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van Baar PM, Grijzenhout WFJ, de Boer MA, de Groot CJM, Pajkrt E, Broekman BFP, van Pampus MG. Considering multifetal pregnancy reduction in triplet pregnancies: do we forget the emotional impact on fathers? A qualitative study from The Netherlands. Hum Reprod 2024; 39:569-577. [PMID: 38199783 PMCID: PMC10905497 DOI: 10.1093/humrep/dead275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
STUDY QUESTION What factors influence the decision-making process of fathers regarding multifetal pregnancy reduction or maintaining a triplet pregnancy, and how do these decisions impact their psychological well-being? SUMMARY ANSWER For fathers, the emotional impact of multifetal pregnancy reduction or caring for triplets is extensive and requires careful consideration. WHAT IS KNOWN ALREADY Multifetal pregnancy reduction is a medical procedure with the purpose to reduce the number of fetuses to improve chances of a healthy outcome for both the remaining fetus(es) and the mother, either for medical reasons or social considerations. Aspects of the decision whether to perform multifetal pregnancy reduction have been rarely investigated, and the impact on fathers is unknown. STUDY DESIGN, SIZE, DURATION Qualitative study with semi-structured interviews between October 2021 and February 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS Fathers either after multifetal pregnancy reduction from triplet to twin or singleton pregnancy or ongoing triplet pregnancies 1-6 years after the decision were included. The interview schedule was designed to explore key aspects related to (i) the decision-making process whether to perform multifetal pregnancy reduction and (ii) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns and trends in the father's data. The process involved familiarization with the data, defining and naming themes, and producing a final report. This study was a collaboration between a regional secondary hospital (OLVG) and a tertiary care hospital (Amsterdam University Medical Center, Amsterdam UMC), both situated in Amsterdam, The Netherlands. MAIN RESULTS AND THE ROLE OF CHANCE Data saturation was achieved after 12 interviews. Five main themes were identified: (i) initial responses and emotional complexity, (ii) experiencing disparities in counselling quality and post-decision care, (iii) personal influences on the decision journey, (iv) navigating parenthood: choices, challenges, and emotional adaptation, and (v) shared wisdom and lessons. For fathers, the decision whether to maintain or reduce a triplet pregnancy is complex, in which medical, psychological but mainly social factors play an important role. In terms of psychological consequences after the decision, this study found that fathers after multifetal pregnancy reduction often struggled with difficult emotions towards the decision; some expressed feelings of doubt or regret and were still processing these emotions. Several fathers after an ongoing triplet had experienced a period of severe stress in the first years after the pregnancy, with major consequences for their mental health. Help in emotional processing was not offered to any of the fathers after the decision or birth. LIMITATION, REASONS FOR CAUTION While our study focuses on the multifetal pregnancy reduction process in the Amsterdam region, we recognize the importance of further investigation into how this process may vary across different regions in The Netherlands and internationally. We acknowledge the potential of selection bias, as fathers with more positive experiences might have been more willing to participate. Caution is needed in interpreting the role of the mother in the recruitment process. Additionally, the time span of 1-6 years between the decision and the interviews may have influenced emotional processing and introduced potential reporting bias. WIDER IMPLICATIONS OF THE FINDINGS The emotional impact of multifetal pregnancy reduction or caring for triplets is significant, emphasizing the need for awareness among caregivers regarding the emotional challenges faced by fathers. A guided trajectory might optimize the decision-making and primarily facilitate the provision of appropriate care thereafter to optimize outcomes around decisions with potential traumatic implications. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- P M van Baar
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - M A de Boer
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - C J M de Groot
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - E Pajkrt
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - B F P Broekman
- Department of Psychiatry, OLVG, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Mental Health Program, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
