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Hulsenboom ADJ, Van der Hout-van der Jagt MB, van den Akker ESA, Bakker PCAM, van Beek E, Drogtrop AP, Kwee A, Westerhuis MEMH, Rijnders RJP, Schuitemaker NWE, Willekes C, Vullings R, Oei SG, van Laar JOEH. New possibilities for ST analysis - A post-hoc analysis on the Dutch STAN RCT. Early Hum Dev 2022; 166:105537. [PMID: 35091162 DOI: 10.1016/j.earlhumdev.2021.105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnostic value of ST analysis of the fetal electrocardiogram (fECG) during labor is uncertain. False alarms (ST events) may be explained by physiological variation of the fetal electrical heart axis. Adjusted ST events, based on a relative rather than an absolute rise from baseline, correct for this variation and may improve the diagnostic accuracy of ST analysis. AIMS Determine the optimal cut-off for relative ST events in fECG to detect fetal metabolic acidosis. STUDY DESIGN Post-hoc analysis on fECG tracings from the Dutch STAN trial (STAN+CTG branch). SUBJECTS 1328 term singleton fetuses with scalp ECG tracing during labor, including 10 cases of metabolic acidosis. OUTCOME MEASURES Cut-off value for relative ST events at the point closest to (0,1) in the receiver operating characteristic (ROC) curve with corresponding sensitivity and specificity. RESULTS Relative baseline ST events had an optimal cut-off at an increment of 85% from baseline. Relative ST events had a sensitivity of 90% and specificity of 80%. CONCLUSIONS Adjusting the current definition of ST events may improve ST analysis, making it independent of CTG interpretation.
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Affiliation(s)
- A D J Hulsenboom
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands.
| | - M B Van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - E S A van den Akker
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - P C A M Bakker
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - E van Beek
- Department of Obstetrics and Gynecology, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands
| | - A P Drogtrop
- Department of Obstetrics and Gynecology, Elisabeth Tweesteden Hospital, P.O. Box 90151, LC 5000 Tilburg, the Netherlands
| | - A Kwee
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - M E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, ZA 5602 Eindhoven, the Netherlands
| | - R J P Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME Hertogenbosch, the Netherlands
| | - N W E Schuitemaker
- Department of Obstetrics and Gynecology, Diakonessenhuis, P.O. Box 80250, 3508 TG Utrecht, the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Vullings
- Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
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Fontanella F, Maggio L, Verheij JBGM, Duin LK, Adama Van Scheltema PN, Cohen‐Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Gracchi V, Oepkes D, Bilardo CM. Fetal megacystis: a lot more than LUTO. Ultrasound Obstet Gynecol 2019; 53:779-787. [PMID: 30043466 PMCID: PMC6593717 DOI: 10.1002/uog.19182] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/29/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Fetal megacystis presents a challenge in terms of counseling and management because of its varied etiology and evolution. The aim of this study was to present a comprehensive overview of the underlying etiologies and structural anomalies associated with fetal megacystis. METHODS This was a retrospective multicenter study of cases referred to the fetal medicine unit of one of the eight academic hospitals in The Netherlands with a diagnosis of fetal megacystis. For each case, data on and measurements of fetal urinary tract and associated structural anomalies were collected. All available postmortem examinations and postnatal investigations were reviewed in order to establish the final diagnosis. In the first trimester, fetal megacystis was defined as longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during an extended ultrasound examination lasting at least 40 min. RESULTS Of the 541 pregnancies with fetal megacystis, it was isolated (or solely accompanied by other signs of lower urinary tract obstruction (LUTO)) in 360 (67%) cases and associated with other abnormal ultrasound findings in 181 (33%) cases. The most common associated ultrasound anomaly was an increased nuchal translucency thickness (22%), followed by single umbilical artery (10%) and cardiac defect (10%). A final diagnosis was established in 418 cases, including 222 (53%) cases with isolated LUTO and 60 (14%) infants with normal micturition or minor isolated urological anomalies. In the remaining 136 (33%) cases, concomitant developmental or chromosomal abnormality or genetic syndrome was diagnosed. Overall, 40 chromosomal abnormalities were diagnosed, including trisomy 18 (n = 24), trisomy 21 (n = 5), Turner syndrome (n = 5), trisomy 13 (n = 3) and 22q11 deletion (n = 3). Thirty-two cases presented with anorectal malformations involving the anus, rectum and urogenital tract. In cases with confirmed urethral and anal atresia, megacystis occurred early in pregnancy and the bladder appeared severely distended (the LBD (in mm) was equal to or greater than twice the gestational age (in weeks)). Fetal macrosomia was detected in six cases and an overgrowth syndrome was detected in four cases, comprising two infants with Beckwith-Wiedemann syndrome and two with Sotos syndrome. Megacystis-microcolon-intestinal hypoperistalsis syndrome was diagnosed in five (1%) cases and prenatally suspected only in one case. CONCLUSIONS Although the main cause of fetal megacystis is LUTO, an enlarged fetal bladder can also be present as a concomitant finding of miscellaneous genetic syndromes, developmental disturbances and chromosomal abnormalities. We provide an overview of the structural anomalies and congenital disorders associated with fetal megacystis and propose a practical guide for the differential diagnosis of genetic syndromes and chromosomal and developmental abnormalities in pregnancies presenting with fetal megacystis, focusing on the morphological examination of the fetus. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. Fontanella
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - L. Maggio
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - J. B. G. M. Verheij
- Department of GeneticsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - L. K. Duin
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - P. N. Adama Van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAcademic Medical Center AmsterdamAmsterdamThe Netherlands
| | - M. Bekker
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisRadboud University Medical CenterNijmegenThe Netherlands
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. Willekes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisMaastricht University Medical Center, Grow School for Oncology and Medical BiologyMaastrichtThe Netherlands
| | - C. J. Bax
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisVU University Medical CenterAmsterdamThe Netherlands
| | - V. Gracchi
