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Moore MD, Mazzoni SE, Wingate MS, Bronstein JM. Severe Maternal Morbidity among Low-Income Patients with Hypertensive Disorders of Pregnancy. Am J Perinatol 2024; 41:e563-e572. [PMID: 35977711 DOI: 10.1055/a-1925-9972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) contribute significantly to the development of severe maternal morbidities (SMM), particularly among low-income women. The purpose of the study was to explore the relationship between maternal characteristics and SMM, and to investigate if differences in SMM exist among patients with HDP diagnosis. STUDY DESIGN This study utilized 2017 Alabama Medicaid administrative claims. SMM diagnoses were captured using the Centers for Disease Control and Prevention's classification by International Classification of Diseases codes. Maternal characteristics and frequencies were compared using Chi-square and Cramer's V statistics. Logistic regression analyses were conducted to examine multivariable relationships between maternal characteristics and SMM among patients with HDP diagnosis. Odds ratios and 95% confidence intervals (CIs) were used to estimate risk. RESULTS A higher proportion of patients experiencing SMM were >34 years old, Black, Medicaid for Low-Income Families eligible, lived in a county with greater Medicaid enrollment, and entered prenatal care (PNC) in the first trimester compared with those without SMM. Almost half of patients (46.2%) with SMM had a HDP diagnosis. After controlling for maternal characteristics, HDP, maternal age, county Medicaid enrollment, and trimester PNC entry were not associated with SMM risk. However, Black patients with HDP were at increased risk for SMM compared with White patients with HDP when other factors were taken into account (adjusted odds ratio [aOR] = 1.37, 95% CI: 1.11-1.69). Patients with HDP and SMM were more likely to have a prenatal hospitalization (aOR = 1.45, 95% CI: 1.20-1.76), emergency visit (aOR = 1.30, 95% CI: 1.07-1.57), and postpartum cardiovascular prescription (aOR = 2.43, 95% CI: 1.95-3.04). CONCLUSION Rates of SMM differed by age, race, Medicaid income eligibility, and county Medicaid enrollment but were highest among patients with clinical comorbidities, especially HDP. However, among patients with HDP, Black patients had an elevated risk of severe morbidity even after controlling for other characteristics. KEY POINTS · Patients with SMM were more likely to have a HDP diagnosis.. · Among those with HDP, Black patients had elevated risk of SMM.. · Differences in care delivery did not explain SMM disparities..
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Affiliation(s)
- Matthew D Moore
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara E Mazzoni
- Department of Obstetrics and Gynecology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha S Wingate
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M Bronstein
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
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Kim HR, Lee BK. Outcomes of singleton preterm very low birth weight infants born to mothers with pregnancy-induced hypertension. Sci Rep 2023; 13:6100. [PMID: 37055502 PMCID: PMC10102139 DOI: 10.1038/s41598-023-33206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023] Open
Abstract
The association between maternal pregnancy-induced hypertension (PIH) and neonatal mortality and morbidities in preterm infants has not been consistent. This study aimed to evaluate the influence of maternal PIH on mortality and morbidities in singleton infants with very low birth weight born before 30 weeks of gestational age using the Korean Neonatal Network (KNN) database. A total of 5340 singleton infants with very low birth weight were registered in the KNN registry, who were born at 23+0 to 29+6 weeks of gestational age between January 2015 and December 2020. Baseline characteristics and neonatal mortality and morbidities were compared between infants with PIH and non-PIH mothers. After adjustment for potential confounders, infants with PIH mothers had significantly higher odds of respiratory distress syndrome (OR 1.983; 95% CI 1.285-3.061, p = 0.002) and bronchopulmonary dysplasia (OR 1.458; 95% CI 1.190-1.785, p < 0.001), and severe bronchopulmonary dysplasia (OR 1.411; 95% CI 1.163-1.713, p < 0.001) than infants with non-PIH mothers, while there were no significant differences in severe intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or death during neonatal intensive care unit admission between infants with PIH and non-PIH mothers. This study showed that preterm infants with PIH mothers had an increased risk of neonatal respiratory morbidities, including respiratory distress syndrome and bronchopulmonary dysplasia.
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Affiliation(s)
- Hye-Rim Kim
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Byoung Kook Lee
- Department of Pediatrics, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, Sejong, Republic of Korea.
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Adu-Bonsaffoh K, Tamma E, Nwameme A, Dako-Gyeke P, Srofenyoh E, Ansah EK, Grobbee DE, Franx A, Browne JL. Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana. Reprod Health 2023; 20:49. [PMID: 36966326 PMCID: PMC10039538 DOI: 10.1186/s12978-023-01593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. OBJECTIVE To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. METHODS A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. RESULTS Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider-client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. CONCLUSION Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu, P.O. Box 77, Accra, Ghana.
- Holy Care Specialist Hospital, Accra, Ghana.
| | | | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Srofenyoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital (Ridge), Accra, Ghana
| | - Evelyn K Ansah
- Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Adu-Bonsaffoh K, Tamma E, Nwameme AU, Browne JL. Health professionals' perspectives on clinical challenges in managing hypertensive disorders of pregnancy and recommendations for improving care: A multi-center qualitative study. Front Glob Womens Health 2022; 3:968914. [PMID: 36440321 PMCID: PMC9686376 DOI: 10.3389/fgwh.2022.968914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/18/2022] [Indexed: 09/15/2023] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity globally despite the intensive international effort to improving maternal care. Substandard clinical care has emerged as a major contributing factor to the high maternal deaths associated with maternal hypertension globally and the impact is severer in low- and middle-income countries (LMICs). Context specific challenges impact negatively on the quality of maternity care and health providers play a crucial role in achieving positive pregnancy experiences for women. This study explored the perspectives of health professionals on the clinical challenges associated with the management of HDP in Ghana and recommendations for improving care. Methods A multi-center qualitative study using in-depth interviews (IDIs) was conducted in five major hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Health professionals (midwives/nurses and medical doctors) who have worked at the study sites for at least three months were included. Data were analysed based on thematic content using Nvivo software. Results We included 62 health professionals comprising 40 midwives/nurses (64.5%) with a median age of 32.5 years (range 26 to 59) and 22 medical doctors (34.5%) with a median age of 34 years (range 25 to 55). Health providers highlighted major challenges associated with clinical management of hypertension in pregnancy: (1) patient-related factors (inadequate understanding and misconceptions about hypertension in pregnancy, women's non-compliance with clinical advice, financial constraints); (2) health system-related challenges (frequent unavailability of logistics, medications and laboratory support, delays in provision of care and limitations in the health insurance coverage); (3) health provider associated factors (inadequate number of health professionals and poor attitudes). Context-specific recommendations suggested for improving the quality of care in managing maternal hypertension include restructuring of the health system to reduce delays in providing care, improving financial coverage of medical insurance, encouraging social/family support, enhancing education on HDP and strengthening the health workers' numbers and working conditions. Conclusion Major challenges in the clinical management of HDP relate to the health system, health professionals and pregnant women themselves. Context-specific interventions are required to improve the quality of care for hypertensive mothers including regular health education, re-structuring of the health systems, refresher courses for health providers, improvement in health insurance coverage and government subsidy for hypertensive women.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
- Holy Care Specialist Hospital, Accra, Ghana
