1
|
Overtoom EM, Huynh TN, Rosman AN, Zwart JJ, Schaap TP, Vogelvang TE, van den Akker T, Bloemenkamp KWM. Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands. J Matern Fetal Neonatal Med 2024; 37:2311083. [PMID: 38350236 DOI: 10.1080/14767058.2024.2311083] [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: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To estimate the incidence of uterine rupture in the Netherlands and evaluate risk indicators prelabour and during labor of women with adverse maternal and/or perinatal outcome. METHODS This is a population-based nationwide study using the Netherlands Obstetrics Surveillance System (NethOSS). We performed a two-year registration of pregnant women with uterine rupture. The first year of registration included both women with complete uterine rupture and women with incomplete (peritoneum intact) uterine rupture. The second year of registration included women with uterine rupture with adverse maternal and/or perinatal outcome. We collected maternal and obstetric characteristics, clinical signs, and symptoms during labor and CTG abnormalities. The main outcome measures were incidence of complete uterine rupture and uterine rupture with adverse outcome and adverse outcome defined as major obstetric hemorrhage, hysterectomy, embolization, perinatal asphyxia and/or (neonatal) intensive care unit admission. RESULTS We registered 41 women with a complete uterine rupture (incidence: 2.5 per 10,000 births) and 35 women with uterine rupture with adverse outcome (incidence: 0.9 per 10,000 births). No adverse outcomes were found among women with incomplete uterine rupture. Risk indicators for adverse outcome included previous cesarean section, higher maternal age, gestational age <37 weeks, augmentation of labor, migration background from Sub-Saharan Africa or Asia. Compared to women with uterine rupture without adverse outcomes, women with adverse outcome more often expressed warning symptoms during labor such as abdominal pain (OR 3.34, 95%CI 1.26-8.90) and CTG abnormalities (OR 9.94, 95%CI 2.17-45.65). These symptoms were present most often 20 to 60 min prior to birth. CONCLUSION Uterine rupture is a rare condition for which several risk indicators were identified. Maternal symptoms and CTG abnormalities are associated with adverse outcomes and time dependent. Further analysis could provide guidance to expedite delivery.
Collapse
Affiliation(s)
- E M Overtoom
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T N Huynh
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - J J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - T P Schaap
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - T van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Beyuo TK, Lawrence ER, Oppong SA, Kobernik EK, Amoakoh-Coleman M, Grobbee DE, Browne JL, Bloemenkamp KWM. Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Pregnancy Hypertens 2023; 33:46-51. [PMID: 37586135 DOI: 10.1016/j.preghy.2023.07.177] [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: 11/02/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To explore how specific measures of antenatal care utilization are associated with outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. STUDY DESIGN Participants were adult pregnant women with preeclampsia or eclampsia at a tertiary hospital in Ghana. Antenatal care utilization measures included timing of first visit, total visits, facility and provider type, and referral status. Antenatal visits were characterized by former and current World Health Organization recommendations, and by gestational age-based adequacy. MAIN OUTCOME MEASURES Composites of maternal complications and poor neonatal outcomes. Multivariate logistic regressions identified associations with antenatal care factors. RESULTS Among 1176 participants, median number of antenatal visits was 5.0 (IQR 3.0-7.0), with 72.9% attending ≥4 visits, 19.4% attending ≥8 visits, and 54.9% attending adequate visits adjusted for gestational age. Care was most frequently provided in a government polyclinic (n = 522, 47.2%) and by a midwife (n = 704, 65.1%). Odds of the composite maternal complications were lower in women receiving antenatal care at a tertiary hospital (aOR 0.47, p = 0.01). Odds of poor neonatal outcomes were lower in women receiving antenatal care at a tertiary hospital (aOR 0.56, p < 0.001), by a specialist Obstetrician/Gynecologist (aOR 0.58, p < 0.001), and who attended ≥8 visits (aOR 0.67, p = 0.04). Referred women had twice the odds of a maternal complication (aOR 2.12, p = 0.007) and poor neonatal outcome (aOR 1.68, p = 0.002). CONCLUSIONS Fewer complications are seen after receiving antenatal care at tertiary facilities. Attending ≥8 visits reduced poor neonatal outcomes, but didn't impact maternal complications. Quality, not just quantity, of antenatal care is essential.
Collapse
Affiliation(s)
- Titus K Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA.
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana.
| | - Emily K Kobernik
- Department of Learning Health Sciences, University of Michigan, 1111 East Catherine Street, Ann Arbor, MI 48109 USA
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - K W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
| |
Collapse
|
3
|
de Vries PLM, van den Akker T, Bloemenkamp KWM, Grossetti E, Rigouzzo A, Saucedo M, Verspyck E, Zwart J, Deneux-Tharaux C. Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care. Int J Gynaecol Obstet 2023; 162:1077-1085. [PMID: 37177815 DOI: 10.1002/ijgo.14829] [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: 10/19/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. METHODS In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. RESULTS For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. CONCLUSION A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.
Collapse
Affiliation(s)
- P L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Grossetti
- Department of Obstetrics, Hospital group du Havre, Le Havre, France
| | - A Rigouzzo
- Department of Anesthesiology, Armand Trousseau Children's Hospital, Paris, France
| | - M Saucedo
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - E Verspyck
- Department of Obstetrics and Gynaecology, University Hospital of Rouen, Rouen, France
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - C Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| |
Collapse
|
4
|
Bos M, Koenders MJM, Dijkstra KL, van der Meeren LE, Nikkels PGJ, Bloemenkamp KWM, Eikmans M, Baelde HJ, van der Hoorn MLP. The severity of chronic histiocytic intervillositis is associated with gestational age and fetal weight. Placenta 2023; 131:28-35. [PMID: 36473391 DOI: 10.1016/j.placenta.2022.11.014] [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: 06/08/2022] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Chronic histiocytic intervillositis (CHI) is a rare histopathological lesion in the placenta that is associated with poor reproductive outcomes. The intervillous infiltrate consists mostly of maternal mononuclear cells and fibrin depositions, which are both indicators for the severity of the intervillous infiltrate. The severity of the intervillous infiltrate as well as the clinical outcomes of pregnancy differ between cases. Our objective is to determine the relation between the severity of the intervillous infiltrate and the clinical outcomes of CHI. METHODS Cases of CHI were semi-quantitatively graded based on histopathological severity scores. Hereto, CD68 positive mononuclear cells were quantified, fibrin depositions visualized by both a PTAH stain and an immuohistochemical staining, and placental dysfunction was assessed via thrombomodulin staining. RESULTS This study included 36 women with CHI. A higher CD68 score was significantly associated with a lower birthweight. Loss of placental thrombomodulin was associated with lower gestational age, lower birthweight, and a lower placenta weight. The combined severity score based on CD68 and PTAH was significantly associated with fetal growth restriction, and the joint score of CD68 and fibrin was associated with birthweight and placental weight. DISCUSSION More severe intervillous infiltrates in CHI placentas is associated with a lower birth weight and placental weight. Furthermore, this study proposes thrombomodulin as a possible new severity marker of placental damage. More research is needed to better understand the pathophysiology of CHI.
Collapse
Affiliation(s)
- M Bos
- Department of Pathology, Leiden University Medical Center, the Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands
| | - M J M Koenders
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands
| | - K L Dijkstra
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | - L E van der Meeren
- Department of Pathology, Leiden University Medical Center, the Netherlands; Department of Pathology, University Medical Center Utrecht, the Netherlands
| | - P G J Nikkels
- Department of Pathology, University Medical Center Utrecht, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
| | - M Eikmans
- Department of Immunology, Leiden University Medical Center, the Netherlands
| | - H J Baelde
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | - M L P van der Hoorn
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands.