- Department of PediatricsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - D. Oepkes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Fontanella F, van Scheltema PNA, Duin L, Cohen-Overbeek TE, Pajkrt E, Bekker MN, Willekes C, Oepkes D, Bilardo CM. Antenatal staging of congenital lower urinary tract obstruction. Ultrasound Obstet Gynecol 2019; 53:520-524. [PMID: 29978555 DOI: 10.1002/uog.19172] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To propose a staging system for congenital lower urinary tract obstruction (LUTO) capable of predicting the severity of the condition and its prognosis. METHODS This was a national retrospective study carried out at the eight Academic Hospitals in The Netherlands. We collected prenatal and postnatal data of fetuses at high risk of isolated LUTO that were managed conservatively. Postnatal renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the Schwartz formula, considering the length of the infant and the creatinine nadir in the first year after birth. Receiver-operating characteristics (ROC) curve analysis, univariate analysis and multivariate logistic regression analysis with stepwise backward elimination were performed in order to identify the best antenatal predictors of perinatal mortality and postnatal renal function. RESULTS In total, 261 fetuses suspected of having LUTO and managed conservatively were included in the study. The pregnancy was terminated in 110 cases and perinatal death occurred in 35 cases. Gestational age at appearance of oligohydramnios showed excellent accuracy in predicting the risk of perinatal mortality with an area under the ROC curve of 0.95 (P < 0.001) and an optimal cut-off at 26 weeks' gestation. Fetuses with normal amniotic fluid (AF) volume at 26 weeks' gestation presented with low risk of poor outcome and were therefore defined as cases with mild LUTO. In fetuses referred before the 26th week of gestation, the urinary bladder volume (BV) was the best unique predictor of perinatal mortality. ROC curve analysis identified a BV of 5.4 cm3 and appearance of oligohydramnios at 20 weeks as the best threshold for predicting an adverse outcome. LUTO cases with a BV ≥ 5.4 cm3 or abnormal AF volume before 20 weeks' gestation were defined as severe and those with BV < 5.4 cm3 and normal AF volume at the 20 weeks' scan were defined as moderate. Risk of perinatal mortality significantly increased according to the stage of severity, from mild to moderate to severe stage, from 9% to 26% to 55%, respectively. Similarly, risk of severely impaired renal function increased from 11% to 31% to 44%, for mild, moderate and severe LUTO, respectively. CONCLUSIONS Gestational age at appearance of oligo- or anhydramnios and BV at diagnosis can accurately predict mortality and morbidity in fetuses with LUTO. Our proposed staging system can triage reliably fetuses with LUTO and predict the severity of the condition and its prognosis. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Fontanella
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - L Duin
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - M N Bekker
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Willekes
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, VU University Medical Center, Amsterdam, The Netherlands
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Fontanella F, Duin LK, Adama van Scheltema PN, Cohen‐Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Gracchi V, Oepkes D, Bilardo CM. Prenatal diagnosis of LUTO: improving diagnostic accuracy. Ultrasound Obstet Gynecol 2018; 52:739-743. [PMID: 29266464 PMCID: PMC6587765 DOI: 10.1002/uog.18990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis. METHODS This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy. RESULTS Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm3 (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo- or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P < 0.001), compared with the poor performance of the ultrasound triad (AUC = 0.63, P = 0.07). CONCLUSIONS We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared with that of the classic ultrasound triad. Future studies to validate these results should be carried out in order to refine antenatal management of LUTO and prevent inappropriate fetal interventions. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - L. K. Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - P. N. Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MC University Medical CenterRotterdamThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAcademic Medical Center AmsterdamAmsterdamThe Netherlands
| | - M. Bekker
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisRadboud University Medical CenterNijmegenThe Netherlands
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical CenterGrow School for Oncology and Medical BiologyMaastrichtThe Netherlands
| | - C. J. Bax
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisVU University Medical CenterAmsterdamThe Netherlands
| | - V. Gracchi
- Department of PediatricsUniversity Medical Center Groningen, University of GroningenThe Netherlands
| | - D. Oepkes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
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Fontanella F, Duin L, Adama van Scheltema PN, Cohen-Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Bilardo CM. Fetal megacystis: prediction of spontaneous resolution and outcome. Ultrasound Obstet Gynecol 2017; 50:458-463. [PMID: 28133847 DOI: 10.1002/uog.17422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/19/2016] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and postnatal outcome after resolution. METHODS This was a national retrospective cohort study. Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during the entire extended ultrasound examination. LBD and gestational age (GA) at resolution were investigated with respect to likelihood of resolution and postnatal outcome, respectively. Sensitivity, specificity and area under the receiver-operating characteristics curve (AUC) were calculated. RESULTS In total, 284 cases of fetal megacystis (93 early megacystis, identified before the 18th week, and 191 late megacystis, identified at or after the 18th week) were available for analysis. Spontaneous resolution occurred before birth in 58 (20%) cases. In cases with early megacystis, LBD was predictive of the likelihood of spontaneous resolution (sensitivity, 80%; specificity, 79%; AUC, 0.84), and, in the whole population, GA at regression was predictive of postnatal outcome, with an optimal cut-off at 23 weeks (sensitivity, 100%; specificity, 82%; AUC, 0.91). In the group with early megacystis, the outcome was invariably good when resolution occurred before the 23rd week of gestation, whereas urological sequelae requiring postnatal surgery were diagnosed in 3/8 (38%) cases with resolution after 23 weeks. In the group with late megacystis, spontaneous resolution was associated with urological complications after birth, ranging from mild postnatal hydronephrosis in infants with resolution before 23 weeks, to more severe urological anomalies requiring postnatal surgery in those with resolution later in pregnancy. This supports the hypothesis that an early resolution of megacystis is often related to a paraphysiological bladder enlargement that resolves early in pregnancy without consequences, while antenatal resolution occurring later in pregnancy (after the 23rd week of gestation) should suggest a pathological condition with urological sequelae. CONCLUSIONS In fetal megacystis, LBD and GA at regression can be used as predictors of resolution and outcome, respectively. These parameters could help in fine-tuning the prognosis and optimizing the frequency of follow-up scans. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - L Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P N Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Centre, Leiden, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Bekker
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - C Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - C J Bax
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, VU University Medical Centre, Amsterdam, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Brouwer MA, Maeckelberghe ELM, van der Hoeven MAFBM, Schutte J, Wee HL, Willekes C, Verhagen AAE. [Trisomy 18: how lethal is 'lethal'?]. Ned Tijdschr Geneeskd 2017; 161:D1716. [PMID: 29171368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Should active treatment be available for children with trisomy 18? In the Netherlands, trisomy 18 is described as a lethal condition leading to death during or immediately after birth. The Dutch course of action for trisomy 18 is termination of pregnancy, almost without exception, or passive treatment without medical interventions. But that approach might be outdated. We present a case that inspired physicians and parents to rethink the perception of trisomy 18.
