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Bijvank SWN, Visser W, Duvekot JJ, Steegers EA, Edens MA, Roofthooft DW, Vulto AG, Hanff LM. Ketanserin versus dihydralazine for the treatment of severe hypertension in early-onset preeclampsia: a double blind randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2015; 189:106-11. [DOI: 10.1016/j.ejogrb.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/17/2015] [Accepted: 02/06/2015] [Indexed: 11/29/2022]
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77
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Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C, Calvert S, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Thilaganathan B, Todros T, Valcamonico A, Visser GHA, Wolf H. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 2015; 385:2162-72. [PMID: 25747582 DOI: 10.1016/s0140-6736(14)62049-3] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). METHODS In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. FINDINGS Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 29·1-32·1) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 140, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. INTERPRETATION Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age. FUNDING ZonMw, The Netherlands and Dr Hans Ludwig Geisenhofer Foundation, Germany.
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Vis JY, van Baaren GJ, Wilms FF, Oudijk MA, Kwee A, Porath MM, Scheepers HC, Spaanderman ME, Bloemenkamp KW, van Lith JM, Bolte AC, Bax CJ, Cornette J, Duvekot JJ, Nij Bijvank SW, van Eyck J, Franssen MT, Sollie KM, Woiski M, Vandenbussche FP, van der Post JA, Bossuyt PM, Opmeer BC, Mol BW. Randomized comparison of nifedipine and placebo in fibronectin-negative women with symptoms of preterm labor and a short cervix (APOSTEL-I Trial). Am J Perinatol 2015; 32:451-60. [PMID: 25486290 DOI: 10.1055/s-0034-1390346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate whether tocolysis with nifedipine can be omitted in women with symptoms of preterm labor, a shortened cervix, and negative fetal fibronectin test. STUDY DESIGN A randomized noninferiority trial was performed in all Dutch perinatal centers. Women with symptoms of preterm labor between 24 and 34 weeks, intact membranes, cervical length between 10 and 30 mm, and negative fibronectin test were randomly allocated to nifedipine (80 mg/day) or placebo. The primary outcome was delivery within 7 days. Secondary outcomes were severe neonatal morbidity and mortality. We also followed all eligible nonrandomized women. RESULTS We allocated 37 women to nifedipine and 36 women to placebo. In the nifedipine group, three women (8.1%) delivered within 7 days, compared with one woman (2.8%) in the placebo group (difference -5.3%; one-sided 95% confidence limit 4.5%). Median gestational age at delivery were respectively 37 + 0 (interquartile range [IQR] 34 + 6 to 38 + 5) and 38 + 2 (IQR 37 + 0 to 39 + 6) weeks (p = 0.008). In the nifedipine group, three pregnancies (8.1%) had a poor outcome; there were no poor outcomes in the placebo group. We observed similar trends in eligible nonrandomized women. CONCLUSION In symptomatic women with preterm labor, a shortened cervix, and negative fibronectin test, placebo treatment is not inferior to tocolysis with nifedipine.
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Duvekot JJ. Re: Maternal venous Doppler characteristics are abnormal in pre-eclampsia but not in gestational hypertension. W. Gyselaers, A. Staelens, T. Mesens, K. Tomsin, J. Oben, S. Vonck, L. Verresen and G. Molenberghs. Ultrasound Obstet Gynecol 2015; 45: 421-426. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:374-375. [PMID: 25833369 DOI: 10.1002/uog.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Prick BW, Auf Altenstadt JFVS, Hukkelhoven CWPM, Bonsel GJ, Steegers EAP, Mol BW, Schutte JM, Bloemenkamp KWM, Duvekot JJ. Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries. BMC Pregnancy Childbirth 2015; 15:43. [PMID: 25885884 PMCID: PMC4341225 DOI: 10.1186/s12884-015-0473-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands. METHODS We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation. RESULTS We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting. CONCLUSIONS In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.