| |
Collapse
|
5
|
Quach D, Ten Eikelder M, Jozwiak M, Davies-Tuck M, Bloemenkamp KWM, Mol BW, Li W. Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials. Ultrasound Obstet Gynecol 2022; 59:83-92. [PMID: 34490668 DOI: 10.1002/uog.24764] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Induction of labor (IOL) is one of the most widely used obstetric interventions. However, one-fifth of IOLs result in Cesarean section (CS). We aimed to assess maternal and fetal characteristics that influence the likelihood of CS following IOL, according to the indication for CS. METHODS This was a secondary analysis of pooled data from four randomized controlled trials, including women undergoing IOL at term who had a singleton pregnancy and an unfavorable cervix, intact membranes and the fetus in cephalic presentation. The main outcomes of this analysis were CS for failure to progress (FTP) and CS for suspected fetal compromise (SFC). Restricted cubic splines were used to determine whether continuous maternal and fetal characteristics had a non-linear relationship with outcome. Optimal cut-offs for those characteristics with a non-linear pattern were determined based on the maximum area under the receiver-operating-characteristics curve. Adjusted odds ratios (aOR) were computed, using multivariable logistic regression analysis, for the associations between optimally categorized characteristics and outcome. RESULTS Of a total of 2990 women undergoing IOL, 313 (10.5%) had CS for FTP and 227 (7.6%) had CS for SFC. The risk of CS for FTP was increased in women aged 31-35 years compared with younger women (aOR, 1.51 (95% CI, 1.15-1.99)), in nulliparous compared with parous women (aOR, 8.07 (95% CI, 5.34-12.18)) and in Sub-Saharan African compared with Caucasian women (aOR, 2.09 (95% CI, 1.33-3.28)). Higher body mass index (BMI) increased incrementally the risk of CS for FTP (aOR, 1.06 (95% CI, 1.04-1.08)). High birth-weight percentile was also associated with an increased risk of CS due to FTP (aOR, 2.66 (95% CI, 1.74-4.07) for birth weight between the 80.0th and 89.9th percentiles and aOR, 4.08 (95% CI, 2.75-6.05) for birth weight ≥ 90th percentile, as compared with birth weight between the 20.0th and 49.9th percentiles). For CS due to SFC, higher maternal age (aOR, 1.09 (95% CI, 1.05-1.12)) and BMI (aOR, 1.05 (95% CI, 1.03-1.08)) were associated with an incremental increase in risk. The risk of CS for SFC was increased in nulliparous compared with parous women (aOR, 5.91 (95% CI, 3.76-9.28)) and in South Asian compared with Caucasian women (aOR, 2.50 (95% CI, 1.23-5.10)). Birth weight < 10.0th percentile increased significantly the risk of CS due to SFC (aOR, 1.93 (95% CI, 1.22-3.05)), as compared with birth weight between the 20.0th and 49.9th percentiles. Bishop score did not demonstrate a significant association with the risk of CS for FTP or for SFC. CONCLUSIONS In women undergoing IOL, maternal age, BMI, parity, ethnicity and birth-weight percentile are predictors of CS due to FTP and of CS due to SFC, but the direction and magnitude of the associations differ according to the indication for CS. These characteristics should be considered in combination with the Bishop score to stratify the risk of CS for different indications in women undergoing IOL. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Quach
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Women's, Monash Health, Clayton, Australia
| | - M Ten Eikelder
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Jozwiak
- Department of Gynecologic Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - K W M Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| |
Collapse
|
6
|
de Vaan MDT, Blel D, Bloemenkamp KWM, Jozwiak M, ten Eikelder MLG, de Leeuw JW, Oudijk MA, Bakker JJH, Rijnders RJP, Papatsonis DN, Woiski M, Mol BW, de Heus R. Induction of labor with Foley catheter and risk of subsequent preterm birth: follow-up study of two randomized controlled trials (PROBAAT-1 and -2). Ultrasound Obstet Gynecol 2021; 57:292-297. [PMID: 32939850 PMCID: PMC7898639 DOI: 10.1002/uog.23117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins. METHODS This was a follow-up study of two large randomized controlled trials (PROBAAT-1 and PROBAAT-2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30-mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT-1 and oral misoprostol in PROBAAT-2). Data on subsequent ongoing pregnancies > 16 weeks' gestation were collected from hospital charts from clinics participating in this follow-up study. The main outcome measure was preterm birth < 37 weeks' gestation in a subsequent pregnancy. RESULTS Fourteen hospitals agreed to participate in this follow-up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow-up. In total, 251 and 258 women had a known subsequent pregnancy > 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38-2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30-3.51). CONCLUSION In women with term singleton pregnancy, induction of labor using a 30-mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M. D. T. de Vaan
- Department of Obstetrics and GynaecologyJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
- Department of Health Care StudiesRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - D. Blel
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
| | - K. W. M. Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CentreUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - M. Jozwiak
- Department of Gynaecologic OncologyErasmus Medical CentreRotterdamThe Netherlands
| | - M. L. G. ten Eikelder
- Department of Obstetrics and Gynaecology, Princess Alexandra WingRoyal Cornwall Hospital NHS TrustTruroUK
| | - J. W. de Leeuw
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
| | - M. A. Oudijk
- Department of ObstetricsAmsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - J. J. H. Bakker
- Department of ObstetricsAmsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - R. J. P. Rijnders
- Department of Obstetrics and GynaecologyJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
| | - D. N. Papatsonis
- Department of Obstetrics and GynaecologyAmphia HospitalBredaThe Netherlands
| | - M. Woiski
- Department of Obstetrics and GynaecologyRadboud University Medical CentreNijmegenThe Netherlands
| | - B. W. Mol
- Department of Obstetrics and GynaecologyMonash UniversityMelbourneAustralia
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | - R. de Heus
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
| |
Collapse
|
7
|
Bos M, Harris-Mostert ETMS, van der Meeren LE, Baelde JJ, Williams DJ, Nikkels PGJ, Bloemenkamp KWM, van der Hoorn MLP. Clinical outcomes in chronic intervillositis of unknown etiology. Placenta 2020; 91:19-23. [PMID: 32174302 DOI: 10.1016/j.placenta.2020.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/27/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Chronic intervillositis of unknown etiology (CIUE) is a histopathological lesion of the placenta that is frequently accompanied by unfavourable pregnancy outcomes, e.g. miscarriage, fetal growth restriction (FGR) and intrauterine fetal death. Earlier described case series and cohorts have been based on diverse diagnostic criteria of CIUE. To improve our understanding of clinical outcomes associated with CIUE, we report the obstetric and perinatal outcomes in a cohort based on the recently described diagnostic criteria. METHODS CIUE is defined as an infiltrate occupying 5% or more of the intervillous space with approximately 80% of mononuclear cells positive for CD68 in the absence of an infection. Thirty-eight cases were included. Also previous and subsequent pregnancies were described. RESULTS Pregnancies accompanied by CIUE frequently resulted in FGR (51.6%) and pre-term birth (55.3%). Twenty-nine out of 38 pregnancies (76.3%) with CIUE resulted in a living baby. Women with CIUE frequently have had a miscarriage (16/38; 42%). Four-teen subsequent pregnancies in 8 women resulted in 2 miscarriages, 2 terminations of pregnancy for FGR, 1 early neonatal death and 9 living babies (9/14; 64.3%). Histopathologically confirmed CIUE recurred in 5 out of 10 subsequent pregnancies. Two pregnancies with recurrent CIUE were terminated, one pregnancy ended in a late miscarriage and another resulted in term birth complicated by FGR. Recurrent CIUE can also be accompanied by an uncomplicated pregnancy (1/5; 20%). CONCLUSION This study provides additional insight into the clinical phenotype of CIUE and emphasises the need for further research to understand the pathophysiology behind different pregnancy outcomes in CIUE.
Collapse
Affiliation(s)
- M Bos
- Department of Pathology, Leiden University Medical Center, the Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands.
| | | | - L E van der Meeren
- Department of Pathology, University Medical Center Utrecht, the Netherlands
| | - J J Baelde
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | - D J Williams
- Institute for Women's Health, University College London Hospitals, United Kingdom
| | - P G J Nikkels
- Department of Pathology, University Medical Center Utrecht, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
| | - M L P van der Hoorn
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands
| |
Collapse
|
8
|
Meuleman T, Baden N, Haasnoot GW, Wagner MM, Picavet C, Dekkers OM, Le Cessie S, van Lith JMM, Claas FHJ, Bloemenkamp KWM. Reply to: Responsibility of scientific community in claiming to have found an association with recurrent pregnancy loss. J Reprod Immunol 2019; 134-135:35. [PMID: 31324386 DOI: 10.1016/j.jri.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Tess Meuleman
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands.
| | - N Baden
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - G W Haasnoot
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - M M Wagner
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - C Picavet
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - O M Dekkers
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - S Le Cessie
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - J M M van Lith
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - F H J Claas
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| | - K W M Bloemenkamp
- Leiden University Medical Centre, Albinusdreef 2, 2300RC, Leiden, the Netherlands
| |
Collapse
|
9
|
Meuleman T, Baden N, Haasnoot GW, Wagner MM, Dekkers OM, le Cessie S, Picavet C, van Lith JMM, Claas FHJ, Bloemenkamp KWM. Oral sex is associated with reduced incidence of recurrent miscarriage. J Reprod Immunol 2019; 133:1-6. [PMID: 30980918 DOI: 10.1016/j.jri.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/31/2018] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
A possible way of immunomodulation of the maternal immune system before pregnancy would be exposure to paternal antigens via seminal fluid to oral mucosa. We hypothesized that women with recurrent miscarriage have had less oral sex compared to women with uneventful pregnancy. In a matched case control study, 97 women with at least three unexplained consecutive miscarriages prior to the 20th week of gestation with the same partner were included. Cases were younger than 36 years at time of the third miscarriage. The control group included 137 matched women with an uneventful pregnancy. The association between oral sex and recurrent miscarriage was assessed with conditional logistic regression, odds ratios (ORs) were estimated. Missing data were imputed using Imputation by Chained Equations. In the matched analysis, 41 out of 72 women with recurrent miscarriage had have oral sex, whereas 70 out of 96 matched controls answered positive to this question (56.9% vs. 72.9%, OR 0.50 95%CI 0.25-0.97, p = 0.04). After imputation of missing exposure data (51.7%), the association became weaker (OR 0.67, 95%CI 0.36-1.24, p = 0.21). In conclusion, this study suggests a possible protective role of oral sex in the occurrence of recurrent miscarriage in a proportion of the cases. Future studies in women with recurrent miscarriage explained by immune abnormalities should reveal whether oral exposure to seminal plasma indeed modifies the maternal immune system, resulting in more live births.