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Leeuwerik AF, van Merendonk LN, de Boer MA, Wilhelm AJ, Kolkman A, Bet PM. A new approach to drug intravenous compatibility research: the case of obstetric parenteral drugs. Eur J Hosp Pharm 2023:ejhpharm-2022-003577. [PMID: 36931718 DOI: 10.1136/ejhpharm-2022-003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES The product information and literature does not provide confirmation of compatibility for co-administration of all commonly used drug pairs in obstetrics. However, there is a need for co-administration of these drugs over one lumen for this group of patients. Therefore, this study focuses on Y-site compatibility. Since different conditions between clinical and laboratory settings can lead to discrepancies in results, a novel approach for drug intravenous compatibility testing was designed to reflect clinical conditions. The aim was to study the compatibility of nine commonly used drug pairs in obstetrics and to evaluate the clinical value of the designed method. METHODS The clinical situation was reflected by using different temperature ranges (20°C and 37°C), actual Y-site flow ratios, clinically relevant drug pairs and an observation time of 120 min. The clinically relevant drugs pairs include atosiban, nicardipine, amoxicillin/clavulanic acid, oxytocin, remifentanil, labetalol and magnesium sulpfate. Drug pairs were visually assessed according to the European Pharmacopoeia (Ph. Eur.) and pH was measured. When incompatibility of a drug pair seemed likely based on literature review or observed abnormalities during visual assessment, subvisual analysis was performed using a particle counter. Y-site compatibility applied for drug pairs when no visual changes occurred or when no additional particles were formed during the observation time. RESULTS Eight of the nine combinations showed no visual changes or noticeable changes in pH during the observation time. The amoxicillin/clavulanic-acid-oxytocin combination showed a colour change at 37°C at the actual Y-site flow ratio. However, subvisual particle counting showed no formation of additional particles. CONCLUSIONS Y-site compatibility was established for all tested drug pairs. The new clinical approach for analysing Y-site compatibility provides a high certainty of outcomes for clinical practice. In this way, clinical complications and use of several additional intravenous catheters can be avoided.
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Affiliation(s)
- A F Leeuwerik
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - L N van Merendonk
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - M A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands.,Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - A J Wilhelm
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - A Kolkman
- Laboratory of the Dutch Pharmacists, The Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | - P M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, Netherlands
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van Limburg Stirum EVJ, Zegveld SJ, Simons NE, de Boer MA, Pajkrt E, Mol BWJ, Oudijk MA, van 't Hooft J. Consequences of cervical pessary for subsequent pregnancy: follow-up of randomized clinical trial (ProTWIN). Ultrasound Obstet Gynecol 2022; 59:771-777. [PMID: 34826166 PMCID: PMC9328140 DOI: 10.1002/uog.24821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effect of cervical pessary, as a strategy to prevent preterm birth (PTB), on the outcome of subsequent pregnancy and maternal quality of life 4 years after the index twin pregnancy. METHODS Between 2009 and 2012, the ProTWIN trial randomized women with a multiple pregnancy to pessary use vs standard care for the prevention of PTB. The trial showed no benefit in unselected women with a twin pregnancy, but showed a 60% reduction in poor perinatal outcomes in favor of the pessary group in the subgroup of women with a mid-trimester short cervix (cervical length < 38 mm). All women were invited to participate in a follow-up study 4 years after their participation in the ProTWIN trial. In this follow-up study, maternal quality of life was assessed using the EQ-5D-3L questionnaire and women were asked separate questions about subsequent pregnancies. Results were compared between women who were randomized to the pessary vs the control group in the ProTWIN trial by calculating relative risk (RR) and 95% CI. Subgroup analysis was performed for women with a mid-trimester short cervix (cervical length < 38 mm). RESULTS Of the 813 women included in the ProTWIN trial, 408 (50.2%) participated in this follow-up study, comprising 228 randomized to the pessary group and 180 to the control group in the original trial. The median interval between participation in the ProTWIN trial and participation in this follow-up study was 4.1 (interquartile range (IQR), 3.9-7.1) years. Ninety-eight (24.0%) participants tried to conceive after their participation in the ProTWIN trial. Of those, 22 (22.4%) women did not have a subsequent pregnancy (no difference between pessary and control groups), seven (7.1%) women had at least one miscarriage but no live birth, and 67 (68.4%) women had at least one live birth (35 in the pessary vs 32 in the control group; RR, 0.93 (95% CI, 0.8-1.07)). In two women, the pregnancy outcome was unknown. Preterm delivery (< 37 weeks of gestation) of the first live birth occurred in three women in the pessary vs one woman in the control group (all singleton; RR, 2.57 (95% CI, 0.28-23.44)). No differences were found between the pessary and control groups in the subgroup of women with mid-trimester short cervix, but the numbers analyzed were small. The median health state index score was 0.95 (IQR, 0.82-0.95), with no difference between the pessary and control groups. CONCLUSION Our findings suggest that there are no long-term effects of pessary use on the outcome of subsequent pregnancies and maternal quality of life. Data on obstetric outcome were limited due to the small numbers. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. V. J. van Limburg Stirum
