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van den Tweel MM, van den Munckhof EHA, van der Zanden M, Molijn AC, van Lith JMM, Le Cessie S, Boers KE. Bacterial vaginosis in a subfertile population undergoing fertility treatments: a prospective cohort study. J Assist Reprod Genet 2024; 41:441-450. [PMID: 38087161 PMCID: PMC10894785 DOI: 10.1007/s10815-023-03000-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/28/2023] [Indexed: 02/27/2024] Open
Abstract
PURPOSE This study investigates the role of bacterial vaginosis (BV) on pregnancy rates during various fertility treatments. BV is known to influence several obstetric outcomes, such as preterm delivery and endometritis. Only few studies investigated the effect of BV in subfertile women, and studies found a negative effect on fecundity especially in the in vitro fertilisation population. METHODS Observational prospective study, 76 couples attending a fertility clinic in the Netherlands between July 2019 and June 2022, undergoing a total of 133 attempts of intra uterine insemination, in vitro fertilization or intra cytoplasmatic sperm injection. Vaginal samples taken at oocyte retrieval or insemination were analysed on qPCR BV and 16S rRNA gene microbiota analysis of V1-V2 region. Logistic regression with a Generalized Estimated Equations analysis was used to account for multiple observations per couples. RESULTS A total of 26% of the 133 samples tested positive for BV. No significant differences were observed in ongoing pregnancy or live birth rates based on BV status (OR 0.50 (0.16-1.59), aOR 0.32 (0.09-1.23)) or microbiome community state type. There was a tendency of more miscarriages based on positive BV status (OR 4.22 (1.10-16.21), aOR 4.28 (0.65-28.11)) or community state type group III and IV. On baseline qPCR positive participants had significantly higher body mass index and smoked more often. Odds ratios were adjusted for smoking status, body mass index, and socioeconomic status. CONCLUSION Bacterial vaginosis does not significantly impact ongoing pregnancy rates but could affect miscarriage rates.
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Affiliation(s)
- Marjolein M van den Tweel
- Department of Obstetrics and Gynecology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands
| | | | - Moniek van der Zanden
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands
| | - Anco C Molijn
- Eurofins NMDL-LCPL, 2288ER, Rijswijk, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Gynecology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Saskia Le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Kim E Boers
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands.
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Bonsen LR, Harskamp V, Feddouli S, Bloemenkamp KWM, Duvekot JJ, Pors A, van Roosmalen J, Zwart JJ, van Lith JMM, Hendriks J, Urlings TAJ, van den Akker T, van der Bom JG, Henriquez DDCA. Prophylactic radiologic interventions to reduce postpartum hemorrhage in women with risk factors for placenta accreta spectrum disorder: a nationwide cohort study. J Matern Fetal Neonatal Med 2023; 36:2251076. [PMID: 37673791 DOI: 10.1080/14767058.2023.2251076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS). METHODS We conducted a retrospective nationwide cohort study of women with risk factors for placenta accreta spectrum disorder who underwent planned cesarean section in 69 Dutch hospitals between 2008 and 2013. All women had two risk factors for PAS: placenta previa/anterior low-lying placenta and a history of cesarean section(s). Women with and without ultrasonographic signs of PAS were studied as two separate groups. We compared the total blood loss of women with prophylactic radiologic interventions, defined as preoperative placement of balloon catheters or sheaths in the internal iliac or uterine arteries, with that of a control group consisting of women without prophylactic radiologic interventions using multivariable regression. We evaluated maternal morbidity by the number of red blood cell (RBC) units transfused within 24 h following childbirth (categories: 0, 1-3, >4), duration of hospital admission, and need for intensive care unit (ICU) admission. RESULTS A total of 350 women with placenta previa/anterior low-lying placenta and history of cesarean section(s) were included: 289 with normal ultrasonography, of whom 21 received prophylactic radiologic intervention, and 61 had abnormal ultrasonography, of whom 22 received prophylactic intervention. Among women with normal ultrasonography without prophylactic intervention (n = 268), the median blood loss was 725 mL (interquartile range (IQR) 500-1500) vs. 1000 mL (IQR 550-1750) in women with intervention (n = 21); the adjusted difference in blood loss was 9 mL (95% confidence interval (CI) -315-513), p = .97). Among women with abnormal ultrasonography, those without prophylactic intervention (n = 39) had a median blood loss of 2500 mL (IQR 1200-5000) vs. 1750 mL (IQR 775-4000) in women with intervention (n = 22); the adjusted difference in blood loss was -1141 mL (95% CI -1694- -219, p = .02). Results of outcomes on maternal morbidity were comparable among women with and without prophylactic intervention. CONCLUSION These findings suggest that prophylactic radiologic interventions prior to planned cesarean section may help to limit perioperative blood loss in women with clear signs of placenta accreta spectrum disorder on ultrasonography, but there was no evidence of a difference within the subgroup without such ultrasonographic signs. The use of these interventions should be discussed in a multidisciplinary shared decision-making process, including discussions of potential benefits and possible complications. TRIAL REGISTRATION Netherlands Trial Registry, https://onderzoekmetmensen.nl/en/trial/28238, identifier NL4210 (NTR4363).
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Affiliation(s)
- Lisanne R Bonsen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Valerie Harskamp
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Sana Feddouli
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Wilhelmina's Children Hospital Birth Center, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aad Pors
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joris Hendriks
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Thijs A J Urlings
- Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Wagijo MR, Crone MR, van Zwicht BS, van Lith JMM, Schindler Rising S, Rijnders MEB. CenteringPregnancy in the Netherlands: Who engages, who doesn't, and why. Birth 2022; 49:329-340. [PMID: 35092071 PMCID: PMC9306804 DOI: 10.1111/birt.12610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. METHODS Data from a stepped-wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. RESULTS A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%-53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. CONCLUSION A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.
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Affiliation(s)
| | | | | | - Jan M. M. van Lith
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
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du Fossé NA, van der Hoorn MLP, de Koning R, Mulders AGMGJ, van Lith JMM, le Cessie S, Lashley EELO. Toward more accurate prediction of future pregnancy outcome in couples with unexplained recurrent pregnancy loss: taking both partners into account. Fertil Steril 2021; 117:144-152. [PMID: 34863518 DOI: 10.1016/j.fertnstert.2021.08.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify, besides maternal age and the number of previous pregnancy losses, additional characteristics of couples with unexplained recurrent pregnancy loss (RPL) that improve the prediction of an ongoing pregnancy. DESIGN Hospital-based cohort study in couples who visited specialized RPL units of two academic centers between 2012 and 2020. SETTING Two academic centers in the Netherlands. PATIENTS Clinical data from 526 couples with unexplained RPL were used in this study. INTERVENTION(S) None. MAIN OUTCOME MEASURES The final model to estimate the chance of a subsequent ongoing pregnancy was determined using a backward selection process and internally validated using bootstrapping. Model performance was assessed in terms of calibration and discrimination (area under the receiver operating characteristic curve). RESULTS Subsequent ongoing pregnancy was achieved in 345 of 526 couples (66%). The number of previous pregnancy losses, maternal age, paternal age, maternal body mass index, paternal body mass index, maternal smoking status, and previous in vitro fertilization/intracytoplasmic sperm injection treatment were predictive of the outcome. The optimism-corrected area under the receiver operating characteristic curve was 0.63 compared with 0.57 when using only the number of previous pregnancy losses and maternal age. CONCLUSIONS The identification of additional predictors of a subsequent ongoing pregnancy after RPL, including male characteristics, is significant for both clinicians and couples with RPL. At the same time, we showed that the predictive ability of the current model is still limited and more research is warranted to develop a model that can be used in clinical practice.
