1
|
Haga M, Nishimura E, Oshima A, Miyahara N, Oka S, Motojima Y, Saito K, Itoh K, Kanai M, Kabe K, Era S, Yabe S, Kikuchi A, Namba F. Prolonged oligohydramnios and the adverse composite outcome of death or severe neurodevelopmental impairment at 3 years of age in infants born at 22-29 gestational weeks. Early Hum Dev 2024; 197:106100. [PMID: 39180798 DOI: 10.1016/j.earlhumdev.2024.106100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To investigate the association between prolonged oligohydramnios and a composite outcome of death or severe neurodevelopmental impairment (NDI) at 3 years of age. METHODS This single-center retrospective cohort study enrolled infants born at 22-29 weeks of gestational age without major congenital anomalies. The patients were classified into three groups depending on the existence and duration of oligohydramnios: no/non-prolonged oligohydramnios (no or 0-7 days of oligohydramnios), prolonged oligohydramnios (8-14 days), and very prolonged oligohydramnios (> 14 days). The primary outcome was a composite of death or severe NDI, which was defined as severe cerebral palsy, developmental delay, severe visual impairment, or deafness at age 3. RESULTS Out of the 843 patients, 784 (93 %), 30 (3.6 %), and 29 (3.4 %) were classified into the no/non-prolonged, prolonged, and very prolonged oligohydramnios groups, respectively. After excluding patients lost to follow-up, the adverse composite outcome at 3 years of age was observed in 194/662 (29 %), 7/26 (27 %), and 8/23 (35 %) in the corresponding groups. The composite outcome showed no significant trend with the duration of oligohydramnios (P = 0.70). In a logistic regression model controlling the known predictors of gestational age, birth weight, small-for-gestational-age, male sex, multiple pregnancy, hypertensive disorders of pregnancy, antenatal corticosteroids, and the number of family-social risk factors, the duration of oligohydramnios was not independently associated with the composite outcome; odds ratio 1.3 (95 % confidence interval, 0.78-2.0). CONCLUSION Prolonged oligohydramnios was not associated with the composite outcome of death or severe NDI at 3 years of age.
Collapse
Affiliation(s)
- Mitsuhiro Haga
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Eri Nishimura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ayumi Oshima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shuntaro Oka
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Institute for children with profound intellectual and multiple disability "Karugamo-no-ie", Kawagoe, Saitama, Japan
| | - Yukiko Motojima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Department of Pediatrics, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Kana Saito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kanako Itoh
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Sumiko Era
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinichiro Yabe
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| |
Collapse
|
2
|
van der Windt L, Klumper J, van Limburg Stirum EVJ, van 't Hooft J, van Wely M, van Wassenaer-Leemhuis AG, Pajkrt E, Oudijk MA. Atosiban versus placebo in the treatment of threatened preterm birth between 30 and 34 weeks gestation: study protocol of the 4-year APOSTEL 8 follow-up. BMJ Open 2024; 14:e083600. [PMID: 39025819 PMCID: PMC11261668 DOI: 10.1136/bmjopen-2023-083600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Currently, the majority of women worldwide with threatened preterm birth are treated with tocolytics. Although tocolytics can effectively delay birth for 48 hours, no tocolytic drug has convincingly been shown to improve neonatal outcomes and effects on long-term child development are unknown. The aim of this follow-up study of a placebo controlled randomised trial is to investigate the long-term effects of atosiban administration in case of threatened preterm birth on child's neurodevelopment and behaviour development, overall health and mortality. METHODS AND ANALYSIS This protocol concerns a follow-up study of the multicentre randomised double-blind placebo controlled APOSTEL 8 trial (NL61439.018.17, EudraCT-number 2017-001007-72). In this trial, women with threatened preterm birth (between 30 and 34 weeks of gestation) defined as uterine contractions with (1) a cervical length of <15 mm or (2) a cervical length of 15-30 mm and a positive fibronectin test or (3) in centres where cervical length measurement is not part of the local protocol: a positive fibronectin test or Actim-Partus test or (4) ruptured membranes, are randomised to atosiban or placebo for 48 hours. The primary outcome is a composite of perinatal mortality and severe neonatal morbidity. Children born to mothers who participated in the APOSTEL 8 study (n=760) will be eligible for follow-up at 4 years of corrected age and assessed using four parent-reported questionnaires. Primary outcomes are neurodevelopment and behaviour problems. Secondary outcomes are on child growth and general health. All outcomes will be compared between the atosiban and placebo group with OR and corresponding 95% CI. Analyses will be performed using the intention-to-treat approach. ETHICS AND DISSEMINATION The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (Dutch WMO-law) did not apply to our study (W21_386 # 21.431). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results.