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Tajik P, van der Ham D, Zafarmand M, Hof M, Morris J, Franssen M, de Groot C, Duvekot J, Oudijk M, Willekes C, Bloemenkamp K, Porath M, Woiski M, Akerboom B, Sikkema J, Nij Bijvank B, Mulder A, Bossuyt P, Mol B. Using Vaginal Group B Streptococcus Colonization in Women With Preterm Premature Rupture of Membranes to Guide the Decision for Immediate Delivery. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/01.aoa.0000472737.09801.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duin LK, Nijhuis JG, Scherjon SA, Vossen M, Willekes C. Comparison of conventional versus three-dimensional ultrasound in fetal renal pelvis measurement and their potential prediction of neonatal uropathies. J Matern Fetal Neonatal Med 2015; 29:2494-9. [PMID: 26430907 DOI: 10.3109/14767058.2015.1090970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness. METHODS In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. RESULTS A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR- 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR- 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR- 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR- 2.10). CONCLUSION This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.
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Affiliation(s)
- L K Duin
- a Department of Obstetrics and Gynecology , University Medical Center , Groningen , the Netherlands and
| | - J G Nijhuis
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
| | - S A Scherjon
- a Department of Obstetrics and Gynecology , University Medical Center , Groningen , the Netherlands and
| | - M Vossen
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
| | - C Willekes
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
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Tajik P, van der Ham DP, Zafarmand MH, Hof MHP, Morris J, Franssen MTM, de Groot CJM, Duvekot JJ, Oudijk MA, Willekes C, Bloemenkamp KWM, Porath M, Woiski M, Akerboom BM, Sikkema JM, Bijvank BN, Mulder ALM, Bossuyt PM, Mol BWJ. Using vaginal Group B Streptococcuscolonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG 2014; 121:1263-72; discussion 1273. [DOI: 10.1111/1471-0528.12889] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Tajik
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - DP van der Ham
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Obstetrics & Gynaecology; Martini Hospital; Groningen the Netherlands
| | - MH Zafarmand
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - MHP Hof
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - J Morris
- Clinical & Population Perinatal Health Research; Kolling Institute of Medical Research; University of Sydney; Sydney NSW Australia
| | - MTM Franssen
- Department of Obstetrics & Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - CJM de Groot
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics & Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - MA Oudijk
- Department of Obstetrics & Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics & Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - M Porath
- Department of Obstetrics & Gynaecology; Máxima Medical Centre; Veldhoven the Netherlands
| | - M Woiski
- Department of Obstetrics & Gynaecology; Radboud University Nijmegen; Nijmegen the Netherlands
| | - BM Akerboom
- Department of Obstetrics & Gynaecology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - JM Sikkema
- Department of Obstetrics & Gynaecology; ZGT; Almelo the Netherlands
| | - B Nij Bijvank
- Department of Obstetrics & Gynaecology; Isala Clinics; Zwolle the Netherlands
| | - ALM Mulder
- Department of Paediatrics; Maastricht University Medical Centre; Maastricht the Netherlands
| | - PM Bossuyt
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - BWJ Mol
- The Robinson Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
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Witters I, Coumans A, Willekes C, Fryns JP. Twin reversed arterial perfusion sequence presenting as intrauterine cyst. Ultrasound Obstet Gynecol 2013; 42:724-725. [PMID: 24151135 DOI: 10.1002/uog.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Affiliation(s)
- I Witters
- Department of Obstetrics and Gynecology, St-Jans Hospital, Genk, Belgium; Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands; Center for Human Genetics, University of Leuven, Leuven, Belgium
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11
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Duin LK, Willekes C, Vossen M, Offermans J, Nijhuis JG. Reproducibility of fetal renal pelvis volume assessed by three-dimensional ultrasonography with two different measurement techniques. J Clin Ultrasound 2013; 41:230-234. [PMID: 23325421 DOI: 10.1002/jcu.22039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate reproducibility of fetal renal pelvis volume as assessed by the Virtual Organ Computer Aided AnaLysis (VOCAL) imaging program and by Automatic Volume Calculation (SonoAVC). In addition, the intra- and interobserver reliability of fetal renal pelvis volume measurements with SonoAVC were established. METHODS In this study, the fetal renal pelvis volume was measured using 3D ultrasonography in 76 kidneys of 66 fetuses with renal pelvis dilatation in the second or third trimester of pregnancy. After volume acquisition by one observer, the reproducibility of volume calculation was assessed using VOCAL imaging program and SonoAVC by two observers. Intra- and interobserver reproducibility was evaluated by calculating intraclass correlation coefficients (ICC), coefficient of variation (CV) and repeatability coefficient (r). Bland-Altman plots were generated to explore agreement. RESULTS A high degree of reproducibility was observed between VOCAL and SonoAVC, ICC of 0.989; 95% CI 0.983-0.993, respectively. Intraobserver reproducibility of volume measurements performed by SonoAVC demonstrated a high degree of reliability with ICC of 0.995 (95% CI 0.993-0.997), CV 6.05% and r of 0.75. The interobserver reproducibility with ICC of 0.995 (95% CI 0.992-0.997), CV 10.14% and r 1.21 was also indicative of good reliability. CONCLUSION Volume measurements of fetal renal pelvis performed by SonoAVC renders reproducible measurements in comparison with the VOCAL imaging program. There is no significant difference between VOCAL imaging program and SonoAVC. The intra- and interobserver reliability of the fetal renal pelvis measurements made by SonoAVC were considered to be very good. SonoAVC, however, needs post processing in the majority of cases but is less time consuming than VOCAL.
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Affiliation(s)
- L K Duin
- Department of Obstetrics and Gynecology of the Maastricht University Medical Centre, 5500 MB Veldhoven, The Netherlands.