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81
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Stoof SCM, van Steenbergen HW, Zwagemaker A, Sanders YV, Cannegieter SC, Duvekot JJ, Leebeek FWG, Peters M, Kruip MJHA, Eikenboom J. Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey. Haemophilia 2015; 21:505-12. [PMID: 25688733 DOI: 10.1111/hae.12635] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL(-1) , prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and duration are unknown and bleeding may still occur. The aim of this study was to investigate the outcome in women with von Willebrand disease (VWD) or haemophilia carriership treated according to current practice guidelines. From the period 2002-2011, 185 deliveries in 154 VWD women or haemophilia carriers were retrospectively included. Data on blood loss, bleeding disorder characteristics and obstetric risk factors were obtained. The outcome was primary PPH, defined as blood loss ≥500 mL within 24 h postpartum and severe PPH as blood loss ≥1000 mL. Primary PPH was observed in 62 deliveries (34%), 14 (8%) of which resulted in severe PPH. In 26 deliveries prophylactic treatment was administered due to factor levels below the 0.50 IU mL(-1) cut-off in the third trimester, 14 of which (54%) were complicated by PPH. We found an increased PPH risk in deliveries given prophylactic treatment compared with deliveries without (OR 2.7, 95% CI 1.2-6.3). In conclusion, PPH incidence was highest in deliveries with the lowest factor levels in the third trimester. Currently, delivery outcome in women with bleeding disorders is unsatisfactory, given the high PPH incidence despite specialised care. Future studies are required to optimise management of deliveries in this patient population.
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Brussé IA, Visser GH, van der Marel IC, Facey-Vermeiden S, Steegers EAP, Duvekot JJ. Electromyographically recorded patellar reflex in normotensive pregnant women and patients with preeclampsia. Acta Obstet Gynecol Scand 2015; 94:376-82. [PMID: 25597232 DOI: 10.1111/aogs.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/23/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To define reference values of the patellar reflex in normotensive pregnant and postpartum women and to compare these with values in women with preeclampsia. DESIGN Observational study. SETTING University teaching hospital in the Netherlands. POPULATION Normotensive non-pregnant women, pregnant women and preeclamptic women. METHODS In normotensive pregnant women the patellar reflex was cross-sectionally recorded using surface electromyography at four time points during pregnancy and six to eight weeks postpartum. In non-pregnant normotensive women this was recorded once. Preeclamptic women were recorded during pregnancy and postpartum. MAIN OUTCOME MEASURES Latency and amplitude of the compound muscle action potential of the patellar reflex. RESULTS Latency and amplitude of the compound muscle action potential during normotensive pregnancies showed no changes compared with the non-pregnant state during reproductive age. Latency of the compound muscle action potential was increased in pregnancies with severe preeclampsia compared with normotensive pregnancies. These differences disappeared postpartum. CONCLUSIONS During pregnancy, the patellar reflex can be assessed using surface electromyography. Latency and amplitude show no changes during normotensive pregnancies and are no different from the postpartum or non-pregnant values. In severely preeclamptic women, latency is increased. The clinical value of this is limited.
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83
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Prick BW, Schuit E, Mignini L, Jansen AJG, van Rhenen DJ, Steegers EAP, Mol BW, Duvekot JJ. Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage. BJOG 2015; 122:1789-97. [DOI: 10.1111/1471-0528.13224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
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84
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van den Berg CB, Duvekot JJ, Güzel C, de Leeuw TG, Luider TM, Steegers EA, Versendaal H, Stoop MP. [91-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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85
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van Eerden L, Zeeman GG, Page-Christiaens GCM, Vandenbussche F, Oei SG, Scheepers HCJ, van Eyck J, Middeldorp JM, Pajkrt E, Duvekot JJ, de Groot CJM, Bolte AC. Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres. BMJ Open 2014; 4:e005145. [PMID: 24939810 PMCID: PMC4067813 DOI: 10.1136/bmjopen-2014-005145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Maternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal effects of the maternal condition. Examples include severe growth restriction in pre-eclampsia and intrauterine infection due to the very early preterm prelabour rupture of membranes. There are very few reports on the prevalence of TOP for maternal indication at the limits of fetal viability. We investigated the prevalence of and indications for TOP on maternal indication in the 10 tertiary care centres in the Netherlands during the past decade. STUDY DESIGN We conducted a retrospective review of the medical records of all women who underwent TOP for maternal indications between 22 and 27 completed weeks of gestation in all 10 tertiary care centres from 2000 to 2009. RESULTS During the study period, there were 1 929 470 deliveries; 163 052 (8.4%) of these took place in one of the 10 tertiary care centres and 177 pregnancies were terminated for severe maternal disease, 131 for hypertensive disorders, 29 for intrauterine infection and 17 for other reasons. The mean gestational age at TOP was 171 days (24(3/7))±10 days. No maternal deaths were recorded. The overall perinatal mortality was 99.4%. CONCLUSIONS Over a 10-year period, TOP for maternal indications was performed in 1 in 1000 deliveries in the 10 Dutch tertiary care centres. Hypertensive disorders comprised three-quarters of the cases.