- Department of Obstetrics and Gynecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
| | - S. J. Zegveld
- Department of Obstetrics and Gynecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
| | - N. E. Simons
- Department of Obstetrics and Gynecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
| | - M. A. de Boer
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC locationVrije UniversiteitAmsterdamThe Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
| | - B. W. J. Mol
- Department of Obstetrics and GynecologyMonash UniversityMelbourneVictoriaAustralia
- Aberdeen Centre for Women's Health Research, School of MedicineUniversity of AberdeenAberdeenUK
| | - M. A. Oudijk
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC locationVrije UniversiteitAmsterdamThe Netherlands
| | - J. van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and Development InstituteAmsterdamThe Netherlands
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Rennert KN, Breuking SH, Schuit E, Bekker MN, Woiski M, de Boer MA, Sueters M, Scheepers HCJ, Franssen MTM, Pajkrt E, Mol BWJ, Kok M, Hermans FJR. Change in cervical length after arrested preterm labor and risk of preterm birth. Ultrasound Obstet Gynecol 2021; 58:750-756. [PMID: 33860985 PMCID: PMC8596619 DOI: 10.1002/uog.23653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/26/2021] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women. METHODS In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15-30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission. RESULTS A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09-0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62-3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84-0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82-1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results. CONCLUSION Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K. N. Rennert
- Faculty of Medicine, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - S. H. Breuking
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - M. N. Bekker
- Department of Obstetrics and GynaecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - M. Woiski
- Department of Obstetrics and GynaecologyRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
| | - M. A. de Boer
- Department of Obstetrics and GynaecologyAmsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - M. Sueters
- Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands
| | - H. C. J. Scheepers
- Department of Obstetrics and GynaecologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - M. T. M. Franssen
- Department of ObstetricsUniversity Medical Center GroningenGroningenThe Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - B. W. J. Mol
- Department of Obstetrics and Gynaecology, School of MedicineMonash UniversityMelbourneVictoriaAustralia
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | - M. Kok
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - F. J. R. Hermans
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Cool J, van Schuppen J, de Boer MA, van Royen BJ. Accuracy assessment of pedicle screw insertion with patient specific 3D‑printed guides through superimpose CT-analysis in thoracolumbar spinal deformity surgery. Eur Spine J 2021; 30:3216-3224. [PMID: 34355276 DOI: 10.1007/s00586-021-06951-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In order to avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‑printed guides can be used. An accuracy assessment of pedicle screw insertion can be obtained by superimposing CT-scan images from a preoperative plan over those of the postoperative result. The aim of this study is to report on the accuracy of drill guide assisted pedicle screw placement in thoracolumbar spinal deformity surgery by means of a superimpose CT-analysis. METHODS Concomitant with the clinical introduction of a new technique for drill guide assisted pedicle screw placement, the accuracy of pedicle screw insertion was analyzed in the first patients treated with this technique by using superimpose CT-analysis. Deviation from the planned ideal intrapedicular screw trajectory was classified according to the Gertzbein scale. RESULTS Superimpose CT-analysis of 99 pedicle screws in 5 patients was performed. The mean linear deviation was 0.92 mm, the mean angular deviation was 2.92° with respect to the preoperatively planned pedicle screw trajectories. According to the Gertzbein scale, 100% of screws were found to be positioned within the "safe zone". CONCLUSION The evaluated patient specific 3D-printed guide technology was demonstrated to constitute a safe and accurate tool for precise pedicle screw insertion in spinal deformity surgeries. Superimpose CT-analysis showed a 100% accuracy of pedicle screw placement without any violation of the pedicle wall or other relevant structures. We recommend a superimpose CT-analysis for the first consecutive patients when introducing new technologies into daily clinical practice, such as intraoperative imaging, navigation or robotics.
