23 research outputs found
Response to 'The drugs we deserve'
No full textDNM Papatsonis, VJ. Flenady, GA. Dekker, B. Carbonne, JF Kin
Risk of developmental dysplasia of the hip in breech presentation: the effect of successful external cephalic version
No full textArticle first published online: 12 NOV 2012Objective: To evaluate the effect of successful external cephalic version on the incidence of developmental dysplasia of the hip (DDH) requiring treatment in singleton breech presentation at term. Design: Observational cohort study. Setting: Three large teaching hospitals in the Netherlands. Population: Women with a singleton breech presentation of 34 weeks of gestation or more, who underwent an external cephalic version attempt. Methods: We made a comparison of the incidence of DDH between children born in breech presentation and children born in cephalic presentation after a successful external cephalic version. Main outcome measure: The incidence of DDH requiring either conservative treatment, with a harness, or surgical treatment. Results: A total of 498 newborns were included in the study, of which 40 (8%) were diagnosed with DDH and 35 required treatment. Multivariate analysis showed that female gender (OR 2.79, 95% CI 1.23–6.35) and successful external cephalic version (OR 0.29, 95% CI 0.09–0.95) were independently associated with DDH. Conclusions: A successful external cephalic version is associated with a lower incidence of DDH, although a high percentage of children born after a successful external cephalic version still appear to have DDH. A larger cohort study is needed to establish the definite nature of this relationship. Until then, we recommend the same screening policy for infants born in cephalic position after a successful external cephalic version as for infants born in breech position.AF Lambeek, M De Hundt, F Vlemmix, BMC Akerboom, JMJ Bais, DNM Papatsonis, BWJ Mol, M Ko
Calcium channel blockers for inhibiting preterm labour
No full textThe definitive version may be found at www.wiley.comBackgroundPreterm birth is a major contributor to perinatal mortality and morbidity and affects approximately six to seven per cent of births in developed countries. Tocolytics are drugs used to suppress uterine contractions. The most widely tested tocolytics are betamimetics. Although they have been shown to delay delivery, betamimetics have not been shown to improve perinatal outcome, and they have a high frequency of unpleasant and even fatal maternal side effects. There is growing interest in calcium channel blockers as a potentially effective and well tolerated form of tocolysis.ObjectivesTo assess the effects on maternal, fetal and neonatal outcomes of calcium channel blockers, administered as a tocolytic agent, to women in preterm labour.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials, the Cochrane Controlled Trials Register (February 2002), MEDLINE, EMBASE, and Current Contents. We also contacted recognised experts and cross referenced relevant material.Selection criteriaAll published and unpublished randomised trials in which calcium channel blockers were used for tocolysis for women in labour between 20 and 36 weeks gestation.Data collection and analysisStandard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by three authors. Additional information was sought to enable assessment of methodology and conduct of intention-to-treat analyses. Meta-analysis was conducted assessing the effects of calcium channel blockers compared with any other tocolytic agent. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.Main resultsEleven randomised controlled trials involving 870 women were included. When compared with any other tocolytic agent (mainly betamimetics), calcium channel blockers reduced the number of women giving birth within 48 hours (relative risk (RR) 0.73; 95% confidence interval (CI) 0.54, 0.98) and within seven days (RR 0.76; 95% CI 0.59, 0.99). Calcium channel blockers also reduced the requirement for women to have treatment ceased for adverse drug reaction (RR 0.15; 95% CI 0.06, 0.43), the frequency of neonatal respiratory distress syndrome (RR 0.64; 95% CI 0.45, 0.91) and neonatal jaundice (RR 0.73; 95% CI 0.57, 0.93).Reviewer's conclusionsWhen tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to betamimetic agents. Further research should address the effects of different dosage regimens and formulations of nifedipine on maternal and neonatal outcomes.King JF, Flenady VJ, Papatsonis DNM, Dekker GA, Carbonne
