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Verrips M, van Haren JS, Oei SG, Moser A, der Hout-van der Jagt MBV. Clinical aspects of umbilical cord cannulation during transfer from the uterus to a liquid-based perinatal life support system for extremely premature infants a qualitative generic study. PLoS One 2023; 18:e0290659. [PMID: 38127930 PMCID: PMC10734990 DOI: 10.1371/journal.pone.0290659] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/13/2023] [Indexed: 12/23/2023] Open
Abstract
A liquid-based perinatal life support system (PLS) for extremely premature infants (born before 28 week of gestational age) envisions a connection between the infant's native umbilical cord and an artificial placenta system through cannulation. This system mimics a natural mothers' womb to achieve better organ maturations. The objective of this study is to gain insight into the clinical focus points of umbilical cord cannulation and how cannulation should be addressed in extremely premature infants during the transfer from the uterus to an in-utero simulating liquid-based PLS system. We performed an explorative qualitative study. Twelve medical specialists with knowledge of vessel cannulation participated. We collected data through twelve interviews and two focus group discussions. Data were analyzed using inductive content and constant comparison analysis via open and axial coding. Results were derived on the following topics: (1) cannulation technique, (2) cannula fixation, (3) local and systemic anticoagulation, and (4) vasospasm. A side-entry technique is preferred as this may decrease wall damage, stabilizes the vessel better and ensures continuous blood flow. Sutures, especially via an automatic microsurgery instrument, are favored above glue, stents, or balloons as these may be firmer and faster. Medication possibilities for both vasospasm and anticoagulation should function locally since there were uncertainties regarding the systemic effects. According to the findings of this research, the needed umbilical cord cannulation method should include minimal wall damage, improved vascular stability, blood flow maintenance, a strong fixation connection, and local anticoagulation effect.
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Affiliation(s)
- M. Verrips
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - J. S van Haren
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Faculty of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S. G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - A Moser
- Department of Family Practice, Maastricht University, Maastricht, the Netherlands
| | - M. B. Van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Hulsenboom ADJ, Van der Hout-van der Jagt MB, van den Akker ESA, Bakker PCAM, van Beek E, Drogtrop AP, Kwee A, Westerhuis MEMH, Rijnders RJP, Schuitemaker NWE, Willekes C, Vullings R, Oei SG, van Laar JOEH. New possibilities for ST analysis - A post-hoc analysis on the Dutch STAN RCT. Early Hum Dev 2022; 166:105537. [PMID: 35091162 DOI: 10.1016/j.earlhumdev.2021.105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnostic value of ST analysis of the fetal electrocardiogram (fECG) during labor is uncertain. False alarms (ST events) may be explained by physiological variation of the fetal electrical heart axis. Adjusted ST events, based on a relative rather than an absolute rise from baseline, correct for this variation and may improve the diagnostic accuracy of ST analysis. AIMS Determine the optimal cut-off for relative ST events in fECG to detect fetal metabolic acidosis. STUDY DESIGN Post-hoc analysis on fECG tracings from the Dutch STAN trial (STAN+CTG branch). SUBJECTS 1328 term singleton fetuses with scalp ECG tracing during labor, including 10 cases of metabolic acidosis. OUTCOME MEASURES Cut-off value for relative ST events at the point closest to (0,1) in the receiver operating characteristic (ROC) curve with corresponding sensitivity and specificity. RESULTS Relative baseline ST events had an optimal cut-off at an increment of 85% from baseline. Relative ST events had a sensitivity of 90% and specificity of 80%. CONCLUSIONS Adjusting the current definition of ST events may improve ST analysis, making it independent of CTG interpretation.
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Affiliation(s)
- A D J Hulsenboom
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands.
| | - M B Van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - E S A van den Akker
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - P C A M Bakker
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - E van Beek
- Department of Obstetrics and Gynecology, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands
| | - A P Drogtrop
- Department of Obstetrics and Gynecology, Elisabeth Tweesteden Hospital, P.O. Box 90151, LC 5000 Tilburg, the Netherlands
| | - A Kwee
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - M E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, ZA 5602 Eindhoven, the Netherlands
| | - R J P Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME Hertogenbosch, the Netherlands
| | - N W E Schuitemaker
- Department of Obstetrics and Gynecology, Diakonessenhuis, P.O. Box 80250, 3508 TG Utrecht, the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Vullings
- Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
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