1
|
|
2
|
Mulder EJH, Versteegh EMJ, Bloemenkamp KWM, Lim AC, Mol BWJ, Bekedam DJ, Kwee A, Bruinse HW, Christiaens GCML. Does 17-α-hydroxyprogesterone caproate affect fetal biometry and birth weight in twin pregnancy? Ultrasound Obstet Gynecol 2013; 42:329-334. [PMID: 23592400 DOI: 10.1002/uog.12486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Increasingly, maternal administration of 17-α-hydroxyprogesterone caproate (17-OHPC) is utilized to prevent preterm birth, but the fetal safety of 17-OHPC is still a matter of concern. This study aimed to assess whether exposure to 17-OHPC during the second and third trimesters of pregnancy affects fetal biometry in twin gestations. METHODS This study included a subset of women with a twin pregnancy who had been previously included in a randomized clinical trial comparing the effectiveness of 17-OHPC and placebo on neonatal outcomes and preterm birth rates in multiple pregnancy. In the present study, the individual growth patterns of femur length, head circumference and abdominal circumference were compared between fetuses of women who had been randomized to receive weekly injections of either 17-OHPC (n = 52) or placebo (n = 58) at between 16-20 and 36 weeks' gestation. RESULTS The three biometric variables assessed developed similarly in fetuses in both the group exposed to 17-OHPC and the placebo group during the second half of pregnancy. Birth weight adjusted for parity and fetal sex was also comparable between groups. CONCLUSION The use of 17-OHPC has no adverse effects on fetal biometry and birth weight in twins.
Collapse
Affiliation(s)
- E J H Mulder
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Lundlaan 6, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Holleboom CAG, van Eyck J, Koenen SV, Kreuwel IAM, Bergwerff F, Creutzberg EC, Bruinse HW. Carbetocin in comparison with oxytocin in several dosing regimens for the prevention of uterine atony after elective caesarean section in the Netherlands. Arch Gynecol Obstet 2013; 287:1111-7. [PMID: 23329341 PMCID: PMC3655222 DOI: 10.1007/s00404-012-2693-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication. METHODS Each of the five participating Dutch hospitals treated 50-100 term patients with 100 μg of intravenous carbetocin on prescription. Each centre retrieved charts of 250 patients treated with oxytocin according to the hospital's policy for the prevention of uterine atony (oxytocin bolus 5 IU, bolus 10 IU or bolus 5 IU followed by 10 IU in 2 h). RESULTS In the carbetocin group 462 subjects were included and in the oxytocin group 1,122. The proportion of subjects needing additional uterotonic treatment was 3.1 % (95 % CI 1.7-5.1 %) after carbetocin and 7.2 % (5.8-8.9 %) after oxytocin; relative risk 0.41 (0.19-0.85); p = 0.0110. Carbetocin was most effective compared with the oxytocin 5 IU bolus subgroup with less need for additional uterotonic medication (3.1 vs. 9.3 %, p = 0.0067) and blood transfusions (2.2 vs. 3.6 %, p = 0.0357). CONCLUSIONS Compared with oxytocin, prophylaxis of uterine atony with carbetocin after an elective CS diminished the need for additional uterotonics by more than 50 %.
Collapse
Affiliation(s)
- C. A. G. Holleboom
- Departments of Gynaecology, Bronovo Hospital, The Hague, The Netherlands
| | - J. van Eyck
- Departments of Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - S. V. Koenen
- Departments of Gynaecology, University Medical Centre, Utrecht, The Netherlands
| | - I. A. M. Kreuwel
- Departments of Gynaecology, Medical Spectrum Twente, Enschede, The Netherlands
| | - F. Bergwerff
- Departments of Gynaecology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E. C. Creutzberg
- Departments of Gynaecology, Ferring B.V. Hoofddorp, P.O. Box 184, 2130 AD Hoofddorp, The Netherlands
| | - H. W. Bruinse
- Departments of Gynaecology, University Medical Centre, Utrecht, The Netherlands
| |
Collapse
|
4
|
Lim AC, Schuit E, Papatsonis D, van Eyck J, Porath MM, van Oirschot CM, Hummel P, Hasaart THM, Kleiverda G, de Graaf IM, van Ginkel AA, Mol BWJ, Bruinse HW. Effect of 17-alpha hydroxyprogesterone caproate on cervical length in twin pregnancies. Ultrasound Obstet Gynecol 2012; 40:426-430. [PMID: 23008102 DOI: 10.1002/uog.11174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Previous studies on singleton pregnancies have indicated that progestogens may reduce the rate of cervical shortening during pregnancy. The aim of this study was to investigate whether treatment with 17-alpha hydroxyprogesterone caproate (17-OHPC) has an effect on cervical shortening in twin pregnancies. METHODS This was a secondary analysis of patients who had participated in a multicenter randomized clinical trial on the effectiveness of 17-OHPC in preventing preterm birth in multiple pregnancies (the AMPHIA-trial). We included all trial participants with a twin gestation who had undergone repeat cervical length measurements during pregnancy. We performed a separate analysis of women with repeat measurements in centers where this was standard protocol for multiple pregnancies. The rate of cervical shortening for both the 17-OHPC group and the placebo group was analyzed using a linear mixed model. RESULTS Of the 671 patients who participated in the trial, 282 (42%) had a twin pregnancy and underwent two or more cervical length measurements. Of these women, 140 were monitored in centers where repeat measurements were standard protocol. We observed an overall reduction of cervical length from 44.3 mm at 14-18 weeks to 30.0 mm at 30-34 weeks' gestation. In the 17-OHPC group, cervical length decreased by 1.04 mm each gestational week, while this was 1.11 mm per week for the placebo group (P = 0.6). For the overall group, each 10% decrease in cervical length led to an increase in the risk of preterm birth (hazard ratio, 1.14; 95% CI, 1.08-1.21). CONCLUSION In women with a twin pregnancy, there is progressive shortening of the cervix during pregnancy, regardless of 17-OHPC use.
Collapse
Affiliation(s)
- A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Meijer WJ, Bruinse HW, van den Broek MPH, Kromdijk W, Wensing AMJ. Oseltamivir and Its Active Metabolite Cross the Placenta at Significant Levels. Clin Infect Dis 2012; 54:1676-7. [DOI: 10.1093/cid/cis265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Lim AC, Hegeman MA, Huis In 'T Veld MA, Opmeer BC, Bruinse HW, Mol BWJ. Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2011; 38:10-17. [PMID: 21465606 DOI: 10.1002/uog.9013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To review the literature on cervical length as a predictor of preterm birth in asymptomatic women with a multiple pregnancy. METHODS We searched MEDLINE, Embase and reference lists of included articles to identify all studies that reported on the accuracy of cervical length for predicting preterm birth in asymptomatic women with a multiple pregnancy. We scored study characteristics and study quality, and extracted data in order to construct two-by-two tables cross-classifying cervical length and preterm delivery. Meta-analysis using a bivariate model was performed. Summary receiver-operating characteristics (ROC) curves were generated for various test characteristics and outcome definitions. RESULTS We found 21 studies reporting on 2757 women. There was a large variation in gestational age at measurement, cut-off point for cervical length and definition of preterm birth. The summary ROC curve indicated a good predictive capacity of short cervical length for preterm birth. Summary estimates of sensitivity and specificity for preterm birth before 34 weeks' gestation were 78% and 66%, respectively, for 35 mm, 41% and 87% for 30 mm, 36% and 94% for 25 mm and 30% and 94% for 20 mm. CONCLUSIONS In women with a multiple pregnancy, second-trimester cervical length is a strong predictor of preterm birth. In the absence of effective preventive strategies, there is currently no place in clinical practice for cervical length measurement in this population. However, future studies should evaluate preventive interventions in women with multiple pregnancies and a short cervix, and cervical length should be measured in any trial studying preventive strategies in multiple pregnancies.
Collapse
Affiliation(s)
- A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
7
|
Claas MJ, de Vries LS, Koopman C, Uniken Venema MMA, Eijsermans MJC, Bruinse HW, Verrijn Stuart AA. Postnatal growth of preterm born children ≤ 750g at birth. Early Hum Dev 2011; 87:495-507. [PMID: 21550187 DOI: 10.1016/j.earlhumdev.2011.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development. AIMS To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5. STUDY DESIGN Retrospective cohort study. SUBJECTS One hundred one children with a BW ≤ 750g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands. OUTCOME MEASURES Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥-1), mildly delayed (-2≤Z-score <-1) or severely delayed (Z-score <-2). AGA (Ht, Wt or OFC at birth ≥-2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <-2 SDS) infants. RESULTS Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥-2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%). CONCLUSIONS Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥-2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.