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Affiliation(s)
- J Cool
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M A de Boer
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B J van Royen
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Vollgraff Heidweiller-Schreurs CA, van Osch IR, Heymans MW, Ganzevoort W, Schoonmade LJ, Bax CJ, Mol B, de Groot C, Bossuyt P, de Boer MA. Cerebroplacental ratio in predicting adverse perinatal outcome: a meta-analysis of individual participant data. BJOG 2020; 128:226-235. [PMID: 32363701 PMCID: PMC7818434 DOI: 10.1111/1471-0528.16287] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
Objective To investigate if cerebroplacental ratio (CPR) adds to the predictive value of umbilical artery pulsatility index (UA PI) alone – standard of practice – for adverse perinatal outcome in singleton pregnancies. Design and setting Meta‐analysis based on individual participant data (IPD). Population or sample Ten centres provided 17 data sets for 21 661 participants, 18 731 of which could be included. Sample sizes per data set ranged from 207 to 9215 individuals. Patient populations varied from uncomplicated to complicated pregnancies. Methods In a collaborative, pooled analysis, we compared the prognostic value of combining CPR with UA PI, versus UA PI only and CPR only, with a one‐stage IPD approach. After multiple imputation of missing values, we used multilevel multivariable logistic regression to develop prediction models. We evaluated the classification performance of all models with receiver operating characteristics analysis. We performed subgroup analyses according to gestational age, birthweight centile and estimated fetal weight centile. Main outcome measures Composite adverse perinatal outcome, defined as perinatal death, caesarean section for fetal distress or neonatal unit admission. Results Adverse outcomes occurred in 3423 (18%) participants. The model with UA PI alone resulted in an area under the curve (AUC) of 0.775 (95% CI 0.709–0.828) and with CPR alone in an AUC of 0.778 (95% CI 0.715–0.831). Addition of CPR to the UA PI model resulted in an increase in the AUC of 0.003 points (0.778, 95% CI 0.714–0.831). These results were consistent across all subgroups. Conclusions Cerebroplacental ratio added no predictive value for adverse perinatal outcome beyond UA PI, when assessing singleton pregnancies, irrespective of gestational age or fetal size. Tweetable abstract Doppler measurement of cerebroplacental ratio in clinical practice has limited added predictive value to umbilical artery alone. Doppler measurement of cerebroplacental ratio in clinical practice has limited added predictive value to umbilical artery alone.
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Affiliation(s)
- C A Vollgraff Heidweiller-Schreurs
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - I R van Osch
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L J Schoonmade
- Department of Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C J Bax
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bwj Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Cjm de Groot
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pmm Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Boer
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
Objective To determine the risk of overall preterm birth (PTB) and spontaneous PTB in a pregnancy after a caesarean section (CS) at term. Design Longitudinal linked national cohort study. Setting The Dutch Perinatal Registry (1999–2009). Population 268 495 women with two subsequent singleton pregnancies were identified. Methods A cohort study based on linked registered data from two subsequent pregnancies in the Netherlands. Main outcome measures The incidence of overall PTB and spontaneous PTB with subgroup analysis on gestational age at first delivery and type of CS (planned or unplanned). Results Of 268 495 women with a singleton first pregnancy who delivered at term, 15.76% (n = 42 328) had a CS. The incidence of PTB in the second pregnancy was 2.79% (n = 1182) in women with a previous CS versus 2.46% (n = 5570) in women with a previous vaginal delivery (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.07–1.21). This increased risk is mainly driven by an increased risk of spontaneous PTB after previous CS at term (aOR 1.50, 95% CI 1.38–1.70). Analysis for type of CS compared with vaginal delivery showed an aOR on spontaneous PTB of 1.86 (95% CI 1.58–2.18) for planned CS and an aOR of 1.40 (95% CI 1.24–1.58) for unplanned CS. Conclusions CS at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Tweetable abstract Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.
