31 research outputs found
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
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
Fetal fibronectin status and cervical length in women with threatened preterm labor and the effectiveness of maintenance tocolysis
No full textObjective: To assess the effect of maintenance tocolysis in women who are at high or low risk for preterm delivery according to fetal fibronectin (fFN) status and cervical length (CL). Study Design: We compared the risk of preterm delivery in fFN pos and fFN neg women and in women with a CL <15 mm and ≥15 mm, by using the Cox regression. Differences between the effectiveness of maintenance tocolysis in high- and low-risk women were assessed by using an interaction term. Results: 122 fFN tests were taken, of which 50 were fFN pos. CL was measured in 236 women, of whom 52 women had a CL <15 mm. The median gestational age at delivery was lower in fFN pos women; fFN pos women had a higher hazard for preterm delivery at any point of time (HR 4.7; 95% CI 2.9 to 7.6). Comparable results were seen for CL. Neither fFN status nor CL did alter the effect of maintenance tocolysis, which was ineffective in the total randomized group, on the risk of preterm delivery (p for interaction = 0.87 for fFN and 0.18 for CL). Conclusion: Maintenance tocolytic therapy with nifedipine is ineffective and not dependent on fFN or CL status.Carolien Roos, Jolande Y. Vis, Hubertina C.J. Scheepers, Kitty W.M. Bloemenkamp, Hans J.J. Duvekot, Jim van Eyck, Christianne de Groot, Joke H. Kok, Brent C. Opmeer, Martijn A. Oudijk, Dimitri N.M. Papatsonis, Martina M. Porath, Krystyna Sollie, Marc E.A. Spaanderman, Fred K. Lotgering, Joris A.M. van der Post, and Ben Willem J. Mo
Neonatal outcome following elective cesarean section of twin pregnancies beyond 35 weeks of gestation
No full textObjective: We sought to assess neonatal morbidity and mortality of elective cesarean section (CS) of uncomplicated twin pregnancies per week of gestation >35+0. Study Design: We performed a retrospective cohort study in our nationwide database including all elective CS of twin pregnancies. Two main composite outcome measures were defined, ie, severe adverse neonatal outcome and mild neonatal morbidity. Result: We report on 2228 neonates. More than 17% were born <37+0 weeks of gestation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for severe adverse neonatal outcome at 35+0-6, 36+0-6, and 37+0-6 weeks were, OR, 9.4; 95% CI, 3.2–27.6; OR, 1.7; 95% CI, 0.5–5.3; and OR, 0.7; 95% CI, 0.2–2.0, respectively; and for mild neonatal morbidity, OR, 4.7; 95% CI, 2.6–8.7; OR, 4.9; 95% CI, 3.1–7.9; and 1.4; 95% CI, 0.9–2.1, respectively, compared to neonates born ≥38+0 weeks of gestation. Conclusion: In uncomplicated twin pregnancies elective CS can best be performed between 37+0 and 39+6 weeks of gestation.Freke A. Wilmink, Chantal W.P.M. Hukkelhoven, Ben Willem J. Mol, Joris A.M. van der Post, Eric A.P. Steegers, Dimitri N.M. Papatsoni
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
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
Timing van electieve keizersneden à terme: trends in Nederland
No full textOBJECTIVE: To analyse if from 2000-2010 the rate of elective caesarean sections (CS) before 39 0/7 weeks of gestation declined when compared with all elective CS, and to evaluate the possible associated factors. DESIGN: Retrospective cohort study. METHOD: Using data from The Netherlands Perinatal Registry, all term elective CS (n = 59,653) from 2000-2010 were selected. Trends in patient characteristics and in performing an elective CS before 39 0/7 weeks were analysed using regression analysis, and differences between hospitals using the χ2 test. Using multiple logistic regression analysis it was analysed which factors were associated with performing an elective CS before 39 0/7 weeks. RESULTS: The percentage of elective CS before 39 0/7 weeks decreased from 56% in 2000 to 43% in 2010 (p < 0.0001). In peripheral hospitals an elective SC was performed more often before 39+0 weeks than in academic hospitals; 53% in peripheral teaching hospitals, 57% in peripheral non-teaching hospitals, and 46% in academic hospitals. Adjusted odds ratios and 95% confidence intervals