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12
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Becker JH, van Rijswijk J, Versteijnen B, Evers ACC, van den Akker ESA, van Beek E, Bolte AC, Rijnders RJP, Mol BWJ, Moons KGM, Porath MM, Drogtrop AP, Schuitemaker NWE, Willekes C, Westerhuis MEMH, Visser GHA, Kwee A. Is intrapartum fever associated with ST-waveform changes of the fetal electrocardiogram? A retrospective cohort study. BJOG 2012; 119:1410-6. [PMID: 22827811 DOI: 10.1111/j.1471-0528.2012.03442.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the association between maternal intrapartum fever and ST-waveform changes of the fetal electrocardiogram. DESIGN Retrospective cohort study. SETTING Three academic and six non-academic teaching hospitals in the Netherlands. POPULATION Labouring women with a high-risk singleton pregnancy in cephalic position beyond 36 weeks of gestation. METHODS We studied 142 women with fever (≥38.0°C) during labour and 141 women with normal temperature who had been included in two previous studies. In both groups, we counted the number and type of ST-events and classified them as significant (intervention needed) or not significant, based on STAN(®) clinical guidelines. MAIN OUTCOME MEASURES Number and type of ST-events. RESULTS Both univariable and multivariable regression analysis showed no association between the presence of maternal intrapartum fever and the number or type of ST-events. CONCLUSIONS Maternal intrapartum fever is not associated with ST-segment changes of the fetal electrocardiogram. Interpretation of ST-changes in labouring women with fever should therefore not differ from other situations.
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Affiliation(s)
- J H Becker
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, the Netherlands.
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van Teeffelen ASP, Van Der Heijden J, Oei SG, Porath MM, Willekes C, Opmeer B, Mol BWJ. Accuracy of imaging parameters in the prediction of lethal pulmonary hypoplasia secondary to mid-trimester prelabor rupture of fetal membranes: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012; 39:495-499. [PMID: 21793083 DOI: 10.1002/uog.10047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In women who have suffered mid-trimester prelabor rupture of membranes (PPROM), prediction of pulmonary hypoplasia is important for optimal management. We performed a systematic review to assess the capacity of imaging parameters to predict pulmonary hypoplasia. We searched for published articles that reported on biometric parameters and allowed the construction of a 2 × 2 table, comparing at least one of these parameters with the occurrence of pulmonary hypoplasia. The selected studies were scored on methodological quality and we calculated sensitivity and specificity of the tests in the prediction of pulmonary hypoplasia and lethal pulmonary hypoplasia. Overall performance was assessed by summary receiver-operating characteristics (sROC) analyses that were performed with bivariate meta-analysis. We detected 13 studies that reported on the prediction of lethal pulmonary hypoplasia. The quality of the included studies was poor to mediocre. The estimated sROC curves for the chest circumference/abdominal circumference ratio and other parameters showed limited accuracy in the prediction of pulmonary hypoplasia. In women with mid-trimester PPROM, the available evidence indicates limited accuracy of biometric parameters in the prediction of pulmonary hypoplasia.
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Affiliation(s)
- A S P van Teeffelen
- Department of Obstetrics and Gynaecology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands.
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14
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Buyens A, Gyselaers W, Coumans A, Al Nasiry S, Willekes C, Boshoff D, Frijns JP, Witters I. Difficult prenatal diagnosis: fetal coarctation. Facts Views Vis Obgyn 2012; 4:230-6. [PMID: 24753914 PMCID: PMC3987479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The prenatal diagnosis of fetal coarctation is still challenging. It is mainly suspected by ventricular disproportion (smaller left ventricle than right ventricle). The sensitivity of ventricular discrepancy is however moderate for the diagnosis of coarctation and there is a high false positive rate. Prenatal diagnosis of coarctation is important because the delivery can be arranged in a centre with a pediatric cardiac intensive careand this reduces postnatal complications and longterm morbidity. For many years the prenatal diagnosis of coarctation has been investigated to improve specificity and sensitivity by several of measurements. This article reviews all relevant articles from 2000 until 2011 searching pubmed and the reference list of interesting articles. An overview of specific measurements and techniques that can improve the diagnosis of coarctation has been made, such as the isthmus diameter, ductal diameter, isthmus/ductal ratio, z-scores derived from measurements of the distal aortic isthmus and arterial duct, the presence of a shelf andisthmal flow disturbance. Also 3-dimensional (3D) and 4-dimensional (4D) imaging with or without STIC has been -suggested to be used as newer techniques to improve diagnosis of coarctation in fetal life. Although more methods regarding prenatal diagnosis of coarctationare being investigated, the ultrasound specialist remains challenged to correctly diagnose this cardiac anomaly in prenatal life.
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Affiliation(s)
- A. Buyens
- Department of Obstetrics and Gynaecology, ZOL Hospitals Campus St Jan, Genk, Belgium
| | - W. Gyselaers
- Department of Obstetrics and Gynaecology, ZOL Hospitals Campus St Jan, Genk, Belgium
| | - A. Coumans
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - S. Al Nasiry
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - C. Willekes
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - D. Boshoff
- Department of Cardiology St-Jans Hospital Genk, Belgium
| | - J.-P. Frijns
- Center for Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - I. Witters
- Department of Obstetrics and Gynaecology, ZOL Hospitals Campus St Jan, Genk, Belgium
,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
,Department of Cardiology St-Jans Hospital Genk, Belgium
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15
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Duin LK, Willekes C, Koster-Kamphuis L, Offermans J, Nijhuis JG. Fetal hydronephrosis: does adding an extra parameter improve detection of neonatal uropathies? J Matern Fetal Neonatal Med 2011; 25:920-3. [DOI: 10.3109/14767058.2011.600365] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Becker JH, Westerhuis MEMH, Sterrenburg K, van den Akker ESA, van Beek E, Bolte AC, van Dessel TJHM, Drogtrop AP, van Geijn HP, Graziosi GCM, van Lith JMM, Mol BWJ, Moons KGM, Nijhuis JG, Oei SG, Oosterbaan HP, Porath MM, Rijnders RJP, Schuitemaker NWE, Wijnberger LDE, Willekes C, Visser GHA, Kwee A. Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN® trial. BJOG 2011; 118:1239-46. [DOI: 10.1111/j.1471-0528.2011.03027.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hack KEA, Derks JB, Elias SG, van Mameren FA, Koopman-Esseboom C, Mol BWJ, Lopriore E, Schaap AHP, Arabin B, Duvekot JJ, Go ATJI, Wieselmann E, Eggink AJ, Willekes C, Vandenbussche FPHA, Visser GHA. Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥ 32 weeks of gestation: a multicentre retrospective cohort study. BJOG 2011; 118:1090-7. [PMID: 21585638 DOI: 10.1111/j.1471-0528.2011.02955.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery. DESIGN Multicentre retrospective cohort study. SETTING Ten perinatal referral centres in the Netherlands. POPULATION All MC twin pregnancies without TTTS delivered at ≥ 32 weeks of gestation between January 2000 and December 2005. METHODS The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed. MAIN OUTCOME MEASURES Perinatal mortality in relation to gestational age and mode of delivery at ≥ 32 weeks of gestation. RESULTS After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants). In women who delivered ≥ 37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome. CONCLUSIONS In MC twin pregnancies the incidence of intrauterine fetal death is low ≥ 32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.