Collapse
Affiliation(s)
- Larissa van der Windt
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Job Klumper
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Emilie V J van Limburg Stirum
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Janneke van 't Hooft
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Obstetrics, Amsterdam UMC Locatie De Boelelaan, Amsterdam, The Netherlands
| | | |
Collapse
|
3
|
van Limburg Stirum EVJ, van der Windt LI, van Dijk CE, van Baar AL, Leemhuis AG, van Wely M, de Boer MA, van 't Hooft J, Oudijk MA, Pajkrt E. Pessary or progesterone to prevent preterm birth in women with short cervical length: protocol of the 4-6 year follow-up of a randomised controlled trial (Quadruple-P). BMJ Open 2022; 12:e064049. [PMID: 36002221 PMCID: PMC9413189 DOI: 10.1136/bmjopen-2022-064049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child's health at 4-6 years of corrected age. METHODS AND ANALYSIS This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4-6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach. ETHICS AND DISSEMINATION The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL9646).
Collapse
Affiliation(s)
- Emilie V J van Limburg Stirum
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Larissa I van der Windt
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Charlotte E van Dijk
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | | | - Aleid G Leemhuis
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Neonatology and Paediatrics, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Landman AJEMC, van Limburg Stirum EVJ, van 't Hooft J, Leemhuis AG, Finken MJJ, van Baar AL, Roseboom TJ, Ravelli ACJ, van Wely M, Oosterlaan J, Painter RC, Pajkrt E, Oudijk MA, de Boer MA. Long-term outcomes following antenatal exposure to low-dose aspirin: study protocol for the 4-year follow-up of the APRIL randomised controlled trial. BMJ Open 2022; 12:e060632. [PMID: 35940829 PMCID: PMC9364408 DOI: 10.1136/bmjopen-2021-060632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The use of low-dose aspirin by pregnant women to prevent preterm pre-eclampsia is gradually increasing. The administration of aspirin during pregnancy improves perinatal outcome, which could translate into improved child outcome in the long term. However, antenatal exposure to aspirin could have adverse effects on child development that may manifest later in life. The aim of this follow-up study is to assess the long-term effects of antenatal exposure to low-dose aspirin compared with placebo on survival, (neuro)development, behaviour and general health at 4 years corrected age. METHODS AND ANALYSIS This is a follow-up study of the Dutch double-blind randomised controlled APRIL trial which assessed the effectiveness of treatment with aspirin (80 mg daily) compared with placebo for the prevention of preterm birth in women with a previous spontaneous preterm birth. Treatment was initiated before 16 weeks of gestation and continued until 36 weeks or birth. We aim to follow-up all 379 children born to women who participated in the APRIL trial and survived the neonatal period, at the corrected age of 4 years. The main outcomes are (neuro)development as assessed by the Ages and Stages Questionnaire, and behaviour as assessed by the Strength and Difficulties Questionnaire. Additional outcomes include mortality, growth and general health from birth up to 4 years, and a composite outcome including mortality, abnormal (neuro)development and problem behaviour. Analyses will be performed by intention-to-treat using a superiority design. ETHICS AND DISSEMINATION Institutional Review Board approval was obtained from the Medical Research Ethics Committee from Amsterdam Medical Center (no. W20 289#20.325). The results will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER The APRIL trial (NTR5675, NL5553; EudraCT number 2015-003220-31) and the APRIL follow-up study (NL8950) are registered in the Dutch trial register. The study is funded by the Amsterdam Reproduction & Development research institute.