| | | | - Adanna Uloaku Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Hofstede A, Lomme M, Gosselink S, van Drongelen J. The Cloud DX connected HealthKit Pulsewave in home blood pressure monitoring during pregnancy: a clinical evaluation and user experience study. Pregnancy Hypertens 2022; 28:1-8. [DOI: 10.1016/j.preghy.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Mulder E, Ghossein-Doha C, Appelman E, van Kuijk S, Smits L, van der Zanden R, van Drongelen J, Spaanderman M. Study protocol for the randomized controlled EVA (early vascular adjustments) trial: tailored treatment of mild hypertension in pregnancy to prevent severe hypertension and preeclampsia. BMC Pregnancy Childbirth 2020; 20:775. [PMID: 33308198 PMCID: PMC7733247 DOI: 10.1186/s12884-020-03475-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In contrast to severe gestational hypertension, it is questioned whether antihypertensive medication for mild to moderate gestational hypertension prevents adverse maternal and offspring outcomes. Hypertensive drugs halve the risk of severe hypertension, but do not seem to prevent progression to preeclampsia or reduce the risk of complications in offspring. In fact, beta-blockers, a first line therapy option, are suspected to impair foetal growth. Disappointing effects of antihypertensive medication can be anticipated when the pharmacological mode of action does not match the underlying haemodynamic imbalance. Hypertension may result from 1) high cardiac output, low vascular resistance state, in which beta blockade is expected to be most effective, or 2) low cardiac output, high vascular resistance state where dihydropyridine calcium channel blockers or central-acting alpha agonists might be the best corrective medication. In the latter, beta-blockade might be maternally ineffective and even contribute to impaired foetal growth by keeping cardiac output low. We propose a randomized controlled trial to determine whether correcting the haemodynamic imbalance in women with mild to moderate hypertension reduces the development of severe hypertension and/or preeclampsia more than non-pharmacological treatment does, without alleged negative effects on foetal growth. METHODS Women diagnosed with mild to moderate hypertension without proteinuria or signs of other organ damage before 37 weeks of pregnancy are invited to participate in this randomized controlled trial. Women randomized to the intervention group will be prescribed tailored antihypertensive medication, using a simple diagnostic and treatment algorithm based on the mean arterial pressure/heart rate ratio, which serves as an easy-to-determine proxy for maternal circulatory state. Women randomized to the control group will receive non-pharmacological standard care according to national and international guidelines. In total, 208 women will be randomized in a 1:1 ratio. The primary outcome is progression to severe hypertension and preeclampsia and the secondary outcomes are adverse maternal and neonatal outcomes. DISCUSSION This trial will provide evidence of whether tailoring treatment of mild to moderate gestational hypertension to the individual haemodynamic profile prevents maternal disease progression. TRIAL REGISTRATION NCT02531490 , registered on 24 August 2015.
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Affiliation(s)
- Eva Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands. .,Department of Obstetrics and Gynaecology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Chahinda Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Evine Appelman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Luc Smits
- Department of Epidemiology, Maastricht University, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Rogier van der Zanden
- Department of Clinical Pharmacy and Toxicology/CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, PO box 9101, GA, Nijmegen, the Netherlands
| | - Marc Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO box 5800, 6202, AZ, Maastricht, the Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Medical Centre, PO box 9101, GA, Nijmegen, the Netherlands
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Mulder EG, Ghossein-Doha C, Crutsen J, Van Kuijk S, Thilaganathan B, Spaanderman M. Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study. BJOG 2020; 128:121-129. [PMID: 32725713 PMCID: PMC7754285 DOI: 10.1111/1471-0528.16435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate the association between deferred delivery in early‐onset pre‐eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. Design Observational study. Setting Tertiary referral hospital. Population Nulliparous women diagnosed with pre‐eclampsia before 34 weeks’ gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded. Methods Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures. Main outcome measures Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function. Results The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4–18) who were assessed at on average 8 months (IQR 6–12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852–0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006–1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome. Conclusion Pregnancy prolongation in early‐onset pre‐eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short‐term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria. Tweetable abstract Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function. Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function.
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Affiliation(s)
- E G Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jrw Crutsen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Smj Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B Thilaganathan
- St George's University of London, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mea Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
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de Sonnaville CMW, Hukkelhoven CW, Vlemmix F, Groen H, Schutte JM, Mol BW, van Pampus MG. Impact of Hypertension and Preeclampsia Intervention Trial At Near Term-I (HYPITAT-I) on obstetric management and outcome in The Netherlands. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:58-67. [PMID: 31486156 DOI: 10.1002/uog.20417] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/18/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The Hypertension and Preeclampsia Intervention Trial At near Term-I (HYPITAT-I) randomized controlled trial showed that, in women with gestational hypertension or mild pre-eclampsia at term, induction of labor, compared with expectant management, was associated with improved maternal outcome without compromising neonatal outcome. The aim of the current study was to evaluate the impact of these findings on obstetric management and maternal and perinatal outcomes in The Netherlands. METHODS We retrieved data for the period 2000-2014 from the Dutch National Perinatal Registry, including 143 749 women with gestational hypertension or pre-eclampsia and a singleton fetus in cephalic presentation, delivered between 36 + 0 and 40 + 6 weeks of gestation (hypertensive disorder of pregnancy (HDP) group). Pregnant women without HDP were used as the reference group (n = 1 649 510). The HYPITAT-I trial was conducted between 2005 and 2008. To study the impact of HYPITAT-I, we compared rate of induction of labor, mode of delivery and maternal and perinatal outcomes in the periods before (2000-2005) and after (2008-2014) the trial. We also differentiated between hospitals that participated in HYPITAT-I and those that did not. RESULTS In the HDP group, the rate of induction of labor increased from 51.1% before the HYPITAT-I trial to 64.2% after it (relative risk (RR), 1.26; 95% CI, 1.24-1.27). Maternal mortality decreased from 0.022% before the trial to 0.004% after it (RR, 0.20; 95% CI, 0.06-0.70) and perinatal death decreased from 0.49% to 0.27% (RR, 0.54; 95% CI, 0.45-0.65), which was attributable mostly to a decrease in fetal death. Both the increase in induction rate and the reduction in hypertensive complications were more pronounced in hospitals that participated in the HYPITAT-I trial than in those that did not. Following HYPITAT-I, the rate of induction of labor also increased (by 4.6 percentage points) in the reference group; however, the relative increase in the HDP group (13.1 percentage points) was significantly greater (P < 0.001 for the interaction). The reduction in maternal and perinatal deaths did not differ significantly between the HDP and reference groups. There was a decreased incidence of placental abruption in both HDP and reference groups, which was significantly greater in the HDP than in the reference group (P < 0.001 for the interaction). There was also an increased incidence of emergency Cesarean section in both HDP and reference groups; however, this change was significantly greater in the reference than in the HDP group (P < 0.001 for the interaction). CONCLUSION Following the HYPITAT-I trial, there was a higher rate of induction of labor and improved obstetric outcome in term pregnancies complicated by HDP in The Netherlands. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
| | | | - F Vlemmix
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M Schutte
- Department of Obstetrics and Gynecology, Isala Klinieken, Zwolle, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - M G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
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Early- and Late-Onset Preeclampsia: A Comprehensive Cohort Study of Laboratory and Clinical Findings according to the New ISHHP Criteria. Int J Hypertens 2019; 2019:4108271. [PMID: 31637053 PMCID: PMC6766116 DOI: 10.1155/2019/4108271] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/05/2019] [Accepted: 08/21/2019] [Indexed: 12/22/2022] Open
Abstract
Recently, the diagnostic criteria of preeclampsia have been changed. No studies are available in the literature that analyzed in detail the differences between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP), taking into account the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Thus, we sought to retrospectively investigate in detail the differences in clinical and laboratory outcomes between EOP and LOP diagnosed according to the ISSHP criteria. A retrospective cohort study was conducted in 214 women with singleton pregnancies and preeclampsia admitted to the Department of Obstetrics and Perinatology of the University Hospital in Kraków, Poland, from 2013 to 2017 (113 (52.8%) women with EOP and 101 (47.2%) women with LOP). Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery and neonatal data. Patients with preeclampsia accounted for 1.7% of the women who delivered during the study period. The EOP and LOP groups did not differ in the distribution of risk factors for preeclampsia. The most common risk factor was primiparity, which was observed in 72.0% of cases. Regarding the ISSHP diagnostic criteria, the two groups differed in the incidence of fetal growth restriction (p=0.0009), hemolysis (p=0.0416), and neurological complications (p=00342), which were found more often in the EOP group. In addition, the EOP group had more frequent occurrence of severe cardiorespiratory (p < 0.0001) and hematological (p=0.0127) complications, adverse fetoplacental conditions (p < 0.0001), and severe fetoplacental complications (p=0.0003). Children born to women with EOP had lower Apgar scores (p < 0.001) and higher rates of intraventricular hemorrhage (p < 0.0001), respiratory disorders requiring mechanical ventilation (p < 0.0001), and early (p=0.0004) and late sepsis (p=0.002). EOP differed from LOP in terms of maternal and perinatal adverse outcomes. The observed higher rates of fetoplacental adverse conditions and severe complications indicate a significant contribution of impaired placentation to the etiopathogenesis of EOP.
