90 research outputs found
Severe hypotension and fetal death due to tocolysis with nifedipine - Correspondence
No full textDimitri N. M. Papatsonis, Bruno Carbonne, Gustaaf A. Dekker, Vicki Flenady & James F. Kin
Atosiban versus fenoterol as a uterine relaxant for external cephalic version: randomised controlled trial
No full textObjective, To compare the effectiveness of the oxytocin receptor antagonist atosiban with the beta mimetic fenoterol as uterine relaxants in women undergoing external cephalic version, ECV, for breech presentation. Design, Multicentre, open label, randomised controlled trial. Setting, Eight hospitals in the Netherlands, August, to May, . Participants, women with a singleton fetus in breech presentation and a gestational age of more than, weeks were randomly allocated in a, ratio to either, ., mg atosiban, n, or, μg fenoterol, n, intravenously for uterine relaxation before ECV. Main outcome measures, The primary outcome measures were a fetus in cephalic position, minutes after the procedure and cephalic presentation at delivery. Secondary outcome measures were mode of delivery, incidence of fetal and maternal complications, and drug related adverse events. All analyses were done on an intention-to-treat basis. Results, Cephalic position, minutes after ECV occurred significantly less in the atosiban group than in the fenoterol group, v, relative risk, ., confidence interval, ., to, ., . Presentation at birth was cephalic in, n, of the atosiban group and, n, of the fenoterol group, ., ., to, ., and caesarean delivery was performed in, n, of women in the atosiban group and, n, in the fenoterol group, ., ., to, ., . No significant differences were found in neonatal outcomes or drug related adverse events. Conclusions, In women undergoing ECV for breech presentation, uterine relaxation with fenoterol increases the rate of cephalic presentation, minutes after the procedure. No statistically significant difference was found for cephalic presentation at delivery.Joost Velzel, Floortje Vlemmix, Brent C Opmeer, Jan F M Molkenboer, Corine J Verhoeven, Mariëlle G van Pampus, Dimitri N M Papatsonis, Joke M J Bais, Karlijn C Vollebregt, Liesbeth van der Esch, Joris A M Van der Post, Ben Willem Mol, Marjolein Ko
Oxytocin Antagonists as Maintenance Therapy for Inhibiting Preterm Birth after Threatened Preterm Labour
No full textBackgroun
Does use of an intrauterine catheter during labor increase risk of infection?
No full textObjectiveTo determine whether the use of an intrauterine catheter during labor is related to the occurrence of infection in mother or newborn during labor and up to 3 weeks postpartum.MethodsWe performed a follow-up study of 1435 women who participated in a previously published multicentre randomized controlled trial in the Netherlands that assigned women in whom labor was induced or augmented with intravenous oxytocin to internal or external tocodynamometry. In the present post hoc analysis, we assessed the risk for infection, defined as a composite measure of any clinical sign of infection, treatment with antibiotics or sepsis during labor or in the postpartum period up to 3 weeks in mother or newborn.ResultsThere were 64 cases with indication of infection in the intrauterine catheter group (8.8%) versus 74 cases in the external monitoring group (10.4%). Relative risk: 0.91, 95% confidence interval: 0.77-1.1, and p: 0.33.ConclusionUse of an intrauterine catheter during labor does not increase the risk of infection.Karlijn Van Halem, Jannet J. H. Bakker, Corine J. Verhoeven, Dimitri N. M. Papatsonis, Elisabeth D. Van Oudgaarden, Petra Janssen, Kitty W. Bloemenkamp, Ben Willem J. Mol & Joris A. M. Van Der Pos
Fetal complications after placement of an intrauterine pressure catheter: a report of two cases and review of the literature