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Ruys TPE, Bekkers JA, Duvekot JJ, Roos-Hesselink JW. A Pregnant Patient with Native Aortic Coarctation and Aneurysm. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:110-2. [PMID: 26798725 DOI: 10.12945/j.aorta.2014.13-038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
Uncorrected coarctation is rare and is known to cause hypertension in adult patients. Retrospective observational studies showed hypertension and occasionally aortic dissection to be the principal risks during pregnancy after correction of aortic coarctation. We present a case of a patient with known hypertension, who presented at 32 weeks of gestation. A saccular aortic aneurysm of 4.5 × 8.8 cm was found by echocardiogram and confirmed with a chest X-ray. She delivered a healthy girl by caesarean section. After delivery a CT-angiography was performed showing a stable situation. Two months postpartum she was successfully operated. We present images of echocardiography, X-ray, CT and the surgical procedure. We discus the literature on native coarctation and the management choices in this difficult case.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/01/2022]
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88
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Delahaije DHJ, Smits LJM, van Kuijk SMJ, Peeters LL, Duvekot JJ, Ganzevoort W, Oudijk MA, van Pampus MG, Scheepers HCJ, Spaanderman ME, Dirksen CD. Care-as-usual provided to formerly preeclamptic women in the Netherlands in the next pregnancy: health care consumption, costs and maternal and child outcome. Eur J Obstet Gynecol Reprod Biol 2014; 179:240-5. [PMID: 24835859 DOI: 10.1016/j.ejogrb.2014.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore hospital costs by pregnant women with a history of early-onset preeclampsia or HELLP syndrome, managed according to customary, but non-standardized prenatal care, by relating maternal and child outcome to maternal health care expenditure. STUDY DESIGN This was a cohort study, in women of 18 years or older who suffered from early-onset preeclampsia or HELLP syndrome in their previous pregnancy (n=104). We retrieved data retrospectively from hospital information systems and medical records of patients who had received customary, non-standardized prenatal care between 1996 and 2012. Our analyses focused on the costs generated between the first antenatal visit at the outpatient clinic and postpartum hospital discharge. Outcome measures were hospital resource use, costs, maternal and child outcome (recurrence of preeclampsia or HELLP syndrome, incidence of eclampsia, gestational age at delivery, intrauterine fetal demise, small-for-gestational-age birth and low 5min Apgar score). We used linear regression analyses to evaluate whether maternal and child outcome and baseline characteristics correlated with hospital costs. RESULTS Maternal hospital costs per patient averaged € 8047. The main cost drivers were maternal admissions and outpatient visits, together accounting for 80% of total costs. Primary cost drivers were preterm birth and recurrent preeclampsia or HELLP syndrome. CONCLUSION Hospital costs in the next pregnancy of formerly preeclamptic women varied widely with over 70% being medically unexplainable. The results of this study support the view that care standardization in these women can be expected to improve costs and efficacy of care without compromising outcome.