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Affiliation(s)
- L Visser
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - C Slaager
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - B M Kazemier
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A L Rietveld
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Cjm de Groot
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - M A de Boer
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Nijman T, van Baaren GJ, van Vliet E, Kok M, Gyselaers W, Porath MM, Woiski M, de Boer MA, Bloemenkamp K, Sueters M, Franx A, Mol B, Oudijk MA. Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial). BJOG 2019; 126:875-883. [PMID: 30666783 DOI: 10.1111/1471-0528.15625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. DESIGN An economic analysis alongside a randomised clinical trial (the APOSTEL III study). SETTING Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. POPULATION Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. METHODS We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses. MAIN OUTCOME MEASURES Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes. RESULTS Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) -€8479 [95% confidence interval (CI) -€14,327 to -€2016)]; multiple pregnancies: €90,248 versus €102,292, MD -€12,044 (95% CI -€21,607 to € -1671). There was a non-significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group. CONCLUSION Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation. TWEETABLE ABSTRACT In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
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Affiliation(s)
- Taj Nijman
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - G J van Baaren
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eog van Vliet
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Kok
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W Gyselaers
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - M M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology, University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - M A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Kwm Bloemenkamp
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A Franx
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bwj Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Vic., Australia
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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9
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Pels A, Mensing van Charante NA, Vollgraff Heidweiller-Schreurs CA, Limpens J, Wolf H, de Boer MA, Ganzevoort W. The prognostic accuracy of short term variation of fetal heart rate in early-onset fetal growth restriction: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 234:179-184. [PMID: 30710764 DOI: 10.1016/j.ejogrb.2019.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Cardiotocography (CTG) is an important tool for fetal surveillance in severe early-onset fetal growth restriction (FGR). Assessment of the CTG is usually performed visually (vCTG). However, it is suggested that computerized analysis of the CTG (cCTG) including short term variability (STV) could more accurately detect fetal compromise. The objective of this study was to systematically review the literature on the association between cCTG and perinatal outcome and the comparison of cCTG with vCTG. STUDY DESIGN A systematic search was performed in MEDLINE, EMBASE and Google Scholar. Studies were included that assessed prognostic accuracy of STV or compared STV to vCTG in patients with FGR. Risk of bias and concerns about applicability were assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) instrument. RESULTS Of the 885 records identified in the search, five cohort studies (387 patients) were included. We found no randomized studies comparing STV with visual CTG in patients with FGR. The risk of bias of all studies was generally judged as 'low'. One small study found an association of low STV with neonatal acidosis. One study observed no association of STV with long-term outcome. Composite analysis of all five studies showed a non-significant relative risk for acidosis after a low STV of 1.4 (95% CI 0.6-3.2, N = 387). Further meta-analysis was hampered due to heterogeneity in outcome reporting and use of different thresholds. CONCLUSION The evidence from the included studies did not support an association of STV and short or long term outcome. However, available data are limited and heterogeneous, and influenced by management based on STV. Solid evidence from a randomized controlled trial comparing STV with vCTG including long term infant outcome is needed before STV can be used clinically for timing of delivery in patients with FGR.
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Affiliation(s)
- A Pels
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - N A Mensing van Charante
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - J Limpens
- Amsterdam UMC, University of Amsterdam, Medical Library, Meibergdreef 9, Amsterdam, the Netherlands
| | - H Wolf
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W Ganzevoort
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
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10
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Schreurs CA, Mol BWJ, de Boer MA. Re: Consensus definition for placental fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2017; 49:159. [PMID: 28058787 DOI: 10.1002/uog.17321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Affiliation(s)
- C A Schreurs
- Department of Obstetrics and Gynecology, Vrije University Medical Centre, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynecology, The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
- The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - M A de Boer
- Department of Obstetrics and Gynecology, Vrije University Medical Centre, Amsterdam, The Netherlands
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11
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Verweij EJ, de Boer MA, Oepkes D. Non-invasive prenatal testing for trisomy 13: more harm than good? Ultrasound Obstet Gynecol 2014; 44:112-114. [PMID: 24753041 DOI: 10.1002/uog.13388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
A 35-year-old primigravida, pregnant after in-vitro fertilization, was seen because of a trisomy 13/trisomy 18 (T13/T18) risk of 1:55, based on the result of her first-trimester combined test. She elected for non-invasive prenatal testing (NIPT) at 14 + 5 weeks' gestation, which was positive for T13. After counseling, the patient elected to undergo amniocentesis. Quantitative fluorescence polymerase chain reaction (QF-PCR) showed no signs of trisomy, and full karyotyping confirmed a normal 46,XY result. Analysis of the published literature on NIPT for T13 gives an overall detection rate of 91.6%, with a false-positive rate of 0.097%. Based on this detection rate, hypothetical calculations show that the positive predictive value is highly dependent on the prevalence of the disease, resulting in an unfavorable balance between benefit and harm in a general population.