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Affiliation(s)
- Nadia A du Fossé
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Rozemarijn de Koning
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Jan M M van Lith
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Eileen E L O Lashley
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Ramler PI, Gillissen A, Henriquez DDCA, Caram‐Deelder C, Markovski AA, de Maat MPM, Duvekot JJ, Eikenboom JCJ, Bloemenkamp KWM, van Lith JMM, van den Akker T, van der Bom JG. Clinical value of early viscoelastometric point-of-care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands. Acta Obstet Gynecol Scand 2021; 100:1656-1664. [PMID: 33999407 PMCID: PMC8453832 DOI: 10.1111/aogs.14172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To evaluate rotational fibrin-based thromboelastometry (ROTEM® FIBTEM) with amplitude of clot firmness at 5 min (A5) as an early point-of-care parameter for predicting progression to severe postpartum hemorrhage, and compare its predictive value with that of fibrinogen. MATERIAL AND METHODS Prospective cohort study in the Netherlands including women with 800-1500 ml of blood loss within 24 h following birth. Blood loss was quantitatively measured by weighing blood-soaked items and using a fluid collector bag in the operating room. Both FIBTEM A5 values and fibrinogen concentrations (Clauss method) were measured between 800 and 1500 ml of blood loss. Predictive accuracy of both biomarkers for the progression to severe postpartum hemorrhage was measured by area under the receiver operating curves (AUC). Severe postpartum hemorrhage was defined as a composite endpoint of (1) total blood loss >2000 ml, (2) transfusion of ≥4 packed cells, and/or (3) need for an invasive intervention to cease bleeding. RESULTS Of the 391 women included, 72 (18%) developed severe postpartum hemorrhage. Median (IQR) volume of blood loss at blood sampling was 1100 ml (1000-1300) with a median (interquartile range [IQR]) fibrinogen concentration of 3.9 g/L (3.4-4.6) and FIBTEM A5 value of 17 mm (13-20). The AUC for progression to severe postpartum hemorrhage was 0.53 (95% confidence interval [CI] 0.46-0.61) for FIBTEM A5 and 0.58 (95% CI 0.50-0.65) for fibrinogen. Positive predictive values for progression to severe postpartum hemorrhage for FIBTEM A5 ≤12 mm was 22.5% (95% CI 14-33) and 50% (95% CI 25-75) for fibrinogen ≤2 g/L. CONCLUSIONS The predictive value of FIBTEM A5 compared to fibrinogen concentrations measured between 800 and 1500 ml of blood loss following childbirth was poor to discriminate between women with and without progression towards severe postpartum hemorrhage.
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Affiliation(s)
- Paul I. Ramler
- Center for Clinical Transfusion ResearchSanquin ResearchLeidenthe Netherlands
- Department of ObstetricsLeiden University Medical CenterLeidenthe Netherlands
| | - Ada Gillissen
- Center for Clinical Transfusion ResearchSanquin ResearchLeidenthe Netherlands
- Department of ObstetricsLeiden University Medical CenterLeidenthe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Dacia D. C. A. Henriquez
- Center for Clinical Transfusion ResearchSanquin ResearchLeidenthe Netherlands
- Department of ObstetricsLeiden University Medical CenterLeidenthe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Camila Caram‐Deelder
- Center for Clinical Transfusion ResearchSanquin ResearchLeidenthe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Moniek P. M. de Maat
- Department of HematologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Johannes J. Duvekot
- Department of ObstetricsErasmus University Medical CenterRotterdamthe Netherlands
| | | | - Kitty W. M. Bloemenkamp
- Department of ObstetricsDivision Woman and BabyBirth Center Wilhelmina Children HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Jan M. M. van Lith
- Department of ObstetricsLeiden University Medical CenterLeidenthe Netherlands
| | - Thomas van den Akker
- Department of ObstetricsLeiden University Medical CenterLeidenthe Netherlands
- Athena InstituteFaculty of ScienceVU University Medical CenterAmsterdamthe Netherlands
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUnited Kingdom
| | - Johanna G van der Bom
- Center for Clinical Transfusion ResearchSanquin ResearchLeidenthe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
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Zwanenburg F, Jongbloed MRM, van Geloven N, Ten Harkel ADJ, van Lith JMM, Haak MC. Assessment of human fetal cardiac autonomic nervous system development using color tissue Doppler imaging. Echocardiography 2021; 38:974-981. [PMID: 34018638 PMCID: PMC8252470 DOI: 10.1111/echo.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Functional development of the fetal cardiac autonomic nervous system (cANS) plays a key role in fetal maturation and can be assessed through fetal heart rate variability (fHRV)‐analysis, with each HRV parameter representing different aspects of cANS activity. Current available techniques, however, are unable to assess the fHRV parameters accurately throughout the whole pregnancy. This study aims to test the feasibility of color tissue Doppler imaging (cTDI) as a new ultrasound technique for HRV analysis. Secondly, we explored time trends of fHRV parameters using this technique. Methods 18 healthy singleton fetuses were examined sequentially every 8 weeks from 10 weeks GA onwards. From each examination, 3 cTDI recordings of the four‐chamber view of 10 seconds were retrieved to determine accurate beat‐to‐beat intervals. The fHRV parameters SDNN, RMSSD, SDNN/RMSSD, and pNN10, each representing different functional aspects of the cANS, were measured, and time trends during pregnancy were explored using spline functions within a linear mixed‐effects model. Results In total, 77% (95% Cl 66–87%) of examinations were feasible for fHRV analysis from the first trimester onwards, which is a great improvement compared to other techniques. The technique is able to determine different maturation rates of the fHRV parameters, showing that cANS function, presumably parasympathetic activity, establishes around 20 weeks GA and matures rapidly until 30 weeks GA. Conclusions This is the first study able to assess cANS function through fHRV analysis from the first trimester onwards. The use of cTDI to determine beat‐to‐beat intervals seems feasible in just 3 clips of 10 seconds, which holds promise for future clinical use in assessing fetal well‐being.