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Hofstede A, Wollaars H, van Drongelen J. A clinical evaluation of blood pressure measurement by iHealth BP5 in pregnancy. Pregnancy Hypertens 2019; 17:69-74. [PMID: 31487660 DOI: 10.1016/j.preghy.2019.05.011] [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: 01/09/2019] [Revised: 04/10/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the value of blood pressure measurement by the smartphone device iHealth BP5 in pregnant women in a clinical setting, as compared to the Omron M6 Comfort and aneroid manometer. MATERIALS AND METHODS Women with a gestational age of thirty weeks or more who visited the outpatient clinic for routine visit were eligible for inclusion. For the clinical evaluation we used an adjusted form of the European Society of Hypertension International Protocol. We performed six blood pressure measurements per patient, divided over the iHealth BP5, Omron M6 Comfort and aneroid monitor. Statistical analysis consisted of repeated measurement ANOVA and Bland-Altman plots. RESULTS We included 45 women. The mean blood pressure differences between all tested devices were less than ±5 mmHg. These differences did not relate to gestational age, BMI or arm circumference. Bland-Altman plots showed good agreement of both iHealth BP5 and Omron M6 Comfort, without any systematic effects, as compared to the aneroid manometer. CONCLUSION The iHealth BP5 is as good as the frequently used Omron M6 Comfort and can be used for blood pressure measurement during pregnancy. CONDENSED ABSTRACT In 45 women the mean blood pressure differences between the Omron M6 Comfort, iHealth BP5 and the aneroid manometer were less dan ±5 mmHg. These differences did not relate to gestational age, BMI or arm circumference. Bland-Altman plots showed good agreement of both iHealth BP5 and Omron M6 Comfort, without any systematic effects, as compared to the aneroid manometer. The iHealth BP5 is as good as the frequently used Omron M6 Comfort and can be used for blood pressure measurement during pregnancy.
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Affiliation(s)
- A Hofstede
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Wollaars
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Thida T, Liabsuetrakul T. Type of health care workers and quality of antenatal and delivery care in communities of Myanmar: An experience- and vignette-based study. Int J Health Plann Manage 2019; 34:e1597-e1608. [PMID: 31292997 DOI: 10.1002/hpm.2853] [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: 05/15/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Understanding who provides antenatal and delivery care services and the quality of care in communities with high maternal deaths is essential for planning the efficient utilization of a limited health care workforce. OBJECTIVES To identify the types of health care workers for antenatal and delivery care in these communities, and assess the quality of care using vignettes of women with hypertensive disorder in pregnancy (HDP) and postpartum hemorrhage (PPH) from the provider's perspectives in Myanmar. METHODS A cross-sectional study was conducted in three townships of Myanmar during May to September 2016. Health assistants, lady health visitors, midwives, and auxiliary midwives rated the type of providers and quality of care based on four HDP vignettes and four PPH vignettes. The agreements of their assessments were analysed using prevalence-adjusted bias-adjusted kappa and Cramer's V coefficient. RESULTS Almost perfect agreement was found that midwives were the providers who provided and who should provide all routine antenatal and delivery care services. Less than 80% of the participants perceived good quality antenatal care (ANC) and delivery care for HDP and PPH, particularly in vignettes featuring cases of pre-existing hypertension or PPH with history of hospitalization. More than 85% of the participants rated quality of care for managing complications as good. Variations of ratings among the providers ranged from small to medium (Cramer's V = .22-.40). CONCLUSION Midwives were key providers of ANC and delivery care in the local communities in Myanmar, but the quality of ANC for women with HDP and PPH was poor and needs improvement.
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Affiliation(s)
- Thida Thida
- Epidemiology Research Division, Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Myanmar
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Tamargo J, Caballero R, Delpón E. Pharmacotherapy for hypertension in pregnant patients: special considerations. Expert Opin Pharmacother 2019; 20:963-982. [PMID: 30943045 DOI: 10.1080/14656566.2019.1594773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.
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Affiliation(s)
- Juan Tamargo
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Ricardo Caballero
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Eva Delpón
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
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Hayes-Ryan D, Hemming K, Breathnach F, Cotter A, Devane D, Hunter A, McAuliffe FM, Morrison JJ, Murphy DJ, Khashan A, McElroy B, Murphy A, Dempsey E, O’Donoghue K, Kenny LC. PARROT Ireland: Placental growth factor in Assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a Stepped Wedge Cluster Randomised Control Trial Research Study Protocol. BMJ Open 2019; 9:e023562. [PMID: 30826791 PMCID: PMC6398700 DOI: 10.1136/bmjopen-2018-023562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/02/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Women presenting with suspected pre-eclampsia are currently triaged on the basis of hypertension and dipstick proteinuria. This may result in significant false positive and negative diagnoses resulting in increased morbidity or unnecessary intervention. Recent data suggest that placental growth factor testing may be a useful adjunct in the management of women presenting with preterm pre-eclampsia. The primary objective of this trial is to determine if the addition of placental growth factor testing to the current clinical assessment of women with suspected preterm pre-eclampsia, is beneficial for both mothers and babies. METHODS AND ANALYSIS This is a multicentre, stepped wedge cluster, randomised trial aiming to recruit 4000 women presenting with symptoms suggestive of preterm pre-eclampsia between 20 and 36+6 weeks' gestation. The intervention of an unblinded point of care test, performed at enrolment, will quantify maternal levels of circulating plasma placental growth factor. The intervention will be rolled out sequentially, based on randomisation, in the seven largest maternity units on the island of Ireland. Primary outcome is a composite outcome of maternal morbidity (derived from the modified fullPIERS model). To ensure we are not reducing maternal morbidity at the expense of earlier delivery and worse neonatal outcomes, we have established a co-primary outcome which will examine the effect of the intervention on neonatal morbidity, assessed using a composite neonatal score. Secondary analyses will examine further clinical outcomes (such as mode of delivery, antenatal detection of growth restriction and use of antihypertensive agents) as well as a health economic analysis, of incorporation of placental growth factor testing into routine care. ETHICS AND DISSEMINATION Ethical approval has been granted from each of the seven maternity hospitals involved in the trial. The results of the trial will be presented both nationally and internationally at conference and published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02881073.
