical facilities and is one of the leading hospitals in Alberta, providing advanced healthcare services to over two million people from Calgary,...
, Calgary, AB - Royal Alexandra HospitalRoyal Alexandra HospitalRoyal Alexandra Hospital can refer to:*Royal Alexandra Hospital *Royal Alexandra Hospital *Royal Alexandra Hospital, Brighton*Royal Alexandra Hospital for Children, Sydney, Australia*Royal Alexandra Hospital...
, Edmonton, AB - Royal University HospitalRoyal University HospitalRoyal University Hospital, often abbreviated RUH, is one of three hospitals in Saskatoon, Saskatchewan. It is located on the University of Saskatchewan campus. RUH is a teaching hospital and closely tied to the College of Medicine within the university. It was opened on May 14, 1955 by...
, Saskatoon, SK - Regina General Hospital, Regina, SK
- The Women's Hospital, Winnipeg, MB
- Kingston General HospitalKingston General HospitalThe Kingston General Hospital is a teaching hospital affiliated with Queen's University located in Kingston, Ontario. The hospital is a partner within Kingston's university hospitals, delivering health care, conducting research and training health care professionals.As the oldest public hospital...
, Kingston, ON - McMaster University Medical CentreMcMaster University Medical CentreThe McMaster University Medical Centre is a major pediatric teaching hospital in Hamilton, Canada. It is a part of McMaster University, but operated by Hamilton Health Sciences....
, Hamilton, ON - Saint Joseph's Health Centre, London, ON
- Mount Sinai Hospital, Toronto, ON
- Sunnybrook Health Centre, Toronto, ON
- The Ottawa HospitalThe Ottawa HospitalThe Ottawa Hospital or L'Hôpital d'Ottawa is a major, non-profit, public, university teaching hospital in Ottawa made up of the former Grace Hospital, Riverside Hospital, Ottawa General Hospital and Ottawa Civic Hospital. It is a 1,195-bed academic health sciences centre...
, Ottawa, ON - Royal Victoria HospitalRoyal Victoria HospitalThe Royal Victoria Hospital, or as it is popularly known, the "Royal Vic", is located at 687 Pine Avenue, Montreal, Quebec, Canada.The Royal Vic is located in downtown Montreal, on the slopes of Mount Royal. There are a number of buildings, including the Surgical, Medical, Ross and Women's...
, Montréal, QC - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
- Centre Hospitalier Universitaire de QuébecCentre hospitalier universitaire de QuébecCentre hospitalier universitaire de Québec is a network of three teaching hospitals affiliated with the medical school of Université Laval and several specialized institutions in Quebec City....
, Québec City, QC - IWK Health CentreIWK Health CentreThe IWK Health Centre is a hospital in Halifax, Nova Scotia that provides care to women, children, and youth from Nova Scotia, New Brunswick and Prince Edward Island.-Location:The IWK Health Centre is located in the south end of Halifax...
, Halifax, NS - Women's Health Program, Eastern Health, St. John's, NL
- Saint John Regional HospitalSaint John Regional HospitalSaint John Regional Hospital is a Canadian hospital in Saint John, New Brunswick.Saint John Regional Hospital is the largest tertiary care referral hospital in New Brunswick and specializes in cardiac and trauma care services....
, Saint John, NB - Hôpital Sainte-Justine, Montréal, QC
- St. Boniface General Hospital, Winnipeg, MB
- Windsor Regional Hospital, Windsor, ON
- Dr. Everett Chalmers Hospital, Fredericton, NB
BILBO: birth before 29 weeks: interventions leading to better outcomes for mothers and babies
The inaugural project of CPN is BILBO (Birth before 29 weeks: Interventions Leading to Better Outcomes for mothers and babies). BILBO is a standardized national databaseDatabase
A database is an organized collection of data for one or more purposes, usually in digital form. The data are typically organized to model relevant aspects of reality , in a way that supports processes requiring this information...
of pregnancies at high risk of very preterm birth at 220 to 28+6 weeks' gestation.