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Affiliation(s)
- Fleur Zwanenburg
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
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Wind M, Hendriks M, van Brussel BTJ, Eikenboom J, Allaart CF, Lamb HJ, Siebelink HMJ, Ninaber MK, van Geloven N, van Lith JMM, Huizinga TWJ, Rabelink TJ, Sueters M, Teng YKO. Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome. Lupus Sci Med 2021; 8:8/1/e000472. [PMID: 33952625 PMCID: PMC8103373 DOI: 10.1136/lupus-2020-000472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/05/2021] [Accepted: 04/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES SLE and/or antiphospholipid syndrome (SLE/APS) are complex and rare systemic autoimmune diseases that predominantly affect women of childbearing age. Women with SLE/APS are at high risk of developing complications during pregnancy. Therefore, clinical practice guidelines recommend that patients with SLE/APS should receive multidisciplinary counselling before getting pregnant. We investigated the clinical effectiveness of implementing a multidisciplinary clinical pathway including prepregnancy counselling of patients with SLE/APS. METHODS A clinical pathway with specific evaluation and prepregnancy counselling for patients with SLE/APS was developed and implemented in a tertiary, academic hospital setting. Patients were prospectively managed within the clinical pathway from 2014 onwards and compared with a retrospective cohort of patients that was not managed in a clinical pathway. Primary outcome was a combined outcome of disease flares for SLE and thromboembolic events for APS. Secondary outcomes were maternal and fetal pregnancy complications. RESULTS Seventy-eight patients with 112 pregnancies were included in this study. The primary combined outcome was significantly lower in the pathway cohort (adjusted OR (aOR) 0.20 (95% CI 0.06 to 0.75)) which was predominantly determined by a fivefold risk reduction of SLE flares (aOR 0.22 (95% CI 0.04 to 1.09)). Maternal and fetal pregnancy complications were not different between the cohorts (respectively, aOR 0.91 (95% CI 0.38 to 2.17) and aOR 1.26 (95% CI 0.55 to 2.88)). CONCLUSIONS The outcomes of this study suggest that patients with SLE/APS with a pregnancy wish benefit from a multidisciplinary clinical pathway including prepregnancy counselling.
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Affiliation(s)
- Merlijn Wind
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maike Hendriks
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen Eikenboom
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
PURPOSE This prospective cohort study aimed to investigate the interrelation between preferred/actual mode of delivery and pre- and postpartum fear of childbirth (FOC). MATERIAL AND METHODS Participants from 13 midwifery practices and four hospitals in Southwest Netherlands filled out questionnaires at 30 weeks' gestation (n = 561) and two months postpartum (n = 463), including questions on preferred mode of delivery, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Hospital Anxiety Depression Scale (HADS). Results were related to obstetric data. RESULTS Both severe FOC (OR 7.0, p < .001) and previous Cesarean section (CS) (OR 16.6, p < .001) predicted preference for CS. Severe prepartum FOC also predicted actual CS. Preferring a vaginal delivery (VD) and actually having a CS predicted higher postpartum W-DEQ scores (partial r = 0.107, p < .05). Other significant predictors for high postpartum W-DEQ scores were high prepartum W-DEQ (partial r = 0.357) and HADS anxiety scores (partial r = 0.143) and the newborn in need of medical assistance (partial r = -0.169). CONCLUSIONS Women preferring a VD but ending up with a CS are at risk for severe FOC postpartum, while the same risk was not demonstrated for women who preferred a CS but had a VD. Prepartum FOC is strongly associated with postpartum FOC, regardless of congruence between preferred and actual mode of delivery.
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Affiliation(s)
- Anne-Marie Sluijs
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Klaas Wijma
- Unit of Medical Psychology, Department of Clinical and Experimental, Linköping University, Sweden Medicine, Linköping, Sweden
| | - Marc P H D Cleiren
- Faculty of Social Sciences, Honours College, Leiden University, Leiden, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Barbro Wijma
- Department of Clinical and Experimental, Unit of Gender and Medicine, Linköping University, Sweden Medicine, Linköping, Sweden
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van Wyk L, Boers KE, Gordijn SJ, Ganzevoort W, Bremer HA, Kwee A, Delemarre FMC, van Pampus MG, Bloemenkamp KWM, Roumen FJME, van Lith JMM, Mol BWJ, Thornton JG, Scherjon SA, le Cessie S. Perinatal death in a term fetal growth restriction randomized controlled trial: the paradox of prior risk and consent. Am J Obstet Gynecol MFM 2020; 2:100239. [PMID: 33345938 DOI: 10.1016/j.ajogmf.2020.100239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The disproportionate intrauterine growth intervention trial at term was an intention to treat analysis and compared labor induction with expectant monitoring in pregnancies complicated by fetal growth restriction at term and showed equivalence for neonatal outcomes. OBJECTIVE To evaluate trial participation bias and to examine the generalizability of the results of an obstetrical randomized trial. STUDY DESIGN We used data from participants and nonparticipants of a randomized controlled trial-the disproportionate intrauterine growth intervention trial at term (n=1116) -to perform a secondary analysis. This study compared induction of labor and expectant management in women with term growth restriction. Data were collected in the same manner for both groups. Baseline characteristics and neonatal and maternal outcomes were compared. The primary outcome was a composite measure of adverse neonatal outcome. Secondary outcomes were delivery by cesarean delivery and instrumental vaginal delivery; length of stay in the neonatal intensive care, neonatal ward, and the maternal hospital; and maternal morbidity. RESULTS Nonparticipants were older, had a lower body mass index, had a higher level of education, smoked less, and preferred expectant management. The time between study inclusion and labor onset was shorter in participants than in nonparticipants. Notably, 4 perinatal deaths occurred among nonparticipants and none among participants. Among nonparticipants, there were more children born with a birthweight below the third centile. The nonparticipants who had expectant management were monitored less frequently than the participants in both the intervention and the expectant arm. CONCLUSION We found less favorable outcomes and more perinatal deaths in nonparticipants. Protocol-driven management, differences between participants and nonparticipants, or the fact that nonparticipants had a preference for expectant management might explain the findings.
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Affiliation(s)
- Linda van Wyk
- Leiden University Medical Center, Leiden, the Netherlands; Haaglanden Medical Center, the Hague, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands.
| | - Kim E Boers
- Haaglanden Medical Center, the Hague, the Netherlands
| | - Sanne J Gordijn
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Anneke Kwee
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Ben W J Mol
- Monash University Health Services, Clayton, Australia
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10
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du Fossé NA, van der Hoorn MLP, van Lith JMM, le Cessie S, Lashley EELO. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Hum Reprod Update 2020; 26:650-669. [PMID: 32358607 PMCID: PMC7456349 DOI: 10.1093/humupd/dmaa010] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although spontaneous miscarriage is the most common complication of human pregnancy, potential contributing factors are not fully understood. Advanced maternal age has long been recognised as a major risk factor for miscarriage, being strongly related with fetal chromosomal abnormalities. The relation between paternal age and the risk of miscarriage is less evident, yet it is biologically plausible that an increasing number of genetic and epigenetic sperm abnormalities in older males may contribute to miscarriage. Previous meta-analyses showed associations between advanced paternal age and a broad spectrum of perinatal and paediatric outcomes. This is the first systematic review and meta-analysis on paternal age and spontaneous miscarriage. OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis is to evaluate the effect of paternal age on the risk of spontaneous miscarriage. SEARCH METHODS PubMed, Embase and Cochrane databases were searched to identify relevant studies up to August 2019. The following free text and MeSH terms were used: paternal age, father's age, male age, husband's age, spontaneous abortion, spontaneous miscarriage, abortion, miscarriage, pregnancy loss, fetal loss and fetal death. PRISMA guidelines for systematic reviews and meta-analysis were followed. Original research articles in English language addressing the relation between paternal age and spontaneous miscarriage were included. Exclusion criteria were studies that solely focused on pregnancy outcomes following artificial reproductive technology (ART) and studies that did not adjust their effect estimates for at least maternal age. Risk of bias was qualitatively described for three domains: bias due to confounding, information bias and selection bias. OUTCOMES The search resulted in 975 original articles. Ten studies met the inclusion criteria and were included in the qualitative synthesis. Nine of these studies were included in the quantitative synthesis (meta-analysis). Advanced paternal age was found to be associated with an increased risk of miscarriage. Pooled risk estimates for miscarriage for age categories 30-34, 35-39, 40-44 and ≥45 years of age were 1.04 (95% CI 0.90, 1.21), 1.15 (0.92, 1.43), 1.23 (1.06, 1.43) and 1.43 (1.13, 1.81) respectively (reference category 25-29 years). A second meta-analysis was performed for the subgroup of studies investigating first trimester miscarriage. This showed similar pooled risk estimates for the first three age categories and a slightly higher pooled risk estimate for age category ≥45 years (1.74; 95% CI 1.26, 2.41). WIDER IMPLICATIONS Over the last decades, childbearing at later ages has become more common. It is known that frequencies of adverse reproductive outcomes, including spontaneous miscarriage, are higher in women with advanced age. We show that advanced paternal age is also associated with an increased risk of spontaneous miscarriage. Although the paternal age effect is less pronounced than that observed with advanced maternal age and residual confounding by maternal age cannot be excluded, it may have implications for preconception counselling of couples comprising an older aged male.