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Affiliation(s)
- K E A Hack
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Witters G, Van Robays J, Willekes C, Coumans A, Peeters H, Gyselaers W, Fryns J. Trisomy 13, 18, 21, Triploidy and Turner syndrome: the 5T's. Look at the hands. Facts Views Vis Obgyn 2011; 3:15-21. [PMID: 24753843 PMCID: PMC3991414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
First trimester spontaneous abortions occur in 15 to 20% of all clinically recognized pregnancies. Chromosomal -anomalies are responsible for more than 50% of spontaneous abortions. The majority (90%) of these chromosomal anomalies are numerical, particularly autosomal trisomies (involving chromosomes 13,16, 18, 21, 22), polyploidy and monosomy X. At birth chromosomal anomalies are still an important cause of congenital malformations occurring in 0,55% of newborns (autosomal: 0,40%, sex chromosomal: 0,15%). Autosomal trisomies result from maternal -meiotic nondisjunction of gametogenesis and the risk increases with maternal age. Polyploidy (triploidy (3n = 69) or tetraploidy (4n = 92)), results from a contribution of one or more extra haploid chromosome sets at fertilization. Unlike the risk for autosomal trisomies, the risk for polyploidies and for monosomy X (Turner syndrome) does not increase with maternal age. In the prenatal period the ultrasonographic diagnosis of some autosomal trisomies such as trisomy 13 and 18 is feasible based on the frequently seen major malformations while the diagnosis of trisomy 21 often remains challenging due to the absence of major malformations in > 50% of cases. For Turner syndrome (monosomy X), the lethal form will present with cystic hygroma colli and hydrops but the non lethal form is difficult to recognize by -ultrasound in the second trimester. The 5 frequently encountered chromosomal anomalies (Trisomy 13, 18, 21, Turner syndrome and Triploidy) referred here as the 5T's have specific hand features which will be discussed.
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Affiliation(s)
- G. Witters
- Center for Human Genetics, Catholic University of Leuven, 3000 Leuven, Belgium
,Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, 6200 MD Maastricht, The Netherlands
,Department of Obstetrics and Gynaecology, ZOL East Limburg Hospital, 3600 Genk, Belgium
| | - J. Van Robays
- Department of Pathology, ZOL East Limburg Hospital, 3600 Genk, Belgium
| | - C. Willekes
- Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, 6200 MD Maastricht, The Netherlands
| | - A. Coumans
- Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, 6200 MD Maastricht, The Netherlands
| | - H. Peeters
- Center for Human Genetics, Catholic University of Leuven, 3000 Leuven, Belgium
| | - W. Gyselaers
- Department of Obstetrics and Gynaecology, ZOL East Limburg Hospital, 3600 Genk, Belgium
,Department of Physiology, Hasselt University, 3590 Diepenbeek, Belgium
| | - J.P. Fryns
- Center for Human Genetics, Catholic University of Leuven, 3000 Leuven, Belgium
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Boers KE, Vijgen SMC, Bijlenga D, van der Post JAM, Bekedam DJ, Kwee A, van der Salm PCM, van Pampus MG, Spaanderman MEA, de Boer K, Duvekot JJ, Bremer HA, Hasaart THM, Delemarre FMC, Bloemenkamp KWM, van Meir CA, Willekes C, Wijnen EJ, Rijken M, le Cessie S, Roumen FJME, Thornton JG, van Lith JMM, Mol BWJ, Scherjon SA. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341:c7087. [PMID: 21177352 PMCID: PMC3005565 DOI: 10.1136/bmj.c7087] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. DESIGN Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). SETTING Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008. PARTICIPANTS Pregnant women who had a singleton pregnancy beyond 36+0 weeks' gestation with suspected intrauterine growth restriction. INTERVENTIONS Induction of labour or expectant monitoring. MAIN OUTCOME MEASURES The primary outcome was a composite measure of adverse neonatal outcome, defined as death before hospital discharge, five minute Apgar score of less than 7, umbilical artery pH of less than 7.05, or admission to the intensive care unit. Operative delivery (vaginal instrumental delivery or caesarean section) was a secondary outcome. Analysis was by intention to treat, with confidence intervals calculated for the differences in percentages or means. RESULTS 321 pregnant women were randomly allocated to induction and 329 to expectant monitoring. Induction group infants were delivered 10 days earlier (mean difference -9.9 days, 95% CI -11.3 to -8.6) and weighed 130 g less (mean difference -130 g, 95% CI -188 g to -71 g) than babies in the expectant monitoring group. A total of 17 (5.3%) infants in the induction group experienced the composite adverse neonatal outcome, compared with 20 (6.1%) in the expectant monitoring group (difference -0.8%, 95% CI -4.3% to 3.2%). Caesarean sections were performed on 45 (14.0%) mothers in the induction group and 45 (13.7%) in the expectant monitoring group (difference 0.3%, 95% CI -5.0% to 5.6%). CONCLUSIONS In women with suspected intrauterine growth restriction at term, we found no important differences in adverse outcomes between induction of labour and expectant monitoring. Patients who are keen on non-intervention can safely choose expectant management with intensive maternal and fetal monitoring; however, it is rational to choose induction to prevent possible neonatal morbidity and stillbirth. TRIAL REGISTRATION International Standard Randomised Controlled Trial number ISRCTN10363217.
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Affiliation(s)
- K E Boers
- Leiden University Medical Centre, Leiden, Netherlands.