In Canada, more than 350,000 babies are born each year. Preterm birth complicates 7.6% of births, with variations of ±15% between provinces. Preterm birth is the most important cause of perinatal mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
and morbidity, and is recognized to hold the greatest potential for improvement of health outcomes.
BILBO ObjectivesIn women at risk of very preterm birth at 220 – 28+6 weeks gestation, CPN seeks to identify obstetric practices that may be associated with good maternal or perinatal outcomes. The Network’s specific objectives are:1. To examine variations in outcomes and practices for the major causes of spontaneous and indicated very preterm birth among Canadian tertiary perinatal units;2. To identify obstetric practices that are associated with favourable and unfavourable outcomes for further intervention studies of the major causes of very preterm birth, after correction for pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
(maternal and fetal) characteristics [and for perinatal outcomes, also neonatal risk markers and neonatal intensive care practices]; and3. To study variations in resource use associated with obstetric practice and tertiary perinatal characteristics, after adjustment for baseline population risks.
The research
The CPN team includes content and methods experts in each of the major causes of spontaneous or indicated very preterm birth, epidemiologyEpidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
, database design/maintenance, national networks, medical informatics, and statistical modelling.
This project involves 24 tertiary perinatal units across Canada and focus on the major determinants of spontaneous and indicated very preterm birth (at 22+0–28+6 weeks): spontaneous preterm labour, shortened cervix, prolapsing
Prolapse
Prolapse literally means "to fall out of place", from the Latin prolabi meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the...
membranes, preterm prelabour rupture of membranes, intrauterine growth restriction
Intrauterine growth restriction
Intrauterine growth restriction refers to poor growth of a baby while in the mother's womb during pregnancy. The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus....
(abdominal circumference), gestational hypertension (with/without proteinuria
Proteinuria
Proteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
), and antepartum haemorrhage. Commencing August 2006, CPN will enroll all (N=4,500) such women at risk of very preterm birth, who are admitted to a Canadian tertiary perinatal unit. Data collection
Data collection
Data collection is a term used to describe a process of preparing and collecting data, for example, as part of a process improvement or similar project. The purpose of data collection is to obtain information to keep on record, to make decisions about important issues, to pass information on to...
proceeds from the maternal and neonatal/infant/paediatric records, and include adverse perinatal and maternal outcomes, patient mix (including maternal demographics, past medical/obstetric history, characteristics of current pregnancy), neonatal care (for perinatal outcomes), and specific key obstetric practices (including maternal transport, cervical cerclage
Cervical cerclage
Cervical cerclage , also known as a cervical stitch, is used for the treatment of cervical incompetence , a condition where the cervix has become slightly open and there is a risk of miscarriage because it may not remain closed throughout pregnancy...
, amnioinfusion
Amnioinfusion
Amnioinfusion is a method of thinning thick meconium that has passed into the amniotic fluid.It can increase fetal space.It has been used to reduce meconium aspiration syndrome, though evidence of benefit is mixed....
, fetal and maternal surveillance, pharmacological and non-pharmacological therapy, and pregnancy prolongation).
Research Goals1. Determine crude outcome incidence rates among centres. 2. Examine variations in outcomes and practices among tertiary perinatal units, using staged multivariate logistic and linear regression analysis
Regression analysis
In statistics, regression analysis includes many techniques for modeling and analyzing several variables, when the focus is on the relationship between a dependent variable and one or more independent variables...
.3. Associate obstetric practice differences with outcomes variation.4. Compare crude measures of resource use.5. Analyze resource use variation among centres.
Relevance of ResearchFor the major causes of very preterm birth, this study will determine whether there are inter-institutional variations in maternal or perinatal outcomes that can be accounted for by variability in obstetric practice, after correction for differences in patient mix. This information will be used to improve outcomes (for both mothers and babies) and reduce costs, by targeting practices for trials of effectiveness.