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89
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Sonneveld MJ, Brussé IA, Duvekot JJ, Steegers EA, Grune F, Visser GH. Cerebral perfusion pressure in women with preeclampsia is elevated even after treatment of elevated blood pressure. Acta Obstet Gynecol Scand 2014; 93:508-11. [DOI: 10.1111/aogs.12358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 02/11/2014] [Indexed: 11/28/2022]
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90
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van de Mheen L, Schuit E, Lim AC, Porath MM, Papatsonis D, Erwich JJ, van Eyck J, van Oirschot CM, Hummel P, Duvekot JJ, Hasaart TH, Groenwold RH, Moons KG, de Groot CJ, Bruinse HW, van Pampus MG, Mol BW. Prediction of Preterm Birth in Multiple Pregnancies: Development of a Multivariable Model Including Cervical Length Measurement at 16 to 21 Weeks’ Gestation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:309-319. [DOI: 10.1016/s1701-2163(15)30606-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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91
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2013] [Indexed: 01/22/2023]
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92
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Cornette J, Herzog E, Buijs EAB, Duvekot JJ, Rizopoulos D, Hop WCJ, Tibboel D, Steegers EAP. Microcirculation in women with severe pre-eclampsia and HELLP syndrome: a case-control study. BJOG 2013; 121:363-70. [PMID: 24206102 DOI: 10.1111/1471-0528.12475] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets). DESIGN Case-control study. SETTING University Hospital Rotterdam, the Netherlands. POPULATION Twenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome. METHODS Microcirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF). MAIN OUTCOME MEASURES Perfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (∅ < 20 μm; capillaries) and non-small vessels (∅ > 20 μm; venules and arterioles). RESULTS There were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P = 0.045), MFI (P = 0.008), and increased HI (P = 0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome. CONCLUSIONS Sidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.
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Vijgen SM, Boers KE, Opmeer BC, Bijlenga D, Bekedam DJ, Bloemenkamp KW, de Boer K, Bremer HA, le Cessie S, Delemarre FM, Duvekot JJ, Hasaart TH, Kwee A, van Lith JM, van Meir CA, van Pampus MG, van der Post JA, Rijken M, Roumen FJ, van der Salm PC, Spaanderman ME, Willekes C, Wijnen EJ, Mol BW, Scherjon SA. Economic analysis comparing induction of labour and expectant management for intrauterine growth restriction at term (DIGITAT trial). Eur J Obstet Gynecol Reprod Biol 2013; 170:358-63. [DOI: 10.1016/j.ejogrb.2013.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/07/2013] [Accepted: 07/06/2013] [Indexed: 02/05/2023]
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94
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Prick BW, Vos AA, Hop WCJ, Bremer HA, Steegers EAP, Duvekot JJ. The current state of active third stage management to prevent postpartum hemorrhage: a cross-sectional study. Acta Obstet Gynecol Scand 2013; 92:1277-83. [PMID: 23962221 DOI: 10.1111/aogs.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the implementation of the International Confederation of Midwives/International Federation of Gynecology and Obstetrics (ICM/FIGO) guideline on active third stage management in vaginal deliveries in daily clinical practice. DESIGN Observational, cross-sectional study. SETTING One tertiary and one teaching hospital in the Netherlands. POPULATION Women undergoing vaginal deliveries. METHODS A case record form was completed after every vaginal delivery. Primary outcome was adequate guideline adherence, defined as initial administration of 10 IU oxytocin, performance of controlled cord traction and uterine massage. Adequate guideline adherence was a priori estimated to be 10%. With a sample size of 600, i.e. 300 women per hospital, the standard error of the resulting percentage would be less than 2% for each hospital. RESULTS Six hundred and twenty six women were included. Guideline adherence was adequately performed in 48% of vaginal deliveries. Oxytocin was administered after birth in 98% of deliveries and in 80% the correct dose was used. Controlled cord traction was performed in 63% and uterine massage in 93%; however, the latter was performed as advised (at least eight times) in only 8%. The amount of blood loss was not associated with the use of either 5 or 10 IU oxytocin (p = 0.818). Controlled cord traction and uterine massage were more frequently performed when blood loss exceeded 500 mL (p < 0.001). CONCLUSIONS Active third stage management according to the ICM/FIGO guideline is adequately performed in only 48% of all vaginal deliveries. Results of this study call for training programs to increase adherence to the ICM/FIGO guideline.
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Van der Kaay DCM, Horsch S, Duvekot JJ. Severe neonatal complication of transverse lie after preterm premature rupture of membranes. BMJ Case Rep 2013; 2013:bcr-2012-008399. [PMID: 23839604 DOI: 10.1136/bcr-2012-008399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Both transverse lie and preterm premature rupture of membranes (PPROM) are associated with neonatal morbidity and mortality. We present a neonate born at 29 weeks gestation with severe birth trauma after PPROM and transverse lie. The patient had extensive swelling and areas of desquamated and necrotic skin of the right lower limb. Neonatal compartment syndrome (NCS) was suspected. Perfusion of the limb improved after decompressing subcutaneous incisions. A fetus in transverse lie may be mechanically damaged in the case of PPROM, especially at an early gestational age. Early recognition is of great interest in the management and prognosis of NCS.