Collapse
Affiliation(s)
- M J Claas
- Department of Obstetrics, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
8
|
Claas MJ, Bruinse HW, Koopman C, van Haastert IC, Peelen LM, de Vries LS. Two-year neurodevelopmental outcome of preterm born children ≤ 750 g at birth. Arch Dis Child Fetal Neonatal Ed 2011; 96:F169-77. [PMID: 20530098 DOI: 10.1136/adc.2009.174433] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe 2-year neurodevelopmental outcome (NDO) in a cohort of extremely low birthweight infants, and compare NDO between two consecutive 5-year periods and between appropriate (AGA, ≥p10) and small for gestational age (SGA, <p10) infants. DESIGN Retrospective cohort study. SETTING Wilhelmina Children's Hospital, Utrecht, the Netherlands. PATIENTS 146 children, born between 1996 and 2005, with a birth weight ≤750 g and a gestational age ≥24 weeks, admitted to the neonatal intensive care unit. 111 children (76%) survived the neonatal period. INTERVENTIONS At 2 years corrected age, 101 children (cohort I: born in 1996-2000, n=45 and cohort II: born in 2001-2005, n=56) were assessed with either the Griffiths Mental Developmental Scales or the Mental Scale of the Bayley Scales of Infant Development, second edition. MAIN OUTCOME MEASURES NDO, classified as normal (≤-1 Z score ≥0), mildly delayed (>-1 Z score ≤-2) or severely delayed (Z score >-2). RESULTS 74.3% of the children had a normal NDO at 2 years corrected age, 20.8% a mildly and 5% a severely delayed outcome. Although survival significantly increased with time (65.8% to 88.1%, p=0.002), significantly fewer children in cohort II (66.1% vs 84.4% in cohort I, p=0.042) as well as fewer SGA children (64.3% vs 86.7% of AGA children, p=0.012) had a normal NDO. CONCLUSIONS Increased survival of infants with a birth weight ≤750 g coincided with more children with an impaired NDO at 2 years corrected age. SGA infants are especially at risk of impaired NDO.
Collapse
Affiliation(s)
- M J Claas
- Department of Obstetrics and Gynaecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
| | | | | | | | | | | |
Collapse
|
9
|
Claas MJ, de Vries LS, Bruinse HW, van Haastert IC, Uniken Venema MMA, Peelen LM, Koopman C. Neurodevelopmental outcome over time of preterm born children ≤750 g at birth. Early Hum Dev 2011; 87:183-91. [PMID: 21220192 DOI: 10.1016/j.earlhumdev.2010.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 12/08/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants are at risk of cognitive impairment and follow-up is therefore of major importance. The age at which their neurodevelopmental outcome (NDO) can reliably be predicted differs in the literature. AIMS To describe NDO at 2, 3.5 and 5.5 years in an ELBW cohort. To examine the value of NDO at 2 years corrected age (CA) for prediction of NDO at 3.5 and 5.5 years. STUDY DESIGN A retrospective cross-sectional and longitudinal cohort study. SUBJECTS 101 children with a BW≤750 g, born between 1996 and 2005, who survived NICU admission and were included in a follow-up program. OUTCOME MEASURES NDO, measured with different tests for general development and intelligence, depending on age of assessment and classified as normal (Z-score≥-1), mildly delayed (-2≤Z-score<-1) or severely delayed (Z-score<-2). RESULTS At 2, 3.5 and 5.5 years 74.3, 82.2 and 76.2% had a normal NDO. A normal NDO at 2 years CA predicted a normal NDO at 3.5 and 5.5 years in 92% and 84% respectively. Of the children with a mildly or severely delayed NDO at 2 years CA the majority showed an improved NDO at 3.5 (69.2%) and 5.5 years (65.4%) respectively. CONCLUSIONS The majority of the children with a BW≤750 g had a normal NDO at all ages. A normal NDO at 2 years CA is a good predictor for normal outcome at 3.5 and 5.5 years, whereas a delayed NDO at 2 years CA is subject to change with the majority of the children showing a better NDO at 3.5 and 5.5 years.
Collapse
Affiliation(s)
- M J Claas
- Department of Obstetrics, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
10
|
Evers ACC, Brouwers HAA, Hukkelhoven CWPM, Nikkels PGJ, Boon J, Egmond-Linden AV, Hillegersberg J, Snuif YS, Sterken-Hooisma S, Bruinse HW, Kwee A. Authors' reply. West J Med 2010. [DOI: 10.1136/bmj.c7023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
11
|
Schaaf JM, Bruinse HW, van der Leeuw-Harmsen L, Groeneveld E, Koopman C, Franx A, van Rijn BB. Reproductive outcome after early-onset pre-eclampsia. Hum Reprod 2010; 26:391-7. [DOI: 10.1093/humrep/deq324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Claas MJ, Bruinse HW, van der Heide-Jalving M, Termote JUM, de Vries LS. Changes in survival and neonatal morbidity in infants with a birth weight of 750 g or less. Neonatology 2010; 98:278-88. [PMID: 20453522 DOI: 10.1159/000285715] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 02/02/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Improvement in perinatal and neonatal care has resulted in increased survival of extremely low birth weight (ELBW) infants. OBJECTIVES To describe survival and neonatal morbidity in a cohort of ELBW infants, to compare two consecutive 5-year periods, and compare appropriate (AGA) with small for gestational age (SGA) infants (AGA ≥p10, and SGA <p10). METHODS Retrospective cohort study of 179 live-born infants with a birth weight (BW) of ≤750 g and gestation of ≥24 weeks, born in 1996-2000 (cohort I, n = 94) and 2001-2005 (cohort II, n = 85) in the Wilhelmina Children's Hospital Utrecht, the Netherlands. RESULTS During NICU stay (n = 146) 62.3% experienced infant respiratory distress syndrome (IRDS), 46.6% bronchopulmonary dysplasia, 50.7% septicemia, 34.2% periventricular leukomalacia grade I and 24.7% intraventricular hemorrhage grade I/II. IRDS grade III/IV occurred significantly more often in cohort I (p = 0.042), whereas septicemia and hyperbilirubinemia occurred more in cohort II (p = 0.045 and p = 0.001). In AGA infants mean gestation was significantly shorter (p < 0.001), and IRDS grade III/IV (p = 0.015), mechanical ventilation (p = 0.045) and patent ductus arteriosus (p = 0.003) were significantly more prevalent. Overall survival was 62%, and survival in the NICU increased from 65.8% (cohort I) to 88.1% (cohort II, p = 0.002). Survival of AGA and SGA infants did not differ, but increased with time (71.4 to 75.9% and 61.4 to 97.4%, respectively). CONCLUSIONS Mortality of infants with a BW of ≤750 g is high, but decreased over time, especially in SGA infants. Considerable neonatal morbidity was present, especially in AGA infants, most likely due to their significantly shorter gestation.
Collapse
Affiliation(s)
- M J Claas
- Department of Obstetrics and Gynaecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
13
|
Wijnberger LDE, de Kleine M, Voorbij HAM, Arabin B, van de Leur JJCM, Bruinse HW, Visser GHA, Bossuyt PMM, Mol BWJ. The effect of clinical characteristics on the lecithin/sphingomyelin ratio and lamellar body count: a cross-sectional study. J Matern Fetal Neonatal Med 2009; 14:373-82. [PMID: 15061315 DOI: 10.1080/14767050412331312210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/26/2022]
Abstract
OBJECTIVES To study the changes in the lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC) during pregnancy and to study the effect of clinical characteristics on these measurements. METHODS We reviewed in retrospect the amniotic fluid samples for the assessment of fetal lung maturity of consecutive women between January 1996 and December 2000. We evaluated the effect of antenatal administration of glucocorticoids, the presence of diabetes, fetal growth restriction and the amount of amniotic fluid on the L/S ratio and LBC. We then constructed normal curves, by relating the L/S ratio and LBC to gestational age in the cases without respiratory distress syndrome (RDS). Data from the literature were added to these curves. RESULTS From the 334 included women, 64 infants (19%) developed RDS. The LBC was lower in women with polyhydramnios (p = 0.04), and similar in women with oligohydramnios. Administration of glucocorticoids, the presence of maternal diabetes or fetal growth restriction did not affect the L/S ratio or the LBC. The median L/S ratio in cases without RDS showed a constant increase from a gestational age of 28 weeks onwards. The median LBC increased slowly between a gestational age of 28 weeks and 34 weeks, to increase more steeply thereafter. CONCLUSIONS The amount of amniotic fluid affects the LBC, but not the L/S ratio. Since the L/S ratio and the LBC increase with gestation, differences in gestational age should be taken into account in the interpretation of these fetal lung maturity tests.