Collapse
Affiliation(s)
- T Meuleman
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
| | - N Baden
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - G W Haasnoot
- Department of Immunohematology and Blood transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - M M Wagner
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands; Medical Statistics, Department of Biomedical Datasciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Picavet
- AllthatChas Research Consultancy, Amsterdam, the Netherlands
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - F H J Claas
- Department of Immunohematology and Blood transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands; Department of Obstetrics, Wilhelmina Children Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| |
Collapse
|
10
|
Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, de Kruif JH, Bloemenkamp KWM, Jansen FW, Veersema S, Mulders AGMGJ, Thurkow AL, Hald K, Mohazzab A, Khalaf Y, Clark TJ, Farrugia M, van Vliet HA, Stephenson MS, van der Veen F, van Wely M, Mol BWJ, Goddijn M. The randomised uterine septum transsection trial (TRUST): design and protocol. BMC Womens Health 2018; 18:163. [PMID: 30290803 PMCID: PMC6173848 DOI: 10.1186/s12905-018-0637-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus. METHODS/DESIGN A multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised. DISCUSSION Hysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed. TRIAL REGISTRATION Dutch trial registry ( NTR1676 , 18th of February 2009).
Collapse
Affiliation(s)
- J F W Rikken
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - C R Kowalik
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M H Emanuel
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - M Y Bongers
- Maxima Medical Centre, de Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - T Spinder
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - J H de Kruif
- Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS, Nijmegen, The Netherlands
| | - K W M Bloemenkamp
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - F W Jansen
- University Medical Centre Leiden, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - A G M G J Mulders
- Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - A L Thurkow
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - K Hald
- Oslo University Hospital, P. O. Box 4950, Nydalen, N-0424, Oslo, Norway
| | - A Mohazzab
- Avicenna research institute Teheran, PO Box: 19615-1177, Teheran, Postal code: 1936773493, Iran
| | - Y Khalaf
- Guy's hospital, Great maze pond, London, SE1 9RT, UK
| | - T J Clark
- Birmingham women's hospital, Mindelsohn Way, Birmingham, West Midlands, B15 2TG, UK
| | - M Farrugia
- East Kent Hospitals University, Ethelbert road, Canterbury, Kent, CT1 3NG, UK
| | - H A van Vliet
- Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - M S Stephenson
- University of Illinois Hospital, 1740 W Taylor St, Chicago, IL, 60612, USA
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Helmerhorst FM, Bloemenkamp KWM, Rosendaal FR, Vandenbroucke JP. Oral Contraceptives and Thrombotic Disease: Risk of Venous Thromboembolism. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657547] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F M Helmerhorst
- Department of Obstetrics, Gynecology and Reproductive Medicine, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Gynecology and Reproductive Medicine, the Netherlands
| | - F R Rosendaal
- Haemostasis and Thrombosis Research Centre, the Netherlands
- Department of Clinical Epidemiology Leiden University and Leiden University Hospital, the Netherlands
| | - J P Vandenbroucke
- Department of Clinical Epidemiology Leiden University and Leiden University Hospital, the Netherlands
| |
Collapse
|
12
|
Henriquez DDCA, Bloemenkamp KWM, van der Bom JG. Management of postpartum hemorrhage: how to improve maternal outcomes? J Thromb Haemost 2018; 16:S1538-7836(22)02220-6. [PMID: 29883040 DOI: 10.1111/jth.14200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/08/2017] [Indexed: 01/18/2023]
Abstract
Postpartum hemorrhage is the leading cause of maternal mortality and severe morbidity. Despite efforts to improve maternal outcomes, management of postpartum hemorrhage still faces at least four challenges, discussed in this review. First, current definitions for severe postpartum hemorrhage hamper early identification of women with a high risk of adverse outcomes. Adaptations to the definitions and the use of clinical tools such as shock index and early warning systems may facilitate this early identification. Second, surgical and radiological interventions to prevent hysterectomy are not always successful. More knowledge on the influence of patient and bleeding characteristics on the success rates of these interventions is necessary. Scarce data suggest that early timing of intrauterine balloon tamponade may improve maternal outcomes, whereas early timing of arterial embolization seems to be unrelated to maternal outcomes. Third, fluid resuscitation with crystalloids and colloids is unavoidable in the early phases of postpartum hemorrhage but may result in dilutional coagulopathy. Effects of different volumes of clear fluids on the occurrence of dilutional coagulopathy and maternal outcomes is unknown. Fourth, a better understanding of diagnosis and correction of coagulopathy during postpartum hemorrhage is needed. Low plasma fibrinogen levels at the start of postpartum hemorrhage predict progression to severe hemorrhage, but standard coagulation screens are time consuming. A solution may be point-of-care coagulation testing; however, clinical usefulness during postpartum hemorrhage has not been demonstrated. To date, early administration of tranexamic acid is the only hemostatic intervention that was proven to improve outcomes in women with postpartum hemorrhage.
Collapse
Affiliation(s)
- D D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Center, Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
13
|
van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM, Scheepers HCJ, Spaanderman MEA, Bloemenkamp KWM, Haak MC, Bax CJ, Cornette JMJ, Duvekot JJ, Nij Bijvanck BWA, van Eyck J, Franssen MTM, Sollie KM, Vandenbussche FPHA, Woiski M, Bolte AC, van der Post JAM, Bossuyt PMM, Opmeer BC, Mol BWJ. Cost-effectiveness of diagnostic testing strategies including cervical-length measurement and fibronectin testing in women with symptoms of preterm labor. Ultrasound Obstet Gynecol 2018; 51:596-603. [PMID: 28370518 DOI: 10.1002/uog.17481] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/29/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of combining cervical-length (CL) measurement and fetal fibronectin (fFN) testing in women with symptoms of preterm labor between 24 and 34 weeks' gestation. METHODS This was a model-based cost-effectiveness analysis evaluating seven test-treatment strategies based on CL measurement and/or fFN testing in women with symptoms of preterm labor from a societal perspective, in which neonatal outcomes and costs were weighted. Estimates of disease prevalence, test accuracy and costs were based on two recently performed nationwide cohort studies in The Netherlands. RESULTS Strategies using fFN testing and CL measurement separately to predict preterm delivery are associated with higher costs and incidence of adverse neonatal outcomes compared with strategies that combine both tests. Additional fFN testing when CL is 15-30 mm was considered cost effective, leading to a cost saving of €3919 per woman when compared with a treat-all strategy, with a small deterioration in neonatal health outcomes, namely one additional perinatal death and 21 adverse outcomes per 10 000 women with signs of preterm labor (incremental cost-effectiveness ratios €39 million and €1.9 million, respectively). Implementing this strategy in The Netherlands, a country with about 180 000 deliveries annually, could lead to an annual cost saving of between €2.4 million and €7.6 million, with only a small deterioration in neonatal health outcomes. CONCLUSION In women with symptoms of preterm labor at 24-34 weeks' gestation, performing additional fFN testing when CL is between 15 and 30 mm is a viable and cost-saving strategy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- G-J van Baaren
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Y Vis
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F F Wilms
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - A Kwee
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C J Bax
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J M J Cornette
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B W A Nij Bijvanck
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - J van Eyck
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - M T M Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - K M Sollie
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - F P H A Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - A C Bolte
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - J A M van der Post
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - P M M Bossuyt
- Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynecology, The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| |
Collapse
|
14
|
Bloemenkamp KWM, Helmerhorst FM, Vandenbroucke JP, Rosendaal FR. Venous Thrombosis, Oral Contraceptives and High Factor VIII Levels. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614323] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryRecently, it has been described that elevated plasma levels of factor VIII are a strong risk factor for venous thrombosis. We analysed the data of the Leiden Thrombophilia Study, a population based case-control study on the causes of venous thrombosis, to verify whether the risk due to oral contraceptive use was higher in women with higher factor VIII levels. Furthermore we investigated the joint risk of high factor VIII levels and oral contraceptive use.We selected 155 premenopausal women with deep-vein thrombosis and 169 control subjects, aged 15-49, who were at the time of their thrombosis (or similar date in control) not pregnant, nor in the puerperium, did not have a recent miscarriage, and were not using injectable progestogens. Of the patients, 109 (70%) women had used oral contraceptives during the month preceding their deep-vein thrombosis, in contrast to 65 (38%) of the control subjects (index date), yielding an odds ratio for oral contraceptive use of 3.8 (95% CI 2.4-6.0). Of the women who suffered a deep-vein thrombosis 56 (36%) had high factor VIII levels (≥150 IU/dl) as compared with 29 (17%) of the control subjects, yielding an odds ratio for high factor VIII of 4.0 (95% CI 2.0-8.0), relative to factor VIII levels <100 IU/dl. The joint effect of oral contraceptive use and high factor VIII resulted in an odds ratio of 10.3 (95% CI 3.7-28.9), comparing women who had both with women who had neither. We conclude that there is an increase in risk due to oral contraceptive use in women with higher factor VIII levels and that both factors have additive effects.