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Affiliation(s)
- Nadia A du Fossé
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | | | - Jan M M van Lith
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Eileen E L O Lashley
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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11
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Everwijn SMP, Namburete AIL, van Geloven N, Jansen FAR, Papageorghiou AT, Noble AJ, Teunissen AKK, Rozendaal L, Blom NA, van Lith JMM, Haak MC. Cortical development in fetuses with congenital heart defects using an automated brain-age prediction algorithm. Acta Obstet Gynecol Scand 2019; 98:1595-1602. [PMID: 31322290 DOI: 10.1111/aogs.13687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Congenital heart defects are associated with neurodevelopmental delay. It is hypothesized that fetuses affected by congenital heart defect have altered cerebral oxygen perfusion and are therefore prone to delay in cortical maturation. The aim of this study was to determine the difference in fetal brain age between consecutive congenital heart defect cases and controls in the second and third trimester using ultrasound. MATERIAL AND METHODS Since 2014, we have included 90 isolated severe congenital heart defect cases in the Heart And Neurodevelopment (HAND)-study. Every 4 weeks, detailed neurosonography was performed in these fetuses, including the recording of a 3D volume of the fetal brain, from 20 weeks onwards. In all, 75 healthy fetuses underwent the same protocol to serve as a control group. The volumes were analyzed by automated age prediction software which determines gestational age by the assessment of cortical maturation. RESULTS In total, 477 volumes were analyzed using the age prediction software (199 volumes of 90 congenital heart defect cases; 278 volumes of 75 controls). Of these, 16 (3.2%) volume recordings were excluded because of imaging quality. The age distribution was 19-33 weeks. Mixed model analysis showed that the age predicted by brain maturation was 3 days delayed compared with the control group (P = .002). CONCLUSIONS This study shows that fetuses with isolated cases of congenital heart defects show some delay in cortical maturation as compared with healthy control cases. The clinical relevance of this small difference is debatable. This finding was consistent throughout pregnancy and did not progress during the third trimester.
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Affiliation(s)
- Sheila M P Everwijn
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Ana I L Namburete
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Fenna A R Jansen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Alison J Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Aalbertine K K Teunissen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke Rozendaal
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
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12
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Ramler PI, Henriquez DDCA, van den Akker T, Caram-Deelder C, Groenwold RHH, Bloemenkamp KWM, van Roosmalen J, van Lith JMM, van der Bom JG. Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study. Acta Obstet Gynecol Scand 2019; 98:1473-1482. [PMID: 31240693 DOI: 10.1111/aogs.13679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. MATERIAL AND METHODS Propensity score-matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first-line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. RESULTS Our 1:1 propensity score-matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30-3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600-5400) for balloon vs 4000 mL (IQR 3250-5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5-10) for balloon vs 6 [IQR 4-9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization-related thrombo-embolic event. Maternal mortality occurred in neither of the intervention groups. CONCLUSIONS No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.
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Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Bustraan J, Dijkhuizen K, Velthuis S, van der Post R, Driessen E, van Lith JMM, de Beaufort AJ. Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands. BMJ Open 2019; 9:e028631. [PMID: 31175199 PMCID: PMC6589009 DOI: 10.1136/bmjopen-2018-028631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme. DESIGN Nationwide online survey study. SETTING Postgraduate education of all hospital-based specialties in the Netherlands. PARTICIPANTS 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017. MAIN OUTCOME MEASURES Factors involved in trainees' decisions to leave specialty training and their subsequent career plans. RESULTS The response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet. CONCLUSIONS This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.
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Affiliation(s)
- Jacqueline Bustraan
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kirsten Dijkhuizen
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Velthuis
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Erik Driessen
- Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnout Jan de Beaufort
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
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14
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Ramler PI, van den Akker T, Henriquez DDCA, Zwart JJ, van Roosmalen J, van Lith JMM, van der Bom JG. Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies. Acta Obstet Gynecol Scand 2019; 98:795-804. [PMID: 30667050 PMCID: PMC6593418 DOI: 10.1111/aogs.13542] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/29/2022]
Abstract
Introduction Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high‐income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years. Material and methods Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands. Results Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56‐75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81‐101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250‐6000) to 6000 mL (interquartile range 4500‐8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006. Conclusions The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care.
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Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Dacia D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost J Zwart
- Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jos van Roosmalen
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan M M van Lith
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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15
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van Wyk L, Boers KE, van Wassenaer-Leemhuis AG, van der Post JAM, Bremer HA, Delemarre FMC, Gordijn SJ, Bloemenkamp KWM, Roumen FJME, Porath M, van Lith JMM, Mol BWJ, le Cessie S, Scherjon SA. Postnatal Catch-Up Growth After Suspected Fetal Growth Restriction at Term. Front Endocrinol (Lausanne) 2019; 10:274. [PMID: 31293512 PMCID: PMC6598620 DOI: 10.3389/fendo.2019.00274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/15/2019] [Indexed: 01/21/2023] Open
Abstract
Objective: The aim of this study was to study growth patterns of children born after suspected fetal growth restriction (FGR) at term and to compare the effect of induction of labor (IoL) and expectant management (EM), also in relation to neurodevelopmental and behavioral outcome at age 2. Methods: We performed a 2 years' follow-up of growth of children included in the Disproportionate Intrauterine Growth Restriction Trial at Term (DIGITAT) study, a Randomized Controlled Trial (RCT) comparing IoL with EM in pregnancies with suspected FGR at term. We collected data on child growth until the age of 2 years. Standard deviation scores (SDSs) for height and weight were calculated at different ages. We assessed the effects of IoL compared with EM and the effects of a birth weight below or above the 3rd or 10th centile on catch-up growth. Target height SDSs were calculated using the height of both parents. Results: We found a significant increase in SDS in the first 2 years. Children born after EM showed more catch-up growth in the first month [height: mean difference -0.7 (95% CI: 0.2; 1.3)] and weight [mean difference -0.5 (95% CI: 0.3; 0.7)]. Children born with a birth weight below the 3rd and 10th centiles showed more catch-up growth after 1 year [mean difference -0.8 SDS (95% CI: -1.1; -0.5)] and after 2 years [mean difference -0.7 SDS (95% CI: -1.2; -0.2)] as compared to children with a birth weight above the 3rd and 10th centiles. SDS at birth had the strongest effect on adverse neurodevelopmental outcome at 2 years of age. Conclusion: After FGR at term, postnatal catch-up growth is generally present and associated with the degree of FGR. Obstetric management in FGR influences postnatal growth. Longer-term follow-up is therefore needed and should be directed at growth and physical health. Clinical Trial Registration: www.ClinicalTrials.gov, identifier SRCTN10363217.