Collapse
Affiliation(s)
- L D E Wijnberger
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
OBJECTIVE To determine the risk factors for anal sphincter injuries during operative vaginal delivery. SETTING AND DESIGN A population-based observational study. POPULATION All 21 254 women delivered with vacuum extraction and 7478 women delivered with forceps, derived from the previously validated Dutch National Obstetric Database from the years 1994 to 1995. METHODS Anal sphincter injury was defined as any injury, partial or complete, of the anal sphincters. Risk factors were determined with multivariate logistic regression analysis. MAIN OUTCOME MEASURES Individual obstetric factors, e.g. fetal birthweights, duration of second stage, etc. RESULTS Anal sphincter injury occurred in 3.0% of vacuum extractions and in 4.7% of forceps deliveries. Primiparity, occipitoposterior position and fetal birthweight were associated with an increased risk for anal sphincter injury in both types of operative vaginal delivery, whereas duration of second stage was associated with an increased risk only in vacuum extractions. Mediolateral episiotomy protected significantly for anal sphincter damage in both vacuum extraction (OR 0.11, 95% CI 0.09-0.13) and forceps delivery (OR 0.08, 95% CI 0.07-0.11). The number of mediolateral episiotomies needed to prevent one sphincter injury in vacuum extractions was 12, whereas 5 mediolateral episiotomies could prevent one sphincter injury in forceps deliveries. CONCLUSIONS Primiparity and occipitoposterior presentation are strong risk factors for the occurrence of anal sphincter injury during operative vaginal delivery. The highly significant protective effect of mediolateral episiotomies in both types of operative vaginal delivery warrants the conclusions that this type of episiotomy should be used routinely during these interventions to protect the anal sphincters.
Collapse
Affiliation(s)
- J W de Leeuw
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
15
|
Kwee A, Elferink-Stinkens PM, Reuwer PJHM, Bruinse HW. Trends in obstetric interventions in the Dutch obstetrical care system in the period 1993–2002. Eur J Obstet Gynecol Reprod Biol 2007; 132:70-5. [PMID: 16884843 DOI: 10.1016/j.ejogrb.2006.06.018] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 05/16/2006] [Accepted: 06/20/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine trends in induction of labour-, instrumental vaginal delivery- and caesarean section rates in the Netherlands in the period 1993-2002. STUDY DESIGN Data derived from The Netherlands Perinatal Registry and Statistics Netherlands were used to calculate annual rates for induction of labour, instrumental vaginal delivery and caesarean section. Regarding caesarean section, rates were also calculated for different subgroups with respect to parity, presentation of the fetus, gestational age and multiple pregnancies. In the subgroup of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation instrumental delivery rates were compared for women with induced labours and women in spontaneous labour. RESULTS The overall CS rate rose from 8.1 to 13.6%. Proportionally the rise was greatest for breech presentation (+37.7%), multiple gestations (+12.7%) and women delivering between 24 and 28 weeks (+9.5%). However, in absolute numbers the rise was most impressive in the group of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation. Rate of induction of labour and instrumental vaginal delivery remained constant (approximately 15% respectively 10% of all deliveries). In nulliparous term women with singletons in vertex presentation the CS rate increased with 8.0% to a rate of 20.7% when labour was induced versus an increase of 3.4% to a rate of 7.5% in spontaneous labour. CONCLUSION In absolute numbers the rise in CS was most extensive in the group of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation. Induction of labour rates and instrumental vaginal delivery rates remained constant during the past decade.
Collapse
Affiliation(s)
- A Kwee
- University Medical Centre Utrecht, Location WKZ, Department of Obstetrics and Gynaecology, Room number KE 04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
16
|
van de Pol G, van Brummen HJ, Bruinse HW, Heintz APM, van der Vaart CH. Is there an association between depressive and urinary symptoms during and after pregnancy? Int Urogynecol J 2007; 18:1409-15. [PMID: 17404679 PMCID: PMC2062491 DOI: 10.1007/s00192-007-0371-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Accepted: 03/19/2007] [Indexed: 11/27/2022]
Abstract
Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy. In the general population, an association is reported between urinary symptoms and depressive symptoms. The association of depressive and urinary symptoms has not yet been assessed in pregnancy. In this study, we assessed (1) the prevalence of depressive symptoms, over-active bladder (OAB) syndrome, urge urinary incontinence (UUI) and stress urinary incontinence (SUI) during and after pregnancy using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Urogenital Distress Inventory (UDI) and (2) the association of depressive symptoms with urinary incontinence and over-active bladder syndrome during and after pregnancy, controlling for confounding socioeconomic, psychosocial, behavioural and biomedical factors in a cohort of healthy nulliparous women. Our data show a significant increase in prevalence of depressive symptoms, UUI, SUI and OAB during pregnancy and a significant reduction in prevalence of depressive symptoms, SUI and OAB after childbirth. UUI prevalence did not significantly decrease after childbirth. In univariate analysis, urinary incontinence and the OAB syndrome were significantly associated with a CES-D score indicative of a possible clinical depression at 36 weeks gestation. However, after adjusting for possible confounding factors, only the OAB syndrome remained significantly associated (OR 4.4 [1.8–10.5]). No association was found between depressive and urinary symptoms at 1 year post-partum. Only OAB was independently associated with depressive symptoms during pregnancy. Possible explanations for this association are discussed.
Collapse
Affiliation(s)
- G van de Pol
- Department of Perinatology and Gynecology, University Medical Center Utrecht, Room F05.216, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
17
|
Hulstein JJJ, van Runnard Heimel PJ, Franx A, Lenting PJ, Bruinse HW, Silence K, de Groot PG, Fijnheer R. Acute activation of the endothelium results in increased levels of active von Willebrand factor in hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. J Thromb Haemost 2006; 4:2569-75. [PMID: 16968329 DOI: 10.1111/j.1538-7836.2006.02205.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [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: 11/25/2022]
Abstract
BACKGROUND HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is a severe complication of pre-eclampsia in pregnancy, characterized by microvascular platelet thrombi. Activation of the endothelium is thought to play a key role in pre-eclampsia and HELLP syndrome. Activation of endothelial cells may lead to release of von Willebrand factor (VWF) multimers, which are highly reactive with platelets. Normally, newly released multimers are cleaved by ADAMTS13, resulting in less reactive derivatives. OBJECTIVE We hypothesized that HELLP syndrome is characterized by increased amounts of active VWF compared with healthy pregnancy and pre-eclampsia, due to acute activation of endothelial cells. This might contribute to thrombocytopenia and thrombotic microangiopathy. METHODS Active VWF and ADAMTS13 activity were measured in healthy pregnant volunteers (n = 9), patients with pre-eclampsia (n = 6) and patients with HELLP syndrome (n = 14) at similar gestational ages. To study the role of endothelial cell activation, the propeptide/mature VWF ratio was determined, and VWF released by cultured endothelial cells was analyzed. RESULTS Active VWF levels were increased 2.1-fold in HELLP syndrome compared with healthy pregnant volunteers (P < 0.001) and 1.6-fold compared with patients with pre-eclampsia (P = 0.001). ADAMTS13 activity was moderately decreased in patients with HELLP syndrome compared with healthy pregnant volunteers (P < 0.004), but not compared with patients with pre-eclampsia. The propeptide/mature VWF ratio was increased 1.7-fold compared with healthy pregnant volunteers (P < 0.001) and 1.5-fold compared with patients with pre-eclampsia (P < 0.05). A significant correlation was found between this ratio and the activation factor of VWF (r = 0.68, P < 0.001). The amount of active VWF was increased 1.4-fold in medium of stimulated endothelial cells when compared with non-stimulated cells (P < 0.05). CONCLUSION Acute endothelial cell activation in HELLP syndrome and decreased ADAMTS13 activity result in increased amounts of active VWF. This might explain the consumptive thrombocytopenia and thrombotic microangiopathy associated with HELLP syndrome. Inhibition of circulating active VWF could be a potential new approach in the treatment of patients with HELLP syndrome.
Collapse
Affiliation(s)
- J J J Hulstein
- Department of Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Childbirth is a substantial physical and emotional endeavor. Because emergency Cesarean and instrumental vaginal delivery impose a greater mortality and physical and emotional morbidity on both the mother and the infant than normal vaginal delivery, it is important to identify factors that are associated with the risk of operative delivery. In previous investigations, some associations have been found, but the effect of psychosocial factors is not clear. In this study we examined several factors which could be associated with the risk for instrumental and surgical delivery. In addition to biomedical factors we included psychosocial factors such as depressive symptoms, quality of the relationship of the woman with her partner, personality, lifestyle and educational level. We assessed 354 healthy nulliparous pregnant women with a child in vertex presentation and spontaneous onset of term labor using validated questionnaires. We found that social support from the woman's partner in pregnancy, lack of depressive symptoms and specific personality traits are not protective against instrumentally assisted vaginal delivery or emergency Cesarean section. Predictive factors for operative delivery after spontaneous onset of labor are higher fetal weight, non-occiput anterior presentation and advanced gestational age, and foremost fetal distress during parturition.