Collapse
|
15
|
Bos M, Nikkels PGJ, Cohen D, Schoones JW, Bloemenkamp KWM, Bruijn JA, Baelde HJ, van der Hoorn MLP, Turner RJ. Towards standardized criteria for diagnosing chronic intervillositis of unknown etiology: A systematic review. Placenta 2017; 61:80-88. [PMID: 29277275 DOI: 10.1016/j.placenta.2017.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/05/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022]
Abstract
Chronic intervillositis of unknown etiology (CIUE) is a poorly understood, relatively rare condition characterized histologically by the intervillous infiltration of mononuclear cells in the placenta. Clinically, CIUE is associated with poor pregnancy outcome (e.g., impaired fetal growth, preterm birth, fetal death) and high risk of recurrence in subsequent pregnancies. Because CIUE is not defined consistently, it is essential to clearly define this condition. We therefore review the published definitions of CIUE. In addition, we provide an overview of the reviewed histopathological and maternal characteristics, obstetric features, and pregnancy outcomes. Medical publication databases were searched for articles published through February 2017. Eighteen studies were included in our systematic review. The sole inclusion criterion used in all studies was the presence of intervillous infiltrates. Overall, CIUE was characterized by adverse pregnancy outcome. Miscarriage occurred in 24% of cases, with approximately half of these miscarriages defined as late. Impaired growth was commonly observed, 32.4% of pregnancies reached term, and the live birth rate was 54.9%. The high recurrence rate (25.1%) of the intervillous infiltrates in subsequent pregnancies underscores the clinical relevance of CIUE, the need for increased awareness among pathologists and clinicians, and the need for further research. Criteria for the diagnosis of CIUE are proposed and a Delphi study could be used to resolve any controversy regarding these criteria. Future studies should be designed to characterize the full clinical spectrum of CIUE.
Collapse
Affiliation(s)
- M Bos
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - P G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D Cohen
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J W Schoones
- Walaeus Medical Library, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Birth Centre, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - J A Bruijn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - H J Baelde
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - M L P van der Hoorn
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - R J Turner
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
16
|
van Oostwaard MF, van Eerden L, de Laat MW, Duvekot JJ, Erwich JJHM, Bloemenkamp KWM, Bolte AC, Bosma JPF, Koenen SV, Kornelisse RF, Rethans B, van Runnard Heimel P, Scheepers HCJ, Ganzevoort W, Mol BWJ, de Groot CJ, Gaugler-Senden IPM. Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series. BJOG 2017; 124:1440-1447. [DOI: 10.1111/1471-0528.14512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/28/2022]
Affiliation(s)
- MF van Oostwaard
- Department of Obstetrics and Gynaecology; IJsselland Ziekenhuis; Capelle aan den Ijssel the Netherlands
| | - L van Eerden
- Department of Obstetrics and Gynaecology; Maasstad Ziekenhuis; Rotterdam the Netherlands
| | - MW de Laat
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics and Gynaecology; Erasmus Medisch Centrum; Rotterdam the Netherlands
| | - JJHM Erwich
- Department of Obstetrics and Gynaecology; Universitair Medisch Centrum Groningen; Groningen the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics and Gynaecology; Leids Universitair Medisch Centrum; Leiden the Netherlands
| | - AC Bolte
- Department of Obstetrics and Gynaecology; Radboud Universitair Medisch Centrum; Nijmegen the Netherlands
| | - JPF Bosma
- Department of Obstetrics and Gynaecology; Isala Ziekenhuis; Zwolle the Netherlands
| | - SV Koenen
- Department of Obstetrics and Gynaecology; Universitair Medisch Centrum Utrecht; Utrecht the Netherlands
| | - RF Kornelisse
- Department of Paediatrics; Erasmus Medisch Centrum; Rotterdam the Netherlands
| | - B Rethans
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - P van Runnard Heimel
- Department of Obstetrics and Gynaecology; Maxima Medisch Centrum; Veldhoven the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology; Maastricht Universitair Medisch Centrum; Maastricht the Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - BWJ Mol
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - CJ de Groot
- Department of Obstetrics and Gynaecology; VU Universitair Medisch Centrum; Amsterdam the Netherlands
| | - IPM Gaugler-Senden
- Department of Obstetrics and Gynaecology; Jeroen Bosch Ziekenhuis; ‘s-Hertogenbosch the Netherlands
| |
Collapse
|
17
|
van de Mheen L, Ravelli AC, Oudijk MA, Bijvank SN, Porath MM, Duvekot JJ, Scholtenhuis MAGHO, Bloemenkamp KWM, Scheepers HCJ, Woiski M, van Pampus MG, Groot CJD, Pajkrt E, Mol BWJ. Prediction of Time to Delivery Week-by-Week in Women with a Triplet Pregnancy. Am J Perinatol 2016; 33:1394-1400. [PMID: 27167642 DOI: 10.1055/s-0036-1583190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 10/21/2022]
Abstract
Objective Some clinicians advise prophylactic administration of antenatal steroids for fetal lung maturation in women with a triplet pregnancy. However, the effect of corticosteroids is limited to 10 to 14 days after administration. The aim of this study was to assess the natural course of triplet pregnancies to allow a better anticipation for administration of corticosteroids. Study Design We collected data on all triplet pregnancies in the Netherlands from 1999 to 2007 from the Netherlands Perinatal Registration. We calculated time to delivery, the risk of delivery in 2-week intervals at different gestational ages, and the time frame between hospital admission and delivery of the first child. Results Median gestational age at delivery of 494 women with a triplet pregnancy was 33+4 weeks (interquartile range of 31-35+1 weeks). Twenty-one women (4.3%) delivered between 22 and 24 weeks and 146 women (29.6%) delivered before 32 weeks. At a gestational age of 24 weeks, the chance to deliver within the next week was 0.6%. For 26, 28, 30, 31, and 32 weeks, these risks were 2.4, 2.5, 8.1, 7, and 16.7%, respectively. Conclusion Before 32 weeks of gestation, prophylactic administration of steroids is not indicated as the risk to deliver within 7 days is < 10%.