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Affiliation(s)
- Linda van Wyk
- Departments of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
- *Correspondence: Linda van Wyk
| | - Kim E. Boers
- Haaglanden Medical Centre, The Hague, Netherlands
| | | | | | | | | | - Sanne J. Gordijn
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
| | | | | | | | - Jan M. M. van Lith
- Departments of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Ben W. J. Mol
- Department of Obstetrics, Monash University Medical Centre, Clayton, VIC, Australia
| | - Saskia le Cessie
- Department of Clinical Epidimiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Sicco A. Scherjon
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
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Dijkhuizen K, Bustraan J, de Beaufort AJ, Velthuis SI, Driessen EW, van Lith JMM. Encouraging residents' professional development and career planning: the role of a development-oriented performance assessment. BMC Med Educ 2018; 18:207. [PMID: 30185174 PMCID: PMC6125996 DOI: 10.1186/s12909-018-1317-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Current postgraduate medical training programmes fall short regarding residents' development of generic competencies (communication, collaboration, leadership, professionalism) and reflective and deliberate practice. Paying attention to these non-technical skills in a structural manner during postgraduate training could result in a workforce better prepared for practice. A development-oriented performance assessment (PA), which assists residents with assessment of performance and deliberately planned learning activities, could potentially contribute to filling this gap. This study aims to explore residents experiences with the PA. METHODS We conducted a qualitative interview study with 16 residents from four different medical specialties who participated in the PA, scheduled halfway postgraduate training. The PA was conducted by an external facilitator, a psychologist, and focused specifically on professional development and career planning. Residents were interviewed 6 months after the PA. Data were analysed using the framework method for qualitative analysis. RESULTS Residents found the PA to be of additional value for their training. The overarching merit was the opportunity to evaluate competencies not usually addressed in workplace-based assessments and progress conversations. In addition, the PA proved a valuable tool for assisting residents with reflecting upon their work and formulating their learning objectives and activities. Residents reported increased awareness of capacity, self-confidence and enhanced feelings of career-ownership. An important factor contributing to these outcomes was the relationship of trust with the facilitator and programme director. CONCLUSION The PA is a promising tool in fostering the development of generic competencies and reflective and deliberate practice. The participating residents, facilitator and programme directors were able to contribute to a safe learning environment away from the busy workplace. The facilitator plays an important role by providing credible and informative feedback. Commitment of the programme director is important for the implementation of developmental plans and learning activities.
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Affiliation(s)
- Kirsten Dijkhuizen
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
- Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, Zone K6-P, 2300 RC Leiden, the Netherlands
| | - Jacqueline Bustraan
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Arnout J. de Beaufort
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Sophie I. Velthuis
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Erik W. Driessen
- Department of Educational Development & Research Maastricht University, Universiteitssingel 60, 6229 Maastricht, the Netherlands
| | - Jan M. M. van Lith
- Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, Zone K6-P, 2300 RC Leiden, the Netherlands
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17
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Meuleman T, Haasnoot GW, van Lith JMM, Verduijn W, Bloemenkamp KWM, Claas FHJ. Paternal HLA-C is a risk factor in unexplained recurrent miscarriage. Am J Reprod Immunol 2017; 79. [PMID: 29205643 DOI: 10.1111/aji.12797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 01/19/2023] Open
Abstract
PROBLEM HLA-C is the only classical HLA-I antigen expressed on trophoblast. We hypothesized that the alloimmune response to paternal HLA-C plays a role in unexplained recurrent miscarriage. METHOD OF STUDY In a case-control design, we included 100 women with at least three unexplained consecutive miscarriages along with their partners and children. For the first control group, we included 90 women with an uneventful singleton pregnancy without pregnancy complications in their history along with their children. The second control group consisted of 425 families. HLA-C*07 and HLA-C*17 frequencies, which are the most immunogenic HLA-C antigens, along with HLA-C mismatches, and the presence of specific HLA antibodies in the mother were determined. RESULTS HLA-C and HLA-C*07 mismatches were significantly increased in couples with recurrent miscarriage compared to control subjects (P = .016, P = .008, respectively). The incidence of child-specific HLA-C*07/HLA-C*17 antibodies was increased in women with recurrent miscarriage (P = .007). CONCLUSION The results show that HLA-C incompatibility between couples is significantly associated with unexplained recurrent miscarriage.
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Affiliation(s)
- Tess Meuleman
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Geert W Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Willem Verduijn
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Obstetrics, Wilhelmina Children Hospital Birth Centre, Division Woman and Baby, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands
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18
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Hermus MAA, Hitzert M, Boesveld IC, van den Akker-van Marle ME, Dommelen PV, Franx A, Graaf JPD, Lith JMMV, Luurssen-Masurel N, Steegers EAP, Wiegers TA, Bruin KMVDPD. Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study. BMJ Open 2017; 7:e016958. [PMID: 29150465 PMCID: PMC5701986 DOI: 10.1136/bmjopen-2017-016958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. DESIGN Prospective cohort study. SETTING Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. PARTICIPANTS 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. MAIN OUTCOME MEASUREMENTS The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. RESULTS There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. CONCLUSION The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.