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Vijgen SMC, Koopmans CM, Opmeer BC, Groen H, Bijlenga D, Aarnoudse JG, Bekedam DJ, van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KWM, Drogtrop AP, Franx A, de Groot CJM, Huisjes AJM, Kwee A, van Loon AJ, Lub A, Papatsonis DNM, van der Post JAM, Roumen FJME, Scheepers HCJ, Stigter RH, Willekes C, Mol BWJ, Van Pampus MG. An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial). BJOG 2010; 117:1577-85. [DOI: 10.1111/j.1471-0528.2010.02710.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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van der Heijden M, Smits H, Willekes C, Marcus-Soekarman D, Wilmink J, Marcus M. Spinal anesthesia for a parturient with the triad of Currarino. Int J Obstet Anesth 2009; 18:173-5. [DOI: 10.1016/j.ijoa.2008.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 07/28/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
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Duin LK, Willekes C, Vossen M, Beckers M, Offermans J, Nijhuis JG. Reproducibility of fetal renal pelvis volume measurement using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2008; 31:657-661. [PMID: 18470970 DOI: 10.1002/uog.5208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the reproducibility of fetal renal pelvis volume measurement in hydronephrotic kidneys using transabdominal three-dimensional (3D) ultrasound. METHODS The fetal renal pelvis volume was measured using 3D ultrasound in one kidney in each of 15 fetuses with hydronephrosis in the second or third trimester of pregnancy. Hydronephrosis was diagnosed when the fetus had an anteroposterior renal pelvis diameter > or = 5 mm. After volume acquisition by one of the observers, the repeatability of volume calculation with manual delineation of the fetal renal pelvis was assessed by six different observers using the Virtual Organ Computer-aided AnaLysis (VOCAL(trade mark)) imaging program. The intraclass correlation coefficients (ICC), coefficient of variation (CV) and within- and between-observer repeatability coefficient (r) were calculated and Bland-Altman plots were constructed. RESULTS Both intra- and interobserver reliability of the fetal renal pelvis volume measurements were considered to be very good. For intraobserver reliability, the ICC was 0.996 and the CV was 10.8%. For the overall interobserver reliability, the ICC was 0.998 and the CV was 15.7%; the interobserver reliability between pairs of observers had ICCs between 0.994 and 0.999, and CVs between 19.5% and 7.6% for inexperienced and experienced observers, respectively. CONCLUSION With 3D ultrasound using the VOCAL imaging program, it is technically feasible to reproduce fetal renal pelvis volume measurements. Further research to establish the clinical applications of this technology is warranted.
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Affiliation(s)
- L K Duin
- Department of Obstetrics and Gynecology, University Hospital, Maastricht, The Netherlands.
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van der Ham DP, van de Laar R, Mol BWJ, Willekes C. Use of C-reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of the membranes: a systematic review. BJOG 2007; 115:127; author reply 128. [PMID: 18053107 DOI: 10.1111/j.1471-0528.2007.01585.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bloemenkamp KWM, Duvekot JJ, Kwee A, Mol BW, van Pampus MG, van der Post JA, Scheepers HC, Willekes C, Wouters MGAJ. [Physicians and scientific research: slight decline of the numbers of physicians with a doctoral degree]. Ned Tijdschr Geneeskd 2006; 150:2116-7. [PMID: 17039607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Duin LK, Willekes C, Baldewijns MML, Robben SGF, Offermans J, Vles J. Major brain lesions by intrauterine herpes simplex virus infection: MRI contribution. Prenat Diagn 2006; 27:81-4. [PMID: 17154224 DOI: 10.1002/pd.1631] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The majority of neonatal Herpes Simplex Virus (HSV) infections are acquired at birth as a consequence of direct fetal contact with the infected birth canal or through an ascending infection after premature rupture of the amniotic membranes. Intrauterine transmission of HSV infection from mother to the fetus is rare; in only 5% of the cases it occurs from haematogenous transplacental dissemination. We present a case of transplacental intrauterine HSV infection after a primary maternal HSV infection in the first trimester of pregnancy. The diagnosis was assessed by viral culture and serologic tests. Ultrasound imaging revealed fetal brain damage in the third trimester. Finally, the MRI showed the devastating extensiveness of the HSV infection, which was beyond the expectation based on the ultrasound images.
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Affiliation(s)
- L K Duin
- Department of Obstetrics and Gynecology of the University Hospital Maastricht, The Netherlands.
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Spaanderman ME, Willekes C, Hoeks AP, Ekhart TH, Peeters LL. The effect of pregnancy on the compliance of large arteries and veins in healthy parous control subjects and women with a history of preeclampsia. Am J Obstet Gynecol 2000; 183:1278-86. [PMID: 11084578 DOI: 10.1067/mob.2000.106750] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early pregnancy is characterized by a fall in total peripheral vascular resistance. In this study we tested the hypothesis that this phenomenon is accompanied by rising compliances of the large arteries and veins. STUDY DESIGN In 42 women with a history of preeclampsia and 10 healthy parous control subjects we measured the following variables in the midfollicular phase and the midluteal phase during the menstrual cycle and again at 5 and at 7 weeks of amenorrhea: cardiac output, mean arterial pressure, carotid and femoral artery compliances, and venous compliance. The total peripheral vascular resistance was determined as the ratio of mean arterial pressure and cardiac output. After screening for thrombophilia and hypertension, women with a history of preeclampsia were divided into subgroups with hypertension, thrombophilic disorders, and no underlying abnormalities. RESULTS In parallel with the fall in total peripheral vascular resistance during early pregnancy, femoral artery compliance and venous compliance increased in the control group. Except for venous compliance, these changes were also observed in the women with thrombophilia and a history of preeclampsia. In the subgroups of the women with a history of preeclampsia with hypertension and with no underlying disorder both arterial and venous compliance failed to increase despite a drop in total peripheral vascular resistance. CONCLUSION These data support the concept that during normal pregnancy the fall in total peripheral vascular resistance is paralleled by improved macrovascular compliance. The latter adaptive change did not occur in women with a history of preeclampsia with hypertension or without an underlying disorder.
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Affiliation(s)
- M E Spaanderman
- Departments of Obstetrics and Gynecology, University Hospital Maastricht, The Netherlands
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Brands PJ, Hoeks AP, Willigers J, Willekes C, Reneman RS. An integrated system for the non-invasive assessment of vessel wall and hemodynamic properties of large arteries by means of ultrasound. Eur J Ultrasound 1999; 9:257-66. [PMID: 10657600 DOI: 10.1016/s0929-8266(99)00033-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To integrate methods for non-invasive assessment of vessel wall properties (diastolic diameter, distension waveform and intima-media thickness) and hemodynamic properties (blood flow velocity and shear rate distribution) of large arteries by means of dedicated ultrasound signal processing. METHODS we have developed an arterial laboratory (ART-lab) system. ART-lab consists of software running on a standard personal computer, equipped with a data acquisition card for the acquisition of radio frequency (RF) ultrasound signals obtained with a conventional echo scanner. It operates either (1) off-line or (2) in real-time. Real-time operation is restricted to the assessment of vessel wall properties because of limitations in computational power. RESULTS This paper provides an overview of ART-lab ultrasound radio frequency data acquisition and dedicated RF-signal processing methods. The capabilities of the system are illustrated with some typical applications. CONCLUSIONS ART-lab in real-time mode is a useful tool for monitoring arterial vessel wall dynamics, while off-line it can be employed to investigate the elastic vessel wall properties in combination with hemodynamics, such as blood flow velocity and shear rate distribution.