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Affiliation(s)
- E J Verweij
- Leiden University Medical Center, Department of Obstetrics, Leiden, The Netherlands
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12
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Abstract
Rare earth elements (REEs) are important for green and a large variety of high-tech technologies and are, therefore, in high demand. As a result, supply with REEs is likely to be disrupted (the degree of depends on the REE) in the near future. The 17 REEs are divided into heavy and light REEs. Other critical elements besides REEs, identified by the European Commission, are also becoming less easily available. Although there is no deficiency in the earth's crust of rare earth oxides, the economic accessibility is limited. The increased demand for REEs, the decreasing export from China, and geopolitical concerns on availability contributed to the (re)opening of mines in Australia and the USA and other mines are slow to follow. As a result, short supply of particularly terbium, dysprosium, praseodymium, and neodymium is expected to be problematic for at least the short term, also because they cannot be substituted. Recycling REEs from electronic waste would be a solution, but so far there are hardly any established REE recycling methods. Decreasing the dependency on REEs, for example, by identifying possible replacements or increasing their efficient use, represents another possibility.
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Affiliation(s)
- M A de Boer
- Department of Chemistry and Pharmaceutical Sciences, VU University Amsterdam, De Boelelaan 1083, 1081 HV Amsterdam (The Netherlands)
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13
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Verweij EJ, Jacobsson B, van Scheltema PA, de Boer MA, Hoffer MJV, Hollemon D, Westgren M, Song K, Oepkes D. European non-invasive trisomy evaluation (EU-NITE) study: a multicenter prospective cohort study for non-invasive fetal trisomy 21 testing. Prenat Diagn 2013; 33:996-1001. [PMID: 23794121 DOI: 10.1002/pd.4182] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/04/2013] [Accepted: 06/17/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the performance of a directed non-invasive prenatal testing method of cell-free DNA analysis for fetal trisomy 21 (T21) by shipping the whole blood samples from Europe to a laboratory in the USA. METHODS A European multicenter prospective, consecutive cohort study was performed enrolling pregnant women from Sweden and the Netherlands. Blood samples were drawn just prior to a planned of invasive diagnostic procedure in a population at increased risk for fetal T21 and then shipped to the USA without any blood processing. Chromosome-selective sequencing was carried out on chromosome 21 with reporting high risk or low risk of T21. Karyotyping or rapid aneuploidy detection was used as the clinical reference standard. RESULTS Of the 520 eligible study subjects, a T21 test result was obtained in 504/520 (96.9%). Risk assessment was accurate in 503/504 subjects (99.8%). There was one false negative result for T21 (sensitivity 17/18, 94.4%, and specificity 100%). CONCLUSION This is the first prospective European multicenter study showing that non-invasive prenatal testing using directed sequencing of cell-free DNA applied to blood samples shipped across the Atlantic Ocean, is highly accurate for assessing risk of fetal T21.
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Affiliation(s)
- E J Verweij
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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14
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Verweij EJ, de Boer MA, Oepkes D. Non-invasive prenatal diagnosis for Down syndrome: no paradigm shift, just better testing... and it is already here! Ultrasound Obstet Gynecol 2012; 40:484-486. [PMID: 23008103 DOI: 10.1002/uog.12287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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15
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Verweij EJ, van den Oever JME, de Boer MA, Boon EMJ, Oepkes D. Diagnostic Accuracy of Noninvasive Detection of Fetal Trisomy 21 in Maternal Blood: A Systematic Review. Fetal Diagn Ther 2012; 31:81-6. [PMID: 22094923 DOI: 10.1159/000333060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022]
Affiliation(s)
- E J Verweij
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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16
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Mouchaers KTB, Schalij I, de Boer MA, Postmus PE, van Hinsbergh VWM, van Nieuw Amerongen GP, Vonk Noordegraaf A, van der Laarse WJ. Fasudil reduces monocrotaline-induced pulmonary arterial hypertension: comparison with bosentan and sildenafil. Eur Respir J 2010; 36:800-7. [DOI: 10.1183/09031936.00130209] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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de Boer MA, Vet JNI, Aziz MF, Cornain S, Purwoto G, van den Akker BEWM, Dijkman A, Peters AAW, Fleuren GJ. Human papillomavirus type 18 and other risk factors for cervical cancer in Jakarta, Indonesia. Int J Gynecol Cancer 2006; 16:1809-14. [PMID: 17009976 DOI: 10.1111/j.1525-1438.2006.00701.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/27/2022] Open
Abstract
Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.