Collapse
Affiliation(s)
- L van de Mheen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - A C Ravelli
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Nij Bijvank
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - K W M Bloemenkamp
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - C J de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- School of Paediatrics and Reproductive Health, The Robinson Institute, Adelaide, Australia
| |
Collapse
|
18
|
Tajik P, Monfrance M, van 't Hooft J, Liem SMS, Schuit E, Bloemenkamp KWM, Duvekot JJ, Nij Bijvank B, Franssen MTM, Oudijk MA, Scheepers HCJ, Sikkema JM, Woiski M, Mol BWJ, Bekedam DJ, Bossuyt PM, Zafarmand MH. A multivariable model to guide the decision for pessary placement to prevent preterm birth in women with a multiple pregnancy: a secondary analysis of the ProTWIN trial. Ultrasound Obstet Gynecol 2016; 48:48-55. [PMID: 26748537 DOI: 10.1002/uog.15855] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/16/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The ProTWIN Trial (NTR1858) showed that, in women with a multiple pregnancy and a cervical length < 25(th) percentile (38 mm), prophylactic use of a cervical pessary reduced the risk of adverse perinatal outcome. We investigated whether other maternal or pregnancy characteristics collected at baseline can improve identification of women most likely to benefit from pessary placement. METHODS ProTWIN is a multicenter randomized trial in which 808 women with a multiple pregnancy were assigned to pessary or control. Using these data we developed a multivariable logistic model comprising treatment, cervical length, chorionicity, pregnancy history and number of fetuses, and the interaction of these variables with treatment as predictors of adverse perinatal outcome. RESULTS Short cervix, monochorionicity and nulliparity were predictive factors for a benefit from pessary insertion. History of previous preterm birth and triplet pregnancy were predictive factors of possible harm from pessary. The model identified 35% of women as benefiting (95% CI, 32-39%), which is 10% more than using cervical length only (25%) for pessary decisions. The model had acceptable calibration. We estimated that using the model to guide the choice of pessary placement would reduce the risk of adverse perinatal outcome significantly from 13.5% when no pessary is inserted to 8.1% (absolute risk reduction, 5.4% (95% CI, 2.1-8.6%)). CONCLUSIONS We developed and internally validated a multivariable treatment selection model, with cervical length, chorionicity, pregnancy history and number of fetuses. If externally validated, it could be used to identify women with a twin pregnancy who would benefit from a pessary, and lead to a reduction in adverse perinatal outcomes in these women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- P Tajik
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Monfrance
- Department of Obstetrics and Gynaecology, Atrium Medical Centre, Heerlen, The Netherlands
| | - J van 't Hooft
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S M S Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - E Schuit
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - B Nij Bijvank
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - M T M Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J M Sikkema
- Department of Obstetrics and Gynaecology, ZGT, Almelo, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - D J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - P M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - M H Zafarmand
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Meuleman T, van Beelen E, Kaaja RJ, van Lith JMM, Claas FHJ, Bloemenkamp KWM. HLA-C antibodies in women with recurrent miscarriage suggests that antibody mediated rejection is one of the mechanisms leading to recurrent miscarriage. J Reprod Immunol 2016; 116:28-34. [PMID: 27172837 DOI: 10.1016/j.jri.2016.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 02/19/2016] [Accepted: 03/21/2016] [Indexed: 12/29/2022]
Abstract
HLA-C is the only polymorphic classical HLA I antigen expressed on trophoblast cells. It is known that higher incidence of C4d deposition on trophoblast cells is present in women with recurrent miscarriage. C4d is a footprint of antibody-mediated classical complement activation. Therefore, this study hypothesize that antibodies against HLA-C may play a role in the occurrence of unexplained consecutive recurrent miscarriage. Present case control study compared the incidence of HLA-C specific antibodies in 95 women with at least three consecutive miscarriages and 105 women with uneventful pregnancy. In the first trimester of the next pregnancy, presence and specificity of HLA antibodies were determined and their complement fixing ability. The incidence of HLA antibodies was compared with uni- and multivariate logistic regression models adjusting for possible confounders. Although in general a higher incidence of HLA antibodies was found in women with recurrent miscarriage 31.6% vs. in control subjects 9.5% (adjusted OR 4.3, 95% CI 2.0-9.5), the contribution of antibodies against HLA-C was significantly higher in women with recurrent miscarriage (9.5%) compared to women with uneventful pregnancy (1%) (adjusted OR 11.0, 95% CI 1.3-89.0). In contrast to the control group, HLA-C antibodies in the recurrent miscarriage group were more often able to bind complement. The higher incidence of antibodies specific for HLA-C in women with recurrent miscarriage suggests that HLA-C antibodies may be involved in the aetiology of unexplained consecutive recurrent miscarriage.
Collapse
Affiliation(s)
- T Meuleman
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
| | - E van Beelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - R J Kaaja
- Department of Obstetrics and Gynaecology, Turku University, 20610 Turku, Finland
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - F H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; Department of Obstetrics, Wilhelmina Children Hospital Birth Centre, Utrecht University Medical Centre, 3508 AB Utrecht, The Netherlands
| |
Collapse
|
20
|
Baaren G, Broekhuijsen K, Pampus MG, Ganzevoort W, Sikkema JM, Woiski MD, Oudijk MA, Bloemenkamp KWM, Scheepers HCJ, Bremer HA, Rijnders RJP, Loon AJ, Perquin DAM, Sporken JMJ, Papatsonis DNM, Huizen ME, Vredevoogd CB, Brons JTJ, Kaplan M, Kaam AH, Groen H, Porath M, Berg PP, Mol BWJ, Franssen MTM, Langenveld J. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (
HYPITAT
‐
II
). BJOG 2016; 124:453-461. [DOI: 10.1111/1471-0528.13957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- G‐J Baaren
- Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam the Netherlands
| | - K Broekhuijsen
- Department of Obstetrics and Gynaecology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - MG Pampus
- Department of Obstetrics and Gynaecology Onze Lieve Vrouwe Gasthuis Amsterdam the Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam the Netherlands
| | - JM Sikkema
- Department of Obstetrics and Gynaecology ZGT Almelo Almelo the Netherlands
| | - MD Woiski
- Department of Obstetrics and Gynaecology Radboud University Medical Centre Nijmegen the Netherlands
| | - MA Oudijk
- Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics Wilhelmina Children's Hospital Birth Centre Division Woman and Baby University Medical Centre Utrecht Utrecht the Netherlands
- Department of Obstetrics Leiden University Medical Centre Leiden the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology Grow School for Oncology and Developmental Biology Maastricht University Medical Centre Maastricht the Netherlands
| | - HA Bremer
- Department of Obstetrics and Gynaecology Reinier de Graaf Gasthuis Delft the Netherlands
| | - RJP Rijnders
- Department of Obstetrics and Gynaecology Jeroen Bosch Hospital Hertogenbosch the Netherlands
| | - AJ Loon
- Department of Obstetrics and Gynaecology Martini Hospital Groningen the Netherlands
| | - DAM Perquin
- Department of Obstetrics and Gynaecology Medical Centre Leeuwarden Leeuwarden the Netherlands
| | - JMJ Sporken
- Department of Gynaecology and Obstetrics Canisius‐Wilhelmina Hospital Nijmegen the Netherlands
| | - DNM Papatsonis
- Department of Obstetrics and Gynaecology Amphia Hospital Breda Breda the Netherlands
| | - ME Huizen
- Department of Obstetrics and Gynaecology HagaZiekenhuis The Hague the Netherlands
| | - CB Vredevoogd
- Department of Obstetrics and Gynaecology Medical Centre Haaglanden Den Haag the Netherlands
| | - JTJ Brons
- Department of Obstetrics and Gynaecology Medisch Spectrum Twente Enschede the Netherlands
| | - M Kaplan
- Department of Obstetrics and Gynaecology Röpcke‐Zweers Ziekenhuis Hardenberg the Netherlands
| | - AH Kaam
- Department of Neonatology Emma Children's Hospital Academic Medical Centre Amsterdam the Netherlands
| | - H Groen
- Department of Epidemiology University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - M Porath
- Department of Obstetrics and Gynaecology Maxima Medical Centre Veldhoven the Netherlands
| | - PP Berg
- Department of Obstetrics and Gynaecology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - BWJ Mol
- The Robinson Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide Australia
| | - MTM Franssen
- Department of Obstetrics and Gynaecology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - J Langenveld
- Department of Obstetrics and Gynaecology Atrium Medical Centre Heerlen the Netherlands
| | | |
Collapse
|
21
|
Bruijn MMC, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM, Oei G, Scheepers HCJ, Spaanderman MEA, Bloemenkamp KWM, Haak MC, Bolte AC, Vandenbussche FPHA, Woiski MD, Bax CJ, Cornette JMJ, Duvekot JJ, Nij Bijvanck BWA, van Eyck J, Franssen MTM, Sollie KM, van der Post JAM, Bossuyt PMM, Opmeer BC, Kok M, Mol BWJ, van Baaren GJ. Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG 2015; 123:1965-1971. [DOI: 10.1111/1471-0528.13752] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- MMC Bruijn
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - JY Vis
- Clinical Chemistry and Haematology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - FF Wilms
- Obstetrics and Gynaecology; Catharina Hospital; Eindhoven the Netherlands
| | - MA Oudijk
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - A Kwee
- Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - MM Porath
- Obstetrics and Gynaecology; Máxima Medical Centre; Veldhoven the Netherlands
| | - G Oei
- Obstetrics and Gynaecology; Máxima Medical Centre; Veldhoven the Netherlands
| | - HCJ Scheepers
- Obstetrics and Gynaecology; University Hospital Maastricht; Maastricht the Netherlands
| | - MEA Spaanderman
- Obstetrics and Gynaecology; University Hospital Maastricht; Maastricht the Netherlands
| | - KWM Bloemenkamp
- Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - MC Haak
- Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - AC Bolte
- Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - FPHA Vandenbussche
- Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - MD Woiski
- Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - CJ Bax
- Obstetrics and Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JMJ Cornette
- Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - JJ Duvekot
- Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - BWA Nij Bijvanck
- Obstetrics and Gynaecology; Isala Clinics; Zwolle the Netherlands
| | - J van Eyck
- Obstetrics and Gynaecology; Isala Clinics; Zwolle the Netherlands
| | - MTM Franssen
- Obstetrics and Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - KM Sollie
- Obstetrics and Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - JAM van der Post
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - PMM Bossuyt
- Clinical Epidemiology, Biostatistics and Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - BC Opmeer
- Clinical Research Unit; Academic Medical Centre; Amsterdam the Netherlands
| | - M Kok
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - BWJ Mol
- The Robinson Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - G-J van Baaren
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| |
Collapse
|
22
|
van de Mheen L, Schuit E, Liem SMS, Lim AC, Bekedam DJ, Goossens SMTA, Franssen MTM, Porath MM, Oudijk MA, Bloemenkamp KWM, Duvekot JJ, Woiski MD, de Graaf I, Sikkema JM, Scheepers HCJ, van Eijk J, de Groot CJM, van Pampus MG, Mol BWJ. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy. Ultrasound Obstet Gynecol 2015; 46:579-584. [PMID: 25402630 DOI: 10.1002/uog.14727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/30/2014] [Accepted: 11/02/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. METHODS This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable association between risk indicators, including second-trimester CL in quartiles, and emergency Cesarean delivery using a logistic regression model. For multivariable analysis, we assessed whether adjustment for other risk indicators altered the associations found in univariable (unadjusted) analysis. Separate analyses were performed for suspected fetal distress and failure to progress in labor as indications for Cesarean section. RESULTS In total, 311 women with a twin pregnancy attempted vaginal delivery after 34 weeks' gestation. Emergency Cesarean delivery was performed in 111 (36%) women, of which 67 (60%) were performed owing to arrest of labor. There was no relationship between second-trimester CL and Cesarean delivery (adjusted odds ratio (aOR): 0.97 for CL 26(th) -50(th) percentiles; 0.71 for CL 51(st) - 75(th) percentiles; and 0.92 for CL > 75(th) percentile, using CL ≤ 25(th) percentile as reference). In multivariable analysis, the only variables associated with emergency Cesarean delivery were maternal age (aOR, 1.07 (95% CI, 1.00-1.13)), body mass index (BMI) (aOR, 3.99 (95% CI, 1.07-14.9) for BMI 20-23 kg/m(2) ; 5.04 (95% CI, 1.34-19.03) for BMI 24-28 kg/m(2) ; and 3.1 (95% CI, 0.65-14.78) for BMI > 28 kg/m(2) ) and induction of labor (aOR, 1.92 (95% CI, 1.05-3.5)). CONCLUSION In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery.