False positive FISH diagnosis of monosomy X in uncultured amniotic fluid cells due to a chromosome Y deletion
No full text
Oxytocin Antagonists for the Management of Preterm Birth: A Review
No full textPreterm birth, the leading cause of neonatal morbidity and mortality, is estimated at incidence of 12.7percent of all births, which has not decreased over the last four decades despite intensive antenatal care programs aimed at high-risk groups, the widespread use of tocolytics, and a series of other preventive and therapeutic interventions. Oxytocin antagonists, namely atosiban, represent an appealing choice that seems to be effective with apparently fewer side effects than the traditional tocolytics. This article reviews the available literature on the pharmacokinetics, mode of administration, and clinical utility of oxytocin antagonists for acute and maintenance tocolysis with special emphasis on its safety profile. © 2011 by Thieme Medical Publishers, Inc.Afschar P, 2004, BJOG-INT J OBSTET GY, V111, P316, DOI 10.1111-j.1471-0528.2004.00095.x; Akerlund M, 1999, BRIT J OBSTET GYNAEC, V106, P1047, DOI 10.1111-j.1471-0528.1999.tb08112.x; AKERLUND M, 1985, ACTA OBSTET GYN SCAN, V64, P499; Al-Omari WR, 2006, EUR J OBSTET GYN R B, V128, P129, DOI 10.1016-j.ejogrb.2005.12.010; Coomarasamy A, 2003, BJOG-INT J OBSTET GY, V110, P1045, DOI 10.1111-j.1471-0528.2003.03071.x; COPPER RL, 1993, AM J OBSTET GYNECOL, V168, P78; de Heus R, 2008, EUR J OBSTET GYN R B, V139, P139, DOI 10.1016-j.ejogrb.2008.01.001; eMC, TRACT 7 5 MG ML CONC; eMC, TRACT 7 5 MG ML SOL; Engstrom T, 1999, BIOL REPROD, V60, P322, DOI 10.1095-biolreprod60.2.322; Food and Drug Administration, 1998, 20797 NDA FOOD DRUG; Food and Drug Administration, 1998, 20797 NDA FOOD DRUG; Cabrol D, 2001, EUR J OBSTET GYN R B, V98, P177; FUCHS AR, 1984, AM J OBSTET GYNECOL, V150, P734; FUCHS AR, 1982, SCIENCE, V215, P1396, DOI 10.1126-science.6278592; GOODWIN TM, 1994, AM J OBSTET GYNECOL, V170, P474; Goodwin TM, 1996, AM J PERINAT, V13, P143, DOI 10.1055-s-2007-994312; GOODWIN TM, 1995, AM J OBSTET GYNECOL, V173, P913; Goodwin TM, 1996, OBSTET GYNECOL, V88, P331, DOI 10.1016-0029-7844(96)00200-1; Hamilton B. E., 2009, NATL VITAL STAT REP, V57, P1; Helmer H, 2003, BJOG-INT J OBSTET GY, V110, P113, DOI 10.1016-S1470-0328(03)00056-9; Husslein P, 2006, BJOG-INT J OBSTET GY, V113, P105, DOI 10.1111-j.1471-0528.2006.01134.x; Husslein P, 2003, INT J CLIN PRACT, V57, P121; Kashanian M, 2005, INT J GYNECOL OBSTET, V91, P10, DOI 10.1016-j.ijgo.2005.06.005; Kim A, 2006, BJOG-INT J OBSTET GY, V113, P113, DOI 10.1111-j.1471-0528.2006.01135.x; LUNDIN S, 1993, CLIN ENDOCRINOL, V39, P369, DOI 10.1111-j.1365-2265.1993.tb02379.x; Lurie S, 2004, J PERINAT MED, V32, P137; MORRISON JC, 1990, OBSTET GYNECOL, V76, pS5; Moutquin JM, 2000, AM J OBSTET GYNECOL, V182, P1191, DOI 10.1067-mob.2000.104950; Norwitz ER, 2004, AM J OBSTET GYNECOL, V191, P1491, DOI 10.1016-j.ajog.2004.06.043; Papatsonis D, 2009, COCHRANE DB SYST REV, DOI 10.1002-14651858.CD005938.pub2; Papatsonis D, 2005, COCHRANE DB SYST REV, DOI DOI 10.1002-14651858.CD004452.PUB2; Papatsonis DNM, 1997, OBSTET GYNECOL, V90, P230, DOI 10.1016-S0029-7844(97)00182-8; Papatsonis DNM, 2000, OBSTET GYNECOL, V95, P477, DOI 10.1016-S0029-7844(99)00596-7; Perry K, 1998, 46 ACOG ANN M MAY 9; Pierzynski P, 2004, J SOC GYNECOL INVEST, V11, P384, DOI 10.1016-j.jsgi.2004.02.008; Rasmussen BB, 2005, BJOG-INT J OBSTET GY, V112, P1492, DOI 10.1111-j.1471-0528.2005.00735.x; Reinheimer Torsten M, 2007, BMC Pregnancy Childbirth, V7 Suppl 1, pS15, DOI 10.1186-1471-2393-7-S1-S15; Reinheimer TM, 2005, J CLIN ENDOCR METAB, V90, P2275, DOI 10.1210-jc.2004-2120; Richter Oliver N., 2005, Archives of Gynecology and Obstetrics, V272, P26, DOI 10.1007-s00404-004-0652-8; ROMERO R, 1989, AM J OBSTET GYNECOL, V161, P817; Romero R, 2000, AM J OBSTET GYNECOL, V182, P1173, DOI 10.1067-mob.2000.95834; Steinwall M, 2004, ACTA OBSTET GYN SCAN, V83, P12, DOI 10.1111-j.1600-0412.2004.00320.x; Steinwall M, 2005, GYNECOL ENDOCRINOL, V20, P104, DOI 10.1080-09513590400021144; The European Atosiban Study Group, 2001, ACTA OBSTET GYNECOL, V80, P413; The worldwide Atosiban versus andbeta;-agonists Study Group, 2001, BJOG, V108, P133; Thornton JG, 2005, BJOG-INT J OBSTET GY, V112, P118, DOI 10.1111-j.1471-0528.2005.00599.x; Thornton JG, 2006, BJOG-INT J OBSTET GY, V113, P93, DOI 10.1111-j.1471-0528.2003.01131.x; Thornton S, OXYTOCIN RECEPTOR AN; Thornton S, 2009, AM J OBSTET GYNECOL, V200, P627; Thornton S, 2009, AM J OBSTET GYNECOL, V200, DOI 10.1016-j.ajog.2009.01.015; Treschan TA, 2006, ANESTHESIOLOGY, V105, P639; Treschan TA, 2006, ANESTHESIOLOGY, V105, P599, DOI 10.1097-00000542-200609000-00026; Tsatsaris V, 2004, DRUGS, V64, P375, DOI 10.2165-00003495-200464040-00003; UKMi, NEW MED MARK; VALENZUELA GJ, 1995, AM J OBSTET GYNECOL, V172, P1304, DOI 10.1016-0002-9378(95)91497-8; Valenzuela GJ, 2000, AM J OBSTET GYNECOL, V182, P1184, DOI 10.1067-mob.2000.105816; Wilson RJ, 2001, BRIT J OBSTET GYNAEC, V108, P960, DOI 10.1111-j.1471-0528.2001.00226.x43