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Affiliation(s)
- Deirdre Hayes-Ryan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), UCC, Cork, Ireland
- University College Cork, Department of Obstetrics and Gynaecology, Cork, Ireland
| | - Karla Hemming
- Public Health, University of Birmingham, Birmingham, UK
| | | | - Amanda Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Declan Devane
- HRB Trials Methodology Research Network, Dublin, Ireland
- National University of Ireland, Galway, Galway, Ireland
| | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - John J Morrison
- Obstetrics and Gynaecology, National University of Ireland Galway, Galway, Ireland
| | - Deirdre J Murphy
- Trinity College Dublin & Coombe Women & Infants University Hospital Dublin 8, Republic of Ireland, Dublin, Ireland
| | - Ali Khashan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Brendan McElroy
- Economics Department, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Economics Department, University College Cork, Cork, Ireland
| | - Eugene Dempsey
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Keelin O’Donoghue
- University College Cork, Department of Obstetrics and Gynaecology, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
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Schaap TP, van den Akker T, Zwart JJ, van Roosmalen J, Bloemenkamp KWM. A national surveillance approach to monitor incidence of eclampsia: The Netherlands Obstetric Surveillance System. Acta Obstet Gynecol Scand 2018; 98:342-350. [PMID: 30346039 DOI: 10.1111/aogs.13493] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There have been many efforts in the last decade to decrease the incidence of eclampsia and its related complications in the Netherlands, such as lowering thresholds for treatment of hypertension and mandatory professional training. To determine the impact of these policy changes on incidence and outcomes, we performed a nationwide registration of eclampsia, 10 years after the previous registration. MATERIAL AND METHODS Cases of eclampsia were prospectively collected using the Netherlands Obstetric Surveillance System (NethOSS; 2013-2016) in all hospitals with a maternity unit in the Netherlands. Complete case file copies were obtained for comparative analysis of individual level data with the previous cohort (2004-2006). Primary outcome measure was incidence of eclampsia; main secondary outcomes were antihypertensive and magnesium sulfate use, and maternal and perinatal mortality. RESULTS NethOSS identified 88 women with eclampsia. The incidence decreased from 6.2/10 000 in 2004-2006 to 1.8/10 000 births (relative risk [RR] 0.28, 95% confidence interval [CI] 0.22-0.36). Increases in the use of antihypertensive medication (61/82 vs 35/216; RR 18.4, 95% CI 9.74-34.70) and magnesium sulfate treatment (82/82 vs 201/216; RR 1.08, 95% CI 1.04-1.12) were observed. There was one intrauterine death following termination of pregnancy. No cases of neonatal mortality were reported in NethOSS compared with 11 in the LEMMoN. Maternal death occurred in one woman compared vs three in the previous registration. CONCLUSIONS There has been a strong reduction of eclampsia and associated perinatal mortality in the Netherlands over the last decade. Management changes and increased awareness may have contributed to this reduction.
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Affiliation(s)
- Timme P Schaap
- Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Risk assessment for preterm preeclampsia in first trimester: Comparison of three calculation algorithms. Eur J Obstet Gynecol Reprod Biol 2018; 231:241-247. [PMID: 30439653 DOI: 10.1016/j.ejogrb.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To better adjust the risk for preeclampsia, multifactorial models in first trimester of pregnancy have found the way in clinical practice. This study compares the available test algorithms. STUDY DESIGN In a cross-sectional study between November 2013 and April 2016 we compared the tests results of three first trimester testing algorithms for preeclampsia in 413 women. Risk for preterm preeclampsia was calculated with three different algorithms: Preeclampsia Predictor™ Software by PerkinElmer (PERK), ViewPoint® Software by GE Healthcare (VP) and the online calculator of the Fetal Medicine Foundation (FMF).We analyzed the data descriptively and determined Cohen's Kappa to assess the agreement among the algorithms. RESULTS VP classified 89(21.5%) women, PERK 43(10.4%) women and FMF 90 (21.8%) women as having high risk for preterm preeclampsia (<34 weeks of gestation for VP and PERK and <37 weeks of gestation for FMF). Agreement between tests ranged from moderate to substantial (PERK/VP: κ = 0.56, PERK/ FMF: κ = 0.50, and VP/ FMF: κ = 0.72). CONCLUSION The three algorithms are similar but not equal. This may depend on chosen cut off, but also on test properties. This study cannot decide which algorithm is the best, but differences in results and cut offs should be taken into account.
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Luitjes SHE, Hermens RPMG, de Wit L, Heymans MW, van Tulder MW, Wouters MGAJ. An innovative implementation strategy to improve the use of Dutch guidelines on hypertensive disorders in pregnancy: A randomized controlled trial. Pregnancy Hypertens 2018; 14:131-138. [PMID: 30527100 DOI: 10.1016/j.preghy.2018.08.451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/08/2018] [Accepted: 08/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an innovative strategy to improve implementation of evidence-based guidelines on the management of hypertension in pregnancy compared to a common strategy of professional audit and feedback. DESIGN Cluster randomized controlled trial (c-RCT). SETTING Sixteen Dutch hospitals. POPULATION All patients with a hypertensive disorder during pregnancy who were admitted to one of the participating hospitals between April 1st 2010 and May 1st 2011, were suitable for inclusion; the only exclusion criterion was the presence of lethal fetal abnormalities. METHODS Hospitals were randomly assigned to either an innovative implementation strategy including a computerized decision support system (DSS) and professional audit and feedback or a minimal implementation strategy of audit and feedback only. MAIN OUTCOME MEASURES Primary outcome measure was a combined rate of major maternal complications. Secondary outcome measures included process-related measures on guideline adherence, and patient-related outcomes. A process evaluation was performed alongside. RESULTS No statistically significant difference was found in both the occurrence of major complications and most secondary outcome measures between the two groups. Process evaluation showed limited use of the computerized DSS, with a large variation between hospitals (0-49,5% of the eligible patients), but positive experiences of actual users. CONCLUSION Using a computerized DSS for implementation of the clinical guidelines for the management of hypertension in pregnancy did not result in fewer major maternal and fetal complications. Limited use of the DSS in the innovative strategy group could be an explanation for the lack of effect.
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Affiliation(s)
- Susanne H E Luitjes
- Department of Obstetrics and Gynaecology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth & Life Sciences, Amsterdam Public Health Institute, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - Rosella P M G Hermens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Health Care (IQ Healthcare), Radboud University Medical Centre (Radboudumc), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Linda de Wit
- Department of Obstetrics and Gynaecology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Health Sciences, Faculty of Earth & Life Sciences, Amsterdam Public Health Institute, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth & Life Sciences, Amsterdam Public Health Institute, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Maurice G A J Wouters
- Department of Obstetrics and Gynaecology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Schlembach D, Hund M, Schroer A, Wolf C. Economic assessment of the use of the sFlt-1/PlGF ratio test to predict preeclampsia in Germany. BMC Health Serv Res 2018; 18:603. [PMID: 30081904 PMCID: PMC6080558 DOI: 10.1186/s12913-018-3406-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany. Methods We adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient. Results In the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient. Conclusions The sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia. Electronic supplementary material The online version of this article (10.1186/s12913-018-3406-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dietmar Schlembach
- Vivantes Network of Health, Clinicum Neukoelln, Clinic of Obstetrics, Rudower Strasse 48, 12351, Berlin, Germany.
| | - Martin Hund
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Cyrill Wolf
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
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Folk DM. Hypertensive Disorders of Pregnancy: Overview and Current Recommendations. J Midwifery Womens Health 2018; 63:289-300. [PMID: 29764001 DOI: 10.1111/jmwh.12725] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are an important cause of maternal and fetal morbidity and mortality. Although advances in effective treatments have been made, current research has yet to identify a biochemical or diagnostic imaging marker to reliably predict preeclampsia. Despite current guidelines that address diagnosis and management of hypertensive disorders in pregnancy, health care providers may overlook or be unaware of signs that require immediate evaluation and treatment. This article reviews the definitions of hypertensive disorders of pregnancy, diagnosis, pathophysiology of preeclampsia, indications for treatment, neurologic sequelae, and counseling about the implications of hypertension in pregnancy for subsequent health.
