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Archives for February 2020

Paul McGivern, K.C. is Selected to Become a Fellow in the Litigation Counsel of America

Tuesday, February 25, 2020 By Admin

Litigation Counsel of America

Paul McGivern, K.C. has been invited to become a Fellow in the Litigation Counsel of America (the “LCA”). The LCA is a trial lawyer honorary society composed of less than one-half of one percent of lawyers in North America. Fellowship in the LCA is highly selective and by invitation only. Fellows are selected based upon excellence and accomplishment in litigation, both at the trial and appellate levels and superior ethical reputation. Established as a trial and appellate lawyer honorary society reflecting the American Bar in the twenty-first century, the LCA represents the best in law among its membership. The number of Fellowships has been kept at an exclusive limit by design, allowing qualifications, diversity, and inclusion to align effectively, with recognition of excellence in litigation across all segments of the Bar. Fellows are generally at the partner or shareholder level or are independent practitioners with recognized experience and accomplishment. In addition, the Litigation Counsel of America is dedicated to promoting superior advocacy, professionalism and ethical standards among its Fellows.

Congratulations Paul, on your inclusion in this esteemed group of accomplished lawyers!

Filed Under: Firm News

Late-Term Pregnancies – Induction of Labour is Safer than Waiting until Post-Term

Friday, February 21, 2020 By Lindsay McGivern

A recent Swedish study compared the safety of inducing labour at 41 weeks to waiting until 42 weeks before inducing. The study was stopped early due to the significantly higher rate of stillbirths in the group that was not induced at 41 weeks. Visit our late-term pregnancies program doc.

A normal pregnancy is, on average, 40 weeks. Pregnancies can be categorized as full term, late-term or post-term. “Full-term” pregnancies are between 39 weeks and 40 weeks, 6 days. “Late-term” pregnancies are between 41 weeks and 41 weeks, 6 days. “Post-term” pregnancies begin at 42 weeks. Adverse outcomes for mother and baby gradually increase after 40 weeks and are substantially increased post-term.[1] Once a pregnancy is post-term, the risks to the baby include fetal macrosomia (being significantly larger than the average), meconium aspiration, cerebral palsy, neonatal encephalopathy (brain damage), need for respiratory assistance, and death at the end of pregnancy or shortly after birth.[2]

Recommendations for the management of pregnancies in the late-term period are varied. For late-term low-risk pregnancies in healthy women, one of two approaches can be considered. Women can be induced as soon as they hit the 41-week mark, as is recommended by the World Health Organization,[3] or they can be monitored for signs of fetal or maternal complications and await spontaneous onset of labour, if no complications arise. The Swedish study compared the safety of these two options.

The study compared the two groups by evaluating Apgar scores and umbilical cord blood gases.  The authors also compared the incidence of hypoxic-ischemic encephalopathy, intracranial hemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours and brachial plexus injury. These outcomes were similar in women who were induced at 41 weeks and those who were monitored while awaiting spontaneous labour between 41 and 42 weeks.[4] The number of major maternal complications was also similar between the two groups.[5]

What was different between the two groups with the rate of perinatal death. There were no stillbirths or deaths in the first 30 days after birth for women induced at 41 weeks. In contrast, there were five stillbirths and one baby, large for its gestational age, died from lack of oxygen in the group that was monitored while awaiting spontaneous labour in the late-term period.[6] In addition, in the group that was induced at 41 weeks, fewer babies had to go to the neonatal intensive care unit, fewer had jaundice requiring treatment, and fewer infants were significantly larger than average.[7]

Based on the results of this study, the authors recommend that the induction of labour should be offered to women at 41 weeks or earlier.[8]  These results differ slightly from guidelines that have been in place in British Columbia for over a decade. [9]

The BC Reproductive Care Program (BCRCP) recommends that until 41 weeks, induction should be recommended only if there are signs of fetal compromise (babies that are too small or have a non-reassuring fetal heart tracing). At 41 weeks, all women with a healthy, uncomplicated pregnancy should be informed of the risks and benefits of induction versus expectant management (monitoring while awaiting spontaneous labour) and offered an induction. If the mother declines induction, the following monitoring should occur:  daily fetal movement counts, fetal heart rate testing twice a week, and ultrasound to assess amniotic fluid twice a week. If the fetal heart rate tracing or amniotic fluid is abnormal, the woman should be induced immediately. If spontaneous labour is not achieved by 42 weeks, labour should be induced.   

