59 research outputs found
Does measurement of intrauterine pressure have predictive value during oxytocin-augmented labor?
No full textIn a previous randomized trial that compared monitoring uterine contractions with an intrauterine pressure catheter (IUPC) versus external monitoring, we demonstrated that use of an IUPC did not improve the outcome of labor. To provide insight in the lack of a positive effect, we evaluated level of IUP in Montevideo units (MU) in correlation with dysfunctional labor and adverse neonatal outcome. Here, we present two secondary analyses on the 503 women who had IUP measured in the trial. Firstly, we assessed labor outcome in relation to the highest IUP measured at any time during labor. Secondly, we assessed labor outcome to the IUP registered at the last vaginal examination during the first stage of labor in two study groups (above and below 200 MU). Women with lower IUP were statistically significant older, had pregnancies with a longer gestational age, longer labors and neonates with a higher birth weight. The risk of a cesarean section was higher in women who had low IUP during labor (Likelihood Ratio 1.6 for IUP 300 MU). IUP was not associated with neonatal outcome. IUP is associated with mode of delivery. However, use of internal tocodynamometry does not improve birth outcome
Hemodynamic and metabolic effects after nifedipine and ritodrine tocolysis
No full textObjectives: The purpose of this study is to compare the hemodynamic and metabolic changes after ritodrine and nifedipine tocolysis. Methods: For an open randomized study, patients with preterm labor (N=185) were allocated to groups to receive ritodrine intravenously (N=90) or nifedipine orally (N=95). Results: The mean diastolic blood pressure was significantly lower in the ritodrine group 24 h (65±12 vs. 70±8, P=0.001) and 48 h (65±12 vs. 71±8, P=0.004) after starting tocolysis compared with the nifedipine group. Mean maternal heart rate was significantly higher in the ritodrine group 24 h (105±17 vs. 86±13, P<0.0001) and 48 h (100±21 vs. 85±12, P<0.0001) after starting tocolysis compared with the nifedipine group. Mean fasting glucose levels were higher (6.68±2.53 vs. 4.93±1.23, P=0.0016), while mean potassium levels were lower (3.52±0.84 vs. 3.81±0.45, P=0.04) in the ritodrine group 48 h after starting tocolysis compared with the nifedipine group. Conclusions: Use of nifedipine for preterm labor is associated with a lower incidence of adverse hemodynamic and metabolic changes compared with ritodrine after 24 and 48 h of tocolysis. In our opinion nifedipine is the preferred drug of choice for the treatment of preterm labor.D. N. M. Papatsonis, H. P. van Geijn, O. P. Bleker, H. J. Adèr and G. A. Dekke
Can neonatal sepsis be predicted in late preterm premature rupture of membranes? Development of a prediction model
No full textAbstract not availableDavid P. van der Ham, Sander van Kuijk, Brent C. Opmeer, Christine Willekes, Johannes J. van Beek, Antonius L.M. Mulder, Aren J. van Loon, Martiët Groenewout, Gerald D. Mantel, Kitty W.M. Bloemenkamp, Martina Porath, Anneke Kwee, Bettina M.C. Akerboom, Dimitri N.M. Papatsonis, Godfried C.H. Metz, Jan G. Nijhuis, Ben W.J. Mol, The PPROMEXIL trial grou
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
Does use of an intrauterine catheter during labor increase risk of infection?
No full textObjective. To 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. Methods. We 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. Results. There 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. Conclusion. Use of an intrauterine catheter during labor does not increase the risk of infectio
RBC transfusion leads to an improvement of physical fatigue in women with acute postpartum anemia: the WOMB study (NCT00335023)
No full textAbstract 64Babette W. Prick, A.J. Gerard Jansen, Eric A.P. Steegers, Wim C.J. Hop, Marie-Louise Essink-Bot, Carin A. Uyl-de Groot, Dimitri N.M. Papatsonis, Bettina M.C. Akerboom, Godfried C.H. Metz, Henk A. Bremer, Aren J. van Loon, Rob H. Stigter, Joris A.M. van der Post, Marcel van Alphen, Martina Porath, Robbert J.P. Rijnders, Marc E.A. Spaanderman, Daniela H. Schippers, Kitty W.M. Bloemenkamp, Kim E. Boers, Hubertina C.J. Scheepers, Frans J.M.E. Roumen, Anneke Kwee, Nico W.E. Schuitemaker, Ben Willem J. Mol, Dick J. van Rhenen, Johannes J. Duveko
Outcomes after internal versus external tocodynamometry for monitoring labor
No full textBackground: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis. Methods: We performed a randomized, controlled trial in six hospitals in the Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours). Results: We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported. Conclusions: Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.)Jannet J.H. Bakker, Corine J.M. Verhoeven, Petra F. Janssen, Jan M. van Lith, Elisabeth D. van Oudgaarden, Kitty W.M. Bloemenkamp, Dimitri N.M. Papatsonis, Ben Willem J. Mol, and Joris A.M. van der Pos
Onderwijsverbetering: Voorbeelden uit het onderwijs
No full textUitgave bij gelegenheid van de CRWO-studiedag, 26 oktober 1990 aan de Technische Universiteit Delft, onder auspiciën van de Contactgroep Research Wetenschappelijk OnderwijsDelft University of Technolog
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
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