Collapse
Affiliation(s)
- Anadeijda J E M C Landman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Emilie V J van Limburg Stirum
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Aleid G Leemhuis
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Emma Children's Hospital, Department of Paediatric Endocrinology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anneloes L van Baar
- Utrecht University, Department of Child and Adolescent Studies, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Tessa J Roseboom
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam UMC Follow-Me program & Emma Neuroscience Group, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Melekoglu R, Celik E. Perinatal and neonatal outcomes of women with very early preterm premature rupture of membranes treated via serial transabdominal amnioinfusion and expectant management: Experience of a tertiary referral center in Turkey. J Obstet Gynaecol Res 2022; 48:1732-1739. [DOI: 10.1111/jog.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 04/09/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Rauf Melekoglu
- Department of Obstetrics and Gynecology Inonu University, Faculty of Medicine Malatya Turkey
| | - Ebru Celik
- Department of Obstetrics and Gynecology Koc University, Faculty of Medicine İstanbul Turkey
| |
Collapse
|
6
|
Simons NE, van Limburg Stirum EVJ, van Wassenaer-Leemhuis AG, Finken MJJ, Aarnoudse-Moens CSH, Oosterlaan J, van Baar A, Roseboom TJ, Lim AC, van Wely M, de Boer MA, Painter RC, Pajkrt E, Oudijk MA, van T Hooft J. Long-term follow-up of children exposed in-utero to progesterone treatment for prevention of preterm birth: study protocol of the AMPHIA follow-up. BMJ Open 2021; 11:e053066. [PMID: 34548367 PMCID: PMC8458362 DOI: 10.1136/bmjopen-2021-053066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Preterm birth is one of the main problems in obstetrics, and the most important cause of neonatal mortality, morbidity and neurodevelopmental impairment. Multiple gestation is an important risk factor for preterm birth, with up to 50% delivering before 37 weeks. Progesterone has a role in maintaining pregnancy and is frequently prescribed to prevent (recurrent) preterm birth and improve pregnancy outcomes in high-risk patients. However, little is known about its long-term effects in multiple gestations. The objective of this follow-up study is to assess long-term benefits and harms of prenatal exposure to progesterone treatment in multiple gestations on child development. METHODS AND ANALYSIS This is a follow-up study of a multicentre, double-blind, placebo-controlled randomised trial (AMPHIA trial, ISRCTN40512715). Between 2006 and 2009 women with a multiple gestation were randomised at 16-20 weeks of gestation to weekly injections 250 mg 17α-hydroxyprogesterone caproate or placebo, until 36 weeks of gestation or delivery. The current long-term follow-up will assess all children (n=1355) born to mothers who participated in the AMPHIA trial, at 11-14 years of age, with internationally validated questionnaires, completed by themselves, their parents and their teachers. MAIN OUTCOMES ARE CHILD COGNITION AND BEHAVIOUR Additional outcomes are death (perinatal and up to age 14), gender identity, educational performance and health-related problems. We will use intention-to-treat analyses comparing experimental and placebo group. To adjust for the correlation between twins, general linear mixed-effects models will be used. ETHICS AND DISSEMINATION Amsterdam UMC MEC provided a waiver for the Medical Research Involving Human Subjects Act (W20_234#20.268). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders, patients and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER NL8933.
Collapse
Affiliation(s)
- Noor E Simons
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Emilie V J van Limburg Stirum
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital Amsterdam, Amsterdam Reproduction & Development, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Anneloes van Baar
- Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Arianne C Lim
- Department of Obstetrics and Gynaecology, Maastricht UMC, Maastricht, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Janneke van T Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Simons NE, de Ruigh AA, van der Windt LI, Kazemier BM, van Wassenaer-Leemhuis AG, van Teeffelen AS, van Leeuwen E, Mol BW, van 't Hooft J, Pajkrt E. Maternal, perinatal and childhood outcomes of the PPROMEXIL-III cohort: Pregnancies complicated by previable prelabor rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2021; 265:44-53. [PMID: 34428686 DOI: 10.1016/j.ejogrb.2021.08.007] [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: 05/04/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Perinatal mortality after previable prelabor rupture of membranes (previable PROM) might be underestimated as most studies exclude patients with poor prognosis, or solely include patients in tertiary-care centers. We aimed to report perinatal, neonatal and long-term outcomes in a consecutive series of women with pregnancies complicated by previable PROM. STUDY DESIGN We conducted a prospective cohort study including women with singleton pregnancies and previable PROM ≤ 23+6 weeks gestational age (GA) from one tertiary hospital and eight affiliated secondary hospitals in the region of Amsterdam, the Netherlands (June 2012 until January 2016, PPROMEXIL-III cohort). Exclusion criteria were signs of active labor before onset of PROM or fetal structural anomalies visible at ultrasound. We assessed perinatal mortality. Furthermore, outcomes were maternal, perinatal, neonatal and long-term child characteristics. RESULTS We included 98 pregnancies with previable PROM. Twelve women (12.2%) opted for termination of pregnancy, resulting in 86 pregnancies included in further analyses. Median GA at PROM was 20+2 weeks (interquartile range (IQR) 17+6-22+0). Median GA at delivery was 22+6 weeks (IQR 20+1-26+4). Delivery within 1 week occurred in 38.4% of women and 60.4% delivered before 24 weeks GA (viability). Perinatal mortality occurred in 73.3% of pregnancies. 23/33 (69.7%) live-born neonates survived to discharge, representing 26.7% of total. None of the children died after discharge. Developmental data at two and/or five years of age was available for 13/23 children (i.e. all children born before 32 weeks of gestation), with 69.2% of children reporting a normal neurodevelopment. However, more than half of children reported respiratory problems. CONCLUSION In women with previable PROM perinatal mortality was 73.3%, with a normal neurodevelopment in 69.2% of surviving children with follow-up data. Due to broad inclusion criteria, this cohort represents a population more generalizable to daily practice as compared to previous studies.
Collapse
Affiliation(s)
- Noor E Simons
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Annemijn A de Ruigh
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Larissa I van der Windt
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|