Internal versus external tocodynamometry during induced or augmented labour
No full textBackgroundUterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child.ObjectivesTo assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013) and PubMed (1966 to 6 April 2013).Selection criteriaWe included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject.Data collection and analysisTwo review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information.Main resultsThree studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88).Authors' conclusionsThis review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.Bakker JJH, Janssen PF, van Halem K, van der Goes BY, Papatsonis DNM, van der Post JAM, Mol BW
Management of gestational hypertension and mild pre-eclampsia at term
No full textZwangerschapshypertensie en preëclampsie compliceren 6-8% van alle zwangerschappen en vormen in Nederland de belangrijkste oorzaak van maternale morbiditeit en mortaliteit. Vaak is het ziektebeeld mild en treedt op in de aterme periode. Soms ontstaan ernstige complicaties, zoals eclampsie, abruptio placentae of het HELLP-syndroom. Wereldwijd was er tot nu toe geen overeenstemming over het beste beleid bij deze aandoeningen. Inleiding van de baring zou enerzijds maternale complicaties kunnen reduceren, maar anderzijds de kans op een sectio caesarea kunnen verhogen.
Het eerste deel van dit proefschrift beschrijft een multicentrisch gerandomiseerde klinische studie (HYPITAT trial (HYpertension and Pre-eclampsia Intervention Trial At Term)), uitgevoerd binnen het Verloskundige Consortium (www.studies-obsgyn.nl/hypitat). Wij onderzochten wat beter is voor vrouwen met een milde zwangerschapsgerelateerde aterme hypertensie: inleiden of afwachten, met het oog op klinische effectiviteit, maternale kwaliteit van leven en kosten. Deze studie werd uitgevoerd in 38 Nederlandse ziekenhuizen. In totaal werden 756 vrouwen gerandomiseerd voor inleiden (n=377) of afwachten (n=379). De resultaten wijzen uit dat inleiden de kans op maternale complicaties verkleint (31% versus 44%; RR 0.71; p<0.001), inleiden een tendens laat zien van minder sectio caesarea (14% versus 19%; RR0.75; p=0.085) en inleiden gemiddeld 831 euro per patiënt goedkoper is dan afwachten. De neonatale uitkomst en de maternale kwaliteit van leven is gelijk tussen beide strategieën. Daarom adviseren wij een inleiding van de baring bij vrouwen met een zwangerschapshypertensie of milde preëclampsie na 37 weken zwangerschap.
Het tweede gedeelte van dit proefschrift beschrijft welke factoren een slechte maternale uitkomst bij vrouwen met een aterme zwangerschapshypertensie of milde preëclampsie kunnen voorspellen. Voor deze studies hebben wij gebruik van de HYPITAT database.
The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry
No full textCalcium channel blockers for the management of preterm birth: A review
No full textPreterm birth continues to be the leading cause of perinatal morbidity and mortality. A wide range of tocolytics have been utilized for the management of preterm labor. Calcium channel blockers, namely nifedipine, gained popularity as tocolytics due to the oral route of administration, availability of immediate- and slow-release preparations, the low incidence of maternal adverse effects associated with their use, and the fact that they are inexpensive. This article reviews the available literature on the clinical utility of calcium channel blockers for acute and maintenance tocolysis with special emphasis on potential adverse effects, the most appropriate dose-regimen, and contemporary practice patterns among obstetricians. There are no randomized, placebo-controlled studies demonstrating the benefit of nifedipine in preterm labor. A suggested tocolytic protocol would be to start with the lowest dose of oral immediate-release nifedipine. For the first 48 hours thereafter, all attempts should be made not to exceed 60-mg daily doses. 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