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Affiliation(s)
- P J Brands
- Department of Biophysics, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD, Maastricht, The Netherlands.
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Willekes C, Hoogland HJ, Keizer HA, Hoeks AP, Reneman RS. Three months use of third-generation oral contraceptives does not affect artery wall properties. Ultrasound Med Biol 1999; 25:723-728. [PMID: 10414888 DOI: 10.1016/s0301-5629(99)00020-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In several studies, artery wall properties have been shown to differ between men and women. It has been hypothesized that these differences may result from hormonal influences but, in a previous study, we were unable to detect any influence of the menstrual cycle on artery wall properties. Therefore, we investigated the differences in artery wall properties, if any, between the menstrual cycle and the use of a third-generation oral contraceptive for 3 months. We investigated the right common carotid (CCA) and femoral (CFA) arteries of normotensive young (18-25-y-old) women volunteers (n = 14). The arterial cross-sectional distensibility and compliance coefficients were determined by means of a specially designed ultrasonic wall-tracking device and automatic brachial artery cuff blood-pressure measurements. The menstrual cycles and the cycles during oral contraceptive use (30 microg ethinylestradiol and 75 microg gestodene) were monitored by ultrasonographic evaluation and the assessment of plasma levels of 17beta-oestradiol and progesterone. The distensibility and cross-sectional compliance coefficients of both the CCA and CFA did not differ significantly between the menstrual cycle and the use of oral contraceptives, despite different ovarian hormone levels. Brachial arterial blood pressure was also not affected. We conclude that 3 months use of a third-generation oral contraceptive does not influence the wall properties of peripheral arteries and cannot explain the observed difference between genders. The absence of a rise in blood pressure and the low androgenic profile of this specific oral contraceptive may have contributed to our findings.
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Affiliation(s)
- C Willekes
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University and Academic Hospital Maastricht, The Netherlands
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29
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Willekes C, Brands PJ, Willigers JM, Hoeks AP, Reneman RS. Assessment of local differences in intima-media thickness in the human common carotid artery. J Vasc Res 1999; 36:222-8. [PMID: 10393508 DOI: 10.1159/000025645] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intimal thickening may be focal in nature and is especially found in areas with low shear rate. To be able to study the relation between intima-media thickness (IMT) and wall shear rate appropriately, a method to assess IMT locally is required. It was the aim of the present study to investigate the ability of a recently developed automated method to assess local differences in IMT, if any, in relatively short arterial segments. Therefore, intrasession interlocation differences in IMT were assessed at the posterior wall of the common carotid artery close to the bulb (0 mm) and 10 and 20 mm more upstream in terms of mean difference +/- 2 standard deviations. Prior to this study we investigated the ability of the system to reproducibly assess IMT locally (intersession intralocation) in terms of repeatability coefficient (= 2 standard deviations). The measurements were performed in the common carotid artery 20 mm proximal to the bulb. The study was performed on young and older subjects presumed to be healthy. The intersession intralocation repeatability coefficient was 0.07 mm in the young group and 0.11 mm in the older group. The IMT close to the bulb (0 mm) was significantly larger (+/-0.050-0.065 mm) than that at the other locations in both age groups. We conclude that local IMT can be assessed reproducibly and local differences in wall morphology in short arterial segments can be studied reliably.
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Affiliation(s)
- C Willekes
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Willekes C, Hoeks AP, Bots ML, Brands PJ, Willigers JM, Reneman RS. Evaluation of off-line automated intima-media thickness detection of the common carotid artery based on M-line signal processing. Ultrasound Med Biol 1999; 25:57-64. [PMID: 10048802 DOI: 10.1016/s0301-5629(98)00138-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Intima-media thickness (IMT) measurements have gained increasing attention, because IMT is assumed to represent the endothelial adaptive response to physiological and pathophysiological processes. The main aim of the present study was to assess the intrasubject intrasession variability of a new off-line automated radio frequency (RF) IMT method in comparison with an already established off-line manual B-mode IMT method. IMT also was assessed by means of an on-line manual B-mode and an on-line manual RF IMT method. We investigated posterior wall IMT 0-1 cm proximal to the bulb in both common carotid arteries of 16 young (20-31 y; mean 25 y) female and male and 13 elderly (51-65 y; mean 56 y) female volunteers. Two commercially available ultrasound devices (Pie Medical Scanner 200 and Ultramark 9) were used to assess the effects of signal processing on the off-line automated RF IMT method. Intrasubject intrasession variability was determined using the standard deviation to evaluate and compare the various methods. Spearman rank correlation coefficients and Bland and Altman bias and limits of agreement were calculated to objectivate the comparability between the various methods. Intrasubject intrasession variation of IMT estimates was not statistically different between any of the methods. We observed a good comparability between the commonly used off-line manual B-mode IMT method and the off-line automated RF IMT method at the level of the common carotid artery.
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Affiliation(s)
- C Willekes
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Willekes C, Hoogland HJ, Hoeks AP, Reneman RS. Bladder filling reduces femoral artery wall distension and strain: beware of a full bladder! Ultrasound Med Biol 1998; 24:803-807. [PMID: 9740382 DOI: 10.1016/s0301-5629(98)00036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During a previous study, we noted that the distension and strain of the femoral artery were relatively low when the bladder was full, a situation normally necessary for transabdominal echography. Therefore, in the present study we investigated the influence of bladder filling, if any, on wall properties of the common femoral artery. The results obtained were compared with those obtained in the common carotid artery. The study was performed on the right common carotid and right common femoral arteries of normotensive young (18-35 y) female volunteers (n = 24). Using a specially designed ultrasonic wall-tracking device and automatic brachial artery cuff blood pressure measurements, arterial distension (absolute change in diameter during the cardiac cycle; deltaD), strain (deltaD/D), and cross-sectional distensibility (DC) and compliance (CC) were determined before and after voiding. Distension and strain of the common femoral artery were significantly lower for a full than for an empty bladder. DC and CC were lower when the bladder was filled, but these differences did not reach the level of significance. Blood pressure as measured at the level of the brachial artery and heart rate were not statistically significantly different during a full or an empty bladder. It is concluded that bladder filling affects femoral artery wall properties, an observation that should be kept in mind when performing studies on artery wall properties at this level of the circulation.