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Ali P, Butt S, Hossain N. Criteria based audit in the management of eclampsia at a public sector tertiary care hospital in Karachi, Pakistan. Pregnancy Hypertens 2018. [PMID: 29523265 DOI: 10.1016/j.preghy.2018.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the practice of Eclampsia management at a tertiary care public sector hospital. PATIENTS & METHODS We conducted criteria based audit of 93 Eclampsia patients admitted in Gynae unit III, Civil hospital and Dow University of Health Sciences Karachi, between 1st January 2016 and 31st December 2016. Management practices were assessed using evidence-based criteria for care. A clinical criteria for standards of care were developed from Royal College of Obstetrician & Gynecologist (RCOG/NICE) guidelines, World Health Organization (WHO) manual, twelve criteria were identified for the audit purpose. RESULT Total deliveries during study periods were 5323,with 93 cases were of Eclampsia, giving prevalence of 1.7%. Majority were antepartum (67%), followed by postpartum (21%) cases. Mean age of patients was 25 years while mean parity was 1.4. Majority 48% were un-booked and 36% were referred. Cesarean section was the main mode of delivery (53%) while 24% delivered vaginally. Live birth rate was 65%. History and examination was performed in 98% of patients. MgSO4 loading dose was given in 81%, antihypertensive labetalol/hydralazine were given in 29% of cases with acute severe hypertension. Initial investigation were sent in 84% of patients and repeat investigations within 12 h were done in 74% of cases. Reflexes were monitored in 12% of cases, consultant was informed in 37% of cases, management plan was made in 74% of cases, 98% patients were delivered within 12 h of admission. CONCLUSION Suboptimal care was observed in monitoring of patients after magnesium sulphate, and in the management plan of patients.
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Affiliation(s)
- Paras Ali
- Department of Obstetrics & Gynecology, Unit II, Dow Medical College & Civil Hospital, Karachi, Pakistan.
| | - Sofia Butt
- Department of Obstetrics & Gynecology, Unit II, Dow Medical College & Civil Hospital, Karachi, Pakistan.
| | - Nazli Hossain
- Department of Obstetrics & Gynecology, Unit II, Dow Medical College & Civil Hospital, Karachi, Pakistan.
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Role and mechanism of AT1-AA in the pathogenesis of HELLP syndrome. Sci Rep 2018; 8:279. [PMID: 29321548 PMCID: PMC5762787 DOI: 10.1038/s41598-017-18553-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/14/2017] [Indexed: 02/08/2023] Open
Abstract
HELLP syndrome remains a leading cause of maternal and neonatal mortality and morbidity worldwide, which symptoms include hemolysis, elevated liver enzymes and low platelet count. The objective of this study was to determine whether HELLP is associated with AT1-AA. The positive rate and titer of AT1-AA in plasma from pregnant women were determined, and the correlation of AT1-AA titer with the grade of HELLP was analyzed. A HELLP rat model established by intravenous injection of AT1-AA. Our experimental results show the AT1-AA titer and positive rate were significantly higher in HELLP group, and AT1-AA titer were positively correlated with the level of TNF-α and ET-1 in plasma and the grade of HELLP syndrome. The results of animal experiments showed that the typical features of HELLP in the pregnant rats after AT1-AA injection. The levels of TNF-α and ET-1 in plasma and liver tissue were significantly increased in AT1-AA-treated rats compared with control rats. The HELLP syndrome induced by AT1-AA was attenuated markedly after administration of losartan. These data support the hypothesis that one the potential pathway that AT1-AA induce damage to capillary endothelial cells and liver during pregnancy is through activation of TNF-α and ET-1.
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Adu-Bonsaffoh K, Ntumy MY, Obed SA, Seffah JD. Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana. BMC Pregnancy Childbirth 2017; 17:388. [PMID: 29157196 PMCID: PMC5696910 DOI: 10.1186/s12884-017-1575-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality especially in Sub-Saharan Africa (SSA). However, the perinatal burden of HDP in Ghana has not been explored. We conducted this study to determine the perinatal outcomes of HDP at a tertiary hospital in Ghana. METHODS A cross-sectional study conducted between January to February 2013 at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Data collection involved baseline review of all the obstetric population who had just delivered to identify those with HDP. An informed consent was obtained after which a structured questionnaire was adminstered to the hypertensive mothers. The medical records of the mothers and their babies were also reviewed to determine the perinatal outcome indicators of relevance to the study. Data obtained were analyzed using SPSS version 20. RESULTS We included 368 women with HDP and singleton births with a mean gestational age at delivery of 37.4 ± 3.3 weeks. Adverse perinatal outcomes determined include the following: 91 (24.7%) neonates were admitted to the Neonatal Intensive Care Unit, 56 (15.2%) had neonatal respiratory distress/asphyxia with 14 (3.8%) requiring ventilatory support and 80 (21.7%) were delivered preterm. Also, stillbirth, early neonatal death, intrauterine growth restriction and low birth weight occurred in 25 (6.8%), 14 (3.8%), 23 (6.1%) and 91 (24.7%) respectively with a perinatal mortality rate of 106 per 1000 births. One and 5 minute APGAR scores <7 occurred in 125 (34.0%) and 55 (14.7%) neonates respectively. Most of the adverse perinatal outcomes were significantly more common in those with preeclampsia compared to the other hypertensive disorders. CONCLUSION There is a significant burden of perinatal morbidity and mortality associated with HDP in the Ghanaian obstetric population and these adverse outcomes were more prevalent in preeclampsia compared to the other hypertensive disorders. Regular goal-oriented clinical audit into perinatal morbidity and mortality associated with HDP and an active multidisciplinary approach to the management of these disorders in the hospital might improve the clinical outcomes of women with maternal hypertension.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
- Department of Physiology, School of Allied and Biomedical Science, University of Ghana, Accra, Ghana
| | - Michael Y. Ntumy
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Samuel A. Obed
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Joseph D. Seffah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Crombag NMTH, Lamain-de Ruiter M, Kwee A, Schielen PCJI, Bensing JM, Visser GHA, Franx A, Koster MPH. Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women: a qualitative study. BMC Pregnancy Childbirth 2017; 17:12. [PMID: 28061818 PMCID: PMC5219667 DOI: 10.1186/s12884-016-1195-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/13/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation. METHOD Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers. RESULTS Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety. CONCLUSION Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.
| | - Marije Lamain-de Ruiter
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,The Netherlands Institute for Health Services Research Utrecht, Utrecht, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.,Department of obstetrics and gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 36:83-102. [PMID: 27531686 PMCID: PMC5096310 DOI: 10.1016/j.bpobgyn.2016.05.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 02/08/2023]
Abstract
In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs.