Collapse
Affiliation(s)
- L van de Mheen
- Department of Obstetrics and Gynaecology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - S M S Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - D J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S M T A Goossens
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M T M Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M D Woiski
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - I de Graaf
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M Sikkema
- Department of Obstetrics and Gynaecology, Zorggroep Twente, Almelo, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - J van Eijk
- Department of Obstetrics and Gynaecology, Isala Clinics Zwolle, Zwolle, The Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - M G van Pampus
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - B W J Mol
- The Robinson Institute, School of Reproductive Health and Paediatrics, University of Adelaide, Adelaide, Australia
| |
Collapse
|
23
|
Vliet EOG, Seinen L, Roos C, Schuit E, Scheepers HCJ, Bloemenkamp KWM, Duvekot JJ, Eyck J, Kok JH, Lotgering FK, Baar A, Wassenaer‐Leemhuis AG, Franssen MT, Porath MM, Post JAM, Franx A, Mol BWJ, Oudijk MA. Maintenance tocolysis with nifedipine in threatened preterm labour: 2‐year follow up of the offspring in the
APOSTEL II
trial. BJOG 2015; 123:1107-14. [DOI: 10.1111/1471-0528.13586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- EOG Vliet
- Department of Obstetrics and Gynaecology University Medical Centre Utrecht Utrecht the Netherlands
| | - L Seinen
- Department of Obstetrics and Gynaecology Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
| | - C Roos
- Department of Obstetrics and Gynaecology Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht Utrecht the Netherlands
- Stanford Prevention Research Centre Department of Medicine Stanford University Stanford CA USA
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology Maastricht University Medical Centre Maastricht the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics and Gynaecology Leiden University Medical Centre Leiden the Netherlands
| | - JJ Duvekot
- Department of Obstetrics and Gynaecology Erasmus Medical Centre Rotterdam the Netherlands
| | - J Eyck
- Department of Obstetrics and Gynaecology Isala Clinics Zwolle the Netherlands
| | - JH Kok
- Department of Neonatology Academic Medical Centre Amsterdam the Netherlands
| | - FK Lotgering
- Department of Obstetrics and Gynaecology Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
| | - A Baar
- Utrecht Centre for Child and Adolescent Studies Utrecht University Utrecht the Netherlands
| | | | - MT Franssen
- Department of Obstetrics University Medical Centre University of Groningen Groningen the Netherlands
| | - MM Porath
- Department of Obstetrics and Gynaecology Máxima Medical Centre Veldhoven the Netherlands
| | - JAM Post
- Department of Obstetrics and Gynaecology Academic Medical Centre Amsterdam the Netherlands
| | - A Franx
- Department of Obstetrics and Gynaecology University Medical Centre Utrecht Utrecht the Netherlands
| | - BWJ Mol
- The Robinson Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide SA Australia
| | - MA Oudijk
- Department of Obstetrics and Gynaecology University Medical Centre Utrecht Utrecht the Netherlands
- Department of Obstetrics and Gynaecology Academic Medical Centre Amsterdam the Netherlands
| |
Collapse
|
24
|
Tajik P, van der Ham DP, Zafarmand MH, Hof MHP, Morris J, Franssen MTM, de Groot CJM, Duvekot JJ, Oudijk MA, Willekes C, Bloemenkamp KWM, Porath M, Woiski M, Akerboom BM, Sikkema JM, Bijvank BN, Mulder ALM, Bossuyt PM, Mol BWJ. Using vaginal Group B Streptococcuscolonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG 2014; 121:1263-72; discussion 1273. [DOI: 10.1111/1471-0528.12889] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Tajik
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - DP van der Ham
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Obstetrics & Gynaecology; Martini Hospital; Groningen the Netherlands
| | - MH Zafarmand
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - MHP Hof
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - J Morris
- Clinical & Population Perinatal Health Research; Kolling Institute of Medical Research; University of Sydney; Sydney NSW Australia
| | - MTM Franssen
- Department of Obstetrics & Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - CJM de Groot
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics & Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - MA Oudijk
- Department of Obstetrics & Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics & Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - M Porath
- Department of Obstetrics & Gynaecology; Máxima Medical Centre; Veldhoven the Netherlands
| | - M Woiski
- Department of Obstetrics & Gynaecology; Radboud University Nijmegen; Nijmegen the Netherlands
| | - BM Akerboom
- Department of Obstetrics & Gynaecology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - JM Sikkema
- Department of Obstetrics & Gynaecology; ZGT; Almelo the Netherlands
| | - B Nij Bijvank
- Department of Obstetrics & Gynaecology; Isala Clinics; Zwolle the Netherlands
| | - ALM Mulder
- Department of Paediatrics; Maastricht University Medical Centre; Maastricht the Netherlands
| | - PM Bossuyt
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - BWJ Mol
- The Robinson Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| |
Collapse
|
25
|
Schaap TP, Knight M, Zwart JJ, Kurinczuk JJ, Brocklehurst P, van Roosmalen J, Bloemenkamp KWM. Eclampsia, a comparison within the International Network of Obstetric Survey Systems. BJOG 2014; 121:1521-8. [DOI: 10.1111/1471-0528.12712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- TP Schaap
- Department of Obstetrics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - M Knight
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - JJ Zwart
- Department of Obstetrics and Gynaecology; Deventer Ziekenhuis; Deventer the Netherlands
| | - JJ Kurinczuk
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - P Brocklehurst
- Institute for Women's Health; University College London; London UK
| | - J van Roosmalen
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
- Department of Medical Humanities; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| |
Collapse
|
26
|
Prick BW, Jansen AJG, Steegers EAP, Hop WCJ, Essink-Bot ML, Uyl-de Groot CA, Akerboom BMC, van Alphen M, Bloemenkamp KWM, Boers KE, Bremer HA, Kwee A, van Loon AJ, Metz GCH, Papatsonis DNM, van der Post JAM, Porath MM, Rijnders RJP, Roumen FJME, Scheepers HCJ, Schippers DH, Schuitemaker NWE, Stigter RH, Woiski MD, Mol BWJ, van Rhenen DJ, Duvekot JJ. Transfusion policy after severe postpartum haemorrhage: a randomised non-inferiority trial. BJOG 2014; 121:1005-14. [DOI: 10.1111/1471-0528.12531] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2013] [Indexed: 01/22/2023]
Affiliation(s)
- BW Prick
- Department of Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
- Department of Obstetrics and Gynaecology; Maasstad Hospital; Rotterdam the Netherlands
| | - AJG Jansen
- Sanquin Blood Supply Foundation; Rotterdam the Netherlands
| | - EAP Steegers
- Department of Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - WCJ Hop
- Department of Biostatistics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - ML Essink-Bot
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - CA Uyl-de Groot
- Institute for Medical Technology Assessment; Erasmus University; Rotterdam the Netherlands
| | - BMC Akerboom
- Department of Obstetrics and Gynaecology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - M van Alphen
- Department of Obstetrics and Gynaecology; Flevo Hospital; Almere the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - KE Boers
- Department of Obstetrics and Gynaecology; Bronovo Hospital; the Hague the Netherlands
| | - HA Bremer
- Department of Obstetrics and Gynaecology; Reinier de Graaf Gasthuis; Delft the Netherlands
| | - A Kwee
- Department of Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - AJ van Loon
- Department of Obstetrics and Gynaecology; Martini Hospital; Groningen the Netherlands