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Mulders AGMGJ, van der Wilk EC, Khan SR, Duvekot JJ, Roeters van Lennep JE. PP068. Evaluation of cardiovascular health in previously preeclamptic women. Pregnancy Hypertens 2013; 3:91-2. [PMID: 26105921 DOI: 10.1016/j.preghy.2013.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Women with a history of preeclampsia have an increased risk of developing cardiovascular disease (CVD) later in life. Classical risk scores are not suitable as risk estimates of CVD in this young population. Recent recommendations from the American Heart Association are aimed to improve cardiovascular health (CVH). OBJECTIVES Examining CVH by Health Life Check (HLC) (http://mylifecheck.heart.org/) in previously severe preeclamptic women is part of our cardiovascular risk follow-up program. Final score is a scale from 1 to 10, where 10 represents ideal CVH. RESULTS Since 2011 HLC is offered to all women in this program. So far, 213 women were included, 148 (70%) underwent a CVH assessment by performing HLC between three months and one year after delivery. The overall HLC score was 7.4 (median; range: 0.8-10.0) at 3.6 months after the delivery. Only 2 out of 148 women (1.4%) had an ideal score. HLC score was 7.1 (median; range: 0.8-10.0) for 48 women who had a HLC score within 6 months after delivery versus 8.2 (median; range: 2.6-9.8) in the second half of the first year after delivery. CONCLUSION These are the first data on CVH in women after severe preeclampsia. Only 1.4% of these women had an ideal score. Active counselling of these women could be the reason of the improved score over time. We showed that CVH as assessed by HLC is an excellent tool for cardiovascular risk management in this specific group of women.
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Mulders AGMGJ, van der Wilk EC, Lugthart J, Roeters van Lennep JE, Duvekot JJ. PP069. Hypertension evaluated by 24-hour ambulatory blood pressure measurements in previously preeclamptic women one year postpartum. Pregnancy Hypertens 2013; 3:92. [PMID: 26105923 DOI: 10.1016/j.preghy.2013.04.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Women with a history of preeclampsia have an increased risk of developing cardiovascular disease (CVD) later in life. 24-hour ambulatory blood pressure measurement is considered to be the gold-standard for diagnosing hypertension. Data on 24-hour ambulatory blood pressure measurement in women with a history of preeclampsia are scarce. OBJECTIVES To evaluate hypertension in previously severe preeclamptic women, 24-hour ambulatory blood pressure measurements were performed one year after delivery as part of our cardiovascular risk follow-up program. RESULTS Since 2011 213 women were included in this program. 24-hour ambulatory blood pressure measurement was performed in 90 out of 121 women (74%) who completed follow-up one year after delivery. Systolic blood pressure was 121 mm Hg (median; range 96-157) and diastolic blood pressure 78mm Hg (median; range 62-114). Twenty-three women (26.0%) used antihypertensive medication one year postpartum. Blood pressure levels were not significantly different between women with and without medication. Five women (5/67, 7.5%) of those not using antihypertensives, were diagnosed as having hypertension by this measurement. CONCLUSION These data show that 30% of these previously severe preeclamptic women have persisting hypertension one year postpartum. These data stress the importance of close monitoring of blood pressure in these women.