This project will also form the basis of the Canadian Perinatal Network (CPN), one of a number of national networks designed to cover maternal, fetal, newborn and paediatric health. Data collection for CPN will be linked to the Canadian Neonatal Network
Canadian Neonatal Network
The Canadian Neonatal Network is an organization composed of neonatologists and neonatal health professionals from across Canada. The network was created in 1995 by Dr. Shoo Kim Lee, and currently its Steering Committee is composed of Drs...
(CNN) that has been an effective vehicle for both the generation of new knowledge, and the translation of existing knowledge into clinical practice.
Funding for CPN has been provided by CIHR (2002–8, Neonatal-perinatal Interdisciplinary Capacity Enhancement Grant and 2005–2009 Operating Grant) and the MSFHR (2003–8, through the Centre for Health Innovation and Improvement, Child and Family Research Institute of British Columbia).
Links to other networks
Upon its creation, CPN was not designed to “reinvent the wheel”; rather, it capitalizes on infrastructureInfrastructure
Infrastructure is basic physical and organizational structures needed for the operation of a society or enterprise, or the services and facilities necessary for an economy to function...
and definitions from existing perinatal and neonatal databases. It was noted that this network should be created with collaboration and convergence of data in mind, in particular with other well-established national networks like the Canadian Neonatal Network (CNN) and the Canadian Perinatal Surgery Network (CAPSNet) through the Maternal-Infant Care Network (MICare). In particular, babies identified by CPN as NICU (Neonatal Intensive Care Unit
Neonatal intensive care unit
A Neonatal Intensive Care Unit —also called a Special Care Nursery, newborn intensive care unit, intensive care nursery , and special care baby unit —is an intensive care unit specializing in the care of ill or premature newborn infants.The problem of premature and congenitally ill infants is not a...
) babies will be linked to the CPN database via the infant’s CNN identification number – a link that provides the unique opportunity for researchers to participate in collaborative projects on a national scale and trace effects all the way from pregnancy to pediatric health.
In creating the definition for CPN’s data field
Data field
A data field is a place where you can store data. Commonly used to refer to a column in a database or a field in a data entry form or web form.The field may contain data to be entered as well as data to be displayed.-See also:*Data dictionary...
s, it was clear that there is no standardization in the published literature for most obstetric or neonatal terms in common use. For example, perinatal mortality
Perinatal mortality
Perinatal mortality , also perinatal death, refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist specifically concerning the issue of inclusion or exclusion of early fetal and...
is defined differently by reproductive care programs in Canadian provinces (e.g., WHO definition by birth at ≥28 weeks versus birth at ≥20 weeks or ≥500g). Furthermore, what constitutes reduced biological growth potential is variably defined, ranging from birth weight
Birth weight
Birth weight is the body weight of a baby at its birth.There have been numerous studies that have attempted, with varying degrees of success, to show links between birth weight and later-life conditions, including diabetes, obesity, tobacco smoking and intelligence.-Determinants:There are...
<2500g, to birth weight <3rd percentile for gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
and gender. With future convergence in mind, CPN terminology was not created independently; rather, it was drawn from the proposed Canadian Perinatal Programs Coalition Minimal Dataset and the CNN database manual.
Links to publications
On behalf of the Canadian Perinatal Network Collaborative Group the following are preliminary publications including topics such as knowledge translation, sharing data, standardization of terminology, etc. Please stay tuned for more publications to come.Massey KA, Magee LA, Dale S,Claydon J, Morris TJ, von Dadelszen P, Liston RM and Ansermino JM. A Current Landscape of Provincial Perinatal Data Collection in Canada. Journal of Obstetrics and Gynaecology of Canada. March 2009.
Massey KA, Morris TJ, Liston RM, von Dadelszen P, Ansermino JM, and Magee LA “Building Knowledge in Maternal and Infant care” in Medical Informatics in Obstetrics and Gynecology. Edited by David Parry and Emma Parry. Auckland New Zealand November 2008.
Massey KA, Ansermino JM von Dadelszen P, Morris TJ, Liston RM, Magee LA. What is SNOMED CT and why should the ISSHP care? Hypertension in Pregnancy. February 2009.