No full textBackground. Uterine contractions during labor can be monitored by external tocodynamometry or by the use of an intrauterine pressure catheter (IUPC). Since an IUPC measures the frequency of contractions as well as their strength and duration, it is thought to be more accurate than external tocodynamometry. However, limited evidence on this subject suggests that IUPC may not improve maternal or perinatal outcomes. Moreover, the use of IUPC may cause fetal complications. Cases. We describe the placement of an IUPC during induction of labor with oxytocin in two cases, one presenting with a singleton pregnancy and the other a twin pregnancy. After introduction of the IUPC, both cases were complicated by blood loss and signs of fetal distress on cardiotocography. An emergency cesarean section was performed in both cases. In the first case, extramembranous placement of the IUPC was observed, whereas in the second case, the IUPC had lacerated an arteriovenous anastomosis in the membranes, resulting in perinatal death. Conclusion. Placement of an intrauterine pressure catheter instead of external tocodynamometry has a small risk for serious fetal complications.Freke A. Wilmink, Femke F. Wilms, Roger Heydanus, Ben W. J. Mol, Dimitri N. M. Papatsoni
Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial
No full textBackground: There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women. Methods We did an open-label, randomised controlled trial, in seven academic hospitals and 44 non-academic hospitals in the Netherlands. Women with non-severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation were randomly allocated to either induction of labour or caesarean section within 24 h (immediate delivery) or a strategy aimed at prolonging pregnancy until 37 weeks of gestation (expectant monitoring). The primary outcomes were a composite of adverse maternal outcomes (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption, or maternal death), and neonatal respiratory distress syndrome, both analysed by intention-to-treat. This study is registered with the Netherlands Trial Register (NTR1792). Findings Between March 1, 2009, and Feb 21, 2013, 897 women were invited to participate, of whom 703 were enrolled and randomly assigned to immediate delivery (n=352) or expectant monitoring (n=351). The composite adverse maternal outcome occurred in four (1·1%) of 352 women allocated to immediate delivery versus 11 (3·1%) of 351 women allocated to expectant monitoring (relative risk [RR] 0·36, 95% CI 0·12–1·11; p=0·069). Respiratory distress syndrome was diagnosed in 20 (5·7%) of 352 neonates in the immediate delivery group versus six (1·7%) of 351 neonates in the expectant monitoring group (RR 3·3, 95% CI 1·4–8·2; p=0·005). No maternal or perinatal deaths occurred. Interpretation For women with non-severe hypertensive disorders at 34–37 weeks of gestation, immediate delivery might reduce the already small risk of adverse maternal outcomes. However, it significantly increases the risk of neonatal respiratory distress syndrome, therefore, routine immediate delivery does not seem justified and a strategy of expectant monitoring until the clinical situation deteriorates can be considered.Kim Broekhuijsen, MDt, Gert-Jan van Baaren, MDa, Maria G van Pampus, MDc, Wessel Ganzevoort, MDa, J Marko Sikkema, MDd, Mallory D Woiski, MDe, Martijn A Oudijk, MDf, Kitty W M Bloemenkamp, MDg, Hubertina C J Scheepers, MDh, Henk A Bremer, MDi, Robbert J P Rijnders, MDj, Aren J van Loon, MDk, Denise A M Perquin, MDl, Jan M J Sporken, MDm, Dimitri N M Papatsonis, MDn, Marloes E van Huizen, MDo, Corla B Vredevoogd, MDp, Jozien T J Brons, MDq, Mesrure Kaplan, MDr, Prof Anton H van Kaam, MDb, Henk Groen, MDs, Martina M Porath, MDu, Prof Paul P van den Berg, MDt, Prof Ben W J Mol, MDv, Maureen T M Franssen, MDt, Josje Langenveld, M
Foleykatheter versus prostaglandine E2-gel voor inleiden van aterme baring
No full textTitle in English: Foley catheter versus prostaglandin E2 gel for induction of labor at term: The PROBAAT studyDoel: Het onderzoeken van de effectiviteit en veiligheid van een transcervicale foleykatheter ten opzichte van vaginale prostaglandine E2-gel voor inleiden van de aterme baring. Opzet: Multicentrische, gerandomiseerde, open-label onderzoek in 12 Nederlandse ziekenhuizen in de periode 10 februari 2009-17 mei 2010. Methode: Aterme vrouwen gepland voor inleiding met een eenlingzwangerschap in hoofdligging, staande vliezen en een onrijpe cervix (bishopscore < 6) werden middels een online-systeem gerandomiseerd tussen rijping van de cervix met een transcervicale foleykatheter dan wel met vaginale prostaglandine E2-gel. De primaire uitkomstmaat was sectio caesarea, secundaire uitkomstmaten waren maternale en neonatale morbiditeit en tijd van begin van de inleiding tot geboorte. Resultaten: Er werden 824 vrouwen gerandomiseerd tussen foleykatheter (n = 412) en prostaglandine E2-gel (n = 412). Het percentage sectio’s was vergelijkbaar tussen de groepen (23 vs. 20%; RR: 1,13; 95%-BI: 0,87-1,47). Er werden in totaal minder