If earlier delivery is safer, should women be induced when they reach the full-term (39 weeks) or should induction wait until 41 or 42 weeks?  Clinical care practices and guidelines evolve over time as evidence accumulates. Some physicians are beginning to advocate for induction of labour at 39 weeks, rather than waiting for 41 or 42 weeks.  Look for our blog on these developments in the weeks ahead.


[1] Wennerholm et al, “Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks” (BMI 2019; 367:l6131), p. 1

[2] British Columbia Reproductive Care Program, “Obstetric Guideline 7: Postterm Pregnancy”, p. 5 http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/PostTermGuideline.pdf

[3] Wennerholm et al, supra,  p. 1

[4] Wennerholm et al, supra, p. 3 and 10

[5] Wennerholm et al, supra,  p. 1

[6] Wennerholm et al, supra,  p. 8 and 10

[7] Wennerholm et al, supra,  p. 10

[8] Wennerholm et al, supra,  p. 11[9] British Columbia Reproductive Care Program, “Obstetric Guideline 7: PostTerm Pregnancy” http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/PostTermGuideline.pdf

Filed Under: Health News

Spinal Cord Stimulation – Potential Game-Changer for Spinal Cord Injuries?

Monday, February 3, 2020 By Brenda Osmond

At Pacific Medical Law we have helped clients with spinal cord injuries that have been caused by, or worsened by, medical negligence.  Delayed diagnosis of spinal cord infections, delayed treatment of spinal cord compression or improper treatment of traumatic spinal cord injuries can all lead to life-altering injuries.

Sometimes, however, spinal cord injuries are caused by trauma alone, such as motor vehicle accidents. Ryan Straschnitzki is an example of that.  Ryan is a survivor of the 2018 Humboldt Broncos bus crash who was paralyzed from the chest down. In early December 2019, he returned to his home in Airdrie, Alberta after spending five weeks in Thailand having a spinal cord stimulator implanted. Since his surgery, he is beginning to be able to move his legs and has seen slow but steady progress after having the surgery, stem cell injections, and intensive physiotherapy.  Ryan is hoping to make Canada’s national sled hockey team and play at the Paralympics.

Limited Approval in North America

Spinal cord stimulators are approved for use in Canada and the USA to treat chronic back pain, but not for treating spinal cord injuries, where they may play a role in improving mobility, as in Ryan’s case. 

There is also a potential role for spinal cord stimulators in improving blood pressure control in those with a spinal cord injury. Vancouver’s International Collaboration on Repair Discoveries (iCord), conducts research on various therapies, treatments, and surgeries that may help people with spinal cord injuries.  iCord reported on a BC man who suffered a spinal cord injury due to a diving accident and had a spinal cord stimulator implanted not to improve his mobility, but to improve cardiovascular function.  Prior to the procedure, Isaac Darrel, of Langley, BC, often felt light-headed, especially during transfers to and from his wheelchair or during exercise.  His blood pressure would drop dramatically, and he would sometimes blackout while sitting in his wheelchair. Now that he has the spinal cord stimulator, that no longer happens. He has also experienced increased sitting tolerance and improved bowel function.

Ongoing Research

There are no centers in Canada conducting further clinical studies on the use of spinal cord stimulators to improve blood pressure control, but studies are ongoing in the USA and Switzerland.

Research on the use of spinal-cord stimulators for the purpose of regaining mobility is underway in Minneapolis and is being conducted in collaboration with researchers from iCord and the University of Calgary. Dr. David Darrow is the chief resident of neurosurgery and a researcher at the University of Minnesota. He estimates that thousands of people have had spinal cord stimulator implants for relieving chronic pain, but only about 30 people in the US have had implants to restore mobility.  His team has the approval to conduct these surgeries on a research basis.

Not a Panacea

Although spinal cord stimulators hold promise to improve the lives of those with spinal cord injuries, they are not expected to be a panacea that will get people up and walking independently. And having an implant is not without risks. Some people with these implants have experienced unwanted electrical shocks and even burns. There is also the potential for infection, any time a surgical procedure is done.  Nonetheless, improvements in mobility that can assist in making transfers to and from a wheelchair, and improvements in blood pressure control and bowel and bladder function, have the potential to greatly improve the quality of life of those suffering from spinal cord injuries.

If you or a loved one has experienced life-altering injuries from a spinal cord injury that may have been caused by or worsened by, medical negligence, please contact us.  We would be happy to discuss your concerns and outline your options.

Filed Under: Adult Injuries, Health News

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