Collapse
Affiliation(s)
- G Van de Pol
- Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE To evaluate which factors determine sexual activity and satisfaction with the sexual relationship 1 year after the first delivery. DESIGN Prospective longitudinal cohort study. SETTING Ten midwifery practices. POPULATION Three hundred and seventy-seven nulliparous women were included. METHODS The Maudsley Marital Questionnaire is a standardised and validated questionnaire with 15 items relating to marital and sexual adjustment, with a nine-point (0-8) scale appended to each question. Scores on the sexual scale (MMQ-S) range from 0 to 40. Higher scores are indicative of greater dissatisfaction. Sexual intercourse was dichotomised into having sexual intercourse or not having sexual intercourse. Several obstetric and maternal factors were analysed. MAIN OUTCOME MEASUREMENTS Sexual intercourse at 1 year postpartum and dissatisfaction with the sexual relationship as assessed by the MMQ-S scale. RESULTS In multiple logistic regression analysis, the main predictive factor for no sexual intercourse 1 year postpartum was no sexual intercourse at 12 weeks of gestation (beta 11.0 [4.01-30.4]). Women were five times less likely to be sexually active after a third/fourth degree anal sphincter tear as compared with women with an intact perineum (beta 0.2 [0.04-0.93]). Dissatisfaction with the sexual relationship 1 year after childbirth, assessed with the MMQ-S scale, is associated with not being sexually active at 12 weeks of gestation (beta- 0.208, P= 0.004) and with an older maternal age at delivery (beta 0.405, P= 0.032). CONCLUSION An important prognostic factor for dissatisfaction with the sexual relationship 1 year postpartum was not being sexually active in early pregnancy. Satisfaction with the sexual relationship seems not to depend on pregnancy- and parturition-associated factors.
Collapse
Affiliation(s)
- H J van Brummen
- Department of Perinatology and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | | | | | | |
Collapse
|
20
|
Sikkema JM, Bruinse HW, Visser GHA, Franx A. [Pregnancy complications as a risk factor for metabolic and cardiovascular disease in later life]. Ned Tijdschr Geneeskd 2006; 150:898-902. [PMID: 16686089] [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: 05/09/2023]
Abstract
In recent years several large epidemiological studies have been published that demonstrate that women who experience gestational diabetes, pregnancy-induced hypertension or pre-eclampsia have an increased risk of developing type-2 diabetes mellitus and cardiovascular disease. 15-50% of women who experience gestational diabetes develop type-2 diabetes mellitus; the risk is particularly high in those who require insulin therapy during pregnancy. - Chronic hypertension frequently develops years after a pregnancy complicated by pregnancy-induced hypertension, especially in women who have had pregnancy-induced hypertension in multiple pregnancies. Women who experience pre-eclampsia in the first 36 weeks of pregnancy or in multiple pregnancies have an increased risk of cardiovascular morbidity and mortality in later life. Therefore gestational diabetes, pregnancy-induced hypertension and pre-eclampsia provide an opportunity to identify individuals with an increased risk of type-2 diabetes mellitus and cardiovascular disease at an early age. This may create new perspectives on prevention.
Collapse
Affiliation(s)
- J M Sikkema
- Universitair Medisch Centrum Utrecht, afd. Perinatologie, Utrecht
| | | | | | | |
Collapse
|
21
|
Verhoeven ATM, de Leeuw JP, Bruinse HW. [Breech presentation: infant versus mother]. Ned Tijdschr Geneeskd 2006; 150:61-3; author reply 63. [PMID: 16440626] [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: 05/06/2023]
|
22
|
van de Pol G, de Leeuw JRJ, van Brummen HJ, Bruinse HW, Heintz APM, van der Vaart CH. The Pregnancy Mobility Index: a mobility scale during and after pregnancy. Acta Obstet Gynecol Scand 2006; 85:786-91. [PMID: 16817074 DOI: 10.1080/00016340500456373] [Citation(s) in RCA: 22] [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: 10/20/2022]
Abstract
BACKGROUND During pregnancy, every second woman will experience some degree of back or pelvic pain. While several validated instruments to assess back pain exist for the general population, these are not suitable for application in a pregnant population and have not been validated for this purpose. A pregnant population not only differs from the general population regarding the type of back pain--frequently a pelvic girdle component is added--but pregnant women also have different mobility patterns and expectations. We therefore present in this study a self-report mobility scale specifically designed for a pregnant population: the Pregnancy Mobility Index. METHODS Longitudinal cohort study including 672 nulliparous women with a singleton low-risk pregnancy. The Pregnancy Mobility Index consists of items concerning day-to-day activities selected through literature research and clinical experience. Participating women completed the questionnaire at 12 and 36 weeks' gestation and one year after delivery. Reliability, construct and criterion validity were tested. RESULTS The internal consistency (Cronbach's alpha) was 0.8 or higher. The Pregnancy Mobility Index scales correlated best with the physical and pain scale of the RAND-36, indicating a good construct validity. The assumptions that the Pregnancy Mobility Index scores increase during pregnancy and decrease after delivery and that women with back or pelvic problems scored higher on the Pregnancy Mobility Index domains than women without back or pelvic pain were confirmed, indicating a good criterion validation. CONCLUSION The Pregnancy Mobility Index has been shown to be a reliable and valid questionnaire well suited for use during and after pregnancy.
Collapse
Affiliation(s)
- G van de Pol
- Department of Perinatology and Gynecology, University Medical Center Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
23
|
van Runnard Heimel PJ, Schobben AFAM, Huisjes AJM, Franx A, Bruinse HW. The transplacental passage of prednisolone in pregnancies complicated by early-onset HELLP syndrome. Placenta 2005; 26:842-5. [PMID: 16226134 DOI: 10.1016/j.placenta.2004.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 12/17/2004] [Accepted: 12/17/2004] [Indexed: 11/24/2022]
Abstract
During pregnancy the placental 11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) enzyme inactivates prednisolone by interconversion into prednisone, protecting the fetus from high levels of prednisolone. Recent reports suggest decreased placental 11beta-HSD2 activity in pregnancies complicated by preeclampsia. The purpose of our investigation was to study the transplacental passage of prednisolone in patients suffering from early preterm HELLP syndrome, a severe complication of preeclampsia. We examined the maternal and umbilical cord plasma concentration of prednisolone in nine women receiving 50 mg of prednisolone twice a day. Samples were obtained during caesarean section at a gestational age between 27 and 31 weeks. Mean fetal concentration was 10-fold lower as compared to maternal prednisolone concentration (mean+/-SD 52.8 nmol/L+/-27.0 vs. 477.5 nmol/L+/-300, p<0.01). A significant correlation was found between the last dose of prednisolone to delivery interval and the fetal prednisone concentration (Spearman's correlation coefficient r=-0.946, p<0.000). Our data demonstrate unimpaired placental 11beta-HSD2 activity in patients suffering from HELLP syndrome at early gestational age as shown by both a 10-fold lower fetal prednisolone concentration as compared to the mother and a strong correlation between the last dose of prednisolone to delivery interval and the fetal prednisone concentration. Prednisolone may therefore have less effect on the fetus than betamethasone or dexamethasone.
Collapse
Affiliation(s)
- P J van Runnard Heimel
- Department of Perinatology and Gynaecology, University Medical Centre Utrecht, KJ.02.507.0/P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
24
|
Verhoeven ATM, de Leeuw JP, Bruinse HW. [Breech presentation at term: elective caesarean section is the wrong choice as a standard treatment because of too high risks for the mother and her future children]. Ned Tijdschr Geneeskd 2005; 149:2207-10. [PMID: 16235796] [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: 05/04/2023]
Abstract
The altered attitude of the obstetrician with regard to term breech delivery after the first results of the Term breech trial in 2000 has led to an increase in elective caesarean section in the Netherlands from 25% in 1999 to 64% in 2004 and a decrease in emergency caesarean section for term breech delivery from 26% in 1999 to I8% in 2004. This increase of about 8500 elective caesarean sections in the last four years probably prevented 19 perinatal deaths. However, this rise in caesarean section also resulted in four maternal deaths that may have been avoidable. Furthermore, in the future, nine perinatal deaths as a result of the uterine scar and 140 women with potentially life-threatening complications from that uterine scar during their future pregnancies can be expected. Information to the patient should take into account not only the short-term benefits but also the higher long-term risks. Vaginal delivery following strict selection is now preferred.