| | - GCH Metz
- Department of Obstetrics and Gynaecology; Ikazia Hospital; Rotterdam the Netherlands
| | - DNM Papatsonis
- Department of Obstetrics and Gynaecology; Amphia Hospital; Breda the Netherlands
| | - JAM van der Post
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - MM Porath
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - RJP Rijnders
- Department of Obstetrics and Gynaecology; Jeroen Bosch Hospital; ‘s-Hertogenbosch the Netherlands
| | - FJME Roumen
- Department of Obstetrics and Gynaecology; Atrium Medical Centre; Heerlen the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - DH Schippers
- Department of Obstetrics and Gynaecology; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
| | - NWE Schuitemaker
- Department of Obstetrics and Gynaecology; Diakonessen Hospital; Utrecht the Netherlands
| | - RH Stigter
- Department of Obstetrics and Gynaecology; Deventer Hospital; Deventer the Netherlands
| | - MD Woiski
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - BWJ Mol
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - DJ van Rhenen
- Sanquin Blood Supply Foundation; Rotterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| |
Collapse
|
27
|
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
|
28
|
van Baaren GJ, Jozwiak M, Opmeer BC, Oude Rengerink K, Benthem M, Dijksterhuis MGK, van Huizen ME, van der Salm PCM, Schuitemaker NWE, Papatsonis DNM, Perquin DAM, Porath M, van der Post JAM, Rijnders RJP, Scheepers HCJ, Spaanderman M, van Pampus MG, de Leeuw JW, Mol BWJ, Bloemenkamp KWM. Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E₂ gel (PROBAAT trial). BJOG 2013; 120:987-95. [PMID: 23530729 DOI: 10.1111/1471-0528.12221] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel. DESIGN Economic evaluation alongside a randomised controlled trial. SETTING Obstetric departments of one university and 11 teaching hospitals in the Netherlands. POPULATION Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section. METHODS Cost-effectiveness analysis from a hospital perspective. MAIN OUTCOME MEASURES We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness ratios, which represent the costs to prevent one of these adverse outcomes. RESULTS Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E₂ gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval -€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction, therefore the incremental cost-effectiveness ratio was not informative. Foley induction resulted in fewer neonatal admissions (incremental cost-effectiveness ratio €2708) and asphyxia/postpartum haemorrhage (incremental cost-effectiveness ratios €5257) compared with prostaglandin induction. CONCLUSIONS Foley catheter and prostaglandin E2 labour induction generate comparable costs.
Collapse
Affiliation(s)
- G J van Baaren
- Department of Obstetrics, Academic Medical Centre, Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kesteren FV, Visser VS, Hermes W, Franx A, Bloemenkamp KWM, Pampus MGV, Mol BW, deGroot CJM. O22. Secondary preventive interventions of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation. Pregnancy Hypertens 2011; 1:267-8. [PMID: 26009084 DOI: 10.1016/j.preghy.2011.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F V Kesteren
- Obstetrics and Gynaecology, LUMC, Leiden, VUMC, Amsterdam
| | - V S Visser
- Obstetrics and Gynaecology, MCHaaglanden, The Hague
| | - W Hermes
- Obstetrics and Gynaecology, LUMC, Leiden
| | - A Franx
- Obstetrics and Gynaecology, UMCU, Utrecht
| | | | | | - B W Mol
- Obstetrics and Gynaecology, AMC, Amsterdam
| | | |
Collapse
|
30
|
Roeters van Lennep JE, Meijer E, Klumper FJCM, Middeldorp JM, Bloemenkamp KWM, Middeldorp S. Prophylaxis with low-dose low-molecular-weight heparin during pregnancy and postpartum: is it effective? J Thromb Haemost 2011; 9:473-80. [PMID: 21232006 DOI: 10.1111/j.1538-7836.2011.04186.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [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: 11/28/2022]
Abstract
BACKGROUND The optimal approach for venous thrombosis (VTE) prophylaxis during pregnancy and postpartum in women with an increased risk of VTE is not established. OBJECTIVES To evaluate the effectiveness, represented as the incidence of pregnancy-related VTE, and safety, represented as incidence of postpartum hemorrhage (PPH), of a protocol recommending prophylaxis with low-dose low-molecular-weight heparin (LMWH) in women at intermediate to high risk of VTE. PATIENTS/METHODS In this retrospective cohort study, we analyzed 34 women (44 pregnancies) with intermediate risk of VTE who received low-dose LMWH for 6 weeks postpartum and 57 women (82 pregnancies) with high risk of VTE who received low-dose LMWH during pregnancy and for 6 weeks postpartum. Pregnancy-related VTE was defined as VTE during pregnancy or ≤ 3 months postpartum. PPH was defined as blood loss >500 mL and severe PPH as blood loss > 1000 mL. RESULTS The incidence of pregnancy-related VTE was 5.5% (95% CI, 2.4-12.3) despite prophylaxis with low-dose LMWH. All events occurred in women at high risk, with a postpartum incidence of 7.0% (95% CI, 2.9-16.7) and antepartum incidence of 1.8% (95% CI, 0.4-9.2). The risk of PPH was 21.6% (95% CI, 14.3-31.3) and severe PPH 9.1% (95% CI, 4.7-16.9), which was not different in women who started LMWH postpartum and those who used LMWH during pregnancy. CONCLUSIONS Although prophylaxis with low-dose LMWH during pregnancy and postpartum proved to be safe, the risk of pregnancy-related VTE is considerable in women with a high risk of VTE. VTE prophylaxis with low-dose LMWH may not be sufficiently effective in these women.
Collapse
|
31
|
Boers KE, Vijgen SMC, Bijlenga D, van der Post JAM, Bekedam DJ, Kwee A, van der Salm PCM, van Pampus MG, Spaanderman MEA, de Boer K, Duvekot JJ, Bremer HA, Hasaart THM, Delemarre FMC, Bloemenkamp KWM, van Meir CA, Willekes C, Wijnen EJ, Rijken M, le Cessie S, Roumen FJME, Thornton JG, van Lith JMM, Mol BWJ, Scherjon SA. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341:c7087. [PMID: 21177352 PMCID: PMC3005565 DOI: 10.1136/bmj.c7087] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. DESIGN Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). SETTING Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008. PARTICIPANTS Pregnant women who had a singleton pregnancy beyond 36+0 weeks' gestation with suspected intrauterine growth restriction. INTERVENTIONS Induction of labour or expectant monitoring. MAIN OUTCOME MEASURES The primary outcome was a composite measure of adverse neonatal outcome, defined as death before hospital discharge, five minute Apgar score of less than 7, umbilical artery pH of less than 7.05, or admission to the intensive care unit. Operative delivery (vaginal instrumental delivery or caesarean section) was a secondary outcome. Analysis was by intention to treat, with confidence intervals calculated for the differences in percentages or means. RESULTS 321 pregnant women were randomly allocated to induction and 329 to expectant monitoring. Induction group infants were delivered 10 days earlier (mean difference -9.9 days, 95% CI -11.3 to -8.6) and weighed 130 g less (mean difference -130 g, 95% CI -188 g to -71 g) than babies in the expectant monitoring group. A total of 17 (5.3%) infants in the induction group experienced the composite adverse neonatal outcome, compared with 20 (6.1%) in the expectant monitoring group (difference -0.8%, 95% CI -4.3% to 3.2%). Caesarean sections were performed on 45 (14.0%) mothers in the induction group and 45 (13.7%) in the expectant monitoring group (difference 0.3%, 95% CI -5.0% to 5.6%). CONCLUSIONS In women with suspected intrauterine growth restriction at term, we found no important differences in adverse outcomes between induction of labour and expectant monitoring. Patients who are keen on non-intervention can safely choose expectant management with intensive maternal and fetal monitoring; however, it is rational to choose induction to prevent possible neonatal morbidity and stillbirth. TRIAL REGISTRATION International Standard Randomised Controlled Trial number ISRCTN10363217.