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Affiliation(s)
- M A de Boer
- Department of Pathology and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
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18
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de Boer MA, van Huisseling JCM, van Roosmalen J. [Foeto-foetal conflict of interests in multiple pregnancies with severe discordant growth; ethical dilemmas]. Ned Tijdschr Geneeskd 2005; 149:1369-72. [PMID: 15997687] [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: 05/03/2023]
Abstract
Two pregnant women, 19 and 26 years old, presented at the beginning of the third trimester with one growth-retarded foetus in a multiple pregnancy. Both cases were managed conservatively. In the first woman, one foetus died at 30 weeks of gestation, after the mother developed pre-eclampsia. After the death of the impaired foetus pre-eclampsia resolved and the second child was born healthy at 36 weeks of gestation. The second woman had triplets with one severely growth-retarded foetus. This foetus died at 3I weeks of gestation. At 33 & 317 weeks, caesarean section was performed on both maternal and foetal indications. Two healthy premature neonates were born. In multiple pregnancy with discordant growth, the interests of the foetuses may be in opposition, which creates an ethical dilemma. This may be resolved by carefully addressing the interests of all those involved and keeping in mind the prognosis, duration of pregnancy and the best interests of the healthy foetus, which should not be harmed by intervention. Therefore, active intervention is not always the best option; the least harm it does is increasing the risk ofpreterm birth.
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Affiliation(s)
- M A de Boer
- Leids Universitair Medisch Centrum, afd. Verloskunde en Gynaecologie, Leiden
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19
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Abstract
OBJECTIVE The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations. STUDY DESIGN Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously. RESULTS All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant. CONCLUSIONS The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.
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Affiliation(s)
- M A de Boer
- Department of Obstetrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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20
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Tangmunkongvorakul A, Celentano DD, Burke JG, de Boer MA, Wongpan P, Suriyanon V. Factors influencing marital stability among HIV discordant couples in northern Thailand. AIDS Care 1999; 11:511-24. [PMID: 10755027 DOI: 10.1080/09540129947677] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The burden of HIV in stable relationships places emotional, economic and physical stresses on families. We compared the influence of HIV notification on marital partnerships in northern Thailand among a cohort of HIV discordant couples, and identified factors associated with marital disruption. Data were collected using in-depth interviews with both members of six separated or divorced couples and 13 couples whose relationship remained intact. Five factors influenced marital stability following HIV notification: longer duration of relationship; economic constraints, extended family members' opinions, especially parents; the existence of children from the marriage; and fear of stigmatization by community members. Social influences, both overt and perceived, are important in shaping marital behaviour and decision-making in HIV epidemic areas. HIV counselling needs to be extended beyond the individual seeking testing to include stable partners (and perhaps further, to include the extended family), although it is recognized that this is not the norm for most HIV testing centres.
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21
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Nelson KE, Rungruengthanakit K, Margolick J, Suriyanon V, Niyomthai S, de Boer MA, Kawichai S, Robison V, Celentano DD, Nagachinta T, Duerr A. High rates of transmission of subtype E human immunodeficiency virus type 1 among heterosexual couples in Northern Thailand: role of sexually transmitted diseases and immune compromise. J Infect Dis 1999; 180:337-43. [PMID: 10395847 DOI: 10.1086/314882] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The heterosexual transmission of subtype E human immunodeficiency virus type 1 (HIV-1) infection was evaluated in 467 couples in Thailand in whom the man was HIV-1 positive and the woman had no risk factors for HIV other than sex with her infected partner. At baseline, 216 (46.3%) of the 467 women were positive for HIV-1; prevalence of HIV among women was 52.2% when their male partners had CD4+ lymphocyte counts of <200 cells/microL, 45.9% in women whose partners had counts of 200-499 micro/L, and 39.2% in women whose partners had counts of >/=500/microL. Women were twice as likely to be HIV positive if their partners had a history of a sexually transmitted disease (STD); however, their HIV prevalence was 29% among couples who had no STD history. It appears that female partners of men infected with subtype E HIV-1 are at high risk of infection even when the man's CD4+ cell count is relatively high. A high rate of STDs may contribute significantly to this risk [corrected].