Collapse
Affiliation(s)
- A T M Verhoeven
- Rijnland Ziekenhuis, afd. Gynaecologie en Verloskunde, Leiderdorp
| | | | | |
Collapse
|
25
|
Graziosi GCM, Mol BW, Ankum WM, Bruinse HW. Management of early pregnancy loss. Int J Gynaecol Obstet 2005; 86:337-46. [PMID: 15325850 DOI: 10.1016/j.ijgo.2004.04.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2003] [Revised: 04/20/2004] [Accepted: 04/28/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In order to assess the available evidence on the management of early pregnancy loss, we performed a meta-analysis on the subject. METHODS MEDLINE and EMBASE were searched for randomized studies reporting on the effectiveness of expectant management, misoprostol treatment or curettage. Outcomes considered were 'complete evacuation', complications, duration of bleeding, pain resulting from the procedure, side effects and women's satisfaction with the procedure. RESULTS Thirteen studies were identified. Combined data in women with missed abortion managed expectantly or treated with misoprostol showed complete evacuation rates of 28% (49/173) (range 14-47%) and 81% (242/298) (range 60-83%), respectively. In women with incomplete abortion, these rates were 94% (31/33) (range 80-100%) and 99% (75/76) (range 99-100%), respectively. CONCLUSION In the management of early pregnancy loss both expectant management and misoprostol treatment reduce the need for curettage, but misoprostol treatment seems to be more effective in women with missed abortion as compared to expectant management.
Collapse
Affiliation(s)
- G C M Graziosi
- Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | | | | | | |
Collapse
|
26
|
Graziosi GCM, Bruinse HW, Reuwer PJH, van Kessel PH, Westerweel PE, Mol BW. Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial. Hum Reprod 2005; 20:2340-7. [PMID: 15831508 DOI: 10.1093/humrep/dei019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 01/18/2023] Open
Abstract
BACKGROUND We aimed to compare patients' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. METHODS A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with early pregnancy failure confirmed at ultrasonography who had been managed expectantly unsuccessfully for > or =1 week were randomly assigned to undergo either treatment with misoprostol (n=79) or curettage (n=75). The main outcome measures were health-related quality of life and satisfaction with treatment. RESULTS In the misoprostol strategy 47% of the women needed additional curettage, as compared to 4% after curettage. In both groups, health-related quality of life was impaired most severely 2 days after treatment. In the misoprostol group, health-related quality of life was more severely impaired; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception. Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful. In both treatment groups, an equal percentage of women (58%) would choose the same treatment in the future. In women treated with misoprostol, however, this choice depended on the initial success of misoprostol: in cases where misoprostol had caused complete evacuation, 76% of the women would opt for the same treatment, whereas only 38% of women who needed curettage after unsuccessful misoprostol would do so (P<0.01). CONCLUSION Our study shows that, although both the misoprostol strategy and the curettage strategy resulted in complete evacuation in the end, women are willing to accept some disadvantages of misoprostol to avoid curettage. A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high. This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure.
Collapse
Affiliation(s)
- G C M Graziosi
- St Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
Corticosteroids are potent antiinflammatory and immunosuppressive drugs, which are used in the treatment of a wide range of medical disorders. During pregnancy, several corticosteroids are administered for maternal as well as fetal reasons. Prednisone and prednisolone show limited transplacental passage and are thus used for treatment of maternal disease. Dexamethasone and betamethasone, drugs that can easily cross the placenta, are more suitable for fetal indications. During the last decade, administration of corticosteroids was introduced in the treatment of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), a severe form of preeclampsia unique to human pregnancy. Several randomized, controlled trials as well as other prospective and retrospective studies have been performed to investigate this beneficial effect of corticosteroids on biochemical measures and clinical signs. This review discusses the characteristics of corticosteroids in humans and details the use of corticosteroids during pregnancy. A review of literature on the effect of corticosteroids on HELLP syndrome is given and possible mechanisms of action are discussed.
Collapse
Affiliation(s)
- P J van Runnard Heimel
- Department of Perinatology and Gynecology, University Medical Center, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
28
|
Graziosi GCM, van der Steeg JW, Reuwer PHW, Drogtrop AP, Bruinse HW, Mol BWJ. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management. Hum Reprod 2004; 20:1067-71. [PMID: 15618248 DOI: 10.1093/humrep/deh709] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [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: 11/13/2022] Open
Abstract
BACKGROUND The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. METHODS We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. RESULTS Direct costs per case were significantly lower in the misoprostol group (mean 433) than in the curettage group (mean 683) (mean difference 250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean 486; curettage mean 428; mean difference 60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage, with a mean difference between both groups of 192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550. CONCLUSION The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.
Collapse
Affiliation(s)
- G C M Graziosi
- Department of Obstetrics and Gynaecology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, The Netherlands.
| | | | | | | | | | | |
Collapse
|
29
|
Graziosi GCM, Mol BWJ, Reuwer PJH, Drogtrop A, Bruinse HW. Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial. Hum Reprod 2004; 19:1894-9. [PMID: 15192065 DOI: 10.1093/humrep/deh344] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [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: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS Women with early pregnancy failure, who had been managed expectantly for at least 1 week, were assigned randomly (using a computer-generated list) to receive either vaginal misoprostol 800 microg or curettage. If, after 24 h, there had not been complete evacuation, a further 800 microg of misoprostol was administered. In the absence of complete evacuation after > days, curettage was performed. The primary end-point was the complete evacuation of the products of conception, with secondary end-points being the occurrence of side effects, pain intensity, need for analgesics, and intensity and duration of bleeding. RESULTS In the misoprostol group, 47% (37/79) required curettage due to incomplete evacuation. After 1 week, evacuation was complete in 85% (67 out of 79) of the misoprostol group and 93% (70 out of 75) of the curettage group. Severity of pain, bleeding and emergency evacuation was higher in the misoprostol group. The complication rate was 0% for misoprostol and 4% for curettage. CONCLUSIONS Curettage is superior to misoprostol in the evacuation of early pregnancy failure after failed expectant management. However, misoprostol could be clinically useful since it reduces the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.
Collapse
Affiliation(s)
- G C M Graziosi
- Department of Obstetrics and Gynaecology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, The Netherlands.
| | | | | | | | | |
Collapse
|
30
|
Dietz V, Derks JB, Mascini EM, Bruinse HW. [A pseudo-epidemic of puerperal sepsis]. Ned Tijdschr Geneeskd 2003; 147:2505-8. [PMID: 14735848] [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: 04/28/2023]
Abstract
Within a four-week period, five patients were admitted to the maternity ward of the Utrecht Children's Hospital diagnosed with puerperal sepsis due to group-A streptococcal infection. The clinical presentation was different for each patient. All patients recovered upon adequate antibiotic treatment. One of the children died, possibly due to sepsis and hypotension of his mother. As group-A streptococci can be extremely contagious and an epidemic was suspected, measures for additional hygiene were taken. Furthermore, all personnel at the maternity ward and the obstetric centre were tested. T-serotyping, M-genotyping, exotoxin A- and C-gene amplification and pulsed field gel electrophoresis were used to characterize the cultured group-A streptococci. Cross-contamination was not found. Therefore, this increase in puerperal sepsis was attributed to polyclonal expansion rather than an epidemic. All mothers of newly born children who present with fever and lower abdominal pain should be suspected of group-A streptococcal infection. Evaluation and treatment in hospital is indicated due to a sometimes fulminant course. When group-A streptococci are cultured again in a new pregnancy, eradication therapy during pregnancy or prophylactic treatment during birth should be considered to prevent recurrent infection.
Collapse
Affiliation(s)
- V Dietz
- Afd. Obstetrie, Universitair Medisch Centrum Utrecht/Wilhelmina Kinderziekenhuis, Postbus 85.090, 3508 AB Utrecht.
| | | | | | | |
Collapse
|
31
|
Manten GT, Derks JB, van Loon AM, Gerards LJ, Bruinse HW. [Chickenpox in pregnancy with serious consequences for both mother and child]. Ned Tijdschr Geneeskd 2003; 147:2029-32. [PMID: 14587147] [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: 04/27/2023]
Abstract
A 41-year-old woman with chickenpox in the third trimester of her pregnancy was admitted to the Intensive Care Unit of our hospital for ventilatory support. She was treated with aciclovir, amoxicillin-clavulanic acid and erythromycin. Her baby was delivered by forceps following placental abruption. After delivery, both mother and child recovered slowly but could eventually leave the hospital in good condition. If a pregnant woman without a prior history of varicella-zoster infection is exposed to a child that has chickenpox, passive immunisation with varicella-zoster immunoglobulin should be administered. This reduces the risk of maternal complications and may prevent a fetal varicella syndrome. If the mother has already developed chickenpox and there are serious complications, she should be treated with intravenous aciclovir. If possible, delivery should be delayed until 5 days after the onset of maternal chickenpox.