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Affiliation(s)
- Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Laura A Magee
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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Thornton C, Tooher J, Ogle R, von Dadelszen P, Makris A, Hennessy A. Benchmarking the Hypertensive Disorders of Pregnancy. Pregnancy Hypertens 2016; 6:279-284. [DOI: 10.1016/j.preghy.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/29/2016] [Indexed: 11/15/2022]
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Ferreira MBG, Silveira CF, Silva SRD, Souza DJD, Ruiz MT. Nursing care for women with pre-eclampsia and/or eclampsia: integrative review. Rev Esc Enferm USP 2016; 50:324-34. [PMID: 27384214 DOI: 10.1590/s0080-623420160000200020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 01/15/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. METHODS Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. RESULTS The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. CONCLUSION Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence. OBJETIVO Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia. MÉTODO Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO. RESULTADOS Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da pressão arterial, identificação e tratamento precoces da crise hipertensiva mediante protocolos institucionais e revisão de casos e processos de trabalho. CONCLUSÃO Mulheres com pré-eclâmpsia e/ou eclâmpsia exigem cuidados de enfermagem específicos, os quais devem ser pautados em protocolos de cuidados baseados em evidências científicas.
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Affiliation(s)
- Maria Beatriz Guimarães Ferreira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental, Ribeirão Preto, SP, Brazil
| | | | - Sueli Riul da Silva
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brazil
| | - Delvane José de Souza
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brazil
| | - Mariana Torreglosa Ruiz
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brazil
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Liabsuetrakul T, Prappre T, Pairot P, Oumudee N, Islam M. Development of a web-based epidemiological surveillance system with health system response for improving maternal and newborn health: Field-testing in Thailand. Health Informatics J 2016; 23:109-123. [PMID: 26879329 DOI: 10.1177/1460458216628312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveillance systems are yet to be integrated with health information systems for improving the health of pregnant mothers and their newborns, particularly in developing countries. This study aimed to develop a web-based epidemiological surveillance system for maternal and newborn health with integration of action-oriented responses and automatic data analysis with results presentations and to assess the system acceptance by nurses and doctors involved in various hospitals in southern Thailand. Freeware software and scripting languages were used. The system can be run on different platforms, and it is accessible via various electronic devices. Automatic data analysis with results presentations in the forms of graphs, tables and maps was part of the system. A multi-level security system was incorporated into the program. Most doctors and nurses involved in the study felt the system was easy to use and useful. This system can be integrated into country routine reporting system for monitoring maternal and newborn health and survival.
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Affiliation(s)
| | | | | | | | - Monir Islam
- World Health Organization Country Office in Namibia, Namibia
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Stepan H, Kuse-Föhl S, Klockenbusch W, Rath W, Schauf B, Walther T, Schlembach D. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75:900-914. [PMID: 28435172 PMCID: PMC5396549 DOI: 10.1055/s-0035-1557924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Hypertensive pregnancy disorders contribute significantly to perinatal as well as maternal morbidity and mortality worldwide. Also in Germany these diseases are a major course for hospitalization during pregnancy, iatrogenic preterm birth and long-term cardiovascular morbidity. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. Recommendations: This guideline summarizes the state-of-art for classification, risk stratification, diagnostic, treatment of hypertensive pregnancy disorders.
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Affiliation(s)
- H. Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - S. Kuse-Föhl
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - W. Klockenbusch
- Universitätsklinikum Münster, Klinik und Poliklinik für Frauenheilkunde und
Geburtshilfe, Abt. für Geburtshilfe, Münster
| | - W. Rath
- Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH
Aachen, Aachen
| | - B. Schauf
- Frauenklinik Sozialstiftung Bamberg, Bamberg
| | - T. Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork,
Ireland
| | - D. Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
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Abstract
Pre-eclampsia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-eclampsia-related maternal deaths in the UK (1952-2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-eclampsia. The Pre-eclampsia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-eclampsia complications. For women at high risk of developing pre-eclampsia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies; heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats eclampsia; there is insufficient evidence to support alternative regimens. Pre-eclampsia predicts later cardiovascular disease; however, at this time we do not know what to do about it.
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Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada,
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Gillon TER, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One 2014; 9:e113715. [PMID: 25436639 PMCID: PMC4249974 DOI: 10.1371/journal.pone.0113715] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. METHODOLOGY & PRINCIPAL FINDINGS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. CONCLUSIONS Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Center, Amsterdam, The Netherlands
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen MacDonell
- College of Physicians and Surgeons of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A. Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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Akkermans J, Payne B, von Dadelszen P, Groen H, Vries JD, Magee LA, Mol BW, Ganzevoort W. Predicting complications in pre-eclampsia: external validation of the fullPIERS model using the PETRA trial dataset. Eur J Obstet Gynecol Reprod Biol 2014; 179:58-62. [PMID: 24965981 DOI: 10.1016/j.ejogrb.2014.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The internally validated fullPIERS model predicts adverse maternal outcomes in women with pre-eclampsia within 48h after eligibility. Our objective was to assess generalizability of this prediction model. STUDY DESIGN External validation study using prospectively collected data from two tertiary care obstetric centers. METHODS The existing PETRA dataset, a cohort of women (n=216) with severe early-onset pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction was used. The fullPIERS model equation was applied to all women in the dataset using values collected within 48h after inclusion. The performance (ROC area and R-squared) of the model, risk stratification and calibration were assessed from 48h up to a week after inclusion. RESULTS Of 216 women in the PETRA trial, 73 (34%) experienced an adverse maternal outcome(s) at any time after inclusion. Adverse maternal outcome was observed in 32 (15%) cases within 48h and 62 (29%) within 7 days after inclusion. The fullPIERS model predicted adverse maternal outcomes within 48h (AUC ROC 0.97, 95% CI: 0.87-0.99) and up to 7 days after inclusion (AUC ROC 0.80, 95% CI: 0.70-0.87). CONCLUSIONS The fullPIERS model performed well when applied to the PETRA dataset. These results confirm the usability of the fullPIERS prediction model as a 'rule-in' test for women admitted with severe pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction. Future research should focus on intervention studies that assess the clinical impact of strategies using the fullPIERS model.
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Affiliation(s)
- Joost Akkermans
- Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
| | - Beth Payne
- Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Peter von Dadelszen
- Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Johanna de Vries
- Departments of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laura A Magee
- Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Ben Willem Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Wessel Ganzevoort
- Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
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Giordano JC, Parpinelli MA, Cecatti JG, Haddad SM, Costa ML, Surita FG, Pinto e Silva JL, Sousa MH. The burden of eclampsia: results from a multicenter study on surveillance of severe maternal morbidity in Brazil. PLoS One 2014; 9:e97401. [PMID: 24825164 PMCID: PMC4019598 DOI: 10.1371/journal.pone.0097401] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/19/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Maternal mortality (MM) is a core indicator of disparities in women's rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). METHODS Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO's obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect). RESULTS Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48-3.59) were associated with SMO. CONCLUSIONS Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia.