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Affiliation(s)
- Marieke A A Hermus
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
- Midwifery Practice Verloskundigen Oosterhout, Werkmansbeemd, Oosterhout, the Netherlands
| | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Paula van Dommelen
- Department of Life Style, TNO (NetherlandsOrganisation for Applied Scientific Research), Leiden, The Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Nathalie Luurssen-Masurel
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Therese A Wiegers
- NIVEL(Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Karin M van der Pal-de Bruin
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
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van Zwicht BS, Crone MR, van Lith JMM, Rijnders MEB. Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:354. [PMID: 27846824 PMCID: PMC5111184 DOI: 10.1186/s12884-016-1152-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND CenteringPregnancy (CP) is a multifaceted group based care-model integrated in routine prenatal care, combining health assessment, education, and support. CP has shown some positive results on perinatal outcomes. However, the effects are less obvious when limited to the results of randomized controlled trials: as there are few trials and there is a variation in reported outcomes. Furthermore, former research was mostly conducted in the United States of America and in specific (often high risk) populations. Our study aims to evaluate the effects of CP in the Netherlands in a general population of pregnant women (low and high risk). Furthermore we aim to explore the mechanisms leading to the eventual effects by measuring potential mediating factors. DESIGN We will perform a stepped wedge cluster randomized controlled trial, in a Western region in the Netherlands. Inclusion criteria are <24 weeks of gestation and able to communicate in Dutch (with assistance). Women in the control period will receive individual care, women in the intervention period (starting at the randomized time-point) will be offered the choice between individual care or CP. Primary outcomes are maternal and neonatal morbidity, retrieved from a national routine database. Secondary outcomes are health behavior, psychosocial outcomes, satisfaction, health care utilization and process outcomes, collected through self-administered questionnaires, group-evaluations and individual interviews. We will conduct intention-to-treat analyses. Also a per protocol analysis will be performed comparing the three subgroups: control group, CP-participants and non-CP-participants, using multilevel techniques to account for clustering effects. DISCUSSION This study contributes to the evidence regarding the effect of CP and gives a first indication of the effect and implementation of CP in both low and high-risk pregnancies in a high-income Western society other than the USA. Also, measuring factors that are hypothesized to mediate the effect of CP will enable to explain the mechanisms that lead to effects on maternal and neonatal outcomes. TRIAL REGISTRATION Dutch Trial Register, NTR4178 , registered September 17th 2013.
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Affiliation(s)
- Birgit S. van Zwicht
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Matty R. Crone
- Department of Public Health and Primary Care, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan M. M. van Lith
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Jansen FAR, Everwijn SMP, Scheepjens R, Stijnen T, Peeters-Scholte CMPCD, van Lith JMM, Haak MC. Fetal brain imaging in isolated congenital heart defects - a systematic review and meta-analysis. Prenat Diagn 2016; 36:601-13. [DOI: 10.1002/pd.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Fenna A. R. Jansen
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - Sheila M. P. Everwijn
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - Robert Scheepjens
- Department of Medical Statistics; Leiden University Medical Center; Leiden The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics; Leiden University Medical Center; Leiden The Netherlands
| | | | - Jan M. M. van Lith
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - Monique C. Haak
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden The Netherlands
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Meuleman T, Lashley LELO, Dekkers OM, van Lith JMM, Claas FHJ, Bloemenkamp KWM. HLA associations and HLA sharing in recurrent miscarriage: A systematic review and meta-analysis. Hum Immunol 2015; 76:362-73. [PMID: 25700963 DOI: 10.1016/j.humimm.2015.02.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/10/2015] [Indexed: 10/24/2022]
Abstract
PROBLEM The aim of this meta-analysis was to evaluate whether specific maternal HLA alleles and HLA sharing of couples are associated with the occurrence of recurrent miscarriage (RM). METHOD OF STUDY A systematic literature search was performed for studies that evaluated the association between HLA alleles, HLA sharing and RM. RM was defined as three or more consecutive unexplained miscarriages and a control group was included of women with at least one live birth and no miscarriages in their history. Meta-analyses were performed and the pooled odds ratio (OR) was calculated. RESULTS We included 41 studies. Selection bias was present in 40 studies and information bias in all studies. Meta-analyses showed an increased risk of RM in mothers carrying a HLA-DRB1*4 (OR 1.41, 95% CI 1.05-1.90), HLA-DRB1*15 (OR 1.57, 95% CI 1.15-2.14), or a HLA-E*01:01 allele (OR 1.47, 95% CI 0.20-1.81), and a decreased risk with HLA-DRB1*13 (OR 0.63, 95% CI 0.45-0.89) or HLA-DRB1*14 (OR 0.54, 95% CI 0.31-0.94). Pooling results for HLA sharing showed that HLA-B sharing (OR 1.39, 95% CI 1.11-1.75) and HLA-DR sharing (OR 1.57, 95% CI 1.10-1.25) were both associated with the occurrence of RM. CONCLUSION Although the present systematic review and meta-analysis demonstrates that specific HLA alleles and HLA sharing are associated with RM, a high degree of bias was present and therefore observed results should be interpreted carefully.
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Affiliation(s)
- Tess Meuleman
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
| | - Lisa E L O Lashley
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
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Abstract
Prenatal screening pathways, as nowadays offered in most Western countries consist of similar tests. First, a risk-assessment test for major aneuploides is offered to pregnant women. In case of an increased risk, invasive diagnostic tests, entailing a miscarriage risk, are offered. For decades, only conventional karyotyping was used for final diagnosis. Moreover, several foetal ultrasound scans are offered to detect major congenital anomalies, but the same scans also provide relevant information for optimal support of the pregnancy and the delivery. Recent developments in prenatal screening include the application of microarrays that allow for identifying a much broader range of abnomalities than karyotyping, and non-invasive prenatal testing (NIPT) that enables reducing the number of invasive tests for aneuploidies considerably. In the future, broad NIPT may become possible and affordable. This article will briefly address the ethical issues raised by these technological developments. First, a safe NIPT may lead to routinisation and as such challenge the central issue of informed consent and the aim of prenatal screening: to offer opportunity for autonomous reproductive choice. Widening the scope of prenatal screening also raises the question to what extent 'reproductive autonomy' is meant to expand. Finally, if the same test is used for two different aims, namely detection of foetal anomalies and pregnancy-related problems, non-directive counselling can no longer be taken as a standard. Our broad outline of the ethical issues is meant as an introduction into the more detailed ethical discussions about prenatal screening in the other articles of this special issue.
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Boere I, Smit M, Roest AAW, Lopriore E, van Lith JMM, te Pas AB. Current practice of cord clamping in the Netherlands: a questionnaire study. Neonatology 2015; 107:50-5. [PMID: 25377126 DOI: 10.1159/000365836] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent meta-analyses recommend delayed cord clamping (DCC) after uncomplicated births as well as preterm births, but there is no clear definition of timing and uniform national guidelines are lacking. OBJECTIVE We aimed to investigate if guidelines for the timing of cord clamping (CC) are followed and what the national practice entails. METHODS A postal questionnaire concerning CC after uncomplicated vaginal, Caesarean term and preterm deliveries was sent to all midwifery practices (n = 526) and obstetrical departments (n = 94) in the Netherlands. RESULTS The response rate was 81% (500/620). CC protocols were present in 16 and 38% of midwifery and obstetric practices, respectively. Early cord clamping (ECC) was recommended in 54%, DCC in 33%, 6% indicated a specific time point and 7% did not specify. In current practice, DCC was applied after uncomplicated vaginal term deliveries in 90% and ECC in 6%, and no timing was specified in 4%. Midwives used DCC more often than obstetricians (97 vs. 75%). Cessation of cord pulsations was often (54%) used as a time point, 40% used a fixed time point, 2% waited for placental expulsion and 4% did not specify. ECC was preferred in obstetric practices after Caesarean deliveries (in 81%). In preterm births, ECC was practised by 36%, DCC by 54 and 10% did not specify. CONCLUSION In the Netherlands, although often not protocolized, DCC is widely used after uncomplicated vaginal term and preterm deliveries, but not after Caesareans. Cessation of cord pulsation is often used as the time point for CC.