Collapse
Affiliation(s)
- G T Manten
- Divisie Perinatologie en Gynaecologie, Universitair Medisch Centrum Utrecht, locatie Wilhelmina Kinderziekenhuis, Postbus 85.090, 3508 AB Utrecht.
| | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE Our purpose was to examine changes in the amniotic fluid index (AFI) in accurately dated term pregnancies both in relation to gestational age and in relation to the onset of spontaneous labor. STUDY DESIGN This was a prospective observational study in 137 women with uneventful term pregnancies, in whom 220 AFI measurements were performed. More than one AFI value was available from 51 individuals. RESULTS The AFI did not change significantly between 37 and 42 weeks' gestation, but a significant reduction was seen during the last 11 days before the spontaneous onset of labor (R = -0.37, n = 83, p < 0.001). The AFI (corrected for gestational age) within individuals remained stable over periods of up to 2 weeks. Meconium staining of the amniotic fluid was related to gestational age, but not to the AFI or fetal distress at birth. No significant correlation was found between fetal distress and the AFI, or between fetal distress and the reduction in AFI during the last two measurements before labor. CONCLUSIONS The reduction of the AFI in pregnancies progressing beyond term is related to the labor process itself rather than to the exact gestational age.
Collapse
Affiliation(s)
- R H Stigter
- Department of Perinatology and Gynecology, University Medical Center Utrecht, The Netherlands
| | | | | | | |
Collapse
|
33
|
Koenen SV, Franx A, Mulder EJH, Bruinse HW, Visser GHA. Fetal and maternal cardiovascular diurnal rhythms in pregnancies complicated by pre-eclampsia and intrauterine growth restriction. J Matern Fetal Neonatal Med 2002; 11:313-20. [PMID: 12389672 DOI: 10.1080/jmf.11.5.313.320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 10/20/2022]
Abstract
OBJECTIVES To determine whether the diurnal blood pressure profiles in pregnant women with pre-eclampsia and/or intrauterine growth restriction (IUGR) differ from those in normal pregnant controls, and, if so, to establish whether such a difference is accompanied by altered diurnal rhythms of fetal heart rate (FHR) and its variation. METHODS Twenty-two women in the third trimester of pregnancy with pre-eclampsia, IUGR, or both, entered the study. Eleven healthy pregnant women served as controls. Maternal systolic and diastolic blood pressures and heart rate (MHR) were determined automatically at 30-min intervals during a period of 26 h starting at 09.00. During the study period, nine 1-h recordings of FHR were made at predetermined timepoints. FHR was analyzed numerically. RESULTS Systolic and diastolic blood pressures and MHR showed diurnal patterns, with the highest values during the day and a trough during the night in all women. Daytime and night-time blood pressures were higher in pre-eclamptic women (p < 0.001), and the day-night difference was smaller than in controls (p < 0.001). Diurnal patterns of FHR and its variation did not differ qualitatively between the three study groups. However, FHR was affected by the maternal blood pressure profile, and all FHR parameters and their diurnal ranges were quantitatively different in IUGR fetuses (p < 0.05). CONCLUSION In pre-eclamptic women, there was blunting of the diurnal blood pressure profile. This altered maternal hemodynamics was associated with a similar reduction in FHR amplitude during the 26-h period but not with FHR variation. Although diurnal rhythms of FHR and its variation persisted qualitatively in the IUGR fetuses, they seemed to have been reset quantitatively, leading to a flattened diurnal pattern.
Collapse
Affiliation(s)
- S V Koenen
- Department of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|
34
|
Abstract
OBJECTIVE To provide reference values for the umbilical coiling index in uncomplicated pregnancy. METHODS Umbilical cords were collected from livebom singleton infants born after uncomplicated pregnancies. The umbilical coiling index (UCI) was calculated as the number of coils divided by the cord length in centimeters. The mean value (SD) for the UCI was calculated, and possible correlations of the UCI with maternal age, parity, gestational age at delivery, mode of delivery, sex and birth weight of the infant were examined. RESULTS A total of 122 umbilical cords were included. The frequency distribution of the UCI was skewed to the right. The mean (SD) UCI was 0.17 (0.009) coils/cm. There were no significant correlations of the UCI with maternal age, parity, gestational age at delivery, mode of delivery, sex or birth weight of the infant. CONCLUSIONS This is the first study to determine the UCI in a group exclusively consisting of uncomplicated pregnancies. The mean value that we found for the UCI may serve as the standard reference, allowing proper interpretation of umbilical coiling in complicated pregnancy.
Collapse
Affiliation(s)
- C C van Diik
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
35
|
Sikkema JM, Franx A, Bruinse HW, van der Wijk NG, de Valk HW, Nikkels PGJ. Placental pathology in early onset pre-eclampsia and intra-uterine growth restriction in women with and without thrombophilia. Placenta 2002; 23:337-42. [PMID: 11969345 DOI: 10.1053/plac.2001.0785] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The incidence of placental thrombotic lesions in early onset preeclampsia (PE) and/or intrauterine growth restriction (IUGR) were compared between women with and without thrombophilia or hyperhomocysteinemia. STUDY DESIGN Matched case-control study. 183 women with a history of early onset PE and/or IUGR were tested for thrombophilia and hyperhomocysteinemia. From the 66 women with a thrombophilic factor the placental histological slides were available in 47 women. These were matched for maternal condition (PE and/or IUGR), gestational age at delivery, parity and maternal age, to 47 women with no thrombophilic factor. All slides were revised for lymphohistiocytic villitis, fetal thrombosis and fibrin depositions. RESULTS There were no significant differences between the placentas of the matched groups with and without a thrombophilic factor. CONCLUSION Placental thrombotic and inflammatory lesions associated with early onset PE and/or IUGR do not occur more often in women with compared to women without thrombophilia or hyperhomocysteinemia.
Collapse
Affiliation(s)
- J M Sikkema
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
36
|
Vermeulen GM, Bruinse HW, de Vries LS. Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous preterm birth. Eur J Obstet Gynecol Reprod Biol 2001; 99:207-12. [PMID: 11788173 DOI: 10.1016/s0301-2115(01)00383-9] [Citation(s) in RCA: 43] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate to what extend perinatal factors contribute to the neurodevelopmental outcome in a group neonates born after spontaneous preterm labour with or without prolonged rupture of the membranes (PROM). METHODS In a cohort of neonates born after the spontaneous onset of labour with or without PROM before 34 weeks of gestation a stepwise forward logistic regression was performed to analyse the influence of antenatal and postnatal variables on adverse outcome. Adverse neurodevelopmental outcome was defined as a Griffith's developmental score <85, cerebral palsy, a major disability or perinatal death associated with severe cerebral damage. RESULTS The study group consisted of 185 neonates. Seven neonates died with severe cerebral damage. After a forward logistic regression analysis three factors appeared to have an independent influence: gestational age protected against an adverse outcome (odds ratio (OR) per day increase 0.95, 95% confidence interval (CI) 0.90-0.97) while abnormal cranial ultrasound (intraventricular haemorrhage and periventricular leucomalacia) (OR 6.33, 95% CI 2.16-18.52) and the need for a second course of antibiotics (OR 1.85, 95% CI 1.02-3.33) increased the risk for adverse outcome. Comparing the group with a normal neurodevelopmental outcome with those with cerebral palsy, cranial ultrasound abnormalities were independently associated with cerebral palsy (OR 48.75, 95% CI 11.78-201.76). CONCLUSION The most important way of preventing neurological damage in infants is to increase gestational age at birth and to avoid the development of intraventricular haemorrhage and periventricular leucomalacia.
Collapse
Affiliation(s)
- G M Vermeulen
- Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, Meppel, The Netherlands.
| | | | | |
Collapse
|
37
|
Stigter RH, Mulder EJ, Bruinse HW, Visser GH. Doppler studies on the fetal renal artery in the severely growth-restricted fetus. Ultrasound Obstet Gynecol 2001; 18:141-145. [PMID: 11529994 DOI: 10.1046/j.1469-0705.2001.00493.x] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To examine changes with time in the fetal renal circulation by Doppler sonography in the severely growth-restricted preterm fetus during the period of gradual deterioration prior to delivery, and to examine the relationship between Doppler measurements, amniotic fluid index, birth weight and fetal condition at birth. METHODS This was a prospective observational study in 16 preterm growth-restricted fetuses between 26 and 35 weeks of gestational age. Serial Doppler measurements were made of the renal artery, umbilical artery, middle cerebral artery and ductus venosus. RESULTS The pulsatility index in the renal artery did not show any correlation with cord blood pH, birth weight or amniotic fluid index corrected for gestational age (Delta/SDAFI). However, peak systolic velocities in the renal artery showed a significant reduction with time (n = 7, P < 0.05) and a significant correlation with: venous cord pH at delivery (n = 12, r = 0.84, P < 0.001), Delta/SDAFI (n = 16, r = 0.67, P < 0.01), and birth weight (n = 16, r = 0.61, P < 0.02). Birth weight correlated significantly with: Delta/SDAFI (n = 15, r = 0.57, P < 0.05), pulsatility index values of the middle cerebral artery (n = 15, r = -0.61, P < 0.02), and pulsatility index values of the ductus venosus (n = 16, r = 0.55, P < 0.05), and Delta/SDAFI correlated significantly with: pulsatility index values of the ductus venosus (n = 15, r = 0.51, P < 0.05) and arterial cord pH values at delivery (n = 8, r = 0.78, P < 0.05). CONCLUSIONS Progressive redistribution of the circulation occurs with deterioration of the fetal condition in the growth-restricted preterm fetus. On spectral Doppler this is reflected by changes in peak systolic velocities, but not by changes in pulsatility values of the fetal renal artery waveforms.