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Affiliation(s)
- Juliana C. Giordano
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Mary A. Parpinelli
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
- * E-mail:
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
- Center for Studies on Reproductive Health of Campinas (CEMICAMP), Campinas, São Paulo, Brazil
| | - Samira M. Haddad
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Fernanda G. Surita
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Joao L. Pinto e Silva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Maria H. Sousa
- Center for Studies on Reproductive Health of Campinas (CEMICAMP), Campinas, São Paulo, Brazil
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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]
Affiliation(s)
- Milan J. Sonneveld
- Department of Clinical Neurophysiology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
- Department of Obstetrics and Gynecology; Division of Obstetrics and Perinatal Medicine; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - Ingrid A. Brussé
- Department of Obstetrics and Gynecology; Division of Obstetrics and Perinatal Medicine; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - Johannes J. Duvekot
- Department of Obstetrics and Gynecology; Division of Obstetrics and Perinatal Medicine; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - Eric A.P. Steegers
- Department of Obstetrics and Gynecology; Division of Obstetrics and Perinatal Medicine; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - Frank Grune
- Department of Anaesthesiology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - Gerhard H. Visser
- Department of Clinical Neurophysiology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
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Van Oostwaard MF, Langenveld J, Schuit E, Wigny K, Van Susante H, Beune I, Ramaekers R, Papatsonis DNM, Mol BWJ, Ganzevoort W. Prediction of recurrence of hypertensive disorders of pregnancy in the term period, a retrospective cohort study. Pregnancy Hypertens 2014; 4:194-202. [PMID: 26104605 DOI: 10.1016/j.preghy.2014.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/06/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the recurrence risk of term hypertensive disease of pregnancy and to determine which potential risk factors are predictive of recurrence. STUDY DESIGN We performed a retrospective cohort study in two secondary and one tertiary care hospitals in the Netherlands. We identified women with a hypertensive disorder in the index pregnancy and delivery after 37weeks of gestation between January 2000 and December 2002. Data were extracted from medical files and women were approached for additional information on subsequent pregnancies. Adverse outcome was defined as recurrence of a hypertensive disorder in the next subsequent pregnancy. MAIN OUTCOME MEASURES The absolute risk of recurrence and a prediction model containing demographic and clinical factors predictive of recurrence. RESULTS We identified 638 women for potential inclusion, of whom 503 could be contacted. Of these women, 312 (62%) had a subsequent pregnancy. Hypertensive disorders recurred in 120 (38%, 95% CI 33-44) women, of whom 15 (5%, 95% CI 3-7) delivered preterm. Women undergoing recurrence were more at risk to develop chronic hypertension after pregnancy (35% versus 16%, OR 2.8, 95% CI 1.5-5.3). Body mass index, non-White European origin, chronic hypertension, maximum diastolic blood pressure, no use of anticonvulsive medication and interpregnancy interval were predictors for recurrence. CONCLUSIONS Women with hypertensive disorders and term delivery have a substantial chance of recurrence, but a small risk of preterm delivery. A number of predictors for recurrence could be identified and women with a recurrence more often developed chronic hypertension.
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Affiliation(s)
- Miriam F Van Oostwaard
- Department of Obstetrics and Gynecology, Erasmus Medisch Centrum, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Amphia Ziekenhuis, Breda, The Netherlands.
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Atrium Medisch Centrum, Heerlen, The Netherlands
| | - Ewoud Schuit
- Julius Centre for Health Sciences and Primary Care, Universitair Medisch Centrum, Utrecht, The Netherlands; Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Kiki Wigny
- Department of Obstetrics and Gynecology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Hilde Van Susante
- Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Irene Beune
- Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Roos Ramaekers
- Department of Obstetrics and Gynecology, Atrium Medisch Centrum, Heerlen, The Netherlands
| | | | - Ben Willem J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
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Esscher A, Binder-Finnema P, Bødker B, Högberg U, Mulic-Lutvica A, Essén B. Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the 'migration three delays' model. BMC Pregnancy Childbirth 2014; 14:141. [PMID: 24725307 PMCID: PMC3998732 DOI: 10.1186/1471-2393-14-141] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. METHODS A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. RESULTS Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. CONCLUSIONS Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
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Affiliation(s)
- Annika Esscher
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden.
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Schaap TP, Knight M, Zwart JJ, Kurinczuk JJ, Brocklehurst P, van Roosmalen J, Bloemenkamp KWM. Eclampsia, a comparison within the International Network of Obstetric Survey Systems. BJOG 2014; 121:1521-8. [DOI: 10.1111/1471-0528.12712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- TP Schaap
- Department of Obstetrics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - M Knight
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - JJ Zwart
- Department of Obstetrics and Gynaecology; Deventer Ziekenhuis; Deventer the Netherlands
| | - JJ Kurinczuk
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - P Brocklehurst
- Institute for Women's Health; University College London; London UK
| | - J van Roosmalen
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
- Department of Medical Humanities; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
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Cronie DJ, Rijnders M, de Vries R, Buitendijk S. Making Evidence Available for Hospital-Based Midwives: A Systematic Examination of the Content and Methodological Quality of Three Protocols Used in Maternity Hospitals in the Netherlands. INTERNATIONAL JOURNAL OF CHILDBIRTH 2014. [DOI: 10.1891/2156-5287.4.4.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: In recent years, the Dutch have begun to question the safety and efficacy of their maternity care system. Particular concerns have been raised about the quality of care in hospital settings. One way to address concerns regarding quality and efficacy of care is by the introduction and use of evidence-based protocols for practice. The primary aims of this study are to (a) describe the availability and diffusion of protocols in Dutch maternity hospitals, (b) systematically assess the methodological quality of these protocols, and (c) consider the content of the protocols in relation to the best evidence for practice.METHODS: A mailed and Internet questionnaire to all hospitals with maternity facilities in the Netherlands inquiring about the availability, content, and methodological quality of protocols for three situations: hypertensive conditions of pregnancy, fetal surveillance, and postpartum hemorrhage. All protocols were systematically assessed twice. We first assessed the methodological quality of the protocol using the Appraisal of Guidelines Research and Evaluation (AGREE) framework, and we then evaluated protocol content using a framework we developed for this purpose. Protocols were scored using a Likert-type scale.RESULTS: There were 53% (N = 48) of all maternity hospitals in the Netherlands that responded. The methodological quality of protocols we evaluated was poor. Using the AGREE framework, 70% of fetal surveillance protocols could not be recommended. Only 1 protocol from 1 hospital scored strongly recommend. Confusion regarding the definition of a protocol and what it should contain were common problems. There was a general paucity of evidence in the protocols assessed.DISCUSSION: Protocols may not be widely available in Dutch maternity hospitals. Where they are available, the quality is poor. There is no national strategy for coordination, implementation, and dissemination of evidence-based protocols. Because centralization, uniformity, and interprofessional collaboration are known to improve adherence, it would be prudent for maternity care professions to develop and disseminate protocols based on best evidence.
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Talungchit P, Liabsuetrakul T, Lindmark G. Multifaceted intervention to implement indicators of quality of care for severe pre-eclampsia/eclampsia. Int J Gynaecol Obstet 2013; 124:106-11. [DOI: 10.1016/j.ijgo.2013.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/06/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
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Luitjes SHE, Wouters MGAJ, König T, Hollander KW, van Os ME, van Tulder MW, Hermens RPMG. Hypertensive disorders in pregnancy: a review of international guidelines. Hypertens Pregnancy 2013; 32:367-77. [DOI: 10.3109/10641955.2013.808663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Polsani S, Phipps E, Jim B. Emerging new biomarkers of preeclampsia. Adv Chronic Kidney Dis 2013; 20:271-9. [PMID: 23928393 DOI: 10.1053/j.ackd.2013.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/02/2013] [Indexed: 01/23/2023]
Abstract
Preeclampsia continues to plague some of the most vulnerable women and fetuses. It is surprisingly prevalent in developing and developed nations. According to the World Health Organization, hypertension during pregnancy is a leading cause of maternal mortality in industrialized countries at 16% and up to 25% in developing countries. As the pathogenesis of this disease is being unraveled, we are afforded new opportunities to develop novel biomarkers for early identification and prevention of disease. The angiogenic markers including soluble fms-like tyrosine kinase 1, placental growth factor, and soluble endoglin have demonstrated to be the most promising, perhaps in conjunction with traditional markers such as plasma protein-13 and uterine artery Doppler studies. There is also increasing evidence that the podocyte is shed during the course of preeclampsia, which may be useful for diagnosis. Systems biology approaches to biomarker discovery such as proteomics and metabolomics are also gaining more attention and will most certainly open new avenues of research. In this review, we present the best studied biomarkers of preeclampsia to date.