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Berks D, Hoedjes M, Raat H, Duvekot JJ, Steegers EAP, Habbema JDF. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG 2013; 120:924-31. [PMID: 23530583 DOI: 10.1111/1471-0528.12191] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study addresses the following questions. Do cardiovascular risk factors fully explain the odds ratio of cardiovascular risk after pre-eclampsia? What is the effect of lifestyle interventions (exercise, diet, and smoking cessation) after pre-eclampsia on the risk of cardiovascular disease? DESIGN Literature-based study. SETTING N/A. POPULATION OR SAMPLE N/A. METHODS Data for the calculations were taken from studies identified by PubMed searches. First, the differences in cardiovascular risk factors after pre-eclampsia compared with an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk were estimated. Validated risk prediction models were used to translate these results into cardiovascular risk. RESULTS After correction for known cardiovascular risk factors, the odds ratios of pre-eclampsia for ischaemic heart disease and for stroke are 1.89 (IQR 1.76-1.98) and 1.55 (IQR 1.40-1.71), respectively. After pre-eclampsia, lifestyle interventions on exercise, dietary habits, and smoking cessation decrease cardiovascular risk, with an odds ratio of 0.91 (IQR 0.87-0.96). CONCLUSIONS Cardiovascular risk factors do not fully explain the risk of cardiovascular disease after pre-eclampsia. The gap between estimated and observed odds ratios may be explained by an additive risk of cardiovascular disease by pre-eclampsia. Furthermore, lifestyle interventions after pre-eclampsia seem to be effective in decreasing cardiovascular risk. Future research is needed to overcome the numerous assumptions we had to make in our calculations.
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Huisman CM, Zwart JJ, Roos-Hesselink JW, Duvekot JJ, van Roosmalen J. Incidence and predictors of maternal cardiovascular mortality and severe morbidity in The Netherlands: a prospective cohort study. PLoS One 2013; 8:e56494. [PMID: 23457576 PMCID: PMC3572972 DOI: 10.1371/journal.pone.0056494] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in the Netherlands. Design A prospective 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 Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in the Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic dissection. All women delivering in the same period served as a reference cohort. Main outcome measures Incidence, case fatality rates and possible risk factors. Results Incidence of severe maternal morbidity due to cardiovascular disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874). Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highest in aortic dissection (83%). Pre-existing acquired or congenital heart disease was identified in 34% of women. Thirty-one percent of women were of advanced maternal age (>35 years of age) and 5 percent above 40 years of age. Possible risk factors for cardiovascular morbidity were caesarean section (either resulting in or as a result of cardiovascular disease), multiple pregnancy, prior caesarean section, non-Western ethnicity and obesity. Conclusions In the Netherlands cardiovascular disease is a rare cause of severe maternal morbidity with an incidence of 2.3 per 10,000 deliveries and a high case fatality rate of 13%. Cardiovascular complications develop mostly in women not known with cardiac disease pre-pregnancy.
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de Kluiver E, Offringa M, Walther FJ, Duvekot JJ, de Laat MWM. [Perinatal policy in cases of extreme prematurity; an investigation into the implementation of the guidelines]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2013; 157:A6362. [PMID: 24050448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine to what extent the recommendations to actively treat preterm infants with a gestational age of 24 weeks upwards laid down in the guidelines 'Perinatal policy in cases of extreme prematurity' have influenced policy in Dutch perinatal centres in the first year after publication, and what the health outcomes were. DESIGN Retrospective, descriptive study. METHOD Our study population included all pregnant women who were admitted to a perinatal centre at 23 5/7 to 26 weeks gestation with a diagnosis of 'threatened preterm labour', and their preterm infants. We collected both obstetric data and data on survival and morbidity of the infants from the medical files. RESULTS Of a total of 192 preterm infants 185 (96%) were born alive; 92% of these infants were admitted to the neonatal intensive care unit. Survival rates were 43% and 61% at 24 weeks and 25 weeks gestation, respectively. Short-term morbidity (bronchopulmonary dysplasia, retinopathy of the newborn, severe intraventricular haemorrhage, necrotising enterocolitis and persistent ductus arteriosus) occurred in 79% and 71% of the infants born at 24 weeks and 25 weeks gestation, respectively. CONCLUSIONS The recommendations from these guidelines have been implemented swiftly in Dutch perinatal centres, and survival of extremely preterm infants has increased. This has imposed a considerable burden on the capacity of these centres. Little is yet known about the long-term (up to school-age) health and survival of these infants.
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MESH Headings
- Adult
- Cesarean Section/statistics & numerical data
- Child
- Female
- Gestational Age
- Guideline Adherence
- Humans
- Infant
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal/standards
- Intensive Care Units, Neonatal/statistics & numerical data
- Morbidity
- Practice Guidelines as Topic
- Pregnancy
- Retrospective Studies
- Survival Rate
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