Collapse
Affiliation(s)
- R H Stigter
- Department of Obstetrics, Neonatology and Gynaecology, University Medical Centre Utrecht, 3508 AB Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
38
|
Vermeulen GM, van Zwet AA, Bruinse HW. Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth. BJOG 2001; 108:697-700. [PMID: 11467693 DOI: 10.1111/j.1471-0528.2001.00175.x] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse alterationS in the vaginal flora after 2% clindamycin vaginal cream or placebo administered for the prevention of preterm delivery in high risk women. DESIGN Observational study during a randomised multicentre double-blind placebo controlled trial. SETTING Twelve city hospitals in The Netherlands. PARTICIPANTS One hundred and sixty-eight women were enrolled. Alterations in the vaginal flora could be analysed in one hundred and twenty-four women by comparing the Nugent score on entry to the trial and at 31 weeks' gestation. The Nugent score was classified into normal, intermediate and bacterial vaginosis. INTERVENTIONS Two percent clindamycin vaginal cream or placebo cream administered daily for seven days at week 26 of pregnancy. MAIN OUTCOME Changes in the vaginal flora at week 31 of pregnancy. RESULTS The placebo group consisted of 64 women and the clindamycin group of 60 women. At week 31 the vaginal flora was similar to week 26 with placebo cream but changed from normal vaginal flora to intermediate or bacterial vaginosis with 2% clindamycin vaginal cream. CONCLUSION Obstetricians should not prescribe 2% clindamycin vaginal cream to pregnant women with normal vaginal flora in order to reduce the incidence of preterm birth. because it has no beneficial effects and is actually harmful. 2% Clindamycin vaginal cream encourages the presence of bacterial vaginosis which is epidemiologically associated with preterm birth.
Collapse
Affiliation(s)
- G M Vermeulen
- Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, The Netherlands
| | | | | |
Collapse
|
39
|
Wijnberger LD, Huisjes AJ, Voorbij HA, Franx A, Bruinse HW, Mol BW. The accuracy of lamellar body count and lecithin/sphingomyelin ratio in the prediction of neonatal respiratory distress syndrome: a meta-analysis. BJOG 2001; 108:583-8. [PMID: 11426891 DOI: 10.1111/j.1471-0528.2001.00142.x] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the performance of the lecithin/sphingomyelin ratio and the lamellar body count in the prediction of neonatal respiratory distress syndrome. DESIGN Meta-analysis. SAMPLE Six studies reporting on the performance of both the lecithin/sphingomyelin ratio and the lamellar body count published between January 1966 and August 1999. METHODS We performed a computerised MEDLINE search to identify articles published on the subject. For the six selected studies, prevalence of respiratory distress syndrome and sensitivity and specificity of the tests in the prediction of respiratory distress syndrome were calculated, and overall performance was assessed by constructing summary receiver-operating characteristic curves. RESULTS The constructed summary receiver-operating characteristic curves showed the lamellar body count to perform slightly better than the lecithin/sphingomyelin ratio in the prediction of respiratory distress syndrome (P= 0.13). CONCLUSIONS Since the lamellar body count can be performed quickly and since it is less expensive than the lecithin/sphingomyelin ratio, we recommend the former as the test of first choice in the assessment of fetal lung maturity.
Collapse
Affiliation(s)
- L D Wijnberger
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
40
|
Schaap AH, Wolf H, Bruinse HW, Smolders-De Haas H, Van Ertbruggen I, Treffers PE. Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants. Obstet Gynecol 2001; 97:954-60. [PMID: 11384702 DOI: 10.1016/s0029-7844(01)01343-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants. METHODS This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insufficiency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26-32 weeks during the years 1984-1991. Infants who had been treated antenatally with corticosteroids more than 24 hours and less than 7 days before birth were matched by birth weight, sex, and year of birth with infants whose mothers had been admitted more than 24 hours before delivery but were not treated antenatally with steroids. The main outcome measure was survival without disability or handicap at 2 years corrected age. A sample of 60 case-control pairs would give 81% power to demonstrate 50% increase of this outcome [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire. RESULTS The study group and control group consisted of 62 infants each. Survival without disability or handicap at 2 years' corrected age was more frequent in the corticosteroid group [OR 3.2, confidence interval (CI) 1.1, 11.2]. In the long-term follow-up at school age there was a statistically significant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected. CONCLUSION Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.
Collapse
Affiliation(s)
- A H Schaap
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
41
|
Bouman EA, Gutiérrez y Leon JA, van der Salm PC, Christiaens GC, Bruinse HW, Broeders IA. [Complicated but successful resuscitation after amniotic fluid embolism]. Ned Tijdschr Geneeskd 2001; 145:747-9. [PMID: 11332260] [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: 02/19/2023]
Abstract
A 33-year-old woman, gravida IV, para III with unexplained polyhydramnios was admitted to give birth at 29 weeks of pregnancy. Directly after the spontaneous breaking of the membranes, asystolia occurred. Following emergency resuscitation the sinus rhythm returned. Upon the relaparotomy due to a large filling requirement and increasing abdomen size, 'crush' lesions to the spleen and liver were visible; following this a splenectomy was carried out and tampons applied to the liver. After seven months the patient had slight residual symptoms; three weeks after his birth her son was transferred in good condition to another hospital. Amniotic fluid embolism is a rare complication of pregnancy with often serious complications for mother and child. The diagnosis is based on the clinical symptoms of cardiac arrest or sudden profound shock, acute respiratory failure, and/or disseminated intravascular coagulation, occurring in most cases during or soon after delivery, in the absence of an alternative cause (in particular primary cardiopulmonary causes). If the clinical picture deviates from the expected post-resuscitation course alternative diagnoses or resuscitation injuries must be considered.
Collapse
Affiliation(s)
- E A Bouman
- Afd. Anesthesiologie, Universitair Medisch Centrum, Postbus 85.500, 3508 GA Utrecht
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
One of the current hypotheses on the pathophysiology of pre-eclampsia (PE) states that the placenta secretes one or more cytotoxic factors resulting in maternal endothelial dysfunction. Among the candidate factors are the products of increased oxidative stress. Although there is circumstantial evidence of such an increase, direct evidence is still lacking. Electron paramagnetic spin trap resonance (EPR), the most direct method to detect free radicals in tissues, was used to measure superoxide levels in placentae from normal pregnancies (n=13) and pregnancies complicated by PE (n=10). The superoxide level was significantly increased in the placental tissue of pre-eclamptic women. Moreover, upon inhibition of Cu-Zn superoxide dismutase (SOD) activity the relative increase of the superoxide levels was significantly smaller in the placentae from the PE patients, implying decreased basal Cu-Zn SOD activity. These findings lend direct support to the hypothesis that oxidative stress in placental tissue is increased in PE.
Collapse
Affiliation(s)
- J M Sikkema
- Department of Obstetrics, Gynaecology and Neonatology, University Medical Centre Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
43
|
Vermeulen GM, Bruinse HW, Gerards LJ, de Vries LS. Perinatal risk factors for cranial ultrasound abnormalities in neonates born after spontaneous labour before 34 weeks. Eur J Obstet Gynecol Reprod Biol 2001; 94:290-5. [PMID: 11165741 DOI: 10.1016/s0301-2115(00)00337-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for cranial ultrasound abnormalities in neonates born after spontaneous preterm labour with or without prolonged premature rupture of the membranes (PROM). METHODS The presence of intraventricular haemorrhage and cystic periventricular leucomalacia was investigated in a cohort of neonates born between 24 and 34 weeks using cranial ultrasound. A stepwise forward logistic regression was performed to analyse the influence of antenatal and postnatal variables on cranial ultrasound abnormalities. RESULTS The study group consisted of 205 neonates and cranial ultrasound abnormalities were identified in 27 infants. Early onset neonatal infectious disease (OR 3.09, 95% CI 1.24--7.70, P=0.01) increased the risk for cranial ultrasound abnormalities. Gestational age at birth (OR 0.96, 95% CI 0.93--0.99, P=0.03) and a full course of antenatal steroids (OR 0.33, 95% CI 0.13--0.85, P=0.02) reduced the risk for cranial ultrasound abnormalities. CONCLUSION Early onset neonatal infectious disease is an independent risk factor for cranial ultrasound abnormalities in the very preterm neonate born after spontaneous labour with or without PROM.