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Groeneveld E, Lambers MJ, Lambalk CB, Broeze KA, Haapsamo M, de Sutter P, Schoot BC, Schats R, Mol BWJ, Hompes PGA. Preconceptional low-dose aspirin for the prevention of hypertensive pregnancy complications and preterm delivery after IVF: a meta-analysis with individual patient data. Hum Reprod 2013; 28:1480-8. [DOI: 10.1093/humrep/det022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Errors in the treatment of hypertensive disorders of pregnancy and their impact on maternal mortality. Int J Gynaecol Obstet 2013; 121:78-81. [DOI: 10.1016/j.ijgo.2012.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/11/2012] [Accepted: 12/18/2012] [Indexed: 11/24/2022]
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Cronie D, Rijnders M, Buitendijk S. Diversity in the scope and practice of hospital-based midwives in the Netherlands. J Midwifery Womens Health 2012; 57:469-75. [PMID: 22954077 DOI: 10.1111/j.1542-2011.2012.00164.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Not all midwives in the Netherlands are independent practitioners. One in 4 midwives registered to practice is employed in the hospital setting, where 67% of all births occur. There has not yet been an in-depth examination of hospital-based midwives' practice in the Netherlands, in the context of care in a higher-risk environment. The primary aims of this study were to describe the diversity and scope of practice of hospital-based midwives in the Netherlands. METHODS This was an online survey of all hospitals throughout the Netherlands with labor/birthing rooms and employing hospital-based midwives. The survey covered 5 topic areas: demographic/organizational details, duties, responsibilities, experience/additional qualifications, and how the midwife functioned within the multidisciplinary hospital team. Descriptive statistics are provided. RESULTS A total of 59 secondary and tertiary level hospitals from a possible total of 98 were included for analysis (60% national response rate). Forty percent of all births occurring during the study period were managed solely by a hospital midwife. The provision of midwifery care in the hospital setting was not universal, and where present, hospital-based midwives were not necessarily available 24 hours a day or 7 days a week. Hospital-based midwives reported a high level of autonomy. DISCUSSION Currently there is no universal provision of midwifery care in the hospital setting in the Netherlands. Where there are hospital-based midwives, they appear to manage the majority of births. However, there are no nationally agreed-upon standards for midwifery practice in the hospital setting, and no agreement exists over minimum requirements relating to additional education for midwives in these settings. A national evaluation and setting of minimum standards is needed.
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Denktaş S, Bonsel GJ, Van der Weg EJ, Voorham AJJ, Torij HW, De Graaf JP, Wildschut HIJ, Peters IA, Birnie E, Steegers EAP. An urban perinatal health programme of strategies to improve perinatal health. Matern Child Health J 2012; 16:1553-8. [PMID: 21870042 PMCID: PMC3505522 DOI: 10.1007/s10995-011-0873-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20-50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle these problems. Without the introduction of measures throughout the entire perinatal health care chain, pregnancy outcomes are difficult to improve. With the support of health care professionals, the City of Rotterdam and the Erasmus University Medical Centre have taken the initiative to develop an urban perinatal health programme called 'Ready for a Baby'. The main objective of this municipal 10-year programme is to improve perinatal health and to reduce perinatal mortality in all districts to at least the current national average of l0 per 1000. Key elements are the understanding of the mechanisms of the large health differences between women living in deprived and non-deprived urban areas. Risk guided care, orientation towards shared-care and improvement of collaborations between health care professionals shapes the interventions that are being developed. Major attention is given to the development of methods to improve risk-selection before and during pregnancy and methods to reach low-educated and immigrant groups.
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Affiliation(s)
- S Denktaş
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Visser GH. Obstetric Care in the Netherlands: Relic or Example? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:971-975. [DOI: 10.1016/s1701-2163(16)35410-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Talungchit P, Liabsuetrakul T, Lindmark G. Development and assessment of indicators for quality of care in severe preeclampsia/eclampsia and postpartum hemorrhage. J Healthc Qual 2012; 35:22-34. [PMID: 22530567 DOI: 10.1111/j.1945-1474.2011.00183.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.
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Affiliation(s)
- Pattarawalai Talungchit
- Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Thailand.
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van Oostwaard MF, Langenveld J, Bijloo R, Wong KM, Scholten I, Loix S, Hukkelhoven CWPM, Vergouwe Y, Papatsonis DNM, Mol BWJ, Ganzevoort W. Prediction of recurrence of hypertensive disorders of pregnancy between 34 and 37 weeks of gestation: a retrospective cohort study. BJOG 2012; 119:840-7. [DOI: 10.1111/j.1471-0528.2012.03312.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The etiology of maternal mortality in developed countries: a systematic review of literature. Arch Gynecol Obstet 2012; 285:1499-503. [PMID: 22454216 DOI: 10.1007/s00404-012-2301-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the literature about MD in developed countries. METHODS A search in PubMed, EMBASE, Medline and reference lists was performed. Key words: maternal death/mortality, pregnancy death and obstetric/maternity care. Articles were selected if they reported the cause of death per livebirths, were performed in developed countries and unselected population, classified MD by the World Health Organization. Maternal age, cause of MD, time of MD (antepartum, intrapartum, postpartum) and delivery mode were abstracted. MD was expressed as maternal mortality ratio (MMR). PRISMA guidelines were followed. RESULTS Twelve articles provided data from 1980 to 2007. The MD rate was 9,750 in 75,560,683 livebirths (MMR: 12.90). MD was direct in 6,791 women (MMR: 8.98), being postpartum hemorrhage the leading cause, and indirect in 2,786 women (MMR: 3.68), with cardiovascular disease as the main cause. The remaining 173 deaths (MMR: 0.22) were unexplained. Maternal age >45 years, vaginal delivery, postpartum period increased the risk of MD. MD reduced over time in all countries except in the Netherlands and USA. CONCLUSIONS Conditions leading to hemorrhage warrant strict management. The risk of an apparently healthy woman to die during motherhood is 0.22 out of 100,000 livebirths.
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de Graaf JP, Schutte JM, Poeran JJ, van Roosmalen J, Bonsel GJ, Steegers EAP. Regional differences in Dutch maternal mortality. BJOG 2012; 119:582-8. [DOI: 10.1111/j.1471-0528.2012.03283.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. During the past 50 years, there has been a significant reduction in the rates of eclampsia, maternal mortality, and maternal morbidity in the developed countries. In contrast, the rates of eclampsia, maternal complications, and maternal mortality remain high in the developing countries. These differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia-eclampsia in the developed countries. In contrast, most of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management of patients with preeclampsia-eclampsia in the developing countries. Preeclampsia/eclampsia is associated with substantial maternal complications, both acute and long-term. Clear protocols for early detection and management of hypertension in pregnancy at all levels of health care are required for better maternal as well as perinatal outcome. This is especially important in the developing countries.
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Affiliation(s)
- Labib Ghulmiyyah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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