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Affiliation(s)
- Isabelle Boere
- Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
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24
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van Vonderen JJ, Roest AAW, Walther FJ, Blom NA, van Lith JMM, Hooper SB, te Pas AB. The influence of crying on the ductus arteriosus shunt and left ventricular output at birth. Neonatology 2015; 107:108-12. [PMID: 25471487 DOI: 10.1159/000368880] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/02/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND During neonatal transition, ductus arteriosus (DA) flow changes from right-to-left to left-to-right and contributes considerably to the increase in pulmonary blood flow. Large transpulmonary pressures generated by crying at birth can influence the DA shunt. OBJECTIVE This study aimed to assess differences in DA shunt during quiet breathing and crying directly after birth. METHODS In healthy term infants born by caesarean section, echocardiography was performed at 2, 5 and 10 min after birth. The velocity time integral of DA flow, DA flow ratio (right-to-left/left-to-right flow) and left ventricular output were assessed using echocardiography. Shunting was compared within each patient during crying and quiet breathing, and between time points. RESULTS A total of 23 infants were studied. The velocity time integral of left-to-right shunting was significantly larger during the inspiratory phase of crying than during quiet breathing [12.8 (9.2-17.4) vs. 5.9 (3.9-7.7) cm at 2 min, p < 0.0001; 14.3 (11.5-22.3) vs. 6.7 (4.1-11.1) cm at 5 min, p < 0.0001, and 18.6 (14.8-22.5) vs. 6.7 (4.4-10.7) cm at 10 min, p < 0.0001, after birth]. The increase in left-to-right shunting during crying was independent from the cardiac cycle as the QRS start of shunt interval time was 138 (82) ms during crying and 156 (35) ms during quiet breathing (n.s.). The DA flow ratio was lower in infants who cried at 0-1 time points versus those who cried at 2-3 time points (n.s.) out of the 3 time points measured. Left ventricular output was higher in infants who cried at 2-3 time points versus 0-1 time points (n.s.). CONCLUSION Crying at birth significantly influences the DA shunt during transition.
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Affiliation(s)
- Jeroen J van Vonderen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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25
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van Lith JMM. Introductory remarks from the Board of Directors of the ISPD on the position statement on aneuploidy screening. Prenat Diagn 2013; 33:621. [PMID: 23824977 DOI: 10.1002/pd.4138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/14/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Jan M M van Lith
- Department of Obstetrics and Fetal Medicine, LUMC, Leiden, The Netherlands.
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van Lith JMM, Johnson MP, Wilson RD. Current controversies in prenatal diagnosis 3: fetal surgery after MOMS: is fetal therapy better than neonatal? Prenat Diagn 2013; 33:13-6. [DOI: 10.1002/pd.4037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jan M. M. van Lith
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; PO Box 96600 Leiden the Netherlands
| | - Mark P. Johnson
- Center for Fetal Diagnosis and Treatment; Children's Hospital of Philadelphia; USA
| | - R. Douglas Wilson
- Department of Obstetrics and Gynecology; Alberta Health Services, Calgary/University of Calgary; Canada
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de Jong A, Dondorp WJ, Krumeich A, Boonekamp J, van Lith JMM, de Wert GMWR. The scope of prenatal diagnosis for women at increased risk for aneuploidies: views and preferences of professionals and potential users. J Community Genet 2012; 4:125-35. [PMID: 23138342 DOI: 10.1007/s12687-012-0126-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/16/2012] [Indexed: 12/23/2022] Open
Abstract
The increasing number of prenatal diagnostic tests in prenatal screening strategies, raises the question what tests to offer and why. This qualitative study investigated the views and preferences of professionals and potential users regarding four diagnostic test options for women at increased risk for common aneuploidies. Seven focus group sessions were conducted in The Netherlands between October 2009 and June 2010, with various categories of participants (n = 55): professionals engaged in prenatal testing and potential users of this testing (meaning pregnant women and parents of young children). Participants were invited to mention all pros and cons and their preferences regarding four hypothetical diagnostic test options, presented on vignettes: a standard offer of rapid aneuploidy detection, karyotyping or array comparative genomic hybridization, representing a narrow, traditional and broad test, respectively, and the option of individualised choice. Then, a semi-structured group interview was conducted. The data were analysed by the constant comparative method. Participants identified similar test-specific pros and cons but showed different preferences. Users' opinion on what test to offer as a general policy differed from what they would choose themselves. All participants agreed that in theory, users should be enabled to make an informed choice about what test to apply, but they disagreed about the feasibility of this ideal. Standard narrow testing was favoured for its limiting effects on emotional and organisational burdens; individualised choice was preferred for assuring women's decisive influence. The varying opinions reflect different views on what autonomy in the prenatal screening context means, suggest that a single standard test offer is inadequate and that differentiation will be needed.
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Affiliation(s)
- Antina de Jong
- Department of Health, Ethics & Society, Maastricht University, PO Box 616, Maastricht, 6200, MD, The Netherlands,
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van Wyk L, Boers KE, van der Post JAM, van Pampus MG, van Wassenaer AG, van Baar AL, Spaanderdam MEA, Becker JH, Kwee A, Duvekot JJ, Bremer HA, Delemarre FMC, Bloemenkamp KWM, de Groot CJM, Willekes C, Roumen FJME, van Lith JMM, Mol BWJ, le Cessie S, Scherjon SA. Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial. Am J Obstet Gynecol 2012; 206:406.e1-7. [PMID: 22444791 DOI: 10.1016/j.ajog.2012.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/22/2012] [Accepted: 02/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We sought to study long-term (neuro)developmental and behavioral outcome of pregnancies complicated by intrauterine growth restriction at term in relation to induction of labor or an expectant management. STUDY DESIGN Parents of 2-year-old children included in the Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) answered the Ages and Stages Questionnaire (ASQ) and Child Behavior Checklist (CBCL). RESULTS We approached 582 (89.5%) of 650 parents. The response rate was 50%. Of these children, 27% had an abnormal score on the ASQ and 13% on the CBCL. Results of the ASQ and the CBCL for the 2 policies were comparable. Low birthweight, positive Morbidity Assessment Index score, and admission to intermediate care increased the risk of an abnormal outcome of the ASQ. This effect was not seen for the CBCL. CONCLUSION In women with intrauterine growth restriction at term, neither a policy of induction of labor nor expectant management affect developmental and behavioral outcome when compared to expectant management.
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Affiliation(s)
- Linda van Wyk
- Leiden University Medical Center, Leiden, The Netherlands.