Collapse
Affiliation(s)
- G M Vermeulen
- Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, PO Box 502, NL 7940 AM Meppel, The Netherlands.
| | | | | | | |
Collapse
|
44
|
Abstract
According to the fetal origins hypothesis, normal growth and development of abdominal organs is disturbed by intra-uterine growth restriction, leading to diseases later in life. The aims of this study were to investigate the effect of growth restriction on the ovaries of human fetuses and to investigate the dynamics of follicular growth in normal fetuses. We selected 21 normal female fetuses (controls) and seven severely intra-uterine growth-restricted female fetuses (IUGR cases) from all autopsy records over a 10-year period. Ovarian volume was calculated and from histological sections the volume-percentage of follicles in the ovarian cortex, the maximum diameters of individual follicles and the distribution of the follicle classes and oogonia were determined. The volume of the ovaries increased significantly from 0.10 to 0.36 cm3 in the second half of gestation. The mean volume-percentage of ovarian follicles and the mean follicle diameter significantly increased with 0.48% and 0.52 microm per week, respectively. Class B/C (intermediary) follicles (72%) were predominantly present. Class B (primordial) follicles decreased from over 20% to less than 10% and class C (primary) increased from 6 to 19%. Class A (oogonia) were frequently present before 30 gestational weeks, but were rare after that age. For all studied parameters we did not find differences between IUGR cases and controls. Intra-uterine growth restriction does not seem to disturb ovarian development in the human fetus. In the second half of gestation the follicle pool increases by the growth of individual follicles, the transition of follicle to larger classes, and probably by increasing follicle numbers. As most follicles at term were class B/C and C, follicles up to class C are probably part of the resting stock.
Collapse
Affiliation(s)
- J P de Bruin
- Department of Obstetrics and Gynaecology, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
45
|
Sikkema JM, Robles de Medina PG, Schaad RR, Mulder EJ, Bruinse HW, Buitelaar JK, Visser GH, Franx A. Salivary cortisol levels and anxiety are not increased in women destined to develop preeclampsia. J Psychosom Res 2001; 50:45-9. [PMID: 11259800 DOI: 10.1016/s0022-3999(00)00208-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare salivary cortisol levels and maternal anxiety (general and pregnancy-specific) in the early and late second trimester of pregnancy between women who developed preeclampsia (PE) and women who remained normotensive. DESIGN Nested case-referent study. In a prospectively studied cohort of 250 pregnant women, nine women developed PE in late pregnancy. These nine patients were matched and compared with nine controls. Diurnal cortisol levels were obtained by collecting saliva samples at 17-18 and 27-28 weeks gestation. Salivary cortisol levels were determined by radioimmunoassay. Maternal anxiety was determined by Spielberger's State-Trait Anxiety Inventory (STAI) and a pregnancy-specific stress questionnaire. RESULTS For both patients and controls, a similar pattern of salivary cortisol excretion was observed. Salivary cortisol levels and anxiety scores (general and pregnancy-specific) did not differ significantly between patients and controls. CONCLUSIONS Our findings do not lend support to a role for maternal anxiety or second trimester increases in circulating stress hormones in the pathogenesis of PE.
Collapse
Affiliation(s)
- J M Sikkema
- Department of Obstetrics, University Medical Center, KE4.134.2, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Koudstaal J, Braat DD, Bruinse HW, Naaktgeboren N, Vermeiden JP, Visser GH. Obstetric outcome of singleton pregnancies after IVF: a matched control study in four Dutch university hospitals. Hum Reprod 2000; 15:1819-25. [PMID: 10920110 DOI: 10.1093/humrep/15.8.1819] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [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: 11/13/2022] Open
Abstract
In singleton pregnancies after IVF a high rate of preterm deliveries and an increased rate of small-for-gestational age (SGA) children in comparison to the general parturient population have been reported. However, due to differences between IVF mothers and their peers who conceived naturally, careful selection of the control group is necessary to assess whether IVF pregnancies really carry increased risks of adverse outcome. In our study 307 IVF pregnancies were compared with 307 control pregnancies after elaborate matching for an extensive number of maternal characteristics, as well as for the hospital that provided the obstetric care. Four Dutch university hospitals contributed to the study. In cases with spontaneous onset of labour, gestational age at delivery was 3 days shorter in the IVF group (275 versus 278 days, P = 0.05). The proportion of SGA was higher in the IVF group (16.2 versus 7.9%, P < 0.001). The combination of these two results denotes a distinct difference between IVF and control pregnancies. Placental weight was comparable in both groups.
Collapse
Affiliation(s)
- J Koudstaal
- Department of Obstetrics and Gynaecology, University Medical Centre, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Koudstaal J, Bruinse HW, Helmerhorst FM, Vermeiden JP, Willemsen WN, Visser GH. Obstetric outcome of twin pregnancies after in-vitro fertilization: a matched control study in four Dutch university hospitals. Hum Reprod 2000; 15:935-40. [PMID: 10739845 DOI: 10.1093/humrep/15.4.935] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [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: 11/14/2022] Open
Abstract
In singleton pregnancies after in-vitro fertilization (IVF), increased rates of obstetric and perinatal complications have been reported. Studies that compared IVF twin pregnancies with spontaneously conceived twins have yielded conflicting results. We compared 96 IVF twin pregnancies to 96 controls after elaborate matching. The design of our study precluded matching by zygosity. The monozygosity rate was higher in the control group and this implies that beforehand the risk for a less favourable outcome in the control group was higher than in the IVF group. However, the average birthweight of the IVF children was less than that of children in the control group (P = 0.04). This was not due to more intrauterine growth retardation in the IVF group. The mean gestational age at birth was 5 days shorter in IVF than control pregnancies, and although this difference was not significant it might explain the lower birthweight in the IVF group. The discordance rate in the IVF group was significantly increased. We found no difference in perinatal mortality and morbidity. We conclude that this study provides further evidence for a different outcome of IVF twin pregnancies in comparison with spontaneously conceived twin pregnancies.
Collapse
Affiliation(s)
- J Koudstaal
- Department of Obstetrics and Gynaecology, University Medical Centre, PO Box 8550, 3508 GA Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
49
|
Stoutenbeek P, Bruinse HW, de Vries LS. [Discordant fetal growth in multiple pregnancy: intervention should be based on chorionicity]. Ned Tijdschr Geneeskd 1999; 143:1889-90. [PMID: 10526604] [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: 02/14/2023]
|
50
|
Schaap AH, Wolf H, Bruinse HW, Smolders-de Haas H, van Ertbruggen I, Treffers PE. School performance and behaviour in extremely preterm growth-retarded infants. Eur J Obstet Gynecol Reprod Biol 1999; 86:43-9. [PMID: 10471141 DOI: 10.1016/s0301-2115(99)00041-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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 To describe school performance and behaviour of extremely preterm, growth-retarded infants. DESIGN Cohort study at two tertiary care centres. Included were all surviving, singleton infants (N= 127) with fetal growth retardation due to placental insufficiency. All were delivered by caesarean section because of signs of fetal distress before the beginning of labour at a gestational age of 26 to 32 weeks during the years 1984-1989. Main outcome measures were special education, mainstream education below the appropriate age level and behaviour according to attention-deficit hyperactivity criteria at school age (4 1/2-10 1/2 yrs). The children were divided into two subgroups according to age at follow-up (> or =7 1/2 and <7 1/2 yr). A logistic regression analysis was performed with special school or repeating a grade and behavioural disturbance as dependent variables and gestational age, birth weight, sex of the infant, neonatal complications (intra cerebral haemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia or sepsis), age category at follow-up and sociodemographic factors as independent variables. RESULTS 114 (90%) had a complete follow-up. Special education was found in 14% of the assessed children. More children in the older age group than in the younger age group were placed in special school (20% versus 10%). Behavioural problems were scored in 39% of the assessed children attending mainstream education. Special education was related to neonatal complications (bronchopulmonary dysplasia), behavioural problems to the absence of either parent. CONCLUSION This specific group of growth-retarded children is at serious disadvantage for adequate performance in school, although the incidence of special education and behavioural problems was comparable to other preterm infants. Both special education and behavioural problems were not related to obstetric variables as gestational age and/or birth weight.
Collapse
Affiliation(s)
- A H Schaap
- Department of Obstetrics, Academic Medical Centre, University of Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|