Collapse
Affiliation(s)
- K E Boers
- Leiden University Medical Centre, Leiden, Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Vijgen SMC, Koopmans CM, Opmeer BC, Groen H, Bijlenga D, Aarnoudse JG, Bekedam DJ, van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KWM, Drogtrop AP, Franx A, de Groot CJM, Huisjes AJM, Kwee A, van Loon AJ, Lub A, Papatsonis DNM, van der Post JAM, Roumen FJME, Scheepers HCJ, Stigter RH, Willekes C, Mol BWJ, Van Pampus MG. An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial). BJOG 2010; 117:1577-85. [DOI: 10.1111/j.1471-0528.2010.02710.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
|
34
|
Abstract
OBJECTIVE To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. DESIGN Prospective audit of selected women with SAMM. SETTING Eight audit meetings held throughout the Netherlands. POPULATION All pregnant women in the Netherlands. METHODS Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. MAIN OUTCOME MEASURES Incidence of substandard care and recommendations for improving the quality of care. RESULTS Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. CONCLUSION Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.
Collapse
Affiliation(s)
- J van Dillen
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands.
| | | | | | | | | |
Collapse
|
35
|
Zwart JJ, Richters JM, Ory F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG 2009; 116:1069-78; discussion 1078-80. [PMID: 19515148 DOI: 10.1111/j.1471-0528.2009.02136.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. DESIGN Population-based cohort study. SETTING All 98 maternity units in The Netherlands. POPULATION All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021). METHODS Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar. MAIN OUTCOME MEASURES Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. RESULTS There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). CONCLUSION The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.
Collapse
Affiliation(s)
- J J Zwart
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | | | | | | | |
Collapse
|
36
|
van Eyck J, Bloemenkamp KWM, Bolte AC, Duvekot JJ, Heringa MP, Lotgering FK, Oei SG, Offermans JPM, Schaap AHP, Sollie-Szarynska KM. [Tertiary obstetric care: the aims of the planning decree on perinatal care of 2001 have not yet been achieved]. Ned Tijdschr Geneeskd 2008; 152:2121-2125. [PMID: 18856029] [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: 05/26/2023]
Abstract
OBJECTIVE To compare the actual situation in tertiary perinatal care in the Netherlands with the objectives laid down in the 2001 decree on perinatal care by the Dutch Ministry of Health, Welfare and Sport. DESIGN Descriptive, retrospective. METHOD Data on tertiary perinatal care, the transfer or refusal of women with very endangered pregnancies and the personnel of obstetric high care (OHC) units in 2006 were compared with the targets laid down in the planning decree on perinatal care and in a report by the Dutch Health Council from 2000. Parameters of tertiary perinatal care output were the number of admissions, and the number of beds in OHC units and neonatal intensive care units (NICU). RESULTS In 2006, 128 of the 250 beds intended for OHC had been obtained. The degree of capacity utilisation was 94%, while the norm is 80%. 312 women were transferred due to lack of capacity of OHC units and NICU. The number of staff, specialised physicians as well as nurses, was considerably lower than the planned capacity. But training for obstetric perinatologists and OHC nurses was given. CONCLUSION The targets for the number of beds for tertiary obstetric care and associated medical personnel have not been achieved as yet. As a consequence, the number of transfers is still too high. The funding of OHC units is not attuned to the complexity of tertiary perinatal care. Closer supervision of the execution of the planning decree and an adequate financing system are needed to achieve the objectives of the planning decree in the next 3 years.
Collapse
Affiliation(s)
- J van Eyck
- Isala klinieken, locatie Sophia, afd. Gynaecologie en Verloskunde, Dr.Van Heesweg 2, 8025 AB Zwolle.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Zwart JJ, Richters JM, Ory F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371,000 pregnancies. BJOG 2008; 115:842-50. [PMID: 18485162 DOI: 10.1111/j.1471-0528.2008.01713.x] [Citation(s) in RCA: 279] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. DESIGN Prospective population-based cohort study. SETTING All 98 maternity units in the Netherlands. POPULATION All pregnant women in the Netherlands. METHODS Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371,021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. MAIN OUTCOME MEASURES Incidence, case fatality rates, possible risk factors and substandard care. RESULTS Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10,000), eclampsia in 222 women (incidence 6.2/10,000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. CONCLUSIONS Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.
Collapse
Affiliation(s)
- J J Zwart
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | | | | | | | |
Collapse
|
38
|
Bloemenkamp KWM, Duvekot JJ, Kwee A, Mol BW, van Pampus MG, van der Post JA, Scheepers HC, Willekes C, Wouters MGAJ. [Physicians and scientific research: slight decline of the numbers of physicians with a doctoral degree]. Ned Tijdschr Geneeskd 2006; 150:2116-7. [PMID: 17039607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
39
|
Bloemenkamp KWM. Epidemiology of oral contraceptive related thrombosis. Thromb Res 2005; 115 Suppl 1:1-6. [PMID: 15790140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- K W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
40
|
De Maat MPM, Jansen MWJC, Hille ETM, Vos HL, Bloemenkamp KWM, Buitendijk S, Helmerhorst FM, Wladimiroff JW, Bertina RM, De Groot CJM. Preeclampsia and its interaction with common variants in thrombophilia genes. J Thromb Haemost 2004; 2:1588-93. [PMID: 15333035 DOI: 10.1111/j.1538-7836.2004.00861.x] [Citation(s) in RCA: 47] [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] [Indexed: 11/28/2022]
Abstract
Recently, it has been proposed that abnormalities in coagulation and fibrinolysis contribute to the development of preeclampsia by increasing the thrombotic tendency. This hypothesis was tested in women who have had preeclampsia (cases) compared with matched controls. Polymorphisms in the thrombophilia genes [plasminogen activator inhibitor type 1 [PAI-1 -675(4G/5G)], thrombin activatable fibrinolysis inhibitor (TAFI -438G/A and 1040C/T), methylenetetrahydrofolate reductase (MTHFR 677C/T), factor V (FV Leiden R/Q506), prothrombin (FII 20210G/A) and factor XIIIA (FXIIIA V/L34)] were determined in 157 women with preeclampsia and 157 women with uncomplicated pregnancy. The associated risk of preeclampsia was analyzed using logistic regression methods. The frequency distributions of the genotypes of these six polymorphisms in thrombophilia genes were similar in the case and control groups. We found no differences in the prevalence of genetic risk factors of thrombosis in women with preeclampsia compared with controls, which makes it unlikely that these polymorphisms are risk factors for preeclampsia.
Collapse
Affiliation(s)
- M P M De Maat
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND The progestogen component of oral contraceptives (OC) has undergone changes since it was first recognised that their chemical structures could influence the spectrum of minor adverse and beneficial effects. The major determinants of OCs are effectiveness, cycle control and common side effects. The rationale of this review is to provide a systematic comparison of OCs containing the progestogens currently in use worldwide. OBJECTIVES The objective of this review is to compare currently available low-dose OCs containing ethinyl estradiol and different progestogens in terms of contraceptive effectiveness, cycle control, side effects and continuation rates. SEARCH STRATEGY The Cochrane Controlled Trials Register, MEDLINE and EMBASE databases have been searched systematically. Relevant pharmaceutical companies and the authors of articles included in this review have been contacted for clarification. SELECTION CRITERIA Randomised trials reporting clinical outcomes were considered for inclusion. We excluded studies comparing mono- with multiphasic pills, and crossover trials with trials in which the difference in total content of ethinyl estradiol between preparations exceeded 105 micro g. DATA COLLECTION AND ANALYSIS The methodological quality and validity of studies were assessed based on the above-mentioned inclusion criteria. Both application of inclusion criteria and data extraction were performed independently by the reviewers. Results are expressed as relative risk (RR) with 95% confidence interval (CI) using a random-effects model. MAIN RESULTS Twenty-two trials have been included in this review, thus generating 14 comparisons. Eighteen trials were sponsored by pharmaceutical companies and in only 5 cases had a blind trial been attempted. Most comparisons between different interventions included 1-3 trials. There was less discontinuation with second- compared to first-generation progestogens (RR: 0.79, 95% CI: 0.69-0.91). Cycle control appears to be better when using second- compared to first-generation progestogens for both mono- (RR: 0.69; 95% CI: 0.52-0.91) and triphasic (RR: 0.61; 95% CI: 0.43-0.85) preparations.Contraceptive effectiveness, spotting, breakthrough bleeding and the absence of withdrawal bleeding was similar when using GSD compared to LNG, although there was less intermenstrual bleeding in the GSD group (RR: 0.71, 95% CI: 0.55, 0.91). Drospirenone (DRSP) appeared to be similar to DSG. REVIEWERS' CONCLUSIONS Based on data from one trial, compared to pills containing LNG, those containing GSD may be associated with less intermenstrual bleeding although they show similar patterns of spotting, breakthrough bleeding and the absence of withdrawal bleeds. GSD is also comparable to DSG. Regarding acceptability, all the indices show that third- and second-generation progestogens are preferred over first-generation preparations. Future research should focus on independently conducted, well-designed randomised trials that compare third- and second-generation progestogens in particular.
Collapse
|