kunstverlossingen vanwege foetale nood uitgevoerd in de groep met de foleykatheter (12 vs. 18%; RR: 0,68; 95-% BI: 0,49-0,95). De mediane tijd tot bevalling was langer (mediaan: 29 vs. 18 h; interkwartiele uitersten: 15-35 vs. 12-33). De maternale uitkomstmaten waren niet verschillend, behoudens minder patiënten met verdenking op maternale infectie durante partu in de groep met een foleykatheter (2 vs. 4%; RR: 0,41; 95%-BI: 0,17-0,98). Na inleiding met een foleykatheter werden significant minder neonaten opgenomen op de kinderafdeling (12 vs. 20%; RR: 0,60; 95%-BI 0,43-0,83). Conclusie: Inleiden van de baring à terme met een foleykatheter leidt niet tot minder sectio’s dan inleiden met prostaglandine E2-gel, maar wel tot minder bijwerkingen.Marta Jozwiak, Katrien Oude Rengerink, Jan Willem de Leeuw, Ben Willem J. Mol, K.W.M. (Kitty) Bloemenkamp, Marjan Benthem, Erik van Beek, Marja Dijksterhuis, Irene de Graaf, Marloes van Huizen, Martijn Oudijk, Dimitri Papatsonis, Denise Perquin, Martina Porath, Joris van der Post, Robert Rijnders, Liesbeth Scheepers, Marc Spaanderman en Mariëlle van Pampu
Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial
No full textBackground Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day.Liv M Freeman, Kitty WM Bloemenkamp, Maureen TM Franssen, Dimitri NM Papatsonis, Petra J Hajenius, Marloes E van Huizen, Henk A Bremer, Eline SA van den Akker, Mallory D Woiski, Martina M Porath, Erik van Beek, Nico Schuitemaker, Paulien CM van der Salm, Bianca F Fong, Celine Radder, Caroline J Bax, Marko Sikkema, M Elske van den Akker-van Marle, Jan MM van Lith, Enrico Lopriore, Renske J Uildriks, Michel MRF Struys, Ben Willem J Mol, Albert Dahan, and Johanna M Middeldor
Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry
No full textPresented orally at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010Objective: We sought to evaluate number and timing of elective cesarean sections at term and to assess perinatal outcome associated with this timing. Study Design: We conducted a recent retrospective cohort study including all elective cesarean sections of singleton pregnancies at term (n = 20,973) with neonatal follow-up. Primary outcome was defined as a composite of neonatal mortality and morbidity. Results: More than half of the neonates were born at <39 weeks of gestation, and they were at significantly higher risk for the composite primary outcome than neonates born thereafter. The absolute risks were 20.6% and 12.5% for birth at <38 and 39 weeks, respectively, as compared to 9.5% for neonates born ≥39 weeks. The corresponding adjusted odds ratios (95% confidence interval) were 2.4 (2.1–2.8) and 1.4 (1.2–1.5), respectively. Conclusion: More than 50% of the elective cesarean sections are applied at <39 weeks, thus jeopardizing neonatal outcome.Freke A. Wilmink, Chantal W.P.M. Hukkelhoven, Simone Lunshof, Ben Willem J. Mol, Joris A.M. van der Post, Dimitri N.M. Papatsoni
Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour (Review)
No full textBackground: In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant. Objectives: To assess the effects of maintenance therapy with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles. Selection criteria: Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after an episode of preterm labour. Data collection and analysis: We used the standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group. Two review authors independently undertook evaluation of methodological quality and extracted trial data. Main results: This review includes one trial of 513 women. When compared with placebo, atosiban did not reduce preterm birth before 37 weeks (risk ratio (RR) 0.89; 95% confidence intervals (CI) 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). No difference was shown in neonatal morbidity, or perinatal mortality. Authors' conclusions: There is insufficient evidence to support the use of oxytocin receptor antagonists to inhibit preterm birth after a period of threatened or actual preterm labour. Any future trials using oxytocin antagonists or other drugs as maintenance therapy for preventing preterm birth should examine a variety of important infant outcome measures, including reduction of neonatal morbidity and mortality, and long-term infant follow-up. Future research should also focus on the pathophysiological pathways that precede preterm labour
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