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van den Oever JME, Balkassmi S, Verweij EJ, van Iterson M, Adama van Scheltema PN, Oepkes D, van Lith JMM, Hoffer MJV, den Dunnen JT, Bakker E, Boon EMJ. Single molecule sequencing of free DNA from maternal plasma for noninvasive trisomy 21 detection. Clin Chem 2012; 58:699-706. [PMID: 22278607 DOI: 10.1373/clinchem.2011.174698] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Noninvasive fetal aneuploidy detection by use of free DNA from maternal plasma has recently been shown to be achievable by whole genome shotgun sequencing. The high-throughput next-generation sequencing platforms previously tested use a PCR step during sample preparation, which results in amplification bias in GC-rich areas of the human genome. To eliminate this bias, and thereby experimental noise, we have used single molecule sequencing as an alternative method. METHODS For noninvasive trisomy 21 detection, we performed single molecule sequencing on the Helicos platform using free DNA isolated from maternal plasma from 9 weeks of gestation onwards. Relative sequence tag density ratios were calculated and results were directly compared to the previously described Illumina GAII platform. RESULTS Sequence data generated without an amplification step show no GC bias. Therefore, with the use of single molecule sequencing all trisomy 21 fetuses could be distinguished more clearly from euploid fetuses. CONCLUSIONS This study shows for the first time that single molecule sequencing is an attractive and easy to use alternative for reliable noninvasive fetal aneuploidy detection in diagnostics. With this approach, previously described experimental noise associated with PCR amplification, such as GC bias, can be overcome.
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Affiliation(s)
- Jessica M E van den Oever
- Center for Human and Clinical Genetics, Laboratory for Diagnostic Genome Analysis, Leiden University Medical Center, Leiden, the Netherlands
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de Jong A, Dondorp WJ, Timmermans DRM, van Lith JMM, de Wert GMWR. Rapid aneuploidy detection or karyotyping? Ethical reflection. Eur J Hum Genet 2011; 19:1020-5. [PMID: 21629296 DOI: 10.1038/ejhg.2011.82] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
No consensus exists whether women at increased risk for trisomy 21, 13, and 18 should be offered stand-alone rapid aneuploidy detection (RAD) or karyotyping. In this paper, the ethical implications of a fast, relatively cheap and targeted RAD are examined. The advantages of RAD seem less robust than its proponents suggest. Fast test results only give a short-term psychological benefit. The cost advantage of RAD is apparent, but must be weighed against consequences like missed abnormalities, which are evaluated differently by professionals and pregnant women. Since pre-test information about RAD will have to include telling women about karyotyping as a possible alternative, the advantage of RAD in terms of the quantity of information that needs to be given may also be smaller than suggested. We conclude that none of the supposed arguments in favour of RAD is decisive in itself. Whether the case for RAD may still be regarded as convincing when taking these arguments together seems to depend on one's implicit view of what prenatal screening is about. Are we basically dealing with a test for trisomy 21 and a few conditions more? Or are there good grounds for also testing for the wider range of abnormalities that karyotyping can detect? As professionals and pregnant women may have different views about this, we suggest that the best approach is to offer women a choice between RAD and karyotyping. This approach is most in line with the general aim of prenatal screening: providing opportunities for autonomous reproductive choice.
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Affiliation(s)
- Antina de Jong
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
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van Lith JMM, Benacerraf BR, Yagel S. Current controversies in prenatal diagnosis 2: Down syndrome screening: is ultrasound better than cell-free nucleic acids in maternal blood? Prenat Diagn 2011; 31:231-4. [PMID: 21374636 DOI: 10.1002/pd.2681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 11/25/2010] [Indexed: 11/07/2022]
Affiliation(s)
- Jan M M van Lith
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Boormans EMA, Birnie E, Knegt AC, Schuring-Blom GH, Bonsel GJ, van Lith JMM. Aiming at multidisciplinary consensus: what should be detected in prenatal diagnosis? Prenat Diagn 2010; 30:1049-56. [DOI: 10.1002/pd.2609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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de Laat MWM, Wiegerinck MM, Walther FJ, Boluyt N, Mol BWJ, van der Post JAM, van Lith JMM, Offringa M. [Practice guideline 'Perinatal management of extremely preterm delivery']. Ned Tijdschr Geneeskd 2010; 154:A2701. [PMID: 21429260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
At the request of the State Secretary of the Dutch Ministry of Health, Welfare and Sport a national multidisciplinary workgroup developed an evidence-based practice guideline for the management of pregnant women with an imminent preterm delivery after a pregnancy of less than 26 weeks duration and for extremely preterm neonates. Active care measures are advised for neonates from a gestational age of 24 0/7 weeks onwards, unless there are serious arguments that justify a conservative management. In cases of imminent preterm delivery, intrauterine transport to a perinatological care centre is advised from a gestational age of 23 4/7 weeks onwards. In cases of imminent preterm delivery, glucocorticoids to enhance fetal lung maturity should be administered from a gestational age of 23 5/7 weeks onwards. From a gestational age of 24 0/7 weeks onwards a caesarean section may be considered if the fetal condition during spontaneous labour justifies this.
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Affiliation(s)
- Monique W M de Laat
- Academisch Medisch Centrum, Afd. Gynaecologie/Verloskunde, Amsterdam, The Netherlands.
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Alderliesten ME, Peringa J, van der Hulst VPM, Blaauwgeers HLG, van Lith JMM. Perinatal mortality: clinical value of postmortem magnetic resonance imaging compared with autopsy in routine obstetric practice. BJOG 2003; 110:378-82. [PMID: 12699799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare postmortem magnetic resonance imaging (MRI) with autopsy in perinatal deaths. To determine the acceptance and feasibility of postmortem perinatal MRI. DESIGN Cohort study. SETTING Large teaching hospital. POPULATION Fetuses and neonates from 16 weeks gestational age until 28 days after birth, stillbirths as well as intrapartum and neonatal deaths. METHODS MRI was performed prior to autopsy in a consecutive cohort of perinatal deaths after full parental consent. Agreement between MRI and autopsy was calculated. The consent rate for both examinations was recorded separately, as well as the time between the perinatal death and the MRI. MAIN OUTCOME MEASURE Full agreement between MRI and autopsy. RESULTS Of 58 cases, 26 parents consented to both examinations (45%). Autopsy showed 18 major malformations, of which 10 were detected with MRI. The positive predictive value of MRI was 80% (4/5) and the negative predictive value was 65% (13/20). Additional consent for MRI was given in eight cases (14%). In 84%, the MRI could be performed within 48 hours. CONCLUSIONS MRI is of value if autopsy is refused, but diagnostic accuracy is insufficient to recommend substitution of full autopsy. The acceptance rate of MRI only is better than that of autopsy.
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Abstract
OBJECTIVE To determine the knowledge of pregnant women about prenatal tests, and what tests they would choose if offered. Also, the preference of pregnant women for second-trimester or first-trimester screening was assessed. PATIENTS AND METHODS Pregnant women receiving antenatal care in a decentralized primary care system (n=80), and pregnant women that were offered a prenatal diagnosis at the Academic Medical Centre (n=195), were asked to complete a questionnaire. RESULTS The response rate was over 80%. Most women in both groups preferred a screening test for Down syndrome to be performed in the first trimester of pregnancy. A combination of nuchal translucency measurement and first-trimester serum screening was the option of choice. The screening possibilities for Down syndrome were less well known to the women in the low-risk group compared with the women in the high-risk group. The offer of a prenatal screening test would have been declined by more than 30% of women at low risk for carrying a fetus with Down syndrome. CONCLUSIONS Our results show that women prefer screening for Down syndrome to be performed in the first trimester of pregnancy, using both serum and ultrasound tests. In women at low risk for Down syndrome the knowledge of prenatal screening methods was less, as well as the acceptance of prenatal screening being lower.
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Affiliation(s)
- Irene M de Graaf
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
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