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Affiliation(s)
- C Willekes
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Academic Hospital Maastricht, The Netherlands
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Willekes C, Hoogland HJ, Keizer HA, Hoeks AP, Reneman RS. Female sex hormones do not influence arterial wall properties during the normal menstrual cycle. Clin Sci (Lond) 1997; 92:487-91. [PMID: 9176022 DOI: 10.1042/cs0920487] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
1. In previous studies, the elastic properties of the common carotid artery were found to differ between men and women. In these studies, however, the phase of the menstrual cycle was not taken into consideration. It was the aim of the present study to investigate the effect of changing ovarian hormone levels during the normal menstrual cycle on the arterial wall properties of female large arteries. 2. We investigated the elastic right common carotid artery and the muscular right common femoral artery of normotensive young (18-35 years) female subjects (n = 12). The arterial distensibility and cross-sectional compliance coefficients were determined by the use of a specially designed ultrasonic wall-tracking device and measurements of automatic brachial artery cuff blood pressure. The phase of the menstrual cycle was assessed by ultrasonographic evaluation and measurement of 17 beta-oestradiol and progesterone blood plasma levels. 3. The distensibility coefficient and the cross-sectional compliance coefficient of both the common carotid and the common femoral artery did not change significantly during the normal menstrual cycle despite evidently changing ovarian hormone levels. 4. We conclude that the menstrual cycle does not influence the arterial wall properties of either the elastic common carotid artery or the muscular common femoral artery.
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Affiliation(s)
- C Willekes
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Hoeks AP, Willekes C, Boutouyrie P, Brands PJ, Willigers JM, Reneman RS. Automated detection of local artery wall thickness based on M-line signal processing. Ultrasound Med Biol 1997; 23:1017-1023. [PMID: 9330445 DOI: 10.1016/s0301-5629(97)00119-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Young's modulus of an arterial segment, a measure of the elastic properties of the arterial wall, requires the simultaneous and local assessment of pulse pressure, wall thickness, diameter, and distensibility (relative increase in cross-sectional area per change in blood pressure). The diameter and relative increase in cross-sectional area can be obtained with a wall track system, processing the radiofrequency (r.f.) ultrasound signals received along a single line of observation (M-line processing). It will be demonstrated that it is feasible to combine, in a single measurement, the assessment of wall thickness and the (relative change in) diameter involving a minimum of user interaction. Phantom tests show a standard error of the estimate for intima-media thickness measurements of less than 20 microns; in vivo registrations exhibit a variation on the order of 45 microns. It is concluded that processing of the radiofrequency ultrasound signal, acquired along an M-line, provides an accurate and time-efficient alternative for videoprocessing of 2-dimensional B-mode ultrasound images to estimate artery wall thickness.
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Affiliation(s)
- A P Hoeks
- Department of Biophysics and Physiology, Maastricht University, The Netherlands
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van Beek E, Houben AJ, van Es PN, Willekes C, Korten EC, de Leeuw PW, Peeters LL. Peripheral haemodynamics and renal function in relation to the menstrual cycle. Clin Sci (Lond) 1996; 91:163-8. [PMID: 8795439 DOI: 10.1042/cs0910163] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
1. The objective of this study was to investigate whether the luteal phase of the menstrual cycle differs from the follicular phase by the development of a state of general vascular relaxation. 2. Once in the follicular and once in the luteal phase of the menstrual cycle, we measured by non-invasive techniques: arterial blood pressure (by finger blood pressure measurements), vascular tone (by pulse-wave velocity and plethysmography), blood flow to skin (by laser-Doppler), blood flow to forearm (by plethysmography) and blood flow to kidneys (by para-aminohippurate clearance), and the glomerular filtration rate (by inulin clearance). The data points obtained in the luteal phase were compared with those in the follicular phase by non-parametric tests. 3. Arterial blood pressure, vascular tone and the blood flows to the forearm and kidneys were comparable in the two phases of the menstrual cycle. In contrast, the blood flow to the skin was consistently lower, and the glomerular filtration rate higher in the luteal phase of the menstrual cycle. 4. The results of the present study do not support our hypothesis of a general vascular relaxation in the luteal phase of the menstrual cycle. The lower skin flow in the luteal phase may be an adaptation needed to ensure the higher core temperature of 0.3-0.5 degree C in the luteal phase. The higher glomerular filtration rate was in most case paralleled by a higher renal blood flow in the luteal phase. This suggests that the higher glomerular filtration rate is secondary to a selective vasorelaxation of the afferent renal arterioles.
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Affiliation(s)
- E van Beek
- Department of Obstetrics and Gynecology, University Hospital Maastricht, The Netherlands
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Willekes C, Roumen FJ, van Elsacker-Niele AM, Weiland HT, Vermey-Keers C, van Krieken JH, De Die-Smulders CE, Hamers GJ, Vaes-Peters GP. Human parvovirus B19 infection and unbalanced translocation in a case of hydrops fetalis. Prenat Diagn 1994; 14:181-5. [PMID: 8052566 DOI: 10.1002/pd.1970140307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a case of hydrops fetalis, serological examination showed a recent maternal human parvovirus B19 infection. Amniocentesis revealed a unique unbalanced translocation between chromosomes 3 and 11 of the fetus. The mother proved to have a balanced reciprocal translocation between chromosomes 3 and 11. A grossly macerated hydropic male fetus was delivered with a flat nose and low implanted deformed ears. Histopathological examination revealed nuclear inclusion bodies in fetal erythroid cells, confirming human parvovirus B19 infection. Parvovirus B19 DNA was demonstrated by in situ hybridization in the nuclei of heart muscle cells. Our finding of two different disorders in one case illustrates the importance of a complete evaluation of every case of hydrops fetalis, especially concerning counselling on the outcome of future pregnancies. The human parvovirus B19 infection will not recur due to the acquired immunity of the mother, whereas the balanced reciprocal translocation will endanger future pregnancies.
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Affiliation(s)
- C Willekes
- Department of Obstetrics, School of Midwifery, Kerkrade, The Netherlands
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