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Affiliation(s)
- K E Nelson
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
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22
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de Boer MA, Celentano DD, Tovanabutra S, Rugpao S, Nelson KE, Suriyanon V. Reliability of self-reported sexual behavior in human immunodeficiency virus (HIV) concordant and discordant heterosexual couples in northern Thailand. Am J Epidemiol 1998; 147:1153-61. [PMID: 9645794 DOI: 10.1093/oxfordjournals.aje.a009414] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A partner study was conducted in northern Thailand between March 1992 and June 1996 which included data that allowed an assessment of the reliability of self-reports of sexual behavior and contraceptive use among heterosexual couples. The authors enrolled 529 couples among whom all male subjects were human immunodeficiency virus (HIV) seropositive voluntary blood donors and their female sexual partners were either HIV infected (n=246) or HIV seronegative (n=283). The levels of agreement within couples were assessed for recency of last sexual intercourse, sexual activity in the prior year, and contraceptive practices. For HIV discordant couples, a prospective study was conducted to examine risk factors for HIV transmission, the primary goal of the study. This allowed assessment of reliability of inter-partner reports over 6-12 months. Overall, agreement among couples was good for common sexual practices, especially vaginal intercourse and time since last intercourse, but was lower for condom use. Anal and oral sex were infrequently reported by these couples and there was greater disagreement for the occurrence of these practices. Partner agreement for contraceptive histories was good to excellent. Prospective data showed less frequent intercourse and more condom use but reliability remained good. Common sexual practices may be reliable for both HIV concordant and discordant couples in studies estimating prevalent infection. Estimates of incident heterosexually transmitted HIV may be made with greater reliability by studies which include assessment of reports of risk behavior by each member of a couple than studies of individuals.
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Affiliation(s)
- M A de Boer
- Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA
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23
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Rugpao S, Tovanabutra S, Beyrer C, Nuntakuang D, Yutabootr Y, Vongchak T, de Boer MA, Celentano DD, Nelson KE. Multiple condom use in commercial sex in Lamphun Province, Thailand: a community-generated STD/HIV prevention strategy. Sex Transm Dis 1997; 24:546-9. [PMID: 9339975 DOI: 10.1097/00007435-199710000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE In an investigation of condom breakage in commercial sex, we found a high proportion of multiple condoms use. This study sought to ascertain the characteristics of brothel-based commercial sex workers (CSWs) and their clients; to identify the decision makers (clients and/or CSWs) active in choosing multiple condom use; and to determine whether there is an implicit hierarchy of condom use negotiation. GOALS To identify factors associated with multiple condom use in commercial sex and to provide an understanding of how this innovation developed in this setting. STUDY DESIGN Sixty-seven brothel-based CSWs in Lamphun Province who participated in a study of condom breakage participated in a case-control study of multiple versus single condom use, which determined CSW and client characteristics for evidence of multiple condom use. Interviews and focus groups were used to determine decision making for condom use and the contexts for multiple use. Association between characteristics of CSWs/clients and multiple condom use was analyzed using X2 for trend. RESULTS No official program encouraged multiple condom use; this appeared to be a community-devised strategy to increase protection from human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). CSWs working in daytime brothels had significantly greater multiple condom use than those working in nighttime brothels; mean percentages + SD of multiple simultaneous use were 57.5% + 28.6 and 35.5% + 22.4, respectively (p < 0.001). Day CSWs were older, had more pregnancies, reported higher frequency of STD symptoms and history of pelvic inflammatory disease, and had more clients per day but had a lower number of sex acts per client than night CSWs. Among factors associated with multiple condoms, only age was significant. The decision to use single or multiple condoms for a sex act was primarily (78.2% in single and 79.3% in multiple) made by the CSW herself. The main reason given for multiple condom use was protection from HIV/STD. CONCLUSIONS There is high compliance between CSWs in Lamphun province and the Ministry of Public Health-sponsored 100% condom use campaign, and CSWs are attempting to further reduce their risks of HIV/STD exposure by using multiple condoms for sex with their clients.
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Affiliation(s)
- S Rugpao
- Faculty of Medicine, Chiang Mai University, Thailand
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24
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O'Campo P, de Boer MA, Faden RR, Gielen AC, Kass N, Chaisson R. Discrepancies between women's personal interview data and medical record documentation of illicit drug use, sexually transmitted diseases, and HIV infection. Med Care 1992; 30:965-71. [PMID: 1405802 DOI: 10.1097/00005650-199210000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- P O'Campo
- Department of Maternal and Child Health, John Hopkins School of Hygiene and Public Health, Baltimore, MD
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