were 1.38 (1.30-1.47) in peripheral teaching hospitals, and 1.55 (1.46-1.65) in peripheral non-teaching hospitals. In hospitals where the number of deliveries per year was situated in the lower quartile, elective CS before 39 0/7 weeks was carried out more often than in hospitals where deliveries per year were in the upper quartile, 60% versus 52% (p < 0.0001). CONCLUSION: In the period 2000-2009 the timing of elective CS improved marginally. In 2010 the trend began to decline, even though 43% of elective caesarean sections were still carried out before 39 0/7 weeks. This results in a higher risk of neonatal morbidity and health problems in long-term.Freke A. Wilmink, Chantal W.P.M. Hukkelhoven, Joris A.M. van der Post, Eric A.P. Steegers, Ben Willem J. Mol, Dimitri N.M. Papatsoni
Aspirin plus Heparin or Aspirin alone in women with recurrent miscarriage
No full textBACKGROUND: Aspirin and low-molecular-weight heparin are prescribed for women with unexplained recurrent miscarriage, with the goal of improving the rate of live births, but limited data from randomized, controlled trials are available to support the use of these drugs. METHODS: In this randomized trial, we enrolled 364 women between the ages of 18 and 42 years who had a history of unexplained recurrent miscarriage and were attempting to conceive or were less than 6 weeks pregnant. We then randomly assigned them to receive daily 80 mg of aspirin plus open-label subcut aneous nadroparin (at a dose of 2850 IU, starting as soon as a viable pregnancy was demonstrated), 80 mg of aspirin alone, or placebo. The primary outcome measure was the live-birth rate. Secondary outcomes included rates of miscarriage, obstetrical complications, and maternal and fetal adverse events. RESULTS: Live-birth rates did not differ significantly among the three study groups. The proportions of women who gave birth to a live infant were 54.5% in t he group receiving aspirin plus nadroparin (combination-therapy group), 50.8% in the aspirin-only group, and 57.0% in the placebo group (absolute difference in live-birth rate: combination therapy vs. placebo, −2.6 percentage points; 95% confidence interval [CI], −15.0 to 9.9; aspirin only vs. placebo, −6.2 percentage points; 95% CI, −18.8 to 6.4). Among 299 women who became pregnant, the live-birth rates were 69.1% in the combination-therapy group, 61.6% in the aspirin-only group, and 67.0% in the placebo group (absolute difference in live-birth rate: combination therapy vs. placebo, 2.1 percentage points; 95% CI, −10.8 to 15.0; aspirin alone vs. placebo −5.4 percentage points; 95% CI, −18.6 to 7.8). An increased tendency to bruise and swelling or itching at the injection site occurred significantly more frequently in the combination-therapy group than in the other two study groups. CONCLUSIONS: Neither aspirin combined with nadroparin nor aspirin alone improved the live-birth rate, as compared with placebo, among women with unexplained recurrent miscarriage. (Current Controlled Trials number, ISRCTN58496168.)Stef P. Kaandorp, Mariëtte Goddijn, Joris A.M. van der Post, Barbara A. Hutten, Harold R. Verhoeve, Karly Hamulyák, Ben Willem Mol, Nienke Folkeringa, Marleen Nahuis, Dimitri N.M. Papatsonis, Harry R. Büller, Fulco van der Veen and Saskia Middeldor
Prenatal Diagnosis of Alobar Holoprosencephaly, Cyclopia, Proboscis, and Isochromosome 18q in the Second Trimester
No full textWe would like to present a rare case of alobar holoprosencephaly (HPE) in a fetus diagnosed by routine sonography in the second trimester. Structural sonography demonstrated multiple facial anomalies including absent nasal bone, flat facial profile, hypotelorism, fusion of the orbits and proboscis. After counseling, termination of pregnancy was performed by vaginally administered misoprostol. Karyotyping of amniotic fluid cells revealed an isochromosome 18q, resulting in a trisomy 18q and monosomy 18p. A stillborn female of 390 g with several congenital anomalies was born. Postmortem examination demonstrated several anomalies including the HPE, cyclopia, double fused eye, absence of the nose, and the presence of a proboscis. In the literature only a few cases have been published
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
